Effective Stakeholder Engagement for Implementation of “Coach McLungsSM”, an Asthma intervention, into Primary Care Practices

Context: Coach McLungsSM is an interactive web-based asthma application currently being implemented in primary care. Our objective is to describe using implementation science frameworks to engage a project stakeholder advisory board in prioritizing recommendations to improve implementation. Setting: 8 Primary care practices within a large, integrated, nonprofit healthcare system.

Populations Studied: Providers and staff from primary care practices and a quarterly meeting Stakeholder Advisory Board, consisting of patients, providers, asthma advocacy organizations, and researchers.

Instruments: Surveys from the Consolidated Framework for Implementation Research (CFIR), Organizational Readiness for Implementing Change (ORIC), and Expert Recommendations for Implementing Change (ERIC).

Survey questions were scored on a Likert scale between 1 and 5. Scores of below 4 identified implementation areas of concern and prompted the selection of associated ERIC recommendations.

Results: Overall survey results showed strong readiness for change with the majority of practices agreeing that there was commitment to implement Coach McLungsSM. In general practices were willing to adopt new programs and felt there was a need for Coach McLungsSM regarding improving patients’ knowledge about uncontrolled asthma and self management, and providing decision support for asthma management. Noted areas of concern were the willingness of leadership to provide time and space to discuss changes that would improve care (mean change commitment = 3.21); and provision of adequate levels of appropriate staffing or training to support the desired change (mean change commitment = 3.47 training; 3.06 staffing). These lower scoring survey results were matched to 7 ERIC recommendations that were presented to stakeholders during a virtual meeting for discussion and prioritization. Based on 20 poll responses from 25 stakeholders the top three identified strategies were: identify and prepare provider champions; involve leaders in the implementation; and capture best practices from providers on working with Coach McLungsSM. These recommendations were fedback to practices as part of implementation process improvement. Conclusion: Engaging stakeholders in a discussion and prioritization process successfully identified three strategies that were fedback to practices to improve practice uptake of Coach McLungsSM, a shared decision making asthma intervention.