title: "One of those areas that people avoid" a qualitative study of implementation in miscarriage management.
abstract: BACKGROUND
  Miscarriage is common and often managed by specialists in the operating room despite evidence that office-based manual vacuum aspiration (MVA) is safe, effective, and saves time and money. Family Medicine residents are not routinely trained to manage miscarriages using MVA, but have the potential to increase access to this procedure. This process evaluation sought to identify barriers and facilitators to implementation of office-based MVA for miscarriage in Family Medicine residency sites in Washington State.
  
  
  METHODS
  The Residency Training Initiative in Miscarriage Management (RTI-MM) is a theory-based, multidimensional practice change initiative. We used qualitative methods to identify barriers and facilitators to successful implementation of the RTI-MM.
  
  
  RESULTS
  Thirty-six RTI-MM participants completed an interview. We found that the common major barriers to implementation were low volume and a perception of miscarriage as emotional and/or like abortion, while the inclusion of support staff in training and effective champions facilitated successful implementation of MVA services.
  
  
  CONCLUSIONS
  Perceived characteristics of the innovation that may conflict with cultural fit must be explicitly addressed in dissemination strategies and support staff should be included in practice change initiatives. Questions remain about how to best support champions and influence perceptions of the innovation. Our study findings contribute programmatically (to improve the RTI-MM), and to broader theoretical knowledge about practice change and implementation in health service delivery.
authors.affiliation: Departments of Medical Informatics and Clinical Epidemiology and Obstetrics and Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mailcode L-466, Portland, OR 97239, USA. darneyb@ohsu.edu
authors.forename: Blair G
authors.initials: BG
authors.lastname: Darney
authors.forename: Marcia R
authors.initials: MR
authors.lastname: Weaver
authors.forename: Deborah
authors.initials: D
authors.lastname: VanDerhei
authors.forename: Nancy G
authors.initials: NG
authors.lastname: Stevens
authors.forename: Sarah W
authors.initials: SW
authors.lastname: Prager
mesh_terms: D000022:Abortion, Spontaneous / Q000628:therapy*; D004059:Diffusion of Innovation; D017598:Efficiency, Organizational; D005194:Family Practice / Q000193:education*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D007407:Interviews as Topic; D008297:Male; D010348:Patient Care Team; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D011247:Pregnancy; D016730:Program Development; D036301:Qualitative Research; D013192:Staff Development; D014619:Vacuum Curettage / Q000193:education* / Q000706:statistics & numerical data; D014861:Washington
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