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Rapport F, Smith J, Hutchinson K, Clay-Williams R, Churruca K, Bierbaum M, Braithwaite J. Too much theory and not enough practice? The challenge of implementation science application in healthcare practice. J Eval Clin Pract 2022; 28:991-1002. [PMID: 34268832 DOI: 10.1111/jep.13600] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Implementation science (IS) should contribute to maintaining high standards of care across healthcare systems and enhancing care practices. However, despite the evident need for greater and more rapid uptake and integration of evidence in practice, IS design and methodology fall short of the needs of effective translation. AIM In this paper we examine what it is about IS that makes it so appealing for effective uptake of interventions in routine practice, and yet so difficult to achieve. We propose a number of ways that implementation scientists could build mutual relationships with healthcare practitioners and other stakeholders including public members to ensure greater shared care practices, and highlight the value of IS training, collaborative educational events, and co-designed research. DISCUSSION More consideration should be given to IS applications in healthcare contexts. Implementation scientists can make a valuable contribution by mobilizing theory and improving practice. However, goals for an evidence-based system may be more appropriately achieved through greater outreach and collaboration, with methods that are flexible to support rapid implementation in complex adaptive systems. Collective learning and mutual trust can be cultivated by embedding researchers into healthcare services while offering greater opportunities for practitioners to learn about, and engage in, implementation research. CONCLUSION To bridge the worlds of healthcare practice and IS, researchers could be more consistent in the relationships they build with professionals and the public, communicating through a shared language and co-joining practical approaches to effective implementation. This will build capacity for improved collaboration and foster respectful, interdisciplinary relationships.
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Affiliation(s)
- Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - James Smith
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Cranley LA, Lo TKT, Weeks LE, Hoben M, Ginsburg LR, Doupe M, Anderson RA, Wagg A, Boström AM, Estabrooks CA, Norton PG. Reporting unit context data to stakeholders in long-term care: a practical approach. Implement Sci Commun 2022; 3:120. [DOI: 10.1186/s43058-022-00369-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
The importance of reporting research evidence to stakeholders in ways that balance complexity and usability is well-documented. However, guidance for how to accomplish this is less clear. We describe a method of developing and visualising dimension-specific scores for organisational context (context rank method). We explore perspectives of leaders in long-term care nursing homes (NHs) on two methods for reporting organisational context data: context rank method and our traditionally presented binary method—more/less favourable context.
Methods
We used a multimethod design. First, we used survey data from 4065 healthcare aides on 290 care units from 91 NHs to calculate quartiles for each of the 10 Alberta Context Tool (ACT) dimension scores, aggregated at the care unit level based on the overall sample distribution of these scores. This ordinal variable was then summed across ACT scores. Context rank scores were assessed for associations with outcomes for NH staff and for quality of care (healthcare aides’ instrumental and conceptual research use, job satisfaction, rushed care, care left undone) using regression analyses. Second, we used a qualitative descriptive approach to elicit NH leaders’ perspectives on whether the methods were understandable, meaningful, relevant, and useful. With 16 leaders, we conducted focus groups between December 2017 and June 2018: one in Nova Scotia, one in Prince Edward Island, and one in Ontario, Canada. Data were analysed using content analysis.
Results
Composite scores generated using the context rank method had positive associations with healthcare aides’ instrumental research use (p < .0067) and conceptual research use and job satisfaction (p < .0001). Associations were negative between context rank summary scores and rushed care and care left undone (p < .0001). Overall, leaders indicated that data presented by both methods had value. They liked the binary method as a starting point but appreciated the greater level of detail in the context rank method.
Conclusions
We recommend careful selection of either the binary or context rank method based on purpose and audience. If a simple, high-level overview is the goal, the binary method has value. If improvement is the goal, the context rank method will give leaders more actionable details.
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103
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Implementing a complex hospital innovation: conceptual underpinnings, program design and implementation of a complex innovation in an international multi-site hospital trial. BMC Health Serv Res 2022; 22:1342. [PMID: 36371214 PMCID: PMC9652896 DOI: 10.1186/s12913-022-08768-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 11/01/2022] [Indexed: 11/15/2022] Open
Abstract
Background Designing implementation programs that effectively integrate complex healthcare innovations into complex settings is a fundamental aspect of knowledge translation. We describe the development of a conceptually grounded implementation program for a complex healthcare innovation and its subsequent application in pediatric hospital settings. Methods We conducted multiple case observations of the application of the Phased Reciprocal Implementation Synergy Model (PRISM) framework in the design and operationalization of an implementation program for a complex hospital wide innovation in pediatric hospital settings. Results PRISM informed the design and delivery of 10 international hospital wide implementations of the complex innovation, BedsidePEWS. Implementation and innovation specific goals, overarching implementation program design principles, and a phased-based, customizable, and context responsive implementation program including innovation specific tools and evaluation plans emerged from the experience. Conclusion Theoretically grounded implementation approaches customized for organizational contexts are feasible for the adoption and integration of this complex hospital-wide innovation. Attention to the fitting of the innovation to local practices, setting, organizational culture and end-user preferences can be achieved while maintaining the integrity of the innovation.
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104
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Weiting H, Yaoxian AZ, Keong YK, Lam SW, How LY, Sahlén AO, Pourghaderi A, Che M, Terrance CSJ, Graves N. The clinical value and cost-effectiveness of treatments for patients with coronary artery disease. HEALTH ECONOMICS REVIEW 2022; 12:56. [PMID: 36348165 PMCID: PMC9644580 DOI: 10.1186/s13561-022-00401-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The clinical value and cost-effectiveness of invasive treatments for patients with coronary artery disease is unclear. Invasive treatments such as coronary artery bypass grafting and percutaneous coronary intervention are frequently used as a starting treatment, yet they are much more costly than optimal medical therapy. While patients may transition into other treatments over time, the choices of starting treatments are likely important determinants of costs and health outcomes. The aim is to predict by how much costs and health outcomes will change from a decision to use different starting treatments for patients with coronary artery disease in an Asian setting. METHODS A cost-effectiveness study using a Markov model informed by data from Singapore General Hospital was done. All patients with initial presentations of stable coronary disease and no acute coronary syndromes who received medical treatments and interventional therapies were included. We compare existing practice, where the starting treatment can be medical therapy or stent percutaneous coronary interventions or coronary artery bypass grafting, with alternate starting treatment strategies. RESULTS When compared to 'existing practice' a policy of starting 14% of patients with coronary artery bypass grafting and 86% with optimal medical therapy showed savings of $1,743 per patient and 0.23 additional quality adjusted life years. A change to policy nationwide would save $10 million and generate 1,380 quality adjusted life years. CONCLUSIONS Increasing coronary artery bypass grafting and use of medical therapy in the setting of coronary artery disease is likely to saves costs and improve health outcomes. A definitive study to address the question we investigate would be very difficult to undertake and so using existing data to model the expected outcomes is a useful tool. There are likely to be large and complex barriers to the implementation of any policy change based on the findings of this study.
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Affiliation(s)
| | | | | | - Shao Wei Lam
- Duke NUS Medical School, 8 College Rd, 169857 Singapore, Singapore
| | - Lau Yee How
- Health Services Research Centre, SingHealth, Singapore, Singapore
| | | | | | - Matthew Che
- Health Services Research Centre, SingHealth, Singapore, Singapore
| | | | - Nicholas Graves
- Duke NUS Medical School, 8 College Rd, 169857 Singapore, Singapore
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105
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Harkin D, Coates V, Brown D. Exploring ways to enhance pain management for older people with dementia in acute care settings using a Participatory Action Research approach. Int J Older People Nurs 2022; 17:e12487. [PMID: 35761509 PMCID: PMC9787744 DOI: 10.1111/opn.12487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Dementia is a progressive condition that leads to reduced cognition, deteriorating communication and is a risk factor for other acute and chronic health problems. The rise in the prevalence of dementia means untreated pain is becoming increasingly common with healthcare staff being challenged to provide optimal pain management. This negatively impacts the person living with dementia and their carers. There is minimal evidence that explores the pain management experience of patients as they move through acute care settings. OBJECTIVE To understand the complexities of managing the pain of older people with dementia as they progress through acute care settings, with the view of assisting staff to improve practice. METHOD A Participatory Action Research approach, guided by the Promoting Action Research in Health Services framework, was used. Three Action Cycles were completed comprising of an exploratory audit and two case studies (Action Cycle One), three focus groups with a total of 14 participants (Action Cycle Two) and the development and implementation of immediate and long-term actions (Action Cycle Three). RESULTS Thematic analysis identified four themes that affected pain management practices. These were not knowing the patient; balancing competing priorities; knowledge and understanding of pain and dementia and not assimilating available information. CONCLUSION Pain management practices for patient living with dementia, across acute care settings, was influenced by shared ways of thinking and working. Not knowing the patient, fragmentation of information and having insufficient knowledge of the subtleties of dementia led participants to deliver task-focused, target and policy-driven care that was not person-centred in its approach. Facilitated reflection enabled acute care teams to actively participate in identifying problems and finding solutions to enhance practice.
