Highlights of PCORI-Funded Implementation Projects
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Current Evidence on Liver Transplant versus Medical Management in Urea Cycle Disorders: Opening a Dialogue with Patients, Caregivers, and Providers
Ah Mew, Nicholas, MD
(Awarded 2021, Limited Competition PFA)
Parents of children with urea cycle disorders, or UCDs, and clinicians consider many factors when deciding between medical management or liver transplant treatment given the sparse and anecdotal information available. This PCORI-funded dissemination project is providing new evidence from PCORI-funded research on the risks and benefits of these treatment options to support families’ treatment decisions. The project team is incorporating messages capturing this evidence into a series of educational videos and partnering with key stakeholder groups, such as the National Urea Cycle Disorders Foundation, to promote and distribute the videos to families caring for children with UCDs, as well as UCD providers and general pediatricians. UCDs are very rare; with this project, the team expects to reach about 40 percent of the families of children in the United States with UCDs who qualify for a liver transplant and at least one person on each child’s care team.
Innovative Implementation of a Robust Executive Function Intervention Delivered in Schools
Anthony, Laura, PhD and Kenworthy, Lauren, PhD
(Awarded 2020, Limited Competition PFA)
Executive function problems are common in children with autism spectrum disorder or attention deficit hyperactivity disorder and can lead to long-term problems in quality of life, academics, and independent living. This PCORI-funded implementation project is laying the groundwork for broad uptake of Unstuck and On Target, or UOT, a school-based cognitive behavioral treatment shown in PCORI-funded research to improve executive function, by putting the program in place in 200 schools across Colorado and Virginia. The project team is adapting the in-person UOT by transferring content to an online platform, training different types of school staff to deliver UOT, and providing schools with coaching support as needed. Approximately 2,000 children with autism spectrum disorder or attention deficit hyperactivity disorder are expected to receive UOT during the project. Through supplemental award funding, the project team is also collecting, measuring, and reporting out the costs associated with implementing the program.
Through a COVID-19-Related Project Enhancement, this project is adapting UOT resources for online use at home and sharing them with parents of children with autism spectrum disorder or attention deficit hyperactivity disorder to support special education at home, as well as when schools are in session.
Shared Decision Making for Bariatric Surgery in Patients with Severe Obesity
Arterburn, David, MD, MPH
(Awarded 2019, Shared Decision Making PFA)
Weight loss surgery can help people lose weight and improve health problems related to obesity, but each type of surgery has risks and benefits. This PCORI-funded implementation project is updating two decision aids with the results from PCORI-funded research that compared different weight loss surgeries for use by patients considering surgery or considering which type of surgery to pursue. The project is putting these decision aids into practice at two large health systems in Washington and Pennsylvania, providing clinicians with in-person and virtual training on shared decision making and working with clinical champions at each site to support the program’s use. The project team is also building processes into sites’ IT systems for ordering decision aids, referring patients to specialists, and documenting use of the decision aids. This project expects to help more than 1,800 patients with severe obesity consider the risks and benefits of different surgeries and make decisions that work best for them.
Implementation of an Online Weight Management Program in Clinical and Community Settings
Baer, Heather, ScD
(Awarded 2021, Limited Competition PFA)
This PCORI-funded implementation project is adapting an online weight management program, tested in PCORI-funded research, and putting it in place at eight specialty and community clinics in Massachusetts. The project team is incorporating the online program, which includes educational modules and tools for tracking weight, diet, and activity, into the electronic health record. The team is also adjusting the program to use with patient navigators and training more than 500 clinicians and patient navigators to support delivery of the program. Finally, the project team is working with practice champions at each site, conducting site visits, and providing sites with ongoing audit and feedback reports. This project expects to improve the management of overweight and obesity for over 7,750 patients.
Technology-Assisted Implementation of a Mobile Health Intervention for Serious Mental Illness
Ben-Zeev, Dror, PhD
(Awarded 2022, Limited Competition PFA)
This PCORI-funded Implementation Project is expanding the use of a PCORI-tested mHealth program, which includes a patient smartphone app and an online clinician dashboard, to three community mental health agencies in New Hampshire and Missouri. The project team is adapting in-person education and training materials to be delivered remotely, training agency staff to deliver the program and monitor patients' progress and providing ongoing remote practice facilitation support. This project expects to help approximately 4,800 patients with serious mental illness manage their symptoms.
Dissemination Child Abuse Clinical Decision Support to Improve Detection, Evaluation, and Reporting
Berger, Rachel, MD, MPH
(Awarded 2017, Limited Competition PFA)
Doctors often don’t recognize signs of child abuse in the emergency department and may not screen for it as part of the care they provide. This completed PCORI-funded implementation project expanded the use of an electronic health record (EHR)-based alert system for detecting and reporting concerns of child maltreatment, developed and tested in PCORI-funded research, to five emergency departments within two health systems in Wisconsin and New York. The project team adapted the alert system for two different EHR systems and worked with each site to put their own physical abuse order sets into the EHR. The project team then trained 995 doctors, nurses, and other clinicians on how to use the alert systems and provided sites with ongoing technical assistance and consultation throughout the project. After the system was put in place, more than 59,000 children were screened for abuse across both health systems. The project team also created guidance to help other hospital systems use the alert system in the future.
