# Using Data-Driven Implementation Strategies to Improve the Quality of Cirrhosis Care

> **NIH VA I50** · VETERANS HEALTH ADMINISTRATION · 2020 · —

## Abstract

Cirrhosis, or advanced liver disease, is the 4th leading and fastest-growing cause of death in the US among
those aged 45-64 and ranks among the top three leading causes of excess mortality in the US overall. Nearly
120,000 Veterans under the care of the Veterans Healthcare Administration (VHA) have cirrhosis due to
alcohol, hepatitis C, fatty liver disease, or other causes, and this number is rapidly increasing. There are life-
saving measures that providers can take to prevent harm from cirrhosis, including providing access to post-
discharge follow-up care and screening for liver cancer and esophageal varices (veins that can cause
catastrophic bleeding). However, less than 30% of Veterans receive care concordant with these three
evidence-based practices (EBPs). Therefore, our operations partner, the HIV, Hepatitis, and Related
Conditions Program Office (HHRC) created a learning collaborative to improve the uptake of cirrhosis EBPs in
VA. As the evaluation team for this Hepatic Innovation Team (HIT) Collaborative, we have developed this
Partnered Evaluation Initiative at the request of and in collaboration with HHRC. Through this PEI we aim to
understand which implementation strategies, or discrete activities that are conducted to promote EBP
implementation, can help improve the uptake of EBPs for cirrhosis care. Our specific aims are to: 1)
Empirically determine which combinations of implementation strategies are associated with the
successful implementation of EBPs for Veterans with cirrhosis; 2) Use Intervention Mapping to
operationalize these ‘data-driven’ implementation strategies; and 3) Assess the effectiveness of using
data-driven implementation strategies to increase cirrhosis EBP uptake in a hybrid type III stepped
wedge cluster randomized trial. To accomplish these aims we have adapted a survey of 73 implementation
strategies, as defined by implementation science experts, that we successfully used in hepatitis C quality
improvement efforts, with response rates of up to 84% nationally across 130 VA stations. We will administer
this survey to all VA stations and use traditional statistical and configurational comparative methods to
determine which combinations of implementation strategies are associated with site-level adherence to EBPs
for cirrhosis. We will then use Intervention Mapping, a systematic, stakeholder-driven, six-step process for
developing interventions and implementation strategies, to develop these strategies into a manualized,
facilitated intervention, guided by the integrated-Promoting Action Research on Implementation in Health
Services (i-PARIHS) framework. We will then test this implementation strategy bundle in 12 sites with low
adherence to EBPs for Veterans with cirrhosis using a stepped wedge design in which four sites will cross from
control to intervention approximately every 6 months. We will assess the impact of the implementation
intervention on the primary outcome of patient level guideline-concordant ca...

## Key facts

- **NIH application ID:** 9950725
- **Project number:** 1I50HX002903-01A1
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Shari S Rogal
- **Activity code:** I50 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2019-10-01 → 2024-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9950725

## Citation

> US National Institutes of Health, RePORTER application 9950725, Using Data-Driven Implementation Strategies to Improve the Quality of Cirrhosis Care (1I50HX002903-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/9950725. Licensed CC0.

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