A qualitative study to identify barriers and facilitators to implementation of pilot interventions in the Veterans Health Administration (VHA) Northwest Network.
OBJECTIVE
To identify barriers and facilitators to implementation of pilot interventions designed to improve measurement and management of low-density lipoprotein cholesterol (LDL-c) levels in coronary heart disease patients using the evidence/context/facilitation model of implementation of evidence-based practice.


METHODS
Theory-based conceptual content analysis of structured interviews conducted between January and April 2001.


METHODS
Six medical centers in the United States Veterans Health Administration Northwest Network.


METHODS
Fifty-one of 64 individuals (physicians, nurses, pharmacists, dieticians, quality managers, and other clinical and nonclinical staff) who participated in planning and/or implementing pilot interventions.


RESULTS
Barriers to successful implementation related primarily to the intervention process and secondarily to characteristics of the intervention context. Interview responses indicated that planning, including identification of resources and assessment of potential barriers and facilitators, was a critical and universally underutilized step in the intervention process.


CONCLUSIONS
Organized team process, documented plans for intervention activities, and ongoing evaluation are essential for sustaining intervention activities. A top priority for facilitating interventions should be the development of educational materials, such as "how to" guides, that teach intervention teams how to anticipate barriers and make plans to address them, as well as identifying and fostering local experts in planning and implementing interventions.
Sharp
Nancy D
ND
VA Puget Sound Health Care System and Department of Health Services, University of Washington, Seattle 98108, USA. Nancy.Sharp@med.va.gov
Pineros
Sandra L
SL
Hsu
Clarissa
C
Starks
Helene
H
Sales
Anne E
AE
D001291:Attitude of Health Personnel; D008078:Cholesterol, LDL / Q000097:blood; D003299:Cooperative Behavior; D003327:Coronary Disease / Q000209:etiology / Q000517:prevention & control; D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine / Q000193:education / Q000458:organization & administration; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000150:complications / Q000517:prevention & control; D007400:Interprofessional Relations; D020380:Needs Assessment; D015404:Nursing Methodology Research; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration; D010865:Pilot Projects; D010934:Planning Techniques; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D011795:Surveys and Questionnaires; D017749:Total Quality Management / Q000458:organization & administration; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration; D014861:Washington
D008078:Cholesterol, LDL