Background/Purpose: To assess the association of the number of implementation strategies for a patient lupus decision aid (DA) with perceived implementation outcomes, and the moderating effect of the organizational climate on this relationship.

Methods: We implemented a lupus patient DA across 15 U.S. rheumatology clinics made available during a regular patient clinic visit. In addition to the standardized implementation strategies provided uniformly by the research team to each site (e.g., training on DA use, designation of a clinic champion and refresher training course), each clinic could choose from a ‘menu’ of implementation strategies directed to both clinic personnel and patients, customized to their clinic. We examined the effect of the number of implementation strategies with clinic-personnel-reported implementation outcomes (acceptability, appropriateness, feasibility), and the extent of impact of the organizational climate (e.g., learning environment, readiness for change) on this relationship.

Results: At the 4-month post-implementation period, the average perceptions of the lupus DA were as follows: acceptability, 3.49; appropriateness, 3.37; and feasibility, 3.40. The mean number of total strategies implemented by the participating clinics was 3.37, with 2.07 clinic-focused strategies and 1.29 patient focused strategies, that remained stable during follow-up. Adjusted for clinic and clinic personnel characteristics, and time since implementation, we found the following associations for implementation strategies: (1) total strategies not significantly associated with lupus DA acceptability, appropriateness, feasibility, success, or permanence; (2) the number of clinic-focused strategies associated positively and significantly with lupus DA acceptability, appropriateness, and feasibility; and (c) the number of patient-focused strategies was negatively significantly associated with lupus DA acceptability and feasibility but not appropriateness. We found significant moderation of the relationship between implementation strategies and implementation outcomes by the learning environment and readiness for change.

Conclusion: We found that the overall number of implementation strategies was not associated with perceptions of DA acceptability, appropriateness, and feasibility; however, these relationships did differ for different implementation targets and under different organizational conditions. Our findings highlight the importance of the context but suggest that a very nuanced consideration of contextual characteristics is needed as aggregated factors such as organizational readiness for change and its learning climate contribute to implementation success in different ways and for different implementation outcomes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/more-implementation-strategies-are-not-associated-with-better-implementation-outcomes-implementing-the-lupus-patient-decision-aid/