Dissemination and Implementation of a Patient-Centered Aid for Ventricular Assist Device Placement
Blumenthal-Barby, Jennifer, PhD, MA
(Awarded 2017, Limited Competition PFA)
Left ventricular assist devices, or LVADs, can help people with advanced heart failure live longer, but LVADs have serious risks and require lifestyle changes. This completed PCORI-funded implementation project expanded the use of a paper and web-based decision aid—shown in PCORI-funded research to help patients with advanced heart failure decide on whether to get an LVAD—by making it part of standard care for patients who are LVAD candidates at eight hospitals in seven states (IL, MA, NY, OH, OK, TX, WI). The project team first trained hospital staff to use the decision aid as part of discussions with patients about their treatment options, goals, and preferences. The team then provided sites with follow-up support and feedback on how they used the decision aid with patients. During the project, approximately 1,750 patients and caregivers received and used the decision aids. The project team also created a plan for hospital staff to use the decision aid long term.
Through a COVID-19-Related Project Enhancement, this project also developed a resource to accompany the decision aid, which addressed LVAD candidates’ questions and concerns about COVID-19 (e.g., concerns about being in the hospital ICU after surgery).
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Implementation of a Self-Care Plan for Patients with Acute Heart Failure Discharged from the Emergency Department
Collins, Sean, MD, MSc
(Awarded 2021, Limited Competition PFA)
About 200,000 people in the United States who visit the emergency department annually for acute heart failure are discharged directly home without having a hospital admission. This PCORI-funded implementation project is working with four high-volume emergency departments in Michigan and Oregon to incorporate GUIDED-HF, a self-care coaching program shown in PCORI-funded research to improve patient-centered outcomes for these patients, into standard practice for discharging patients with acute heart failure home from the emergency department. The project team is training self-care coaches and emergency department staff to prepare tailored discharge plans with patients, help patients schedule follow-up visits with a provider, and conduct virtual/home visits and follow-up phone calls. The team is also modifying the electronic health record to support delivery of the program and providing sites with ongoing consultation and audit and feedback reports. Approximately 2,800 patients with acute heart failure are expected to receive GUIDED-HF during the project.
Implementing Outcomes-Based Matching of Patients to Mental Health Care Therapists' Strengths
Constantino, Michael, PhD
(Awarded 2022, Limited Competition D&I)
This PCORI-funded implementation project is expanding the use of the Match System, a program that uses therapist report cards to pair patients with therapists based on patients’ primary mental health concerns and therapists’ strengths, shown in PCORI-funded research to improve patient-centered outcomes. The project is putting this program in place first at nine mental health clinics in Pennsylvania and then rapidly scaling to 53 additional clinics in 11 states (AL, CO, DE, FL, IL, KY, MI, MO, NJ, TN, TX) across the United States. The project team is adapting the program to work for differently sized and staffed clinics, incorporating the program into clinics’ electronic health record systems, training more than 800 therapists and staff to use the program, and working with local champions at sites to support its use. The project team is also developing an implementation guide to support uptake at future sites. Approximately 60,000 patients are expected to participate in the program during the project.
Rethink the Strip: De-Adoption of Glucose Monitoring for Non-Insulin Treated Type 2 Diabetes in Primary Care
Donahue, Katrina, MD, MPH
(Awarded 2018, Limited Competition PFA)
This PCORI-funded implementation project is working to de-implement routine daily blood sugar testing for patients with type 2 diabetes who don’t need insulin, based on PCORI-funded research that showed daily testing doesn’t help these patients to manage their diabetes or improve quality of life. The project team is developing a program called Re-Think the Strip, which aims to increase clinician knowledge about daily blood sugar testing and reduce unnecessary self-testing when appropriate, and putting it in place at 20 community-based primary care practices in North Carolina that provide care for approximately 4,400 patients. The team is providing clinics educational materials for clinicians and patients, tools like communication scripts to support clinicians’ use of the program, report cards that capture prescription trends in daily blood sugar testing using electronic health record data, and ongoing practice facilitation support. Through supplemental award funding, the project team is also collecting, measuring, and reporting out the costs associated with implementing the program.
Through a COVID-19-Related Project Enhancement, this project is updating Re-Think the Strip to answer common questions about diabetes care during COVID-19 and to include strategies patients and their healthcare providers can use to stay on top of their blood glucose control during the pandemic.
Dissemination and Implementation of a Virtual Care Model for Parkinson’s Disease and other Chronic Conditions
Dorsey, Ray, MD, MBA
(Awarded 2016, Limited Competition PFA)
This completed PCORI-funded implementation project refined a telehealth model for delivering care for Parkinson’s disease, found in PCORI-funded research to be a feasible and convenient way for people with Parkinson’s disease to access care from specialists, and implemented this model though a statewide program called Parkinson Disease Care New York. The adapted program provided multispecialty telehealth services to more than 500 individuals with Parkinson’s disease, reaching a varied group of patients, including those who lacked access to nearby specialty care, patients over 80 years old, and patients who were homebound. The project also expanded virtual care access through satellite locations such as libraries and community centers, so that patients without access to technology or internet at home could receive specialty care within their community. The project team created free educational and training resources and programs for patients and for clinicians, including neurologists, physical therapists, speech therapists, occupational therapists, and dementia and depression specialists, to support expanded use of the telehealth model.
