Availability of evidence-based practices (EBPs) is critical for improving health care outcomes, but diffusion can be challenging. Implementation activities increase the adoption of EBPs and support sustainability. However, when implementation activities are a part of quality improvement processes, evaluation of the time and cost associated with these activities is challenged by the need for a correct classification of these activities to a known taxonomy of implementation strategies by implementation actors. Observational study of a four-stage, stakeholder-engaged process for identifying implementation activities and estimating the associated costs. A national initiative in the Veterans Health Administration (VHA) to improve Advance Care Planning (ACP) via Group Visits (ACP-GV) for rural veterans identified 49 potential implementation activities. Evaluators translated and reduced these to 14 strategies used across three groups with the aid of implementation actors. Data were collected to determine the total implementation effort and applied cost estimates to estimate the budget impact of implementation for VHA. Recall bias may influence the identification of potential implementation activities. This process improved understanding of the implementation effort and allowed estimation of ACP-GV 's budget impact. A four-stage, stakeholder-engaged methodology can be applied to other initiatives when a pragmatic evaluation of implementation efforts is needed.

中文翻译：

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让利益相关者回顾性地辨别实施策略以支持计划评估：建议的方法和案例研究

循证实践 (EBP) 的可用性对于改善医疗保健结果至关重要，但推广可能具有挑战性。实施活动增加了 EBP 的采用并支持可持续性。然而，当实施活动是质量改进过程的一部分时，与这些活动相关的时间和成本的评估面临着挑战，因为需要将这些活动正确分类为实施参与者的实施策略的已知分类法。对利益相关者参与的四阶段流程进行观察性研究，以确定实施活动并估算相关成本。退伍军人健康管理局 (VHA) 发起了一项全国性倡议，旨在通过对农村退伍军人进行团体访问 (ACP-GV) 来改进预先护理计划 (ACP)，该倡议确定了 49 项潜在的实施活动。评估人员在实施者的帮助下将这些策略翻译并减少为三个小组使用的 14 项策略。收集数据以确定总体实施工作量，并应用成本估算来估计实施 VHA 的预算影响。回忆偏差可能会影响潜在实施活动的识别。这一过程提高了对实施工作的理解，并可以估计 ACP-GV 的预算影响。当需要对实施工作进行务实评估时，可以将四阶段、利益相关者参与的方法应用于其他举措。