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Transl Behav Med. 2019 Jun 6. pii: ibz085. doi: 10.1093/tbm/ibz085. [Epub ahead of print]

Using the Practical, Robust Implementation and Sustainability Model (PRISM) to qualitatively assess multilevel contextual factors to help plan, implement, evaluate, and disseminate health services programs.

McCreight MS1,2, Rabin BA1,3,4,5, Glasgow RE1,4,5,6, Ayele RA1,2,7, Leonard CA1,2, Gilmartin HM1,2,7, Frank JW1,2,8, Hess PL1,2,9, Burke RE10,11, Battaglia CT1,2,7.

Author information

1
Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO, USA.
2
Research Service, VA Eastern Colorado Health Care System, Aurora, CO, USA.
3
Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, CA, USA.
4
Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado, Aurora, CO, USA.
5
Department of Family Medicine, School of Medicine, University of Colorado, Aurora, CO, USA.
6
Geriatric Research Education and Clinical Center, VA Eastern Colorado Health Care System, Aurora, CO, USA.
7
Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
8
Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
9
Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
10
Center for Health Equity Research and Promotion (CHERP), Corporal Crescenz VA Medical Center, Philadelphia, PA, USA.
11
Section of Hospital Medicine, Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.

Abstract

There is consensus in dissemination and implementation (D&I) science that addressing contextual factors is critically important for understanding translation of health care delivery interventions but little agreement on which contextual factors are key determinants of implementation outcomes. We describe the application of the Practical Robust Implementation and Sustainability Model (PRISM), which expands the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to identify contextual factors across four diverse programs. Multiple qualitative methods were used to collect multilevel, multistakeholder perspectives from the adopting organizations and staff. We identified measures for evaluating context through the various domains of PRISM to guide health services research across the phases of program implementation. The PRISM domains of Recipients, Implementation and Sustainability Infrastructure, and External Environment identified important multilevel contextual factors, including variability in operational processes and available resources. These domains helped to facilitate planning and implementation phases of the four interventions and guide purposeful adaptations. We found assessments of PRISM domains useful to systematically assess multilevel contextual factors across various content areas as well as phases of program implementation. Additionally, these contextual factors were found to be relevant to RE-AIM outcomes. Lessons learned can be applied to future research as there is a need to investigate the measurement properties of PRISM and continue to test which contextual factors are most important to successful implementation and for which outcomes.

KEYWORDS:

Assessment; Context; Contextual factors; Implementation; PRISM

PMID:
31170296
DOI:
10.1093/tbm/ibz085

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