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Objective: To assess whether a team collaboration strategy (CONNECT) improves implementation outcomes of a family caregiver skills training program (iHI‐FIVES). Data Sources and Study Setting: iHI‐FIVES was delivered to caregivers at eight Veterans Affairs (VA) medical centers. Data sources were electronic health records, staff surveys, and interviews. Study Design: In a stepped wedge cluster randomized trial, sites were randomized to a 6‐month time interval start date for iHI‐FIVES launch. Sites were then randomized 1:1 to either (i) CONNECT, a team collaboration training strategy plus Replicating Effective Programs (REP), brief technical support training for staff, or (ii) REP only (non‐CONNECT arm). Implementation outcomes included reach (proportion of eligible caregivers enrolled) and fidelity (proportion of expected trainings delivered). Staff interviews and surveys assessed team function including communication, implementation experience, and their relation to CONNECT and iHI‐FIVES implementation outcomes. Data Collection/Extraction Methods: The sample for assessing implementation outcomes included 571 Veterans referred to VA home‐ and community‐based services and their family caregivers eligible for iHI‐FIVES. Prior to iHI‐FIVES launch, staff completed 65 surveys and 62 interviews. After the start of iHI‐FIVES, staff completed 52 surveys and 38 interviews. Mixed methods evaluated reach and fidelity by arm. Principal Findings: Fidelity was high overall with 88% of expected iHI‐FIVES trainings delivered, and higher among REP only (non‐CONNECT) compared with CONNECT sites (95% vs. 80%). Reach was 18% (average proportion of reach across eight sites) and higher among non‐CONNECT compared with CONNECT sites (22% vs. 14%). Qualitative interviews revealed strong leadership support at high‐reach sites. CONNECT did not influence self‐reported team function. Conclusions: A team collaboration strategy (CONNECT), added to REP, required more resources to implement iHI‐FIVES than REP only and did not substantially enhance reach or fidelity. Leadership support was a key condition of implementation success and may be an important factor for improving iHI‐FIVES reach with national expansion. [ABSTRACT FROM AUTHOR]

Objective: To assess the effects of an evidence‐based family caregiver training program (implementation of Helping Invested Families Improve Veteran Experiences Study [iHI‐FIVES]) in the Veterans Affairs healthcare system on Veteran days not at home and family caregiver well‐being. Data Sources and Study Setting: Participants included Veterans referred to home‐ and community‐based services with an identified caregiver across 8 medical centers and confirmed family caregivers of eligible Veterans. Study Design: In a stepped wedge cluster randomized trial, sites were randomized to a 6‐month time interval for starting iHI‐FIVES and received standardized implementation support. The primary outcome, number of Veteran "days not at home," and secondary outcomes, changes over 3 months in measures of caregiver well‐being, were compared between pre‐ and post‐iHI‐FIVES intervals using generalized linear models including covariates. Data Collection/Extraction Methods: Patient data were extracted from the electronic health record. Caregiver data were collected from 2 telephone‐based surveys. Principal Findings: Overall, n = 898 eligible Veterans were identified across pre‐iHI‐FIVES (n = 327) and post‐iHI‐FIVES intervals (n = 571). Just under one fifth (17%) of Veterans in post‐iHI‐FIVES intervals had a caregiver enroll in iHI‐FIVES. Veteran and caregiver demographics in pre‐iHI‐FIVES intervals were similar to those in post‐iHI‐FIVES intervals. In adjusted models, the estimated rate of days not at home over 6‐months was 42% lower (rate ratio = 0.58 [95% confidence interval: 0.31–1.09; p = 0.09]) post‐iHI‐FIVES compared with pre‐iHI‐FIVES. The estimated mean days not at home over a 6‐month period was 13.0 days pre‐iHI‐FIVES and 7.5 post‐iHI‐FIVES. There were no differences between pre‐ and post‐iHI‐FIVES in change over 3 months in caregiver well‐being measures. Conclusions: Reducing days not at home is consistent with effectiveness because more time at home increases quality of life. In this study, after adjusting for Veteran characteristics, we did not find evidence that implementation of a caregiver training program yielded a reduction in Veteran's days not at home. [ABSTRACT FROM AUTHOR]

Introduction: The timely translation of evidence-based programs into real-world clinical settings is a persistent challenge due to complexities related to organizational context and team function, particularly in inpatient settings. Strategies are needed to promote quality improvement efforts and implementation of new clinical programs., Objective: This study examines the role of CONNECT, a complexity science-based implementation intervention to promote team readiness, for enhancing implementation of the 'Assisted Early Mobility for Hospitalized Older Veterans' program (STRIDE), an inpatient, supervised walking program., Design: We conducted a stepped-wedge cluster randomized trial using a convergent mixed-methods design. Within each randomly assigned stepped-wedge sequence, Veterans Affairs Medical Centers (VAMCs) were randomized to receive standardized implementation support only or additional training via the CONNECT intervention. Data for the study were obtained from hospital administrative and electronic health records, surveys, and semi-structured interviews with clinicians before and after implementation of STRIDE., Setting: Eight U.S. VAMCs., Participants: Three hundred fifty-three survey participants before STRIDE implementation and 294 surveys after STRIDE implementation. Ninety-two interview participants., Intervention: CONNECT, a complexity-science-based intervention to improve team function., Main Outcome Measures: The implementation outcomes included STRIDE reach and fidelity. Secondary outcomes included validated measures of team function (i.e., team communication, coordination, role clarity)., Results: At four VAMCs randomized to CONNECT, reach was higher (mean 12.4% vs. 3.8%), and fidelity was similar to four non-CONNECT VAMCs. VAMC STRIDE delivery teams receiving CONNECT reported improvements in team function domains, similar to non-CONNECT VAMCs. Qualitative findings highlight CONNECT's impact and the influence of team characteristics and contextual factors, including team cohesion, leadership support, and role clarity, on reach and fidelity., Conclusion: CONNECT may promote greater reach of STRIDE, but improvement in team function among CONNECT VAMCs was similar to improvement among non-CONNECT VAMCs. Qualitative findings suggest that CONNECT may improve team function and implementation outcomes but may not be sufficient to overcome structural barriers related to implementation capacity., (© 2024 American Academy of Physical Medicine and Rehabilitation.)