Three Case-Based Approaches to Preimplementation Evaluation in Nursing Homes: Understanding Enablers, Barriers, and Implementation Strategies.

Nursing homes are diverse environments because they serve as both medical institutions and long-term homes for individuals with significant care requirements and social support needs. This complexity can make implementing evidence-based interventions and quality improvement projects challenging. We demonstrate how investigators can use a preimplementation process to assess the enablers and barriers to innovation implementation prior to the allocation of significant resources. In this article, we present 3 preimplementation exemplars applying the "3 Is"-Identify an implementation framework, Investigate barriers and enablers, and Integrate strategies-to support the eventual uptake of evidence-based interventions. A deliberate preimplementation phase that is built into the life of a project can help identify enablers and barriers to inform the use of implementation strategies or help teams make a data-informed decision not to proceed with implementation. We describe 3 different implementation science frameworks to consider using during preimplementation, highlight common barriers assessed during preimplementation in nursing homes, and demonstrate ways to mitigate those barriers by leveraging enablers.