Using Personalized Risk/Benefit Profiles in Shared Decision Making for Diabetes Prevention
Duru, O. Kenrik, MD, MS
(Awarded 2018, Limited Competition PFA)
Understanding one’s risk for diabetes can help patients and clinicians work together to decide on a prevention approach. This PCORI-funded implementation project is working to make better diabetes risk information part of patients’ conversations with their clinicians about the healthcare choices that work best for them. The project is incorporating a diabetes risk prediction tool, developed in a PCORI-funded implementation project, into an existing shared decision making approach and making it part of regular care at 39 primary care practices in two health systems in California and Utah. The project team is incorporating the tool into the health systems’ patient record systems; training clinic staff, including nurses, pharmacists, care coordinators, and primary care providers, to use the tool and talk about diabetes risk; working with nurse and physician champions at each site who promote use of the tool; and creating a guide to help other health systems use this shared decision making approach. Approximately 4,700 patients are expected to receive individually tailored risk estimates and participate in shared decision making with their clinicians during the project.
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Multi-Component Implementation of Shared Decision Making for Uterine Fibroids Across Socioeconomic Strata
Elwyn, Glyn, MD, PhD, MSc
(Awarded 2017, Shared Decision Making PFA)
Uterine fibroids are a common health problem and can cause heavy bleeding, pain, problems with pregnancy, and preterm birth. This PCORI-funded implementation project is putting a shared decision making program into place at five gynecology clinics (MA, MN, MO, NH, NY) to help women with uterine fibroids and their doctors make decisions about treatment. The project team is updating a patient decision aid to include new evidence from PCORI-funded research, developing multiple formats of the decision aid including written text, picture, online interactive, and Spanish formats and working with clinics to develop processes for making the decision aids available to patients. The project team is also training clinic staff to use the decision aids when talking with patients about fibroid treatment. Approximately 2,600 women are expected to use the decision aid during the project. Through supplemental award funding, the project team is also collecting, measuring, and reporting out the costs associates with implementing the shared decision making program.
Through a COVID-19-Related Project Enhancement, this project is working with each clinic to figure out how to best offer the decision aid through telehealth, such as online or mailing a paper copy, and to support patients using telehealth to make decisions about treatments for uterine fibroids.
Implementing Shared Decision Making for Breast Cancer Using a Coproduction Learning Collaborative
Elwyn, Glyn, MD, PhD, MSc
(Awarded 2021, Shared Decision Making PFA)
Mastectomy and breast-conserving surgery with radiation are equally effective treatment options for early-stage breast cancer but involve distinct tradeoffs. This PCORI-funded implementation project is putting in place two conversation aids, shown in PCORI-funded research to help women with early-stage breast cancer choose treatment, at 33 clinics across the United States. To support the use of the aids at the clinics, the project team is hosting a learning collaborative and training site clinicians and champions on shared decision making, how to use the conversation aids, and how to integrate the conversation aids into electronic health record systems and patient portals. Over 6,500 women with early-stage breast cancer considering breast removal or breast-conserving surgery treatment are expected to receive shared decision making support during the project.
The TRIAD (Treatment Individualized Appendicitis Decision-making) Implementation Program
Flum, David, MD, MPH
(Awarded 2022, Limited Competition PFA)
This PCORI-funded Implementation Project is promoting informed decision-making between antibiotics and appendectomy for eligible patients with appendicitis, based on PCORI-funded research that showed antibiotics were non-inferior to appendectomy in the short term and had helped a majority of patients avoid surgery after a year’s time. The project team is working with 15 diverse hospitals across the U.S. to adopt a program that includes a patient decision support tool, clinician training, and standardized operational protocols. At least 2,500 patients are expected to engage in shared decision-making about treatment options for appendicitis during this project.
Reducing Inappropriate Antibiotic Prescribing for Children with ARTIs in Outpatient Settings
Gerber, Jeffrey, MD, PhD
(Awarded 2020, Open Competition: Implementation of Findings from PCORI’s Research Investments PFA)
Using broad-spectrum antibiotics when they’re not needed can cause unnecessary side effects and contribute to antibiotic resistance. This PCORI-funded implementation project is working to reduce rates of inappropriate antibiotic prescribing for children with acute respiratory tract infections, or ARTIs, through a tested multicomponent antibiotic prescribing program. The project team is creating online educational modules for clinicians and helping sites set up systems that generate audit-and-feedback reports for clinicians on their prescribing. The project team is putting this program in place in a variety of outpatients settings at 115 sites across five health systems in three states (FL, OH, PA). At least 900 clinicians who see about 350,000 children with ARTIs are expected to participate in the project.
Implementing Contextual Factors Assessment in Clinical Settings
Greco, Carol, PhD
(Awarded 2017, Limited Competition PFA)
The Healing Encounters and Attitudes Lists, or HEAL, surveys, tested in PCORI-funded research, measure patients’ expectations and other beliefs that may affect treatment outcomes. This PCORI-funded implementation project is incorporating HEAL into the regular care that patients receive across a network of pain clinics at the University of Pittsburgh Medical Center. The project team is adding HEAL into an online form that patients fill out prior to their visit and then training doctors to discuss the results with patients when working with them to choose treatments. Over 17,000 patients seeking treatment for chronic pain are expected to use HEAL during the project. Through supplemental award funding, the project team is also collecting, measuring, and reporting out the costs associated with implementing HEAL.
Through a COVID-19-Related Project Enhancement, this project team is supporting the use of HEAL in telehealth visits for patients with chronic pain as well as training and supporting clinicians on how to use it as part of telehealth visits.