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Affiliation(s)
| | - Vivien Coates
- Florence Nightingale Foundation Professor of Clinical Nursing Practice ResearchUlster University & Western Health & Social Care TrustLondonderryUK
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106
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Basham C, Billings E, El Rifay AS, Badra R, Ali MA, Asy A, Refaey S, Kayali G, Meyer C. Designing and validating a One Health Research Translation Framework through literature-based case studies in Egypt. One Health 2022; 15:100454. [DOI: 10.1016/j.onehlt.2022.100454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/06/2022] Open
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107
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Bucknall TK, Considine J, Harvey G, Graham ID, Rycroft-Malone J, Mitchell I, Saultry B, Watts JJ, Mohebbi M, Bohingamu Mudiyanselage S, Lotfaliany M, Hutchinson A. Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO): a pragmatic cluster randomised controlled trial evaluating the effectiveness of a facilitation intervention on recognition and response to clinical deterioration. BMJ Qual Saf 2022; 31:818-830. [PMID: 35450936 PMCID: PMC9606509 DOI: 10.1136/bmjqs-2021-013785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 03/01/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Most hospitals use physiological signs to trigger an urgent clinical review. We investigated whether facilitation could improve nurses' vital sign measurement, interpretation, treatment and escalation of care for deteriorating patients. METHODS In a pragmatic cluster randomised controlled trial, we randomised 36 inpatient wards at four acute hospitals to receive standard clinical practice guideline (CPG) dissemination to ward staff (n=18) or facilitated implementation for 6 months following standard dissemination (n=18). Expert, hospital and ward facilitators tailored facilitation techniques to promote nurses' CPG adherence. Patient records were audited pre-intervention, 6 and 12 months post-intervention on randomly selected days. Escalation of care as per hospital policy was the primary outcome at 6 and 12 months after implementation. Patients, nurses and assessors were blinded to group assignment. Analysis was by intention-to-treat. RESULTS From 10 383 audits, improved escalation as per hospital policy was evident in the intervention group at 6 months (OR 1.47, 95% CI (1.06 to 2.04)) with a complete set of vital sign measurements sustained at 12 months (OR 1.22, 95% CI (1.02 to 1.47)). There were no significant differences in escalation of care as per hospital policy between study groups at 6 or 12 months post-intervention. After adjusting for patient and hospital characteristics, a significant change from T0 in mean length of stay between groups at 12 months favoured the intervention group (-2.18 days, 95% CI (-3.53 to -0.82)). CONCLUSION Multi-level facilitation significantly improved escalation as per hospital policy at 6 months in the intervention group that was not sustained at 12 months. The intervention group had increased vital sign measurement by nurses, as well as shorter lengths of stay for patients at 12 months. Further research is required to understand the dose of facilitation required to impact clinical practice behaviours and patient outcomes. TRIAL REGISTRATION NUMBER ACTRN12616000544471p.
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Affiliation(s)
- Tracey K Bucknall
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research - Alfred Health Partnership, Alfred Health, Melbourne, Victoria, Australia
| | - Julie Considine
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research - Eastern Health Partnership, Eastern Health, Box Hill, Victoria, Australia
| | - Gillian Harvey
- Caring Futures Institute, Flinders University College of Nursing and Health Sciences, Bedford Park, South Australia, Australia
| | - Ian D Graham
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- School of Epidemiology and Public Health and School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Imogen Mitchell
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Bridey Saultry
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research - Alfred Health Partnership, Alfred Health, Melbourne, Victoria, Australia
| | - Jennifer J Watts
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Shalika Bohingamu Mudiyanselage
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Mojtaba Lotfaliany
- Biostatistics Unit, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Alison Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research - Monash Health Partnership, Monash Health, Clayton, Victoria, Australia
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108
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Rycroft-Malone J, Rogers L, Burton CR. Optimising the Conceptualisation of Context Comment on "Stakeholder Perspectives of Attributes and Features of Context Relevant to Knowledge Translation in Health Settings: A Multi-country Analysis". Int J Health Policy Manag 2022; 11:2365-2367. [PMID: 37579347 PMCID: PMC9808282 DOI: 10.34172/ijhpm.2022.6900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 08/27/2022] [Indexed: 08/02/2023] Open
Abstract
Context matters. Therefore, efforts to develop greater conceptual clarity are important for science and practice. In this commentary, we outline some key issues that were prompted by Squire's et al.'s contribution. Specifically, we reinforce context as an interactive concept and therefore something that is hard to 'pin down', the problematic nature of conceptualising context in implementation and de-implementation, and a requirement for the development of culturally sensitive understandings. Finally, we suggest it is vital that continued investment into providing a more comprehensive list of determinants needs to be accompanied by an equal effort in developing practical methods and tools to support use and application.
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Affiliation(s)
| | - Lisa Rogers
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), Health Sciences Centre, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
- Health Sciences Centre, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin 4, Ireland
| | - Christopher R. Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
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109
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Loza E, Carmona L, Woolf A, Fautrel B, Courvoisier DS, Verstappen S, Aarrestad Provan S, Boonen A, Vliet Vlieland T, Marchiori F, Jasinski T, Van der Elst K, Ndosi M, Dziedzic K, Carrasco JM. Implementation of recommendations in rheumatic and musculoskeletal diseases: considerations for development and uptake. Ann Rheum Dis 2022; 81:1344-1347. [PMID: 35961760 DOI: 10.1136/ard-2022-223016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/18/2022] [Indexed: 11/03/2022]
Abstract
A clinical guideline is a document with the aim of guiding decisions based on evidence regarding diagnosis, management and treatment in specific areas of healthcare. Specific to rheumatic and musculoskeletal diseases (RMDs), adherence to clinical guidelines recommendations impacts the outcomes of people with these diseases. However, currently, the implementation of recommendations is less than optimal in rheumatology.The WHO has described the implementation of evidence-based recommendations as one of the greatest challenges facing the global health community and has identified the importance of scaling up these recommendations. But closing the evidence-to-practice gap is often complex, time-consuming and difficult. In this context, the implementation science offers a framework to overcome this scenario.This article describes the principles of implementation science to facilitate and optimise the implementation of clinical recommendations in RMDs. Embedding implementation science methods and techniques into recommendation development and daily practice can help maximise the likelihood that implementation is successful in improving the quality of healthcare and healthcare services.
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Affiliation(s)
- Estibaliz Loza
- Instituto de Salud Musculoesquelética (Inmusc), Madrid, Spain
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (Inmusc), Madrid, Spain
| | - Anthony Woolf
- Bone and Joint Research Group, Royal Cornwall Hospital, Truro, UK
| | - Bruno Fautrel
- Rheumatology, Pitie Salpetriere Hospital - Assistance Publique-Hopitaux de Paris, Paris, France.,INSERM UMRS 1136, Sorbonne University, Paris, France
| | | | - Suzanne Verstappen
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | | | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastrich University Medical Center+, Maastricht, Netherlands.,CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Thea Vliet Vlieland
- Orthopaedics, Rehabilitation and Physical Therapy, J11, Leiden University Medical Center, Leiden, Netherlands
| | | | | | | | - Mwidimi Ndosi
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK.,Academic Rheumatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Krysia Dziedzic
- Impact Accelerator Unit, School of Medicine, Keele University, Newcastle, UK
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110
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Improving the Physical Health of Psychiatric Hospital Residents: An Evaluation of an Obesity Education Program for Mental Health Professionals. Healthcare (Basel) 2022; 10:healthcare10101851. [PMID: 36292296 PMCID: PMC9601487 DOI: 10.3390/healthcare10101851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/06/2022] [Accepted: 09/19/2022] [Indexed: 11/19/2022] Open
Abstract
Background: People living with mental health disorders are at increased risk for developing obesity due to poor diet, physical inactivity, and antipsychotic medications. In the United States, the obesity rate is 36% in the general population and more than 50% for people living with mental health disorders. Although mental health clinicians concentrate on managing psychiatric disorders, they seldom recognize the gradual increase in body mass index of their patients. The result is a disconnection between the clinical management of psychiatric disorders and the medical management of obesity. Purpose: This study assessed the effectiveness of an evidence-based education program for improving the obesity management practices of mental health clinicians caring for residents at a state psychiatric hospital. Methods: This was a quasi-experimental study design with a pretest and posttest evaluation. Convenience sampling was used to recruit mental health professionals, or clinicians, at a large psychiatric hospital in the Southern region of the United States. Data was collected with the Advising and Treating Overweight and Obese Patient questionnaire (17 items). Data analysis included descriptive and inferential statistics. The findings were reported in accordance with the TREND and GREET guidelines. Results: The education program was completed by 50 MHCs. The pretest indicated that 76% of MHCs were not involved in helping obese residents manage their weight, but the posttest indicated 90% were involved. There was a significant increase in MHC knowledge about obesity management and reported actions 90-days after the program. MHCs were unable to arrange follow-up visits for residents, a task not directly within their control. Conclusions: Mental health clinicians reported increased knowledge and improved clinical practice after an education program. Because the outcomes were reported at 90-days after the program, further research needs to evaluate the longitudinal impact of this type of program, where the reported behaviors are correlated to process and clinical outcome measures for obesity.
