Applying Implementation Science Methods to Prospectively Track the Adaptation of an Evidence-Based Deprescribing Intervention for Use in a New Health System and Country

INTRODUCTION: Falls are common among older people, and medications, in particular central nervous system-active medications, increase fall risk. The Centers for Disease Control and Prevention funded a pragmatic trial to test a deprescribing intervention (STOP-FALLS) for its effect on falls, while simultaneously collecting implementation process data. This article describes prospective modifications to the STOP-FALLS intervention and offers a summary of the strategies deployed per reporting recommendations from implementation science. METHODS: In a preimplementation phase for this pragmatic trial, the multidisciplinary research team collaborated with delivery system leaders to modify the intervention for this new context, held focus groups with end users representative of the new population to optimize patient educational brochures, and pilot-tested the intervention in a single clinic. This study took place in the Kaiser Permanente Washington integrated health care delivery system, primary care settings. Preimplementation activities were systematically tracked using 2 established implementation frameworks for: 1) intervention adaptation and 2) strategy deployment. RESULTS: Twenty-seven adaptations were made to STOP-FALLS, and 13 discrete implementation strategies were deployed across the 3 preimplementation phases of the study. CONCLUSION: Adaptation tracking revealed several changes to the intervention context and content that reflected different guidelines for this trial (eg, include opioid medications) and idiosyncrasies of Kaiser Permanente Washington delivery system operations, in addition to refinements to optimize the intervention according to patient and primary care practitioner preferences. Implementation strategies were not specific to the focus of the trial and may reflect best practices for health system-embedded pragmatic effectiveness trials moving forward.