Using Childbirth-Specific Patient-Reported Outcomes Measures in the Hospital Setting
Gregory, Kimberly, MD, MPH
(Awarded 2017, Limited Competition PFA)
This PCORI-funded implementation project is adapting the Childbirth Experience Survey, developed in PCORI-funded research, for hospital use in identifying opportunities to improve the care women receive while in the hospital for childbirth. The project team is putting the surveys, available in English and Spanish, into an online platform and working with 15 diverse hospitals in California to get the survey to women in different ways, such as through delivery registration lists or childbirth classes. The team is also working with hospital staff and leadership to identify ways they can use the results to improve their patients’ experience with childbirth services. More than 2,000 women are expected to complete the Childbirth Experience Survey during the project.
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Preventing Venous Thromboembolism (VTE): Engaging Patients to Reduce Preventable Harm from Missed/Refused Doses of VTE Prophylaxis
Haut, Elliot, MD, PhD
(Awarded 2016, Limited Competition PFA)
This completed PCORI-funded implementation project adapted a VTE prophylaxis program, tested in PCORI-funded research, and put it in place in two Maryland hospitals. The program alerts nurses in real time when a patient misses a dose of their medicine so that they can have a discussion with the patient and provide educational materials, including a video and handout. The project team modified sites’ electronic health record systems to automatically send the alerts to nurses. Nurses also received online training on blood clot prevention and on discussing prophylaxis with patients. During the project, nurses received alerts for approximately 17,000 patients. The program successfully reduced the number of missed or refused doses of blood clot prevention medicine among patients in both hospitals.
Implementing Best-Practice, Patient-Centered Venous Thromboembolism (VTE) Prevention in Trauma Centers
Haut, Elliot, MD, PhD
(Awarded 2020, Limited Competition PFA)
This PCORI-funded implementation project is expanding a VTE prophylaxis program, shown to reduce missed and refused doses of medicine in a prior PCORI-funded implementation project, to a network of 10 trauma centers across the United States (CA, CO, DE, MD, OR, PA, SC, UT, and WI). The project team is building on its prior success incorporating the real-time alert system into the electronic health record and leveraging existing educational materials for patients and nurses. The project team is also working with administrators and nurse champions at each site to tailor the program and support its use. More than 3,500 nurses and 30,000 patients at high risk for VTE are expected to receive the program through this project.
Implementation of a Shared Decision Making Intervention in Practice: The Chest Pain Choice Pathway
Hess, Erik, MD, MSc
(Awarded 2017, Limited Competition PFA)
Many patients who go to the emergency department for chest pain stay in the hospital for testing, but patients at low risk for a heart attack may not need to. This completed PCORI-funded implementation project incorporated a decision aid, shown in PCORI-funded research to help patients learn about their treatment options and to reduce unnecessary hospitalizations and healthcare services, into regular care for patients with chest pain at six hospital emergency departments across three health systems in four states (AL, CA, FL, MN). The project team trained 235 emergency department staff, including physicians, nurse managers, and administrators, to use the decision aid with patients and worked with clinical champions at each emergency department to support its use. Approximately 1,300 patients, or about 11 percent of eligible patients, received the decision aid during the project. However, the project team faced challenges integrating the decision aid into the electronic health record and clinical workflow. Additionally, improved testing options that became available during the project increased provider confidence regarding best treatment options for low-risk patients and lessened the need for the decision aid.
Implementing Team-based Outpatient Palliative Care in Parkinson’s Foundation Centers of Excellence
Kluger, Benzi, MD, MS
(Awarded 2019, Limited Competition PFA)
This PCORI-funded implementation project is integrating a team-based outpatient palliative care program, shown in PCORI-funded research to improve outcomes for people with Parkinson’s disease, into standard care across a national network of 34 medical centers in 20 states and the District of Columbia designated as Centers of Excellence by the Parkinson’s Foundation. The project team is tailoring program materials and protocols, training staff at the medical centers to use the program, and providing ongoing coaching support. At least 54,000 people with Parkinson’s disease are expected to receive team-based palliative care during the project. Through supplemental award funding, the project team is also collecting, measuring, and reporting out the costs associated with implementing the program.
Through a COVID-19-Related Project Enhancement, the project team is adapting staff training from an in-person to online format, as well as adapting the palliative care program to work for telehealth delivery and to address COVID-19 concerns.
Implementation of the IMPaCT Community Health Worker Intervention
Kangovi, Shreya, MD, MS
(Awarded 2018, Limited Competition PFA)
This PCORI-funded implementation project is expanding the use of a standardized community health worker, or CHW, program, called IMPaCT, shown in PCORI-funded research to improve quality of care and reduce hospital stays for patients facing socioeconomic disadvantage, to five health organizations across the United States (CA, DE, OR, VA/TN, NY) to support patients who have chronic health problems. The project team is adapting program materials including manuals, training, and software to work for each organization and helping sites use structured protocols to recruit, hire, and train CHWs as well as to manage CHW documentation, workflow, and program evaluation. Approximately 4,600 people with chronic disease who live in low-income communities are expected to receive support from CHWs during the project.
Using the Child Health Ratings Inventories (CHRIS) to Improve Diabetes Care for Children
Kaplan, Sherrie, PhD, MPH
(Awarded 2019, Limited Competition PFA)
This PCORI-funded implementation project is making the Child Health Ratings Inventories Surveys, or CHRIS—animated cartoon surveys shown in PCORI-funded research to accurately capture children’s quality of life—part of healthcare visits for children with type 1 diabetes and their families at three children’s hospitals in California and Massachusetts. The project team is working with sites to add CHRIS into their health record systems and setting up a system that collects and analyzes completed CHRIS surveys. The system makes the results available immediately to both patients and clinicians. The project team is also training families and clinicians on how to use CHRIS during office visits to help make treatment decisions that work best for the child. More than 800 families and their clinicians are expected to participate in the program during the project.