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111
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Estabrooks C, Song Y, Anderson R, Beeber A, Berta W, Chamberlain S, Cummings G, Duan Y, Hayduk L, Hoben M, Iaconi A, Lanham H, Perez J, Wang J, Norton P. The Influence of Context on Implementation and Improvement: Protocol for a Mixed Methods, Secondary Analyses Study. JMIR Res Protoc 2022; 11:e40611. [PMID: 36107475 PMCID: PMC9523530 DOI: 10.2196/40611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/13/2022] [Accepted: 07/30/2022] [Indexed: 12/05/2022] Open
Abstract
Background Caring for the well-being of older adults is one of the greatest challenges in modern societies. Improving the quality of care and life for older adults and the work lives of their care providers calls for effective knowledge translation of evidence-based best practices. Objective This study’s purpose is to contribute to knowledge translation by better understanding the roles of organizational context (workplace environment) and facilitation (process or role) in implementation and improvement success. Our study has 2 goals: (1) to advance knowledge translation science by further developing and testing the Promoting Action on Research Implementation in Health Services framework (which outlines how implementation relies on the interplay of context, facilitation, and evidence) and (2) to advance research by optimizing implementation success via tailoring of modifiable elements of organizational context and facilitation. Methods This is secondary analyses of 15 years of longitudinal data from the Translating Research in Elder Care (TREC) program’s multiple data sources. This research is ongoing in long-term care (LTC) homes in western Canada. TREC data include the following: 5 waves of survey collection, 2 clinical trials, and regular ongoing outcome data for LTC residents. We will use a sequential exploratory and confirmatory mixed methods design. We will analyze qualitative and quantitative data holdings in an iterative process: (1) comprehensive reanalysis of qualitative data to derive hypotheses, (2) quantitative modeling to test hypotheses, and (3) action cycles to further refine and integrate qualitative and quantitative analyses. The research team includes 4 stakeholder panels: (1) system decision- and policy makers, (2) care home managers, (3) direct care staff, and (4) a citizen engagement group of people living with dementia and family members of LTC residents. A fifth group is our panel of external scientific advisors. Each panel will engage periodically, providing their perspectives on project direction and findings. Results This study is funded by the Canadian Institutes of Health Research. Ethics approval was obtained from the University of Alberta (Pro00096541). The results of the secondary analyses are expected by the end of 2023. Conclusions The project will advance knowledge translation science by deepening our understanding of the roles of context, the interactions between context and facilitation, and their influence on resident and staff quality outcomes. Importantly, findings will inform understanding of the mechanisms by which context and facilitation affect the success of implementation and offer insights into factors that influence the implementation success of interventions in nursing homes. International Registered Report Identifier (IRRID) DERR1-10.2196/40611
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Affiliation(s)
| | - Yuting Song
- School of Nursing, Qingdao University, Qingdao, China
| | - Ruth Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Anna Beeber
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Greta Cummings
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Yinfei Duan
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Leslie Hayduk
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Alba Iaconi
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Holly Lanham
- Department of Medicine, University of Texas Health Sciences Center San Antonio, San Antonio, TX, United States
| | - Janelle Perez
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jing Wang
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Peter Norton
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
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Ritchie MJ, Drummond KL, Smith BN, Sullivan JL, Landes SJ. Development of a qualitative data analysis codebook informed by the i-PARIHS framework. Implement Sci Commun 2022; 3:98. [PMID: 36104801 PMCID: PMC9476709 DOI: 10.1186/s43058-022-00344-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and its predecessor, PARIHS, have been widely utilized in implementation studies. Although i-PARIHS developers have focused on creating tools to guide facilitators in its application in practice, tools are also needed for evaluation and research. Codebooks with clear and meaningful code labels and definitions are an important component of qualitative data analysis and have been developed for other widely used frameworks. There is no such codebook for i-PARIHS. Additionally, sub-constructs for the Innovation, Recipients, and Context constructs lack definitions, and there is no sub-classification of facilitation activities for the Facilitation construct. The lack of a standardized codebook hinders our ability to synthesize research findings across studies, explore and test the range of activities that are utilized in facilitation efforts, and potentially validate and further refine i-PARIHS. This paper describes a rigorous process of developing a detailed qualitative codebook informed by the i-PARIHS framework. Methods A workgroup of qualitative researchers conducted a rigorous four-phase process to develop a codebook informed by i-PARIHS. In phase 1, workgroup members reviewed and discussed literature, consulted an organizational scientist, and drafted and refined subcodes and definitions for i-PARIHS constructs. In phase 2, they obtained feedback from an expert panel and further refined subcodes and definitions. In phase 3, they obtained feedback from i-PARIHS developers/experts and incorporated it into the codebook. Finally, two studies piloted the application of the codebook which informed the final version. Results The resulting i-PARIHS-informed codebook includes definitions for the four main constructs of the framework: Innovation, Recipients, Context, and Facilitation; subcodes and definitions for characteristics of each of these constructs; and instructions for the suggested application of individual codes and use of the codebook generally. Conclusions The standardized codes and definitions in the codebook can facilitate data exploration, pattern identification, and insight development informed by the i-PARIHS framework. Qualitative analysts can also use them to explore interactions between i-PARIHS constructs, maximize the potential for comparing findings across studies, and support the refinement of the i-PARIHS framework using empirical findings from multiple studies. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00344-9.
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Alidina S, Sydlowski MM, Ahearn O, Andualem BG, Barash D, Bari S, Barringer E, Bekele A, Beyene AD, Burssa DG, Derbew M, Drown L, Gulilat D, Gultie TK, Hayirli TC, Meara JG, Staffa SJ, Workineh SE, Zanial N, Zeleke ZB, Mengistu AE, Ashengo TA. Implementing surgical mentorship in a resource-constrained context: a mixed methods assessment of the experiences of mentees, mentors, and leaders, and lessons learned. BMC MEDICAL EDUCATION 2022; 22:653. [PMID: 36045356 PMCID: PMC9434847 DOI: 10.1186/s12909-022-03691-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND A well-qualified workforce is critical to effective functioning of health systems and populations; however, skill gaps present a challenge in low-resource settings. While an emerging body of evidence suggests that mentorship can improve quality, access, and systems in African health settings by building the capacity of health providers, less is known about its implementation in surgery. We studied a novel surgical mentorship intervention as part of a safe surgery intervention (Safe Surgery 2020) in five rural Ethiopian facilities to understand factors affecting implementation of surgical mentorship in resource-constrained settings. METHODS We designed a convergent mixed-methods study to understand the experiences of mentees, mentors, hospital leaders, and external stakeholders with the mentorship intervention. Quantitative data was collected through a survey (n = 25) and qualitative data through in-depth interviews (n = 26) in 2018 to gather information on (1) intervention characteristics including areas of mentorship, mentee-mentor relationships, and mentor characteristics, (2) organizational context including facilitators and barriers to implementation, (3) perceived impact, and (4) respondent characteristics. We analyzed the quantitative and qualitative data using frequency analysis and the constant comparison method, respectively; we integrated findings to identify themes. RESULTS All mentees (100%) experienced the intervention as positive. Participants perceived impact as: safer and more frequent surgical procedures, collegial bonds between mentees and mentors, empowerment among mentees, and a culture of continuous learning. Over 70% of all mentees reported their confidence and job satisfaction increased. Supportive intervention characteristics included a systems focus, psychologically safe mentee-mentor relationships, and mentor characteristics including generosity with time and knowledge, understanding of local context, and interpersonal skills. Supportive organizational context included a receptive implementation climate. Intervention challenges included insufficient clinical training, inadequate mentor support, and inadequate dose. Organizational context challenges included resource constraints and a lack of common understanding of the intervention. CONCLUSION We offer lessons for intervention designers, policy makers, and practitioners about optimizing surgical mentorship interventions in resource-constrained settings. We attribute the intervention's success to its holistic approach, a receptive climate, and effective mentee-mentor relationships. These qualities, along with policy support and adapting the intervention through user feedback are important for successful implementation.
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Affiliation(s)
- Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA.
| | - Meaghan M Sydlowski
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | - Olivia Ahearn
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | - Bizuayehu G Andualem
- Amhara Regional Health Bureau, Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Sehrish Bari
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | | | - Abebe Bekele
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Andualem D Beyene
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Miliard Derbew
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Laura Drown
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | - Dereje Gulilat
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Tuna C Hayirli
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Steven J Staffa
- Department of Anesthesiology and Surgery, Boston Children's Hospital, Boston, MA, USA
| | | | - Noor Zanial
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | - Zebenay B Zeleke
- Amhara Regional Health Bureau, Federal Ministry of Health, Addis Ababa, Ethiopia
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Parascandola M, Neta G, Salloum RG, Shelley D, Rositch AF. Role of Local Evidence in Transferring Evidence-Based Interventions to Low- and Middle-Income Country Settings: Application to Global Cancer Prevention and Control. JCO Glob Oncol 2022; 8:e2200054. [PMID: 35960906 PMCID: PMC9812451 DOI: 10.1200/go.22.00054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Although the global burden of cancer falls increasingly on low- and middle-income countries (LMICs), much of the evidence for cancer prevention and control comes from high-income countries and may not be directly applicable to LMIC settings. In this paper, we focus on the following question: When the majority of the evidence supporting an evidence-based intervention or implementation strategy comes from high-income countries, what local, contextual evidence is needed when transferring and adapting an intervention or strategy to a specific LMIC setting? METHODS We draw on an existing framework (the Population, Intervention, Environment, Transfer-T process model) for assessing transferability of interventions between distinct settings and apply the model to two case studies as learning examples involving implementation of tobacco use treatment guidelines and self sampling for human papillomavirus DNA in cervical cancer screening. RESULTS These two case studies illustrate how researchers, policymakers, practitioners, and consumers may approach the need for local evidence from different perspectives and with different priorities. As uses and expectations around local evidence may be different for different groups, aligning these priorities through multistakeholder engagement in which all parties participate in defining the questions and cocreating the solutions is critical, along with promoting standardized reporting of contextual factors. CONCLUSION Local, contextual evidence can be important for both researchers and practitioners, and its absence may hinder translation of research and implementation efforts across different settings. However, it is essential for researchers, practitioners, and other stakeholders to be able to clearly articulate the type of data needed and why it is important. In particular, where resources are limited, evidence generation should be prioritized to address real needs and gaps in knowledge.
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Affiliation(s)
- Mark Parascandola
- Center for Global Health, National Cancer Institute, Bethesda, MD,Mark Parascandola, PhD, MPH, Research and Training Branch, Center for Global Health, National Cancer Institute, 9609 Medical Center Dr, Room 3W564, Bethesda, MD 20892; Twitter: @parafoto; e-mail:
| | - Gila Neta
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Ramzi G. Salloum
- Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL
| | - Donna Shelley
- Department of Policy and Public Health Management, NYU School of Global Public Health, New York, NY
| | - Anne F. Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Facilitation as a component of evidence implementation: a multinational perspective. INT J EVID-BASED HEA 2022; 20:180-188. [PMID: 36373356 DOI: 10.1097/xeb.0000000000000321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND Facilitation is a key component of JBI's approach to evidence implementation along with context analysis and evaluation of process and outcomes. Although the role of facilitation is recognized as a critical component of evidence implementation, what constitutes effective facilitation is poorly understood. AIM This article presents a descriptive exploration of facilitation as it occurs in evidence implementation initiatives conducted in various healthcare and geographical contexts. All projects used the JBI approach to evidence implementation. METHODS To provide a multinational perspective on how facilitation was operationalized to promote positive changes in clinical practice and health outcomes, five case studies of evidence implementation projects are presented. RESULTS The cases highlighted that facilitation is a multifaceted process that can be met through a variety of roles that address aspects of education and capacity building, partnerships, action planning, problem solving and evaluation. Facilitation in all cases appeared to be collaborative, with multiple 'players' within and outside of the health organization being involved in the process. Although there are similarities in activities, facilitation involved some level of local contextualization where there were unique or additional activities performed to accommodate the local needs and requirements of the health organization involved in each case. Numerous contextual factors influenced the success of the implementation initiative. CONCLUSION The cases emphasized the complex nature of facilitation as a strategy for evidence implementation, indicating that contextual attributes and features define the range of knowledge, skills, and activities that should take place in order for facilitation to be effective. Although there appears to be some core components, tailoring and adaptation of the facilitation process (or roles) is required.
