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Quality Enhancement Research Initiative

2020 Adaptation, Fidelity, and Tailoring (AFT) Implementation Workgroup Activity Summary

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Group leaders: Borsika Rabin, MPH, PhD, PharmD and Russell E. Glasgow, PhD

Group Facilitator: Christine Kowalski, MPH




January 13, 2020

David Goodrich

An overview of methods to support adaptation and fidelity in the new QUERI Implementation Roadmap

David presented on the VA QUERI Implementation Roadmap, including: The theoretical and methodologic influences underlying the Roadmap’s recommendations for balancing fidelity with the need for adaption(s)

·         Recommendations for pre-implementation planning to enhance the usability and acceptability of effective practices across diverse sites

·         Considerations for dynamically supporting fidelity and adaptation over time to sustain clinical effectiveness of the clinical practice

·         Integration of tools and methods to monitor adaptations and fidelity over time to support organizational learning

February 10, 2020

Chris Miller

Adaptation, Fidelity, and Tailoring group AFT call IDEA and FRAME

“What’s the Big I.D.E.A.? An Iterative Flowmap for Cataloguing Modifications in Implementation Science.” Dr. Miller discussed two new modification frameworks based on work with Shannon Wiltsey Stirman, Ana Baumann, and others. First, the IDEA is an iterative decision tree spelling out the modification process. Second, the FRAME-IS is based heavily on the ‘FRAME’ and is intended for documenting modifications to implementation strategies.

April 13, 2020

Group discussion

This AFT session was a journal article group discussion led by Russ, Borsika, and Christine for the following article (article attached):

MovsisyanL. Arnold, R. EvansB. Hallingberg, G. MooreA. O’CathainL. M. PfadenhauerJ. Segrott &  E. Rehfuess Adapting evidence-informed complex population health interventions for new contexts: a systematic review of guidance. Implementation Science 2019. 14 (105).

May 11, 2020

Monica Perez Jolles

May Adaptation, Fidelity, and Tailoring group AFT call

Dr. Mónica Pérez Jolles, an assistant professor at the University of Southern California, Los Angeles, is a health services researcher and implementation research scientist. Her work focuses on examining health delivery arrangements, implemented in under-resourced clinical settings, to address health disparities. She will be presenting on the concepts of forms and functions, with a concrete application in Federally Qualified Health Center (FQHC) health settings as complex health systems. Please read the attached article prior to this session.


Core Functions and Forms of Complex Health Interventions: a Patient-Centered Medical Home Illustration. Perez Jolles M1, Lengnick-Hall R2, Mittman BS3. J Gen Intern Med. 2019 Jun;34(6):1032-1038. doi: 10.1007/s11606-018-4818-7. Epub 2019 Jan 8.

June 8, 2020

Graham Moore, Monica Perez Jolles,

Borsika, and Russ

Form and function: follow up discussion on the applicability of these concepts in the VA

Dr. Moore, Dr. Perez Jolles, Borsika and Russ will led a follow up discussion to Dr. Mónica Pérez Jolles presentation last month on form and function. During this discussion we explored how these concepts apply and can be operationalized in various settings with special focus on the VA context.

August 10, 2020

Emily Treichler

"Adapting a Group Skills Training to Improve Collaborative Decision-Making for Veterans with Psychosis"

Summary: Collaborative decision-making is an approach that assigns equal power and responsibility to patients and providers across all aspects of decision-making, and is preferred by Veterans with serious mental illness and associated with a number of positive outcomes. In the current study, we are systematically adapting a group skills training intervention intended to increase collaborative decision-making between Veterans with serious mental illness and their mental health providers. The study is just about to begin data collection, and so feedback into the methods and analysis will be welcomed. 

September 14, 2020

Michaela McCarthy

Lexus Ujano-De Motta

Mary Nunnery

Findings from Real Time and Reflective Adaptations Tracking in the rural Transitions Nurse Program

Speakers: Michaela McCarthy, PhD, RN
                 Lexus Ujano-De Motta, BS
                 Mary Nunnery, MPH
Affiliation: Veterans Health Administration, Seattle/Denver Center of Innovation (COIN)

Summary: The rural Transitions Nurse Program (TNP) is a national care coordination quality improvement project designed to help Veterans transition from an urban tertiary hospital to their rural home. Adaptations were tracked across five cohort one sites using both real time (database) and reflective (interviews) tools. Analysis of adaptations was conducted using a modified Stirman/REAIM framework. We will present local site adaptations across timepoints from pre-implementation through sustainment. Suggestions/recommendations for other methods of adaptations tracking are welcome!

October 19, 2020

Sarah Birken

Julia Moore

Borsika Rabin

32 attendees

October Adaptation, Fidelity, and Tailoring group call

Sarah Birken and Julia Moore gave a summary discussion of their recent manuscript. Borsika also presented a very nice summary of the article and then the group had a lively journal club article discussion of the following article:

Kirk, M.A., Moore, J.E., Wiltsey Stirman, S. et al. Towards a comprehensive model for understanding adaptations’ impact: the model for adaptation design and impact (MADI). Implementation Sci 15, 56 (2020).

Also see MADI website:

22 attendees

November 9, 2020



29 attendees

Using FRAME to track adaptations to an evidence-based colorectal cancer screening outreach program

Promoting uptake of evidence-based innovations in healthcare systems requires attention to how innovations are adapted to enhance their fit with a given setting. Using BENEFIT as an example, I will share how two Medicaid health plans, operating in two states, made real-world changes to their direct-to-member mailed fecal test outreach programs.