Through a COVID-19-Related Project Enhancement, the project team is adapting CHRIS for use with adults who have type 1 or 2 diabetes and are receiving care via telehealth.
Improving Diabetes Prevention with Benefit-Based Tailored Treatment: Dissemination Patient-Centered Estimates of Benefit
Kent, David, MD, MS
(Awarded 2016, Limited Competition PFA)
This completed PCORI-funded implementation project put a clinical decision support tool, providing clinicians with information about a patient’s near-term risk of progression from prediabetes to diabetes, into place at 52 primary care clinics in two health systems, Premier Health in Pennsylvania and Mercy Health in Missouri. The project adapted a prediction model developed in PCORI-funded research into a manual risk calculator for Mercy Health and an electronic health record (EHR)-based tool for Premier Health, which uses the Allscripts system. The project team trained 96 clinicians across both health systems to use these tools and to discuss risk information with patients. During the project, clinicians accessed the tools for visits with 2,536 patients, including 54 percent of eligible patients at Mercy and 79 percent of eligible patients at Premier. In both systems, targeted referrals to diabetes prevention programs and metformin increased after the tools were put in place. To support broader use of the risk prediction model, the project team also developed a cloud-based SMART on FHIR risk prediction tool, integrated it into the Epic EHR at Mercy Health, and piloted its use with approximately 950 patients with prediabetes.
Disseminating Community Health Worker Training from the Guidelines to Practice (G2P) Project
Kramer, Bradley, MPA and Stout, James, MD, MPH
(Awarded 2018, Limited Competition PFA)
This completed PCORI-funded implementation project expanded a community health worker, or CHW, asthma home visit program, tested in PCORI-funded research, to three regional healthcare organizations and a federally qualified health center within four Accountable Communities of Health across Washington. The project team created online tutorials for CHWs who care for patients with asthma and hosted an online and in-person learning collaborative to provide ongoing training and feedback to CHWs and CHW managers. During the project, 64 CHWs and 22 CHW supervisors completed the CHW asthma home visit training program. The trained CHWs provided home visits for 155 people with uncontrolled asthma, 70 percent of which occurred by phone. Due to COVID-19-related challenges, the program reached fewer patients with asthma than intended.
Through a COVID-19-Related Project Enhancement, the project team adapted program materials for use during phone- and video-based asthma home visits, updated CHW training protocols to support virtual visits, and developed asthma education videos for patients in English and Spanish.
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Disseminating and Implementing Patient-and Family-Centered I-PASS to Improve Patient Safety
Landrigan, Christopher, MD, MPH
(Awarded 2018, Limited Competition PFA)
This PCORI-funded implementation project is expanding the use of Patient and Family-Centered I-PASS, a program to improve hospital safety for children, to 21 large and small hospitals that care for children in 16 states. The program, which integrates families into medical rounds, was shown in PCORI-funded research to improve communication among hospital staff and families and to reduce serious adverse events among hospitalized children. The project team is working with a team of I-PASS mentors to adapt the program to work for the 21 hospitals, training 2,800 physicians and nurses to use the program, and developing a guide to help other hospitals put the program into place. Approximately 48,000 children and families are expected to participate in the program during the project.
Implementing the Infusion Clinic Model in Sickle Cell Disease
Lanzkron, Sophie, MD, MHS
(Awarded in 2022, Limited Competition PFA)
This PCORI-funded implementation project is optimizing sickle cell disease care at nine health systems across the United States (DE, IN, KS, MA, MD, MN, NC, PA, VA), based on PCORI-funded research that showed patients receiving care at infusion centers waited half as long for pain medicine, were less likely to be admitted to the hospital, and were more satisfied with their care compared to patients receiving care in the emergency department. The project team is providing centers with technical assistance, including consultation and practice facilitation; feedback reports; training; and clinical care resources, such as specialized treatment policies and protocols. Many of these resources are included in a standardized implementation toolkit, developed in a PCORI-funded capacity-building project, which the team is refining to support uptake at future sites. Approximately 3,500 patients with sickle cell disease are expected to experience improved care and patient-centered outcomes during the project.
Leveraging Patient Partner and Stakeholder Engagement to Implement PCOR-PlanYourLifespan.org
Lindquist, Lee, MD, MPH, MBA
(Awarded 2016, Limited Competition PFA)
This completed PCORI-funded implementation project worked with two community organizations to promote the use of PlanYourLifespan (PYL), a web-based program tested in PCORI-funded research that helps older adults and their families create a plan to support them in aging at home. Using a train-the-trainer approach, the project team trained people at FirstVitals Health and Wellness (Hawaii) and Pastors4PCOR (Illinois) on how to encourage use of PYL in their communities. FirstVitals Health and Wellness also worked to incorporate PYL into Medicare intake materials and to add it as a resource provided to older adults, caregivers, and families seeking services at local Agency on Elderly Affairs offices. The project team also partnered with Epic systems to provide access to PYL as a resource for patients using MyChart.
Implementing an Intervention to Address Concerns of Older Patients with Cancer Receiving Chemotherapy and Their Caregivers
Lowenstein, Lisa, PhD
(Awarded 2021, Limited Competition PFA)
This PCORI-funded implementation project is incorporating a geriatric assessment and summary report, shown in PCORI-funded research to improve satisfaction and communication about age-related concerns, into standard practice at eight community oncology clinics in four states (AZ, NY, SC, and WI). The project team is adapting the program to work in real-world settings, for example, by developing a web-based tool to help clinics prepare the report; training 700 clinic staff to deliver the program and discuss patients’ concerns during an office visit; and providing sites with practice facilitation support. Approximately 6,150 older patients (65 years of age or older) are expected to complete the geriatric assessment during the project to inform their discussions with clinicians regarding cancer chemotherapy.