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Squires JE, Hutchinson AM, Coughlin M, Bashir K, Curran J, Grimshaw JM, Dorrance K, Aloisio L, Brehaut J, Francis JJ, Ivers N, Lavis J, Michie S, Hillmer M, Noseworthy T, Vine J, Graham ID. Stakeholder Perspectives of Attributes and Features of Context Relevant to Knowledge Translation in Health Settings: A Multi-Country Analysis. Int J Health Policy Manag 2022; 11:1373-1390. [PMID: 34060269 PMCID: PMC9808341 DOI: 10.34172/ijhpm.2021.32] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 03/13/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Context is recognized as important to successful knowledge translation (KT) in health settings. What is meant by context, however, is poorly understood. The purpose of the current study was to elicit tacit knowledge about what is perceived to constitute context by conducting interviews with a variety of health system stakeholders internationally so as to compile a comprehensive list of contextual attributes and their features relevant to KT in healthcare. METHODS A descriptive qualitative study design was used. Semi-structured interviews were conducted with health system stakeholders (change agents/KT specialists and KT researchers) in four countries: Australia, Canada, the United Kingdom, and the United States. Interview transcripts were analyzed using inductive thematic content analysis in four steps: (1) selection of utterances describing context, (2) coding of features of context, (3) categorizing of features into attributes of context, (4) comparison of attributes and features by: country, KT experience, and role. RESULTS A total of 39 interviews were conducted. We identified 66 unique features of context, categorized into 16 attributes. One attribute, Facility Characteristics, was not represented in previously published KT frameworks. We found instances of all 16 attributes in the interviews irrespective of country, level of experience with KT, and primary role (change agent/KT specialist vs. KT researcher), revealing robustness and transferability of the attributes identified. We also identified 30 new context features (across 13 of the 16 attributes). CONCLUSION The findings from this study represent an important advancement in the KT field; we provide much needed conceptual clarity in context, which is essential to the development of common assessment tools to measure context to determine which context attributes and features are more or less important in different contexts for improving KT success.
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Affiliation(s)
- Janet E. Squires
- Department of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Alison M. Hutchinson
- Monash Health, Melbourne, VIC, Australia
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Mary Coughlin
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kainat Bashir
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Janet Curran
- Faculty of Health, School of Nursing, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
| | - Jeremy M. Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Laura Aloisio
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jamie Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Jill J. Francis
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Noah Ivers
- Women’s College Hospital, Toronto, ON, Canada
| | - John Lavis
- McMaster University, Hamilton, ON, Canada
| | | | - Michael Hillmer
- Ontario Ministry of Health and Long-Term Care, Toronto, ON, Canada
| | | | | | - Ian D. Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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Kitson A. How and Why Context Matters: A Personal Reflection Comment on "Stakeholder Perspectives of Attributes and Features of Context Relevant to Knowledge Translation in Health Settings: A Multi-Country Analysis". Int J Health Policy Manag 2022; 11:1590-1591. [PMID: 35490256 PMCID: PMC9808323 DOI: 10.34172/ijhpm.2022.6782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/28/2022] [Indexed: 01/12/2023] Open
Abstract
This commentary acknowledges that the evidence-based practice (EBP) movement did not automatically or initially understand the impact of context on successful implementation (SI). The subsequent work of research teams, such as the PARIHS (Promoting Action on Research in Health Services) team, and the Ottawa team led by Squires, have contributed to the ongoing refinement of the concept. However, still under discussion is whether having a more comprehensive set of contextual attributes will necessarily lead to more implementation success. Just as the strength of the evidence does not automatically lead to implementation success, so having a comprehensive understanding of contextual factors will not necessarily improve implementation uptake.
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Affiliation(s)
- Alison Kitson
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
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118
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Sakowski JA, Song PH. The Extent Hospital Organizational Factors Influence Inpatient Care Delivery: A Case Study Looking at Knee and Hip Replacement Surgery. Health Serv Insights 2022; 15:11786329221109303. [PMID: 35813564 PMCID: PMC9260580 DOI: 10.1177/11786329221109303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/24/2022] [Indexed: 11/25/2022] Open
Abstract
There is a body of Implementation and Dissemination research describing the
importance of “context”—the characteristics describing the setting where a
process or innovation occurs—when evaluating delivery, outcomes and cost of
health services. These contextual factors, which can occur at the system,
organization, or provider level, may either facilitate or erect barriers to the
utilization of evidence-based practices and the outcomes achieved. This paper
examines the influence of organizational structure and operating environment
characteristics of where inpatient health care is delivered, controlling for
patient and provider characteristics, on health services delivery and outcomes
achieved. We used inpatient cost-of-care to represent the bundle of services
provided to patients receiving primary knee and hip replacement procedures. Data
includes patient level data from discharge records for 62 140 knee replacements
and 42 392 hip replacements from the 2015 AHRQ Healthcare Cost and Utilization
Project State Inpatient Discharge database and hospital characteristics from the
2015 American Hospital Association survey. Multi-level linear estimation models
controlling for patient and payer characteristics were employed to assess the
impact of specific organizational and operating environment factors. We found
that although patient and payer characteristics significantly impacted the
inpatient cost of care, there is significant variation between hospitals and
among physicians within a hospital beyond what can be explained by patient,
payer and local price effect characteristics. Organizational and physician
characteristics that had the most significant impact on cost of care included
the volume of services provided, urban location, and for-profit ownership. These
factors can inform future policy and program design and evaluation.
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Affiliation(s)
- Julie Ann Sakowski
- Associate Professor of Health Care Management, Appalachian State University, Boone, NC, USA
| | - Paula H Song
- Richard M. Bracken Professor and Chair, Department of Health Administration, Virginia Commonwealth University, Richmond, VA, USA
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Petersson L, Larsson I, Nygren JM, Nilsen P, Neher M, Reed JE, Tyskbo D, Svedberg P. Challenges to implementing artificial intelligence in healthcare: a qualitative interview study with healthcare leaders in Sweden. BMC Health Serv Res 2022; 22:850. [PMID: 35778736 PMCID: PMC9250210 DOI: 10.1186/s12913-022-08215-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/20/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Artificial intelligence (AI) for healthcare presents potential solutions to some of the challenges faced by health systems around the world. However, it is well established in implementation and innovation research that novel technologies are often resisted by healthcare leaders, which contributes to their slow and variable uptake. Although research on various stakeholders' perspectives on AI implementation has been undertaken, very few studies have investigated leaders' perspectives on the issue of AI implementation in healthcare. It is essential to understand the perspectives of healthcare leaders, because they have a key role in the implementation process of new technologies in healthcare. The aim of this study was to explore challenges perceived by leaders in a regional Swedish healthcare setting concerning the implementation of AI in healthcare. METHODS The study takes an explorative qualitative approach. Individual, semi-structured interviews were conducted from October 2020 to May 2021 with 26 healthcare leaders. The analysis was performed using qualitative content analysis, with an inductive approach. RESULTS The analysis yielded three categories, representing three types of challenge perceived to be linked with the implementation of AI in healthcare: 1) Conditions external to the healthcare system; 2) Capacity for strategic change management; 3) Transformation of healthcare professions and healthcare practice. CONCLUSIONS In conclusion, healthcare leaders highlighted several implementation challenges in relation to AI within and beyond the healthcare system in general and their organisations in particular. The challenges comprised conditions external to the healthcare system, internal capacity for strategic change management, along with transformation of healthcare professions and healthcare practice. The results point to the need to develop implementation strategies across healthcare organisations to address challenges to AI-specific capacity building. Laws and policies are needed to regulate the design and execution of effective AI implementation strategies. There is a need to invest time and resources in implementation processes, with collaboration across healthcare, county councils, and industry partnerships.
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Affiliation(s)
- Lena Petersson
- School of Health and Welfare, Halmstad University, Box 823, 301 18, Halmstad, Sweden.
| | - Ingrid Larsson
- School of Health and Welfare, Halmstad University, Box 823, 301 18, Halmstad, Sweden
| | - Jens M Nygren
- School of Health and Welfare, Halmstad University, Box 823, 301 18, Halmstad, Sweden
| | - Per Nilsen
- School of Health and Welfare, Halmstad University, Box 823, 301 18, Halmstad, Sweden.,Department of Health, Medicine and Caring Sciences, Division of Public Health, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Margit Neher
- School of Health and Welfare, Halmstad University, Box 823, 301 18, Halmstad, Sweden.,Department of Rehabilitation, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Julie E Reed
- School of Health and Welfare, Halmstad University, Box 823, 301 18, Halmstad, Sweden
| | - Daniel Tyskbo
- School of Health and Welfare, Halmstad University, Box 823, 301 18, Halmstad, Sweden
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Box 823, 301 18, Halmstad, Sweden
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120
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Mishra M, Pickett M, Weiskopf NG. The Role of Informatics in Implementing Guidelines for Chronic Opioid Therapy Risk Assessment in Primary Care: A Narrative Review Informed by the Socio-Technical Model. Stud Health Technol Inform 2022; 290:447-451. [PMID: 35673054 PMCID: PMC10128894 DOI: 10.3233/shti220115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Approximately 2 million Americans live with opioid use disorder (OUD), most of whom also have chronic pain. The economic burden of chronic pain and prescription opioid misuse runs into billions of dollars. Patients on prescription opioids for chronic non-cancer pain (CNCP) are at increased risk for OUD and overdose. By adhering to the Center for Disease Control and Prevention (CDC) opioid prescribing guidelines, primary care providers (PCPs) have the potential to improve patient outcomes. But numerous provider, patient, and practice-specific factors challenge adherence to guidelines in primary care. Many of the barriers may be mediated by informatics interventions, but gaps in knowledge and unmet needs exist. This narrative review examines the risk assessment and harm reduction process in a socio-technical context to highlight the gaps in knowledge and unmet needs that can be mediated through informatics intervention.
