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Considerations for implementation of a multicomponent evidence-based intervention in a large healthcare system
Abstract   Open access   Peer reviewed

Considerations for implementation of a multicomponent evidence-based intervention in a large healthcare system

Connor M Warren, Octavia Goodman, Kirstin Manges Piazza, Amanda Peeples, Rebecca T Brown, Laura Ellen Ashcraft, Laura N Gitlin and Sokha Koeuth
Implementation science : IS, v 20, pp 23-23
20 Jun 2025
DOI: https://doi.org/10.1186/s13012-025-01433-8 (S50)
url
https://doi.org/10.1186/s13012-025-01433-8View
Published, Version of Record (VoR)CC BY-NC-ND V4.0,  Open

Abstract

Background The Department of Veterans Affairs (VA) has prioritized adoption of an Age-Friendly Health System (AFHS). In response, the VA’s Safer Aging Through Geriatrics-Informed Evidence-Based Practices (SAGE) Quality Enhancement Research Initiative (QUERI) was developed to test tailored implementation strategies on the effectiveness and reach of four evidence-based care practices (EBPs) in nine VA Medical Centers (VAMCs) that align with the “four Ms” of AFHS: What Matters, Medication, Mentation, and Mobility. The Tailored Activity Program (TAP), a multicomponent EBP for Veterans with dementia and their caregivers, was chosen to address “Mentation”. TAP is designed to realign the abilities of a person with dementia with their environment, facilitate meaningful engagement, and reduce caregiver burden. Implementing multicomponent interventions, such as TAP, can pose significant challenges. We explored the determinants (i.e., barriers and facilitators) necessary to consider before implementation. Methods We conducted semi-structured interviews with clinicians and leaders at each VAMC prior to implementation of TAP to understand the unique implementation contexts and to engage key informants. We used a team-based rapid qualitative analysis based on the integrated PRISM-REAIM framework to identify themes related to implementation determinants. Findings We conducted 59 interviews with 66 clinicians and leaders across 6 VAMCs. Participants identified three key determinants that are crucial to consider before implementing TAP: 1) Alignment with organizational priorities, including Geriatrics and Extended Care initiatives and programs (e.g., home-based primary care, dementia specialty programs), AFHS implementation, and Whole Health; 2) Competing priorities that require funding and staff time, including falls prevention programs and Caregiver Support Program initiatives; and 3) Perceptions of TAP, including clinicians’ positive or negative beliefs about TAP’s core components (e.g., required number of visits, assessment, activity prescriptions) and the perceived benefit or burden of the intervention for Veterans and caregivers (e.g., decreasing caregiver burden, caregivers being too overwhelmed to participate). Implications for D&I Research: We identified key factors to consider for successful implementation of a multicomponent EBP within a complex healthcare system. These factors provide useful guidance for clinicians, leaders, and implementation scientists planning for implementation of multicomponent interventions in healthcare systems.

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