Implementing Advance Care Planning for Dialysis Patients
Lupu, Dale, PhD, MPH
(Awarded 2020, Limited Competition PFA)
This PCORI-funded implementation project is working with three large dialysis organizations to make a social worker-led advance care planning program, tested in PCORI-funded research, a part of regular care at 50-60 dialysis centers across the United States. The project team is adapting the program to work for patients with all stages of kidney disease, to be delivered remotely for patients on home dialysis and work across different platforms (e.g., iPads and tablets). The project team is training 100 social workers and dialysis center staff to deliver the program and providing ongoing coaching and mentoring for social workers at sites. Approximately 2,000 in-clinic and 250 home dialysis patients are expected to engage in discussions about advance care planning with their care team during the project.
Tailored Implementation of a Decision Support Strategy for Left Ventricular Assist Devices
Matlock, Daniel, MD, MPH
(Awarded 2017, Shared Decision Making PFA)
Left ventricular assist devices, or LVADs, can help people with advanced heart failure live longer, but LVADs have serious risks and require lifestyle changes. This PCORI-funded implementation project is expanding the use of a shared decision making program, shown in PCORI-funded research to help patients with advanced heart failure decide whether to get an LVAD, to LVAD clinics across the United States. The project team is first putting the program in place at 18 clinics that expressed early interest in the program, and then to the remaining 157 clinics in the United States. The team is offering the clinics free patient materials, user manuals, training webinars, and support calls for staff. The project team is also helping interested clinics design the program to fit their needs.
Through a COVID-19-Related Project Enhancement, the project team is supporting caregiver well-being during COVID-19 by adding two ways to support caregivers to the program. One way will be support from a trained coach via telehealth. The other way will be a web-based support group.
Implementation Strategies to Enhance Use of Conservative Management of Urinary Incontinence in Women
Mittman, Brian, PhD and Menefee, Shawn, MD
(Awarded 2022, Open Competition: Implementation of Findings from PCORI’s Research Investments PFA)
Nearly half of adult women in the United States experience some level of urinary incontinence, or UI, but a majority do not receive treatment. This PCORI-funded implementation project is increasing access to, and delivery of, evidence-based first-line treatment for UI in women aged 60 and older. The project is putting a virtual program that provides screening, treatment, and referrals as needed, in place at 15 sites within a large health system in southern California. The project team is incorporating the program into sites’ existing electronic platforms, training clinicians and staff on UI treatment and how to use the program, and providing technical assistance to support the program’s use. More than 26,000 women with UI are expected to access and use the program during the project.
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Effective Dissemination Approach for a Successful Asthma Self-Management Support Intervention
Nkoy, Flory, MD, MS, MPH
(Awarded 2019, Limited Competition PFA)
This PCORI-funded implementation project is making an electronic asthma tracker, or e-AT, shown in PCORI-funded research to improve children’s asthma control, part of regular care for treating children with asthma in 61 clinics and community centers across four states (UT, ID, NE, and MT). The e-AT, available in English and Spanish, allows families to track asthma symptoms regularly and alerts clinic staff when a patient’s asthma control is declining, helping families and clinicians coordinate effective and timely care for children with asthma. The project team is training clinic staff, physician champions, and care coordinators/care managers to deliver and use the e-AT. The team is also providing ongoing supports to sites, for example, through site visits and providing monthly reports on patients’ use of the e-AT. More than 6,000 children with asthma and their parents are expected to use the e-AT during the project.
Implementing Peer-Driven Care to Patients with Sleep Apnea
Parthasarathy, Sairam, MD
(Awarded 2018, Limited Competition PFA)
More than half of people with obstructive sleep apnea don’t use continuous positive airway pressure, or CPAP, machines the right way or decide not to use them at all. This PCORI-funded implementation project is expanding the use of an interactive phone-based peer support program, shown in PCORI-funded research to help people use their CPAP machines correctly. The project team is putting this program in place at 11 sleep centers and clinics in Arizona and Colorado within the Banner Health System, adapting the program to work with each center’s record systems, working with local sleep center champions at each site, and training at least 500 peer-buddies using a train-the-trainer approach to participate in the program. Approximately 2,000 patients at these sleep centers and clinics are expected to receive peer buddy support and care coordination during the project.
Through a COVID-19-Related Project Enhancement, the project team is updating training materials for patients and peer buddies to address peoples’ COVID-19-related concerns about CPAP use. The project team is also partnering with the American Sleep Apnea Association to train an additional 2,000 peer buddies across a network of patient education and support groups to provide virtual or in-person support for an additional 14,000 patients with obstructive sleep apnea.
Implementation of Effective Home Oxygen Weaning Strategies in Premature Infants
Rhein, Lawrence, MD, MPH
(Awarded 2020, Limited Competition PFA)
Infants who are born prematurely often need home oxygen therapy after they leave the hospital; recorded home oximetry allows parents to check their infants’ oxygen levels at home. This PCORI-funded implementation project is putting a recorded home oximetry program, shown in PCORI-funded research to be a safe and effective strategy for managing home oxygen therapy for premature infants and to reduce the amount of time these infants stay on this therapy, in place at 14 diverse medical systems in 12 states. The project team is creating educational and training materials for hospital staff and families, adapting the program to work with different types of data processing supports at sites, training providers and practice champions to use the program, and providing sites with ongoing coaching and feedback. At least 600 families of premature infants per year are expected to receive the recorded home oximetry program during the project.