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Affiliation(s)
- Meenakshi Mishra
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA
| | - Mary Pickett
- Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, Portland, OR, USA
| | - Nicole G. Weiskopf
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA
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121
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Inness EL, Jagroop D, Andreoli A, Bayley M, Biasin L, Danells C, Hall J, Mansfield A, McDonald A, Nishri D, Salbach NM, Taylor D, Wong K, Tang A. Factors That Influence the Clinical Implementation of Aerobic Exercise in Stroke Rehabilitation: A Theory-Informed Qualitative Study. Phys Ther 2022; 102:6534400. [PMID: 35194641 DOI: 10.1093/ptj/pzac014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 10/14/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Best practice guidelines recommend that aerobic exercise (AEx) be implemented as early as possible poststroke, yet the prescription of AEx remains limited in stroke rehabilitation settings. This study used theoretical frameworks to obtain an in-depth understanding of barriers and enablers to AEx implementation in the stroke rehabilitation setting. METHODS A qualitative, descriptive study was conducted. Participants were recruited from 4 stroke rehabilitation settings in Ontario, Canada, that have participated in an implementation study to provide structured AEx programming as part of standard care. Six clinician focus groups (with 19 physical therapists and 5 rehabilitation assistants) and one-to-one interviews with 7 managers and 1 physician were conducted to explore barriers and enablers to AEx implementation. The Theoretical Domains Framework and Consolidated Framework for Implementation Research informed content analysis for clinician and manager perspectives, respectively. RESULTS Barriers specific to resource constraints and health care system pressures, combined with patient goals, led to interventions to improve function being prioritized over AEx. Successful implementation was enabled through an interprofessional approach and team engagement in the planning and implementation process. Health care providers described concerns about patient safety, but confidence and capability for implementing AEx were enabled by education, skill development, use of exercise tests, and consultation with individuals with content expertise. Participants described the development of supportive processes that enabled AEx implementation within team workflows and shared resources. CONCLUSION Strategies to support implementation of AEx in stroke rehabilitation should incorporate knowledge and skills, the provision of clinical decision-making tools, access to expert consultation, the roles and social influence of the interprofessional team and formal and informal leaders, and supportive processes adapted to the local context. IMPACT Results from this study will inform the development of a clinical implementation toolkit to support clinical uptake of AEx in the stroke rehabilitation setting.
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Affiliation(s)
- Elizabeth L Inness
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - David Jagroop
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Angie Andreoli
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Mark Bayley
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Louis Biasin
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Cynthia Danells
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Jayne Hall
- Regional Rehabilitation Outpatient Services, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Avril Mansfield
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Evaluative Clinical Sciences, Hurvtiz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Alison McDonald
- Nova Scotia Rehabilitation & Arthritis Centre, Halifax, NS, Canada
| | - Diane Nishri
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Nancy M Salbach
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Denise Taylor
- St Joseph's Care Group, Thunder Bay, ON, Canada.,Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Karl Wong
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Ada Tang
- McMaster University, School of Rehabilitation, Hamilton ON, Canada
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Gately ME, Quach ED, Shirk SD, Trudeau SA. Understanding Variation in Adoption of Video Telehealth and Implications for Health Care Systems. MEDICAL RESEARCH ARCHIVES 2022; 10:10.18103/mra.v10i5.2751. [PMID: 36405543 PMCID: PMC9670247 DOI: 10.18103/mra.v10i5.2751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Telehealth has rapidly expanded since COVID-19. Veterans Health Administration (VHA), the largest integrated health care system in the United States, was well-positioned to incorporate telehealth across specialties due to existing policies and infrastructure. OBJECTIVES The objective of this study is to investigate predictors of occupational therapy (OT) practitioners' adoption of video telehealth. METHODS This study presents data from a convenience sample of VHA occupational therapy (OT) practitioners administered pre-pandemic, in fall 2019. Survey development was guided by the Promoting Action on Research Implementation in Health Services framework, and gathered clinician attitudes, experiences, and perspectives about video telehealth to deliver OT services. Items included telehealth usage, perceived effectiveness of specific OT interventions, and perceptions about evidence. Our outcome variable denoted practitioners' level of adoption of video telehealth: telehealth users (adopters), non-users who want to use telehealth (potential adopters and reference group), and non-users who do not want to use telehealth (non-adopters). In multiple multinomial logistic regressions, we tested whether level of adoption was associated with years of VHA work experience and perceived strength of evidence. RESULTS Of approximately 1455 eligible practitioners, 305 VHA occupational therapy practitioners participated in the survey (21% response rate). One hundred and twenty-five (41%) reported using video telehealth, whereas 180 (59%) reported not using video telehealth. Among non-users, 107 (59%) indicated willingness to adopt telehealth whereas 73 (41%) were not willing. More VHA work experience predicted higher odds of being an adopter than a potential adopter; perceptions of stronger evidence regarding video telehealth predicted higher odds of being a potential adopter than a non-adopter. CONCLUSION Clinician beliefs and years of experience exerted an influence on clinicians' use or willingness to use video telehealth. Efforts to enhance adoption of video telehealth should address clinicians' beliefs regarding the innovative nature of and organizational resources necessary to foster utilization.
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Affiliation(s)
- Megan E Gately
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System Bedford, MA
| | - Emma D Quach
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System Bedford, MA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
- Department of Gerontology, University of Massachusetts Boston
| | - Steven D Shirk
- VA Bedford Healthcare System, Bedford, MA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Scott A Trudeau
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System Bedford, MA
- American Occupational Therapy Association, Bethesda, MD
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Douglas NF, Feuerstein JL, Oshita JY, Schliep ME, Danowski ML. Implementation Science Research in Communication Sciences and Disorders: A Scoping Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1054-1083. [PMID: 35104415 PMCID: PMC10721253 DOI: 10.1044/2021_ajslp-21-00126] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/30/2021] [Accepted: 11/03/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE The purpose of this study was to complete a scoping review of implementation science (IS) research in communication sciences and disorders (CSD) over time and to determine characteristics of IS research in CSD. METHOD A scoping review was conducted of PubMed and Education Resources Information Center for sources published in English that (a) included CSD practitioners, (b) addressed IS research, and (c) identified a specific evidence-based practice. Resulting sources were systematically examined for study aim, patient populations, implementation framework utilized, setting of the study, implementation strategy examined, and implementation outcome measured. RESULTS The majority of the 82 studies that underwent a full-text review (80.5%) were published in 2014 or later. One fourth of the studies were concept papers, and another one fourth focused on context assessment (25.6% of studies, each), 11% focused on designing implementation strategies, and 36.6% focused on testing implementation strategies. The patient population most frequently represented aphasia (21.3%), and most studies (34.4%) were conducted in inpatient medical settings. Nearly half (42.6%) of the nonconcept studies lacked an IS framework. Among implementation strategies identified, approximately one third of studies focused on education and/or training plus another strategy and one fourth focused on education and/or training alone. Implementation outcomes measured typically represented early stages of implementation. CONCLUSIONS This scoping review of IS research in CSD described the landscape of IS studies in CSD. IS is intersecting with CSD at a rapid rate, especially since 2014. Future IS research in CSD should adopt an implementation framework a priori and consider the broad range of implementation strategies and outcomes to support the uptake of research into typical practice settings.
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Rohrbasser A, Wong G, Mickan S, Harris J. Understanding how and why quality circles improve standards of practice, enhance professional development and increase psychological well-being of general practitioners: a realist synthesis. BMJ Open 2022; 12:e058453. [PMID: 35508344 PMCID: PMC9073411 DOI: 10.1136/bmjopen-2021-058453] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To understand how and why participation in quality circles (QCs) improves general practitioners' (GPs) psychological well-being and the quality of their clinical practice. To provide evidence-informed and practical guidance to maintain QCs at local and policy levels. DESIGN A theory-driven mixed method. SETTING Primary healthcare. METHOD We collected data in four stages to develop and refine the programme theory of QCs: (1) coinquiry with Swiss and European expert stakeholders to develop a preliminary programme theory; (2) realist review with systematic searches in MEDLINE, Embase, PsycINFO and CINHAL (1980-2020) to inform the preliminary programme theory; (3) programme refinement through interviews with participants, facilitators, tutors and managers of QCs and (4) consolidation of theory through interviews with QC experts across Europe and examining existing theories. SOURCES OF DATA The coinquiry comprised 4 interviews and 3 focus groups with 50 European experts. From the literature search, we included 108 papers to develop the literature-based programme theory. In stage 3, we used data from 40 participants gathered in 6 interviews and 2 focus groups to refine the programme theory. In stage 4, five interviewees from different healthcare systems consolidated our programme theory. RESULT Requirements for successful QCs are governmental trust in GPs' abilities to deliver quality improvement, training, access to educational material and performance data, protected time and financial resources. Group dynamics strongly influence success; facilitators should ensure participants exchange knowledge and generate new concepts in a safe environment. Peer interaction promotes professional development and psychological well-being. With repetition, participants gain confidence to put their new concepts into practice. CONCLUSION With expert facilitation, clinical review and practice opportunities, QCs can improve the quality of standard practice, enhance professional development and increase psychological well-being in the context of adequate professional and administrative support. PROSPERO REGISTRATION NUMBER CRD42013004826.
