{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:01:28Z","timestamp":1773792088001,"version":"3.50.1"},"reference-count":43,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2022,3,17]],"date-time":"2022-03-17T00:00:00Z","timestamp":1647475200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,3,17]],"date-time":"2022-03-17T00:00:00Z","timestamp":1647475200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background and Aims<\/jats:title>\n            <jats:p>The Veterans Health Administration (VHA) provides care for more than 80,000 veterans with cirrhosis. This longitudinal, multimethod evaluation of a cirrhosis care quality improvement program aimed to (1) identify implementation strategies associated with evidence\u2010based, guideline\u2010concordant cirrhosis care over time, and (2) use qualitative interviews to operationalize strategies for a manualized intervention.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Approach and Results<\/jats:title>\n            <jats:p>VHA providers were surveyed annually about the use of 73 implementation strategies to improve cirrhosis care in fiscal years 2018 (FY18) and 2019 (FY19). Implementation strategies linked to guideline\u2010concordant cirrhosis care were identified using bivariate statistics and comparative configurational methods. Semistructured interviews were conducted with 12 facilities in the highest quartile of cirrhosis care to specify the successful implementation strategies and their mechanisms of change. A total of 106 VHA facilities (82%) responded at least once over the 2\u2010year period (FY18, <jats:italic toggle=\"yes\">n<\/jats:italic> = 63; FY19, <jats:italic toggle=\"yes\">n<\/jats:italic> = 100). Facilities reported using a median of 12 (interquartile range [IQR] 20) implementation strategies in FY18 and 10 (IQR 19) in FY19. Of the 73 strategies, 35 (48%) were positively correlated with provision of evidence\u2010based cirrhosis care. Configurational analysis identified multiple strategy pathways directly linked to more guideline\u2010concordant cirrhosis care. Across both methods, a subset of eight strategies was determined to be core to cirrhosis care improvement and specified using qualitative interviews.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>In a national cirrhosis care improvement initiative, a multimethod approach identified a core subset of successful implementation strategy combinations. This process of empirically identifying and specifying implementation strategies may be applicable to other implementation challenges in hepatology.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/hep.32395","type":"journal-article","created":{"date-parts":[[2022,2,6]],"date-time":"2022-02-06T13:29:06Z","timestamp":1644154146000},"page":"404-417","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":25,"title":["Core implementation strategies for improving cirrhosis care in the Veterans Health Administration"],"prefix":"10.1097","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9233-2867","authenticated-orcid":false,"given":"Vera","family":"Yakovchenko","sequence":"first","affiliation":[{"name":"Center for Healthcare Organization and Implementation Research,VA Bedford Healthcare System,Bedford,Massachusetts,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1328-0307","authenticated-orcid":false,"given":"Timothy R.","family":"Morgan","sequence":"additional","affiliation":[{"name":"Gastroenterology Section,VA Long Beach Healthcare System,Long Beach,California,USA"},{"name":"Division of Gastroenterology,Department of Medicine,University of California,Irvine,California,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7187-1570","authenticated-orcid":false,"given":"Edward J.","family":"Miech","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs,Roudebush VA Medical Center,HSR&D Center for Health Information & Communication,VA PRIS\u2010M QUERI,Indianapolis,Indiana,USA"},{"name":"Regenstrief Institute,Indianapolis,Indiana,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brittney","family":"Neely","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion,VA Pittsburgh Healthcare System,Pittsburgh,Pennsylvania,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolyn","family":"Lamorte","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion,VA Pittsburgh Healthcare System,Pittsburgh,Pennsylvania,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"Gibson","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion,VA Pittsburgh Healthcare System,Pittsburgh,Pennsylvania,USA"},{"name":"Division of Gastroenterology, Hepatology, and Nutrition,Department of Medicine,University of Pittsburgh,Pittsburgh,Pennsylvania,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6488-435X","authenticated-orcid":false,"given":"Lauren A.","family":"Beste","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine,Department of Medicine,University of Washington School of Medicine,Seattle,Washington,USA"},{"name":"General Medicine Service,VA Puget Sound Health Care System,Seattle,Washington,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3354-0014","authenticated-orcid":false,"given":"Heather","family":"McCurdy","sequence":"additional","affiliation":[{"name":"VA Ann Arbor Healthcare System,Ann Arbor,Michigan,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dawn","family":"Scott","sequence":"additional","affiliation":[{"name":"Department of Medicine,Central Texas Veterans Healthcare System,Temple,Texas,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel I.","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs,Sierra Pacific Veterans Integrated Service Network,Pharmacy Benefits Management,Mather,California,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela M.","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs,Office of Healthcare Transformation,Washington,DC,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5245-1186","authenticated-orcid":false,"given":"Byron J.","family":"Powell","sequence":"additional","affiliation":[{"name":"Brown School,Washington University in St. Louis,St. Louis,Missouri,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4928-3681","authenticated-orcid":false,"given":"Jasmohan S.","family":"Bajaj","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition,Virginia Commonwealth University,Richmond,Virginia,USA"},{"name":"Division of Gastroenterology,Central Virginia Veterans Affairs Healthcare System,Richmond,Virginia,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8070-7086","authenticated-orcid":false,"given":"Jason A.","family":"Dominitz","sequence":"additional","affiliation":[{"name":"Gastroenterology Section,Veterans Affairs Puget Sound Health Care System,Seattle,Washington,USA"},{"name":"Division of Gastroenterology,Department of Medicine,University of Washington School of Medicine,Seattle,Washington,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maggie","family":"Chartier","sequence":"additional","affiliation":[{"name":"HIV, Hepatitis, and Related Conditions Programs,Office of Specialty Care Services,Veterans Health 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A correction of three misunderstandings between configurational comparativists and regressional analysts","volume":"49","year":"2015","journal-title":"Comparative Political Studies"},{"key":"hep32395-bib-0022-20250824","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s13012-020-01050-7","article-title":"Getting to implementation: a protocol for a Hybrid III stepped wedge cluster randomized evaluation of using data\u2010driven implementation strategies to improve cirrhosis care for Veterans","volume":"15","year":"2020","journal-title":"Implement Sci"},{"key":"hep32395-bib-0023-20250824","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1186\/s13012-015-0295-0","article-title":"Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study","volume":"10","year":"2015","journal-title":"Implement 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