A Mixed-Methods Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Study of Implementation Outcomes of the Childhood Dysphagia Management Scale (CDMS): Part 1 of a CDMS Hybrid Effectiveness-Implementation Study.

PURPOSE: The Childhood Dysphagia Management Scale (CDMS) is a validated outcomes measure completed by evaluating therapists following instrumental swallow assessments to determine the level of follow-up care needed for children with dysphagia. We assessed the implementation outcomes of the CDMS to evaluate its readiness to be scaled out.

METHOD: The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) implementation science framework informed our explanatory sequential mixed-methods design. CDMS implementation outcomes were tested in a single tertiary-care children's hospital with five sites. Quantitatively, completion (number of CDMS completed/number of possible) was measured across all possible instrumental swallow assessments over a 30-month period (N = 4,829), compared across sites and settings (inpatient vs. outpatient), measured longitudinally, and evaluated using linear mixed models across sociodemographic variables. Qualitatively, therapists (n = 35) and referring providers (n = 17) participated in surveys, focus groups, and semistructured interviews. Qualitative data were analyzed and integrated with quantitative findings.

RESULTS

By RE-AIM domain, CDMS completion was not significantly associated with any patient sociodemographic factor outside of age, showing effective reach across patient-level factors. Effectiveness outcomes are reported on in a separate article (Part 2). Variability in CDMS completion was observed across the five sites and inpatient versus outpatient settings, suggesting that adoption was influenced by site of care. The CDMS was completed in 4,456 (92.3%) instrumental swallow assessments, demonstrating strong implementation across the hospital system. Surveys and qualitative interviews revealed that workflow integration and short CDMS scoring time supported high completion rates. Lower completion rates in some sites/settings were explained by inpatient characteristics and barriers to dissemination to local providers. Over 30 months, completion rates ranged from 77.1% to 92.8% across the hospital system, indicating strong maintenance.

CONCLUSION

CDMS implementation outcomes across a five-site pediatric hospital system indicate that this validated outcomes measure for instrumental swallow assessments can be implemented, adopted, and sustained, demonstrating its readiness for widespread diffusion.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.32942303.