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Affiliation(s)
- Adrian Rohrbasser
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Medical Center, Medbase, Wil, Switzerland
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - Sharon Mickan
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Janet Harris
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Abejirinde IOO, Castellano Pleguezuelo V, Benova L, Dossou JP, Hanson C, Metogni CB, Meja S, Mkoka DA, Namazzi G, Sidney K, Marchal B. Strengthening capacity in hospitals to reduce perinatal morbidity and mortality through a codesigned intervention package: protocol for a realist evaluation as part of a stepped-wedge trial of the Action Leveraging Evidence to Reduce perinatal morTality and morbidity (ALERT) in sub-Saharan Africa project. BMJ Open 2022; 12:e057414. [PMID: 35440457 PMCID: PMC9020280 DOI: 10.1136/bmjopen-2021-057414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Despite a strong evidence base for developing interventions to reduce child mortality and morbidity related to pregnancy and delivery, major knowledge-implementation gaps remain. The Action Leveraging Evidence to Reduce perinatal morTality and morbidity (ALERT) in sub-Saharan Africa project aims to overcome these gaps through strengthening the capacity of multidisciplinary teams that provide maternity care. The intervention includes competency-based midwife training, community engagement for study design, mentoring and quality improvement cycles. The realist process evaluation of ALERT aims at identifying and testing the causal pathway through which the intervention achieves its impact. METHODS AND ANALYSIS This realist process evaluation complements the effectiveness evaluation and the economic evaluation of the ALERT intervention. Following the realist evaluation cycle, we will first elicit the initial programme theory on the basis of the ALERT theory of change, a review of the evidence on adoption and diffusion of innovations and the perspectives of the stakeholders. Second, we will use a multiple embedded case study design to empirically test the initial programme theory in two hospitals in each of the four intervention countries. Qualitative and quantitative data will be collected, using in-depth interviews with hospital staff and mothers, observations, patient exit interviews and (hospital) document reviews. Analysis will be guided by the Intervention-Actors-Context-Mechanism-Outcome configuration heuristic. We will use thematic coding to analyse the qualitative data. The quantitative data will be analysed descriptively and integrated in the analysis using a retroductive approach. Each case study will end with a refined programme theory (in-case analysis). Third, we will carry out a cross-case comparison within and between the four countries. Comparison between study countries should enable identifying relevant context factors that influence effectiveness and implementation, leading to a mid-range theory that may inform the scaling up the intervention. ETHICS AND DISSEMINATION In developing this protocol, we paid specific attention to cultural sensitivity, the do no harm principle, confidentiality and non-attribution. We received ethical approval from the local and national institutional review boards in Tanzania, Uganda, Malawi, Benin, Sweden and Belgium. Written or verbal consent of respondents will be secured after explaining the purpose, potential benefits and potential harms of the study using an information sheet. The results will be disseminated through workshops with the hospital staff and national policymakers, and scientific publications and conferences. TRIAL REGISTRATION NUMBER PACTR202006793783148.
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Affiliation(s)
- Ibukun-Oluwa Omolade Abejirinde
- International Program Evaluation Unit, Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Social & Behavioural Health Sciences, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | | | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Jean-Paul Dossou
- Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Claudia Hanson
- Department of Public Global Health, Karolinska Institute, Stockholm, Sweden
| | | | - Samuel Meja
- University of Malawi College of Medicine, Blantyre, Malawi
| | - D A Mkoka
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gertrude Namazzi
- Department of Health Policy Planning and Management, Makerere University, Kampala, Uganda
| | - Kristi Sidney
- Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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Straw C, Antelo VS, Paolino M, Murillo R, Espina C, Arrossi S. Acceptability, appropriateness and feasibility of the Latin American and Caribbean Code against Cancer: perceptions of decision-makers and health professionals in Argentina. Ecancermedicalscience 2022; 16:1375. [PMID: 35702416 PMCID: PMC9116998 DOI: 10.3332/ecancer.2022.1375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background Cancer is an important public health problem. In Latin America and the Caribbean, there were approximately 1,500,000 new cases of cancer and 700,000 deaths due to cancer in 2020. These figures will increase by 78% by 2040 to more than 2.5 million people diagnosed with cancer each year, who will require medical attention, care and support. However, it is estimated that at least 40% of cancers could be prevented by adopting a healthier lifestyle, reducing risky behaviours and implementing recommended health interventions. Objective To evaluate the perceptions of health decision-makers and professionals regarding the Latin American and Caribbean Code against Cancer (CLCC) as a support tool for designing and implementing public policies for cancer prevention and control (acceptability, appropriateness and feasibility) in Argentina. Methods A qualitative study was conducted using individual, semi-structured interviews with health decision-makers and professionals (n = 30). The questions and thematic analysis of the information gathered have been guided by the principles of the Consolidated Framework for Implementation Research: intervention characteristics, outer setting, inner setting and characteristics of individuals. Results Health professionals and health decision-makers broadly accepted the proposal of the CLCC as a tool for supporting the design and implementation of public policies for cancer prevention and control, and considered it to be appropriate. Additionally, from the interviewees' perspective, factors should be ensured to guarantee the implementation of the CLCC as a viable public health policy. They also felt it was right to take the CECC as a model and to adapt its content to the specific characteristics of the Latin American population, customs, lifestyle habits, epidemiological characteristics and, in particular, the Argentinian socio-economic context. Interviewees perceived the CLCC as a health intervention whose complexity varied depending on the recommendation, although most of them were feasible. The broad consensus among the interviewees was that the development of the CLCC could yield numerous advantages in improving cancer prevention and control policy, and responding to the needs of the population. It was also considered to be an opportunity to introduce fundamental changes. With regard to the implementation of the CLCC, interviewees reported a favourable institutional climate, since they perceived that it would receive a priority equal to or greater than the ongoing prevention measures, and that it would have the commitment of the health authorities. They also felt that the implementation of the CLCC in their work environment would not be very complicated, and that the decision-makers and professionals had the necessary capacity to implement it. Finally, they felt that the implementation would be facilitated by the participation and consensus of health decision-makers at the primary care level, and negotiation with industrial and environmental sectors. Conclusions Our study shows that health professionals and decision-makers consider the CLCC to be highly acceptable, appropriate and feasible. This would facilitate its implementation as a tool that could enhance current cancer prevention and control policies in Argentina. The results of the study indicate the necessity for the CLCC to be adapted to the socio-economic context of Argentina, and highlight that population adherence to the CLCC recommendations will depend on complex and diverse factors, especially those involving changing unhealthy behaviours linked to cancer risk.
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Affiliation(s)
- Cecilia Straw
- Faculty of Social Sciences, University of Buenos Aires, Santiago del Estero 1029, Buenos Aires 1075, Argentina
- Centre for the Study of State and Society, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Victoria Sánchez Antelo
- Centre for the Study of State and Society/National Council for Scientific and Technical Research, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Melisa Paolino
- Centre for the Study of State and Society/National Council for Scientific and Technical Research, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Raúl Murillo
- San Ignacio University Hospital, Kra 7 40-62, Bogotá, Colombia
| | - Carolina Espina
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon CEDEX 08, France
| | - Silvina Arrossi
- Centre for the Study of State and Society/National Council for Scientific and Technical Research, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
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Marsden E, Craswell A, Taylor A, Barnett A, Wong PK, Wallis M. Translation of the geriatric emergency department intervention into other emergency departments: a post implementation evaluation of outcomes for older adults. BMC Geriatr 2022; 22:290. [PMID: 35392828 PMCID: PMC8988321 DOI: 10.1186/s12877-022-02999-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Increasing numbers of older adults with complex health deficits presenting to emergency departments has prompted the development of innovative models of care. One such model designed to reduce poor outcomes associated with acute healthcare, is the Geriatric Emergency Department Intervention. This intervention is a nurse-led, physician-championed, Emergency Department intervention that improves the health outcomes for frail older adults in the emergency department. Methods This quantitative cohort study aimed to evaluate the healthcare outcomes and costs associated with the implementation of the Geriatric Emergency Department Intervention (GEDI) for adults aged 70 years and over at two hospital sites that implemented the model using the integrated-Promoting Action on Research Implementation in Health Services (i-PARHIS) framework. Hospital A was large teaching hospital located in the tropical north of Australia. Hospital B was a medium sized teaching hospital near Brisbane, Queensland Australia. The effect of the intervention was examined in two ways. Outcomes were compared between: 1) all patients in the pre- and post- implementation periods, and 2) patients seen or not seen by the Geriatric Emergency Department Intervention team in the post-implementation period. The outcomes measured were disposition (discharged home, admitted); emergency department length of stay; hospital length of stay; all cause in-hospital mortality within 28 days; time to re-presentation up to 28 days post-discharge; emergency department and in-hospital costs. Survival analyses were used for the primary and secondary outcome variables and a Cox survival model was used to estimate the associations between variables and outcomes. Multiple regression models were used to examine other secondary outcomes whilst controlling for a range of confounders. Results The Geriatric Emergency Department Intervention was successfully translated into two different emergency departments. Both demonstrated an increased likelihood of discharge, decreased emergency department length of stay, decreased hospital costs for those who were admitted, with an associated reduction in risk of mortality, for adults aged 70 years and over. Conclusions The Geriatric Emergency Department Intervention was successfully translated into new sites that adapted the model design. Improvement in healthcare outcomes for older adults presenting to the emergency department was demonstrated, although this was more subtle than in the original model setting.
Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02999-4.
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Affiliation(s)
- Elizabeth Marsden
- Sunshine Coast Hospital and Health Service, Sunshine Coast University Hospital, 4 Doherty Street, Birtinya, QLD, 4575, Australia
| | - Alison Craswell
- University of the Sunshine Coast, Sunshine Coast Health Institute, 4 Doherty Street, Birtinya, QLD, Australia.
| | - Andrea Taylor
- Sunshine Coast Hospital and Health Service, Sunshine Coast University Hospital, 4 Doherty Street, Birtinya, QLD, 4575, Australia
| | - Adrian Barnett
- Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, Qld, 4059, Australia
| | - Pan-Kar Wong
- Gold Coast Hospital and Health Service, Gold Coast University Hospital, 1 Hospital Blvd, Gold Coast, Qld, 4215, Australia
| | - Marianne Wallis
- University of the Sunshine Coast, Sunshine Coast Health Institute, 4 Doherty Street, Birtinya, QLD, Australia.,Southern Cross University, Southern Cross Drive, Bilinga, QLD, 4225, Australia
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Kim B, Miller CJ, Ritchie MJ, Smith JL, Kirchner JE, Stolzmann K, Connolly SL, Drummond KL, Bauer MS. Time–motion analysis of external facilitation for implementing the Collaborative Chronic Care Model in general mental health clinics: Use of an interval-based data collection approach. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221086275. [PMID: 37091094 PMCID: PMC9924237 DOI: 10.1177/26334895221086275] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Facilitation is an effective strategy to implement evidence-based practices, often involving external facilitators (EFs) bringing content expertise to implementation sites. Estimating time spent on multifaceted EF activities is complex. Furthermore, collecting continuous time–motion data for facilitation tasks is challenging. However, organizations need this information to allocate implementation resources to sites. Thus, our objectives were to conduct a time–motion analysis of external facilitation, and compare continuous versus noncontinuous approaches to collecting time–motion data. Methods: We analyzed EF time–motion data from six VA mental health clinics implementing the evidence-based Collaborative Chronic Care Model (CCM). We documented EF activities during pre-implementation (4–6 weeks) and implementation (12 months) phases. We collected continuous data during the pre-implementation phase, followed by data collection over a 2-week period (henceforth, “a two-week interval”) at each of three time points (beginning/middle/end) during the implementation phase. As a validity check, we assessed how closely interval data represented continuous data collected throughout implementation for two of the sites. Results: EFs spent 21.8 ± 4.5 h/site during pre-implementation off-site, then 27.5 ± 4.6 h/site site-visiting to initiate implementation. Based on the 2-week interval data, EFs spent 2.5 ± 0.8, 1.4 ± 0.6, and 1.2 ± 0.6 h/week toward the implementation’s beginning, middle, and end, respectively. Prevalent activities were preparation/planning, process monitoring, program adaptation, problem identification, and problem-solving. Across all activities, 73.6% of EF time involved email, phone, or video communication. For the two continuous data sites, computed weekly time averages toward the implementation’s beginning, middle, and end differed from the interval data’s averages by 1.0, 0.1, and 0.2 h, respectively. Activities inconsistently captured in the interval data included irregular assessment, stakeholder engagement, and network development. Conclusions: Time–motion analysis of CCM implementation showed initial higher-intensity EF involvement that tapered. The 2-week interval data collection approach, if accounting for its potential underestimation of irregular activities, may be promising/efficient for implementation studies collecting time–motion data.
