Table 2 CHAPS implementation fidelity moderators
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] |