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BMC Health Services Research

, 13:123

Organization, structure and delivery of healthcare


BackgroundMiscarriage is common and often managed by specialists in the operating room despite evidence that office-based manual vacuum aspiration MVA is safe, effective, and saves time and money. Family Medicine residents are not routinely trained to manage miscarriages using MVA, but have the potential to increase access to this procedure. This process evaluation sought to identify barriers and facilitators to implementation of office-based MVA for miscarriage in Family Medicine residency sites in Washington State.

MethodsThe Residency Training Initiative in Miscarriage Management RTI-MM is a theory-based, multidimensional practice change initiative. We used qualitative methods to identify barriers and facilitators to successful implementation of the RTI-MM.

ResultsThirty-six RTI-MM participants completed an interview. We found that the common major barriers to implementation were low volume and a perception of miscarriage as emotional and-or like abortion, while the inclusion of support staff in training and effective champions facilitated successful implementation of MVA services.

ConclusionPerceived characteristics of the innovation that may conflict with cultural fit must be explicitly addressed in dissemination strategies and support staff should be included in practice change initiatives. Questions remain about how to best support champions and influence perceptions of the innovation. Our study findings contribute programmatically to improve the RTI-MM, and to broader theoretical knowledge about practice change and implementation in health service delivery.

KeywordsMiscarriage Reproductive health services Family medicine Practice change Interprofessional training Dissemination Process evaluation Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-13-123 contains supplementary material, which is available to authorized users.

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Autor: Blair G Darney - Marcia R Weaver - Deborah VanDerhei - Nancy G Stevens - Sarah W Prager


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