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Affiliation(s)
- Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Christopher J. Miller
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mona J. Ritchie
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey L. Smith
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - JoAnn E. Kirchner
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kelly Stolzmann
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | - Samantha L. Connolly
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Karen L. Drummond
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mark S. Bauer
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Rahman Jabin MS, Pan D, Nilsson E. Characterizing healthcare incidents in Sweden related to health information technology affecting care management of multiple patients. Health Informatics J 2022; 28:14604582221105440. [PMID: 35762538 DOI: 10.1177/14604582221105440] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to examine health information technology-related incidents and identify risks associated with multiple patients' management. Sources of information comprised interviews with healthcare professionals and three small sets of local voluntary incident reports using two sampling strategies, purposive and snowball sampling. Incident reports, in the form of free-text narratives, were aggregated for analysis using the Health Information Technology Classification System and thematic analysis. Of 95 incidents, 176 issues were identified, comprising 77% (n = 136) technical issues, and 23% (n = 40) use or human-related issues. Human issues were over two times more likely to harm patients (OR 2.25, 95% CI 1.01 - 4.98) than technical issues. Incidents that affected multiple patients' care accounted for 70% (n = 66) of the total sample, and large-scale events comprised 39% (n = 26) of the incidents that affected multiple patients' care. Systematically identifying and characterizing such incidents should be prioritized for health information technology implementations.
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Affiliation(s)
| | - Ding Pan
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Evalill Nilsson
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
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Hunt AW, Allen KA, Dittmann K, Linkewich E, Donald M, Hutter J, Patel A, McEwen S. Clinician perspectives on implementing a team-based metacognitive strategy training approach to stroke rehabilitation. J Eval Clin Pract 2022; 28:201-207. [PMID: 34390294 DOI: 10.1111/jep.13610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/16/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The objective of this research study was to explore site and clinician specific experiences, successes and challenges in implementing a complex intervention (cognitive orientation to daily occupational performance approach) to enhance stroke team's ability to address cognitive impairments as part of comprehensive stroke rehabilitation. METHODS A focus group was held with clinicians from five study sites, all rehabilitation stroke hospitals in a large urban setting, to discuss implementation experiences. Participants were clinicians (site champions) from each of the five participating stroke program study sites and included four occupational therapists, three physiotherapists and one speech-language pathologist. Thematic analysis was used to identify themes that represented clinicians' perspectives. RESULTS Implementing this complex team-based intervention was influenced by three themes-organizational support, experiential evidence, and clinicians' perspectives. Continued implementation of the intervention following the withdrawal of study support was represented on a continuum that ranged from not using the approach at all to implementing it with all patients. Sites where managers encouraged and supported use of the intervention within teams (organization support), continued to use it after the study support period as did clinicians who were willing to try new interventions (clinicians' perspectives). Development of iterative conclusions through implementation or attempts to implement the intervention had both positive and negative effects on continued implementation (experiential evidence). CONCLUSIONS Strategies that reinforce development of positive experiential evidence and building organizational support for innovative practice were found to be useful adjuncts in facilitating implementation of complex interprofessional interventions.
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Affiliation(s)
- Anne W Hunt
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | | | | | | | | | - Jennifer Hutter
- Department of Kinesiology, McMaster University, Hamilton, Canada
| | - Alexandra Patel
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Sara McEwen
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Sunnybrook Research Institute, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
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Growing pains: Lessons learned from a failed mobile mindfulness clinical trial for patients with complex care needs. Contemp Clin Trials Commun 2022; 26:100858. [PMID: 35079658 PMCID: PMC8777278 DOI: 10.1016/j.conctc.2021.100858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022] Open
Abstract
This paper discusses lessons learned from a failed clinical trial investigating the use of a mobile application (app) to deliver a mindfulness intervention to middle-aged and older adults receiving services at a rehabilitation hospital in Ontario, Canada. A randomized controlled trial with 82 participants was planned, with the experimental group receiving access to a mindfulness app and a wait-list control group receiving access to the app after 4 weeks; however, the study could not be completed due to low recruitment rates. This implementation failure was considered from the perspective of the PARIHS framework. More specifically, Three key recruitment challenges were identified, and recommendations for future research provided. Firstly, the increasingly complex care needs of the study population appeared to influence eligibility; it would be beneficial for future research to consider adopting strategies to better understand the needs of the target population. Secondly, participants’ stage of care and readiness of change likely negatively influenced compliance and retention in this study, and should be assessed in future research. Finally, a lack of clinician integration into the research team negatively impacted recruitment in this study; future studies should consider integrating direct service providers into the research team as this may increase buy-in and referral rates. The challenges and recommendations outlined can inform design and implementation of future studies in this area.
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Williams S, Keogh S, Herd D, Riggall S, Glass R, Douglas C. Building effective engagement for implementation with i-PARIHS: a collaborative enquiry into paediatric pain care in the emergency department. BMC Health Serv Res 2022; 22:330. [PMID: 35279137 PMCID: PMC8916941 DOI: 10.1186/s12913-022-07740-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/03/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Pain is a central and distressing experience for children in the emergency department (ED). Despite the harmful effects of pain, ED care often falls short of providing timely and effective pain relief. Knowledge translation research targeting systems of care holds potential to transform paediatric pain care. This article reports on the first stages of an implementation project aimed at embedding effective and sustainable practice change in an Australian children's hospital ED. METHODS The integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework underpinned a cooperative process of engagement to establish a practitioner-led, interprofessional research collaborative. The Kids Pain Collaborative (KPC) aimed to co-design innovation in paediatric ED pain care, facilitating an extensive reconnaissance of research evidence, clinician and family experiences, and local evaluation data. This critical appraisal of the context and culture of pain management generated foci for innovation and facilitation of implementation action cycles. RESULTS Engaging in a complex process of facilitated critical reflection, the KPC unpacked deeply embedded assumptions and organisational practices for pain care that worked against what they wanted to achieve as a team. A culture of rules-based pain management and command and control leadership produced self-defeating practices and ultimately breakdowns in pain care. By raising a critical awareness of context, and building consensus on the evidence for change, the KPC has established a whole of ED shared vision for prioritising pain care. CONCLUSIONS In-depth key stakeholder collaboration and appraisal of context is the first step in innovation of practice change. The KPC provided a space for collaborative enquiry where ED clinicians and researchers could develop context-specific innovation and implementation strategy. We provide an example of the prospective application of i-PARIHS in transforming ED pain care, using a collaborative and participatory approach that has successfully enabled high levels of departmental engagement, motivation and ownership of KPC implementation as the facilitation journey unfolds.
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Affiliation(s)
- Suzanne Williams
- School of Nursing and Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), QLD, Brisbane, Australia.
- Acute Pain Service, Children's Health Queensland Hospital and Health Service, Queensland Health, Brisbane, QLD, Australia.
| | - Samantha Keogh
- School of Nursing and Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), QLD, Brisbane, Australia
- Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - David Herd
- Emergency Department, Children's Health Queensland Hospital and Health Service, Queensland Health, Brisbane, QLD, Australia
| | - Sharonn Riggall
- Emergency Department, Children's Health Queensland Hospital and Health Service, Queensland Health, Brisbane, QLD, Australia
| | - Roselyn Glass
- Emergency Department, Children's Health Queensland Hospital and Health Service, Queensland Health, Brisbane, QLD, Australia
| | - Clint Douglas
- School of Nursing and Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), QLD, Brisbane, Australia
- Metro North Hospital and Health Service, Brisbane, QLD, Australia
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Jorgenson A, Adalberto Luz R, Fábrega Juskevicius L, Clara Padoveze M, Price L. The Consolidated Framework for Implementation Research: a reflection on researchers' experiences of its benefits and challenges and the lessons learnt from using it. Nurse Res 2022; 30:31-38. [PMID: 35238188 DOI: 10.7748/nr.2022.e1827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND In healthcare implementation research, there is little discussion of researchers' experiences of using frameworks, including the Consolidated Framework for Implementation Research (CFIR). AIM To identify and discuss the benefits and challenges encountered and the lessons learnt from researchers' experiences of using the CFIR in different contexts and phases of research. DISCUSSION This article synthesises the reflections of nursing and public health researchers on their experiences of using the CFIR across four separate healthcare-associated infection prevention and control implementation studies. The CFIR's benefits and challenges, the resolutions to these challenges and the lessons learnt from the application of the framework were discussed. CONCLUSIONS Identified benefits included the framework's adaptability and flexibility, and its provision of structure and shared language for research. Translation to another language and differentiating between domains and constructs were challenges. IMPLICATIONS FOR PRACTICE Nurse researchers may find this article useful when considering use of the CFIR, or to anticipate and prepare to overcome the challenges highlighted when using the framework.
