Cover: The Association Between Implementation Strategy Use and the Uptake of Hepatitis C Treatment in a National Sample

The Association Between Implementation Strategy Use and the Uptake of Hepatitis C Treatment in a National Sample

Published in: Implementation Science, Volume 12, Issue 1 (May 2017), page 60. doi: 10.1186/s13012-017-0588-6

Posted on Jun 6, 2017

by Shari S. Rogal, Thomas J. Waltz, Byron J. Powell, JoAnn E. Kirchner, Enola Proctor, Matthew Chinman

Research Questions

  1. Of the strategies identified in the Expert Recommendations for Implementing Change (ERIC) study, which do providers in the Veterans Health Administration (VHA) use?
  2. How does use of these strategies affect evidence-based practice of treatment for Hepatitis C infection, namely use of interferon-free medications?


Hepatitis C virus (HCV) is a common and highly morbid illness. New medications that have much higher cure rates have become the new evidence-based practice in the field. Understanding the implementation of these new medications nationally provides an opportunity to advance the understanding of the role of implementation strategies in clinical outcomes on a large scale. The Expert Recommendations for Implementing Change (ERIC) study defined discrete implementation strategies and clustered these strategies into groups. The present evaluation assessed the use of these strategies and clusters in the context of HCV treatment across the US Department of Veterans Affairs (VA), Veterans Health Administration, the largest provider of HCV care nationally.


A 73-item survey was developed and sent to all VA sites treating HCV via electronic survey, to assess whether or not a site used each ERIC-defined implementation strategy related to employing the new HCV medication in 2014. VA national data regarding the number of Veterans starting on the new HCV medications at each site were collected. The associations between treatment starts and number and type of implementation strategies were assessed.


A total of 80 (62%) sites responded. Respondents endorsed an average of 25 ± 14 strategies. The number of treatment starts was positively correlated with the total number of strategies endorsed (r = 0.43, p < 0.001). Quartile of treatment starts was significantly associated with the number of strategies endorsed (p < 0.01), with the top quartile endorsing a median of 33 strategies, compared to 15 strategies in the lowest quartile. There were significant differences in the types of strategies endorsed by sites in the highest and lowest quartiles of treatment starts. Four of the 10 top strategies for sites in the top quartile had significant correlations with treatment starts compared to only 1 of the 10 top strategies in the bottom quartile sites. Overall, only 3 of the top 15 most frequently used strategies were associated with treatment.


These results suggest that sites that used a greater number of implementation strategies were able to deliver more evidence-based treatment in HCV. The current assessment also demonstrates the feasibility of electronic self-reporting to evaluate ERIC strategies on a large scale. These results provide initial evidence for the clinical relevance of the ERIC strategies in a real-world implementation setting on a large scale. This is an initial step in identifying which strategies are associated with the uptake of evidence-based practices in nationwide healthcare systems.

Key Findings

  • ERIC strategy use appears to increase the evidence-based practice of using interferon-free medications to treat Hepatitis C virus.
  • Three of the 15 most-endorsed strategy clusters, "revise professional roles," "build on existing high-quality working relationships and networks to promote information sharing and problem solving," and "engage in efforts to prepare patients to be active participants," were associated with starting treatment.
  • Cluster strategies most associated with treatment rates were "providing interactive assistance," "supporting clinicians," and "developing stakeholder interrelationships."
  • Treatment was not associated with any of the strategies in the financial cluster, which may be because many of them are not applicable to the VHA.

This report is part of the RAND external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.