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Using PCORI Data to Drive Better Decision Quality for Men with Localized Prostate Cancer
Saigal, Christopher, MD, MPH
(Awarded 2017, Limited Competition PFA)
Men with prostate cancer may face decisions regarding whether they prefer to pursue treatment with surgery, radiation, or a watch-and-wait approach with regular check-ups. This PCORI-funded implementation project is adapting an existing decision aid to include updated evidence, including from PCORI-funded research that compared the benefits and risks of these three options, and making it part of a shared decision making program to help men with localized prostate cancer choose a treatment approach based on what is important to them. The project team is putting the program in place at urology clinics in three health systems in California and Tennessee, first incorporating the decision aid into sites’ electronic health record systems, and then training physicians and clinic staff on shared decision making and how to use the decision aid and an accompanying report that summarizes patients’ preferences. More than 1,000 men are expected to complete and use the decision aid in English or Spanish during the project. Through supplemental award funding, the project team is also collecting, measuring, and reporting out the costs associated with implementing the shared decision making program.
A Learning Collaborative Approach to Support Behavioral Health Home Plus Dissemination
Schuster, James, MD, MBA
(Awarded 2017, Limited Competition PFA)
Teens receiving care in residential treatment facilities and adults who attend opioid treatment programs are at high risk for poor health outcomes resulting from unhealthy behaviors, such as smoking, poor diet, and a lack of exercise. This completed PCORI-funded implementation project put the Behavioral Health Home Plus (BHHP) program, tested in PCORI-funded research, in place at five residential facilities and seven treatment programs in Pennsylvania, helping 4,354 service users (541 teens at residential facilities and 3,813 adults in treatment programs) address wellness and physical health challenges. The project team trained approximately 300 staff using a train-the-trainer approach and convened a learning collaborative to support sites’ use of the program. After the program was put in place, service users in both settings reported high involvement in managing their physical health and wellness; nearly all had wellness goals and completed physical health assessments. Physical and behavioral health providers also documented reciprocal communication in both settings, including 90 percent at residential facilities and 63 percent at treatment programs. Use of specialty care decreased for service users at residential facilities and use of both specialty and primary care decreased for service users at treatment programs.
Learning Collaborative to Improve the Quality of Elective Orthopedic Surgery Decisions
Sepucha, Karen, PhD:
(Awarded 2019, Limited Competition PFA)
This PCORI-funded implementation project is making patient decision aids, including ones shown in PCORI-funded research to effectively support decision making, part of routine orthopedic care for patients considering hip, knee, or back surgery at 12 orthopedic centers in four states (MA, NY, TX, and WA). The project team is hosting a learning collaborative to help clinical and administrative champions at each site integrate the decision aids into workflow and train them on shared decision making and how to deliver and use the decision aids with patients. The project team is developing a toolkit to support further uptake at future sites. More than 20,000 individuals considering surgery are expected to receive decision-making support during the project. Through supplemental award funding the project team is also collecting, measuring, and reporting out the costs associated with convening the learning collaborative and supporting uptake of these decision aids at participating sites.
Implementing Individualized Lupus Nephritis Patient Decision-Aid for Immunosuppressive Drugs
Singh, Jasvinder, MD
(Awarded 2017, Shared Decision Making PFA)
This PCORI-funded implementation project is helping to make a decision aid, shown in PCORI-funded research to help patients with lupus nephritis choose a treatment that is right for them, part of routine care at 15 lupus centers around the United States. The project team is adapting the decision aid by including more information about lupus beyond its effect on the kidneys, developing paper and Spanish-language versions, and then working with sites to incorporate it into clinics’ existing workflows and processes. The project team is training doctors and clinic staff to use the decision aid and working with champions at each site to support its use. The project team is also developing a best practices manual to support future use of the decision aid in other clinics. Approximately 500 patients are expected to receive support in deciding on treatment options for this rare disease. Through supplemental award funding, the project team is also collecting, measuring, and reporting out the costs associated with implementing the decision aid at participating sites.
Through a COVID-19-Related Project Enhancement, the project team is supporting decision aid use during telehealth visits by developing new ways for patients to access and complete the decision aid, such as via smartphone or website and developing systems that alert clinics when patients complete the decision aid at home.
SAFE CT: Software, Actionable Feedback, and Education for Computed Tomography to Help Institution Optimize Their Radiation Doses
Smith-Bindman, Rebecca, MD
(Awarded 2018, Limited Competition PFA)
Lowering the amount of radiation patients receive during a computed tomography, or CT, scan can reduce unnecessary health risks. This PCORI-funded implementation project is adapting a CT dose optimization program, developed in PCORI-funded research, that generates feedback reports that hospitals and imaging facilities can use to reduce unnecessary radiation exposure. The project team is first working to improve the feedback reports, for example by making them easier to use, reducing the number of CT scans required to generate a report, and adding measures of image quality. The team is then providing online training for medical staff including radiologists, radiological technologists, and administrators on how to interpret the reports. The project team is working with professional societies and others to encourage organizations to use the program. The project includes 13 health systems across the United States and will help reduce radiation doses for up to 1.5 million unique patients per year.
