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Table 2 CHAPS implementation fidelity moderators

From: Implementation fidelity of a nurse-led RCT-tested complex intervention, care coordination for health promotion and activities in Parkinson’s disease (CHAPS) in meeting challenges in care management

Potential Moderator Types CHAPS Implementation
Participant Responsiveness (i.e., individuals receiving and individuals delivering CHAPS) Patient/participants’ survey responses about CHAPS [20]
• Positive (n = 246, 74%)
• Neutral (n = 53, 16%)
• Negative (n = 35, 10%)
Patient/participants’ usability survey responses about the CHAPS Initial Assessment [20]
• Positive (n = 51, 81%)
• Neutral (n = 11, 17%)
• Negative (n = 1, 2%)
CHAPS nurse care manager survey responses noting specific program benefits [20]
• Yes (n = 72, 74%)
• Unsure (n = 19, 20%)
• No (n = 6, 6%)
Parkinson’s disease specialist survey responses noting specific program benefits [20]
• Yes (n = 107, 77%)
• Unsure (n = 30, 21%)
• No (n = 3, 2%)
CHAPS nurse care manager usability survey responses to Siebens Domain Management Model™ [20]
• Facilitators in using the Model (n = 55, 65%)
• Challenges in using a new Model (n = 29, 35%)
CHAPS nurse care manager usability survey responses to the self-care Notebook [20]
• Facilitators for coaching about the Notebook (n = 46, 62%)
• Challenges to coaching about the Notebook (n = 28, 38%)
Patient/participant reported feedback on Notebook to CHAPS nurse care managers [20]
• Notebook assets (n = 97, 67%)
• Notebook review deferred (n = 28,19%)
• Reasons for not using Notebook (n = 19,13%)
Principal Investigator observed CHAPS nurse care managers actively using CHAPS tools
Neurology clinic physician assistant appreciated participants’ Notebooks
Comprehensiveness of policy description (i.e., CHAPS protocol) CHAPS intervention protocol published [7]
Intervention implementation details published [14]
CHAPS nurse care manager orientation (10–40 h) [14]
Parkinson’s disease specialist & administrative staff orientation (1 h) [14]
Content of CHAPS Nurse Care Manager Binder (7 sections) [14]
Neurology leadership informed in person about CHAPS protocol (1 h) [14]
Strategies to facilitate implementation (i.e., supports for delivering CHAPS components) Print and online version of CHAPS Nurse Care Manager Binder [14]
CHAPS nurse care manager hands-on practice of CHAPS Initial Assessment and Notebook during orientation [14]
Principal Investigator (nurse researcher) was available and provided feedback on documentation and care management
CHAPS nurse care manager conference calls twice monthly, then monthly – reported to Principal Investigator
CHAPS nurse care manager huddles with Parkinson’s disease specialists monthly – reported to Principal Investigator [14]
Quality of delivery (i.e., extent to which provider (CHAPS) approaches theoretical ideals) Fidelity to Chronic Care Model achieved (Table 1)
5 patient-centered steps of the Nursing Process documented [14] a
5 intervention protocol steps to address problems/topics utilized [14] b
Evidence-based Organizing Framework, Siebens Domain Management Model™ for holistic care management actively used [14]
140 (100%) of participants were provided 3-ringed binder self-care tool Notebook to encourage self-management [14]
Nurse care managers discussed Notebook with participants (n = 108, 77%)
CHAPS nurse care managers reported and documented participant self-care actions [14]
• I Medically-focused (n = 239)
• II Mentally/emotionally/coping-focused (n = 871)
• III Functionally-focused (n = 196)
• IV Environmentally-focused (n = 29)
CHAPS nurse care manager and Parkinson’s disease specialist communicated regularly through huddles [14]
Recruitment including barriers to maintaining involvement of participants Recruitment performed through letters and telephone calls
140 of 162 (86%) of those randomized to intervention received nurse care management [17]
3 of these 140 (2%) declined after care management started [14]
Context (economic, organizational, community) Veterans Affairs Health Services Research and Development, Nursing Research Initiative funded the CHAPS trial
Veterans Affairs open to quality of care improvement initiatives
Veterans willing to participate in research
Relationships with local community organizations (e.g., Parkinson’s support groups)
Unable to incorporate CHAPS Initial Assessment and algorithms in electronic medical record (Computerized Personal Record System), requiring separate software
Primary barrier to full intervention implementation was maintaining sufficient nurse care manager staffing due to Veterans Affairs hiring freeze in setting of normal turnover [14]
  1. CHAPS – Care Coordination for Health Promotion and Activities in Parkinson’s Disease; Notebook – Siebens Health Care Notebook [18]
  2. a Nursing Process: Assessment, Nursing Diagnoses, Planning Outcomes, Implementing Interventions
  3. b Intervention Protocol Steps: Assess further, Provide information, Problem solve collaboratively, Clinical Referrals, Community and Social Service Referrals