Abstract：
BACKGROUND: 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.
METHODS: Observational study of a four-stage, stakeholder-engaged process for identifying implementation activities and estimating the associated costs.
RESULTS: 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.
CONCLUSIONS: Recall bias may influence the identification of potential implementation activities.
CONCLUSIONS: This process improved understanding of the implementation effort and allowed estimation of ACP-GV \'s budget impact.
CONCLUSIONS: A four-stage, stakeholder-engaged methodology can be applied to other initiatives when a pragmatic evaluation of implementation efforts is needed.
METHODS: Observational study of a four-stage, stakeholder-engaged process for identifying implementation activities and estimating the associated costs.
RESULTS: 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.
CONCLUSIONS: Recall bias may influence the identification of potential implementation activities.
CONCLUSIONS: This process improved understanding of the implementation effort and allowed estimation of ACP-GV \'s budget impact.
CONCLUSIONS: A four-stage, stakeholder-engaged methodology can be applied to other initiatives when a pragmatic evaluation of implementation efforts is needed.
摘要：
背景：基于证据的实践（EBP）的可用性对于改善医疗保健结果至关重要，但是扩散可能具有挑战性。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，对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行为者已知的实施战略分类法。
方法：四个阶段的观察性研究，利益相关者参与的过程，用于确定实施活动并估计相关成本。
结果：退伍军人健康管理局（VHA）通过对农村退伍军人的团体访问（ACP-GV）改善高级护理计划（ACP）的国家倡议确定了49项潜在的实施活动。评估人员在执行行为者的帮助下，将这些策略翻译并简化为在三个小组中使用的14种策略。收集数据以确定总体实施工作，并应用成本估算来估算VHA实施的预算影响。
结论：召回偏差可能会影响潜在实施活动的识别。
结论：此过程提高了对实施工作的理解，并允许估计ACP-GV的预算影响。
结论：四阶段，当需要对实施工作进行务实评估时，可以将利益相关者参与的方法应用于其他举措。
方法：四个阶段的观察性研究，利益相关者参与的过程，用于确定实施活动并估计相关成本。
结果：退伍军人健康管理局（VHA）通过对农村退伍军人的团体访问（ACP-GV）改善高级护理计划（ACP）的国家倡议确定了49项潜在的实施活动。评估人员在执行行为者的帮助下，将这些策略翻译并简化为在三个小组中使用的14种策略。收集数据以确定总体实施工作，并应用成本估算来估算VHA实施的预算影响。
结论：召回偏差可能会影响潜在实施活动的识别。
结论：此过程提高了对实施工作的理解，并允许估计ACP-GV的预算影响。
结论：四阶段，当需要对实施工作进行务实评估时，可以将利益相关者参与的方法应用于其他举措。
