Abstract Body: Abstract
Background: A multisite quality improvement (QI) program within the United States Department of Veterans Affairs (VA) healthcare system, Addressing Sleep Apnea Post-Stroke/TIA (ASAP), sought to increase sleep apnea diagnostic testing among patients with ischemic stroke and transient ischemic attack (TIA). Highly choreographed in-person kickoff meetings are routinely used to initiate such QI programs. When in-person kickoffs supporting the launch of this QI initiative were not possible due to the COVID-19 pandemic, the national implementation team faced a new challenge: how to effectively translate an in-person kickoff to a virtual format.

Methods: The national implementation team re-conceptualized and implemented a virtual kickoff for this cross-service QI project, including the development and operationalization of a multilevel conceptual framework for virtual kickoffs. The virtual kickoff was then implemented at six diverse VA medical centers in sequential order with based on the cluster-randomized stepped-wedge study design. The impact of the virtual kickoffs was evaluated by assessing the change in the ASAP-related multidisciplinary team activity (the Group Organization score) from baseline (pre-kickoff) to 7 months post-kickoff (Tables 1 and 2).

Findings: A new framework for virtual kickoffs was developed (Figure 1) that provided a model for facilitating the formation of a new multidisciplinary team that culminates with the development of an Implementation Plan where participants volunteer for specific tasks with target deadlines for activity completion. All sites participating in the ASAP program increased multidisciplinary team activity over time, with sites on average moving from no activity, communication, or collaboration related specifically to ASAP goals to a multidisciplinary group actively developing a facility-wide approach to coordinate cross-service ASAP-specific care.

Implications: Although many quality improvement studies describe the objectives and details of kickoffs, there appears to be no prior work explicitly describing a conceptual model for the kickoff itself. Given the many real-world challenges associated with implementing stroke-related QI initiatives in healthcare settings, this new conceptual framework supports the deliberate planning of virtual kickoffs in forming new multidisciplinary teams and galvanizing the launch of innovative programs.