{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T17:41:56Z","timestamp":1790444516333,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"S2","license":[{"start":{"date-parts":[[2024,5,15]],"date-time":"2024-05-15T00:00:00Z","timestamp":1715731200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,5,15]],"date-time":"2024-05-15T00:00:00Z","timestamp":1715731200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100007181","name":"Quality Enhancement Research Initiative","doi-asserted-by":"publisher","award":["PII 21\u2010285"],"award-info":[{"award-number":["PII 21\u2010285"]}],"id":[{"id":"10.13039\/100007181","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      To describe\n                      <jats:italic>a<\/jats:italic>\n                      structured, iterative, data\u2010driven approach for modifying implementation strategies for a complex evidence\u2010based practice during a nationwide scale\u2010up initiative.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Study Setting<\/jats:title>\n                    <jats:p>We scaled\u2010up implementation of Critical Time Intervention (CTI)\u2014an evidence\u2010based case management model\u2014across 32 diverse community\u2010based Veterans Affairs (VA) \u201cGrant and Per Diem\u201d case management (GPD\u2010CM) agencies that serve homeless\u2010experienced Veterans transitioning to independent living. Primary data were collected using qualitative methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>We embarked on a scale\u2010up initiative while conducting a pragmatic randomized evaluation using a roll\u2010out design, comparing two versions of a CTI implementation package tailored to VA's GPD\u2010CM program. We iteratively assessed contextual factors and implementation outcomes (e.g., acceptability); findings informed package modifications that were characterized using the Framework for Reporting Adaptations and Modifications to Evidence\u2010based Implementation Strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Collection Methods<\/jats:title>\n                    <jats:p>We conducted semi\u2010structured interviews with Veterans, GPD\u2010CM staff, and liaising VA clinicians; periodic reflections with liaising VA clinicians and implementation team members; and drew upon detailed meeting notes. We used rapid qualitative methods and content analysis to integrate data and characterize modifications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>After each scale\u2010up wave\u2014in response to variations in agency\u2010level characteristics\u2014 we made iterative modifications to the implementation package to increase CTI adoption and fidelity across the diverse contexts of our scale\u2010up sites. Modifications included adding, deleting, integrating, and altering the package; core package components were preserved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Implementation packages for complex evidence\u2010based practices undergoing scale\u2010up in diverse contexts may benefit from iterative modifications to optimize practice adoption with fidelity. We offer a structured, pragmatic approach for iteratively identifying data\u2010driven, midstream implementation package adjustments, for use in both VA and non\u2010VA scale\u2010up initiatives. Our project demonstrates the importance of assessing for and making modifications in a scale\u2010up initiative, as well as the trade\u2010offs of projects having simultaneous formative and summative evaluation aims.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.14313","type":"journal-article","created":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T00:05:35Z","timestamp":1715817935000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["A structured approach to modifying an implementation package while scaling up a complex evidence\u2010based practice"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5866-1763","authenticated-orcid":false,"given":"Kristina M.","family":"Cordasco","sequence":"first","affiliation":[{"name":"VA Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System  Los Angeles California USA"},{"name":"Department of Medicine VA Greater Los Angeles Healthcare System  Los Angeles California USA"},{"name":"Department of Medicine David Geffen School of Medicine at the University of California at Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1790-4271","authenticated-orcid":false,"given":"Sonya E.","family":"Gabrielian","sequence":"additional","affiliation":[{"name":"VA Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System  Los Angeles California USA"},{"name":"Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA Greater Los Angeles  Los Angeles California USA"},{"name":"Department of Psychiatry VA Greater Los Angeles Healthcare System  Los Angeles California USA"},{"name":"Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine University of California at Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Barnard","sequence":"additional","affiliation":[{"name":"VA Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3471-029X","authenticated-orcid":false,"given":"Taylor","family":"Harris","sequence":"additional","affiliation":[{"name":"VA Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System  Los Angeles California USA"},{"name":"Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA Greater Los Angeles  Los Angeles California USA"},{"name":"Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine University of California at Los Angeles  Los Angeles California USA"},{"name":"National Center on Homelessness among Veterans (NCHAV)  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4497-7721","authenticated-orcid":false,"given":"Erin P.","family":"Finley","sequence":"additional","affiliation":[{"name":"VA Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System  Los Angeles California USA"},{"name":"Departments of Medicine and Psychiatry and Behavioral Sciences, Long School of Medicine University of Texas Health Science Center at San Antonio  San Antonio Texas 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