Evaluation of a Shared Decision Making Intervention for Patients with Asthma in the Emergency Department
Tapp, Hazel, PhD
(Awarded 2017, Limited Competition PFA)
Many children who have trouble managing asthma go to the emergency department for treatment instead of a clinic. This PCORI-funded implementation project is adapting a training program to support shared decision making between clinicians and their patients who have asthma, tested in PCORI-funded research, to a virtual iPad program called Coach McLungs and putting this program in place at two children’s emergency departments in two health systems in Georgia and North Carolina. The project team is adapting standard asthma education for clinicians to include training on shared decision making, as well as training doctors and nurses on how to use the program and work with families to make asthma treatment decisions based on reports generated by Coach McLungs that summarize children’s asthma symptoms, goals, and preferences. Approximately 2,400 children with uncontrolled asthma are expected to use the program during the project.
Dissemination and Implementation of Effective Childhood Obesity Treatment Innovations
Taveras, Elsie, MD, MPH
(Awarded 2017, Limited Competition PFA)
Childhood obesity affects millions of children and can lead to lifelong health problems. This PCORI-funded implementation project is incorporating a pediatric weight management program, shown in PCORI-funded research to improve children’s weight, into standard practice at 23 federally qualified, hospital-, or community-based health centers in three states (CO, MA, and SC). The project team is adapting sites’ electronic health record systems to include clinical decision support tools and working with sites to set up systems that send families automated text messages to help monitor their child’s weight management goals. The project team is also adapting educational materials and community resources for families at each site and training clinicians on how to use these systems and deliver weight management counseling during in-person or telehealth well-child visits. Approximately 19,000 children with overweight or obesity are expected to receive weight management counseling and support during the project. Through supplemental award funding, the project team is also collecting, measuring, and reporting out the costs associated with implementing the program.
Implementation of Health-E You/Salud iTu to Promote Adolescent-Centered Contraceptive Care
Tebb, Kathleen, PhD
(Awarded 2021, Limited Competition PFA)
Contraceptive education can help teens choose birth control that is right for them and prevent unplanned pregnancies. This PCORI-funded implementation project is putting Health-E/Salud iTu, an interactive mobile app available in English and Spanish and shown in PCORI-funded research to increase teens’ knowledge and use of birth control, into practice at 27 school-based health centers in 10 states and the District of Columbia. The project team is adapting the app to work for different clinical settings and developing systems to help clinic staff access information about teen’s preferred birth control method before their visit. The project team is also training clinic staff to use the app as part of regular care for teens and providing ongoing technical assistance and consultation to sites. More than 16,000 teens, most of whom are non-White, are expected to use the app during the project.
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Implementing Patient Decision Support for Lung Cancer Screening Through Tobacco Quitlines
Volk, Robert, PhD
(Awarded 2019, Limited Competition PFA)
Screening can reduce deaths from lung cancer among heavy smokers who are at high risk for developing lung cancer, but screening can also lead to harms. This PCORI-funded implementation project is expanding the use of a patient decision aid shown in PCORI-funded research to help people understand their options and the trade-offs of screening and be more prepared to talk about screening with their health provider. The project team is working with eight state tobacco quitlines (AL, AZ, CO, IL, MS, NY, OK, and PA) to develop processes and tools for identifying callers eligible for lung cancer screening and referring them to the decision aid and other lung cancer resources. The project team is also creating a best practices guide that quitline providers and state health agencies can use to support further referral and use of the decision aid. Several thousand high-risk smokers are expected to receive lung cancer screening decision support during the project.
Widespread Implementation of a Patient-Centered Online Therapy for Adolescent Traumatic Brain Injury
Wade, Shari, PhD
(Awarded 2019, Limited Competition PFA)
More than 150,000 children in the United States experience persistent problems due to traumatic brain injury, or TBI, and many thousands go untreated. This PCORI-funded implementation project is making family problem-solving therapy, or F-PST, tested in PCORI-funded research, part of regular care for treating teens with complicated mild-to-severe TBI at 15 children’s hospitals and rehab centers in 10 states and Toronto. The program can be delivered in person, online with a therapist, or online without a therapist. The project team is adapting the program by developing a Spanish language version and working with sites to develop processes that enable teens to receive F-PST in ways that work best for them and their families. The team is also training different types of providers to deliver the program, offering sites ongoing consultation and supervision, and helping sites establish programs to certify trainers who will continue training and supervising therapists to deliver the program after the project completes. Approximately 1,400 teens with TBI are expected to receive the program during the project.
Through a COVID-19-Related Project Enhancement, the project team is adapting F-PST for use by teens with other brain injuries, such as tumors or stroke, and expanding training and supports to offer F-PST via telehealth. An additional 600 patients are expected to receive F-PST through these activities.
Dissemination and Implementation of Causal Inference Methods through Partnerships with Large Health Systems
Zhang, Yi, PhD
(Awarded 2016, Limited Competition PFA)
Researchers often find it difficult to analyze data about the effectiveness of dynamic treatments, i.e., when doctors change treatment over time based on how the patients respond. PCORI-funded research developed analyses called g-methods to help researchers study dynamic treatments using patients’ medical records. This completed PCORI-funded implementation project worked with eight teams of researchers and statisticians at four hospital systems to use these methods to compare the effectiveness of different treatments in 11 studies. The project team helped these researchers design and improve their analyses. The team also provided training on use of the g-methods via webinars and offered ongoing individual coaching and consultation sessions. At the end of the project, more than three-fourths of the researchers who completed surveys at the end of the project found g-methods appropriate and suitable for their work and individual research questions; half reported their intention to use these methods in future projects.
Posted: April 7, 2022; Updated: August 1, 2022
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