Application of a refined web-based adaptation tracking tool across three varied interventions to understand adaptations, their characteristics, and perceived impact on outcomes.

BACKGROUND

Adaptations are changes to interventions or implementation strategies to improve fit in the real-world. Adaptations can promote research translation and intervention sustainment.

PURPOSE: The study adaptations team refined their tracking methods and analyzed adaptations' perceived impact across three interventions executed in Veterans Health Administration (VHA).

METHODS

From 2020 to 2025 the study team supported 15 VHA sites implementing one of three interventions intended to improve Veteran outcomes, clinician engagement, and care costs. Intervention and implementation strategy adaptations were tracked and analyzed in a web-based tool refined from previous projects, incorporating Framework for Reporting Modifications to Evidence-based Implementation Strategies and Practical, Robust, Implementation, and Sustainability Model components. Data were collected pragmatically via multi-methods. Proximal impact was analyzed close to real-time. The team used data validation, member checking, and data triangulation.

RESULTS

Across interventions, 224 unique adaptations were recognized from audit trails (n = 119), interviews (n = 55), process maps (n = 51), and team meetings (n = 17). Intervention 1 made 119 adaptations, Intervention 2 made 44, Intervention 3 made 23, and the study team made 38 to enhance implementation support (implementation strategy adaptations). Most adaptations occurred during implementation (n = 161) and targeted adoption and implementation. The study adaptations team assessed adaptations' perceived impact on outcomes and found 130 adaptations impacted multiple outcomes. Adoption (n = 153) was impacted the most.

CONCLUSIONS

The refined tool was effective for tracking and analyzing adaptations' impact. Future research should refine strategies for adaptation impact assessment.