title: The Obstetric Hemorrhage Initiative (OHI) in Florida: The Role of Intervention Characteristics in Influencing Implementation Experiences among Multidisciplinary Hospital Staff.
abstract: Objectives Obstetric hemorrhage is one of the leading causes of maternal mortality. The Florida Perinatal Quality Collaborative coordinates a state-wide Obstetric Hemorrhage Initiative (OHI) to assist hospitals in implementing best practices related to this preventable condition. This study examined intervention characteristics that influenced the OHI implementation experiences among Florida hospitals. Methods Purposive sampling was employed to recruit diverse hospitals and multidisciplinary staff members. A semi-structured interview guide was developed based on the following constructs from the intervention characteristics domain of the Consolidated Framework for Implementation Research: evidence strength; complexity; adaptability; and packaging. Interviews were audio-recorded, transcribed and analyzed using Atlas.ti. Results Participants (n = 50) across 12 hospitals agreed that OHI is evidence-based and supported by various information sources (scientific literature, experience, and other epidemiologic or quality improvement data). Participants believed the OHI was 'average' in complexity, with variation depending on participant's role and intervention component. Participants discussed how the OHI is flexible and can be easily adapted and integrated into different hospital settings, policies and resources. The packaging was also found to be valuable in providing materials and supports (e.g., toolkit; webinars; forms; technical assistance) that assisted implementation across activities. Conclusions for Practice Participants reflected positively with regards to the evidence strength, adaptability, and packaging of the OHI. However, the complexity of the initiative adversely affected implementation experiences and required additional efforts to maximize the initiative effectiveness. Findings will inform future efforts to facilitate implementation experiences of evidence-based practices for hemorrhage prevention, ultimately decreasing maternal morbidity and mortality.
authors.affiliation: Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL, 33612, USA. cvamos@health.usf.edu.|The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA. cvamos@health.usf.edu.
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Vamos
authors.affiliation: Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL, 33612, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Cantor
authors.affiliation: Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL, 33612, USA.|The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA.
authors.forename: Erika L
authors.initials: EL
authors.lastname: Thompson
authors.affiliation: Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL, 33612, USA.|The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA.|Florida Perinatal Quality Collaborative, The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA.
authors.forename: Linda A
authors.initials: LA
authors.lastname: Detman
authors.affiliation: The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA.|Florida Perinatal Quality Collaborative, The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Bronson
authors.affiliation: Florida Perinatal Quality Collaborative, The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA.
authors.forename: Annette
authors.initials: A
authors.lastname: Phelps
authors.affiliation: Florida Perinatal Quality Collaborative, The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA.|Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, STC, 6th Floor, Tampa, FL, 33606, USA.
authors.forename: Judette M
authors.initials: JM
authors.lastname: Louis
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida, P.O Box 100294, Gainesville, FL, 32610, USA.
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Gregg
authors.affiliation: Florida Perinatal Quality Collaborative, The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA.|Faculty and Academic Affairs, USF Health, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL, 33612, USA.
authors.forename: John S
authors.initials: JS
authors.lastname: Curran
authors.affiliation: Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL, 33612, USA.|The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA.|Florida Perinatal Quality Collaborative, The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: Sappenfield
mesh_terms: D055317:Evidence-Based Practice; D005260:Female; D005431:Florida; D006761:Hospitals; D006801:Humans; D058025:Interdisciplinary Studies; D007407:Interviews as Topic; D008427:Maternal Health Services / Q000458:organization & administration*; D008428:Maternal Mortality; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic; D015397:Program Evaluation / Q000379:methods*; D036301:Qualitative Research; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D014592:Uterine Hemorrhage / Q000517:prevention & control*; D055815:Young Adult
keywords: Evaluation; Implementation; Obstetric hemorrhage; Qualitative; Quality improvement