Table 1 Comparison of conditions
Contextual factor | Implementation strategies | Standardized, “best practices” | Tailored, “customized and collaborative” |
|---|---|---|---|
Resources | Needs assessment Electronic Health Record (EHR) Enhancements | Client completion of paper PHQ-9 and score entered in EHR for review by the clinician | Client Completion of paper PHQ-9 and score entered in EHR for review by the clinician |
Networks & Linkages | Teams were formed and met triweekly | All clinicians were invited to attend | Opinion leaders and champions were invited to attend |
Policies and Incentives | Guideline for PHQ-9 administration frequency | Each session with client | Determined by implementation teams, specific to each site |
Norms & Attitudes | Initial MBC training Audit & Feedback with fidelity data | Standardized training material Penetration data to monitor fidelity, but not provided to clinicians | Tailored training material targeting identified barriers from the needs assessment Penetration data to inform tailored implementation |
Structure & Process | Progress note modifications in EHR | Graph available for score review | Graph available for score review |
Media & Change Agents | Triweekly meetings with external experts | Consultation focused on promoting MBC fidelity: (1) session-by-session administration of PHQ-9; (2) clinician score to inform session; (3) discussion of scores with clients in session. Clinicians were offered tips on targeting lack of progress | Consultation focused on targeting contextual barriers, with emphasis placed on fidelity to site-specific guideline |