1048. Diffusion of Innovative Clinical Practices: Understanding Implementation
Carol VanDeusen Lukas, EdD, HSR&D Management Decision and Research Center, M Meterko, HSR&D Management Decision and Research Center, D Mohr, HSR&D Management Decision and Research Center, MN Seibert, HSR&D Management Decision and Research Center

Objectives: Clinical process innovations often fail, not because they are not effective but because they are not implemented, that is, not put into practice. The implementation of clinical process innovations is not well understood. This study was designed to increase that understanding by identifying factors that affect the implementation of a national innovation in VA, Advanced Clinic Access (ACA).

Methods: ACA is a set of principles for managing clinics so that veterans have access to medical care when they want it. In 2000, VA launched a national initiative to disseminate ACA in six target clinic areas (e.g., primary care, audiology) across VA. Because ACA was not mandated, this initiative provided a natural experiment for analyzing factors associated with different levels of implementation. The sample included 78 VAMCs stratified by clinic wait time and size. Data were drawn from structured telephone interviews with local ACA points of contact, survey data from 3870 staff and VA administrative databases. Factors in three domains (Implementation Structure and Activities, Staff Awareness and Operations, and Facility Context) were used in multiple regression analyses to predict extent of ACA implementation.

Results: Success in predicting implementation varied by factor and clinic area. Some factors were consistent predictors across clinic areas (e.g., staff knowledge and skills, staff awareness of ACA, management support). Others varied by clinic area (e.g., effectiveness of spread activities, clinic logistics).

Conclusions: The diffusion of new clinical practices and other innovations can be improved by ensuring that factors related to successful implementation are in place.