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Affiliation(s)
| | | | | | | | - Lesley Price
- Glasgow Caledonian University, Glasgow, Scotland
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Finlay-Jones A, Elliott E, Chapman A, Halliday J, Jones H, Kippin N, Mullan N, Passmore H, Reibel T, Reynolds N, Symons M, Tsang TW, Watkins R, Bower C. It takes a village: Influencing policy and practice to prevent alcohol use in pregnancy and promote better outcomes for individuals living with Fetal Alcohol Spectrum Disorder. Int J Popul Data Sci 2022; 6:1703. [PMID: 35309099 PMCID: PMC8900649 DOI: 10.23889/ijpds.v6i1.1703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Fetal Alcohol Spectrum Disorder (FASD) is a neurodevelopmental disorder caused by exposure to alcohol in utero. It has pervasive, lifelong impacts and is recognised as a major public health concern in many countries where alcohol is used. The FASD Research Australia Centre of Research Excellence (CRE) was funded by the National Health and Medical Research Council to generate and translate evidence to address prevention, diagnosis, and management of FASD in Australia. The current paper describes the approach to policy and practice impact taken by our CRE, including our stakeholder engagement processes and the key principles that underlie our approach. We provide examples of policy and practice influence in FASD prevention, diagnosis and management that have been achieved over the past five years and discuss challenges that are routinely faced in the translation of our work.
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Affiliation(s)
- Amy Finlay-Jones
- FASD Research Australia Centre of Research Excellence, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia, 6009
| | - Elizabeth Elliott
- FASD Research Australia Centre of Research Excellence, Australia
- The University of Sydney, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Westmead, NSW, Australia, 2145
- Sydney Children’s Hospital Network, Kids Research, Westmead, NSW, Australia, 2145
| | - Astrid Chapman
- FASD Research Australia Centre of Research Excellence, Australia
| | - Jane Halliday
- FASD Research Australia Centre of Research Excellence, Australia
- Reproductive Epidemiology, Genetics, Murdoch Children’s Research Institute, The Royal Children’s Hospital, Victoria, 3052, Australia
- Department of Paediatrics, University of Melbourne, Victoria, 3010, Australia
| | - Heather Jones
- FASD Research Australia Centre of Research Excellence, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia, 6009
| | - Natalie Kippin
- FASD Research Australia Centre of Research Excellence, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia, 6009
| | - Narelle Mullan
- FASD Research Australia Centre of Research Excellence, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia, 6009
| | - Hayley Passmore
- FASD Research Australia Centre of Research Excellence, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia, 6009
| | - Tracy Reibel
- FASD Research Australia Centre of Research Excellence, Australia
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Western Australia, 6150, Australia
| | - Neil Reynolds
- FASD Research Australia Centre of Research Excellence, Australia
| | - Martyn Symons
- FASD Research Australia Centre of Research Excellence, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia, 6009
| | - Tracey W Tsang
- FASD Research Australia Centre of Research Excellence, Australia
- The University of Sydney, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Westmead, NSW, Australia, 2145
- Sydney Children’s Hospital Network, Kids Research, Westmead, NSW, Australia, 2145
| | - Rochelle Watkins
- FASD Research Australia Centre of Research Excellence, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia, 6009
| | - Carol Bower
- FASD Research Australia Centre of Research Excellence, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia, 6009
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Hewko SJ. Individual-Level Factors are Significantly More Predictive of Employee Innovativeness Than Job-Specific or Organization-Level Factors: Results From a Quantitative Study of Health Professionals. Health Serv Insights 2022; 15:11786329221080039. [PMID: 35221693 PMCID: PMC8874207 DOI: 10.1177/11786329221080039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/18/2022] [Indexed: 12/14/2022] Open
Abstract
Individual innovativeness is particularly indispensable among health professionals. The healthcare environment is complex and its knowledge workers must continually adapt to change and be comfortable with ambiguity. The objective of this study was to determine the relative importance of individual, job-specific, and organizational factors on innovative output of health professionals. Employed Canadian Registered Dietitians (n = 237) completed an online survey incorporating relevant validated tools, including the 10-item Big Five Inventory and the Alberta Context Tool. Factors were classified by level and introduced in blocks to a multivariate linear regression model, with the outcome of self-reported innovative output. Factors included in the model explained 44% of variation in self-reported innovative output. Although all blocks contributed significantly to the model, minimal variation was explained by factors at the job-specific (4%) and organizational levels (4%). Factors at the individual level most predictive of innovative output were role innovation, the personality trait of conscientiousness and voluntary membership in a professional association. To encourage employee innovativeness, health administrators, and managers of health professionals should consider how best to incorporate screens for individual-level indicators of innovative output (eg, personality tests) in their institutional hiring and selection processes.
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Affiliation(s)
- Sarah J Hewko
- Sarah J Hewko, Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, HSB 316, 550 University Avenue, Charlottetown, PE C1A 4N3, Canada.
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Abstract
Changing health care delivery systems and processes of care to improve health care quality is complex. What is done (intervention) is equally important as how it is done (implementation) and where it is done (context). Furthermore, it has been consistently observed that among groups participating in multisite quality improvement (QI) efforts and implementation studies, significant heterogeneity in the improvements is seen. Our objective is to provide a step-by-step guide to assist both researchers and groups practicing QI on the frontlines in addressing context in planning, implementing, and disseminating their QI and implementation interventions. We discuss in depth a sample of the >60 available dissemination and implementation frameworks that consider context. We then provide an approach to addressing context in QI and implementation initiatives and discuss an application of this approach, using a published study as an example. Finally, we discuss next steps for the field of context and implementation science. Data from networks of health systems working together on QI are needed on both network-wide rates of process and outcome measures. Also needed are segmented/stratified data that inform our understanding of the influence of context on successful implementation in subgroups. Finally, multisite prospective studies are needed to develop an in-depth understanding of how specific context and implementation factors affect the successful spread of proven interventions.
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Affiliation(s)
- Heather C Kaplan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Perinatal Institute, Division of Neonatology.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kathleen E Walsh
- Department of General Pediatrics, Harvard Medical School, Boston, Massachusetts.,Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
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Jackson C, Manley K. Contemporary Challenges of Nursing CPD: Time to change the model to meet citizens' needs. Nurs Open 2022; 9:880-891. [PMID: 34029011 PMCID: PMC8859082 DOI: 10.1002/nop2.941] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/18/2021] [Accepted: 03/15/2021] [Indexed: 11/16/2022] Open
Abstract
The purpose of this paper is to present the evidence shared with a citizen Consensus panel detailing key issues associated with how nursing CPD can best influence the quality of health and social care experienced by citizens and communities. It presents a summary of contemporary theory, research and evidence of the effectiveness of nursing CPD and outlines four key challenges: (i) how to strengthen the focus on patient experience as the starting point for CPD; (ii) the lack of evidence of CPD effectiveness and accountability in its transfer to practice; (iii) evaluation of CPD effectiveness; and (iv) involving citizens in targeting CPD where it is most needed. It briefly describes the methods used to facilitate public consultation through a citizen Consensus panel as part of a collaborative project with the RCN Strategic Research Alliance in 2020 and outlines 7 themes identified as important by the public for future development. The main challenge for nursing is capitalizing on the workplace as a learning resource that can integrate learning with development, improvement, knowledge translation, inquiry and innovation. This requires skilled facilitators, particularly at meso- levels, and systems leaders with the full skillset to develop system-wide cultures of learning that enable everyone to flourish and create good places to work. The paper concludes that the development of CPD process measures would indicate how CPD investment contributes to person-centred, safe and effective care and system transformation and enable commissioners and education providers to optimize CPD's full potential.
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Affiliation(s)
- Carolyn Jackson
- Director ImpACT Research GroupAssociate Professor Practice TransformationFaculty of Medicine and Health SciencesUniversity of East AngliaNorwichUK
| | - Kim Manley
- CBEProfessor of Practice Development & Co‐Director ImpACT Research Group Faculty of Medicine and Health SciencesUniversity of East AngliaNorwichUK
- Emeritus Professor in the Faculty of Medicine, Health and Social CareCanterbury Christ Church UniversityCanterburyUK
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Strazza K, Jordan J, Ferriola-Bruckenstein K, Kane H, Whitehill J, Teachout E, Yarnoff B. Approaches for Implementing Healthy Food Interventions in Settings With Limited Resources: A Case Study of Sodium Reduction Interventions in Emergency Food Programs Addressing Food Insecurity. Am J Health Promot 2022; 36:487-496. [PMID: 34860600 PMCID: PMC9297099 DOI: 10.1177/08901171211056121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study describes how recipients of the Centers for Disease Control and Prevention funded Sodium Reduction in Communities Program (SRCP) worked with emergency food programs to improve access to healthy food to address chronic conditions. DESIGN SRCP recipients partnered with emergency food programs to implement sodium reduction strategies including nutrition standards, procurement practices, environmental strategies, and behavioral economics approaches. SETTING SRCP recipients and emergency food programs in Washington County and Benton County, Arkansas and King County, Washington. SUBJECTS SRCP recipient staff, emergency food program staff, and key stakeholders. MEASURES We conducted semi-structured interviews with key stakeholders and systematic review of program documents. ANALYSIS Data were analyzed using effects matrices for each recipient. Matrices were organized using select implementation science constructs and compared in a cross-case analysis. RESULTS Despite limited resources, emergency food programs can implement sodium reduction interventions which may provide greater access to healthy foods and lead to reductions in health disparities. Emergency food programs successfully implemented sodium reduction interventions by building on the external and internal settings; selecting strategies that align with existing processes; implementing change incrementally and engaging staff, volunteers, and clients; and sustaining changes. CONCLUSION Findings contribute to understanding the ways in which emergency food programs and other organizations with limited resources have implemented public health nutrition interventions addressing food insecurity and improving access to healthy foods. These strategies may be transferable to other settings with limited resources.
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Affiliation(s)
- Karen Strazza
- Community Health Research Division, RTI International, Research Triangle Park, NC, USA
| | - Julia Jordan
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Heather Kane
- Community Health Research Division, RTI International, Research Triangle Park, NC, USA
| | - John Whitehill
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily Teachout
- Applied Research and Evaluation Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ben Yarnoff
- Community Health Research Dvision, RTI International, Research Triangle Park, NC, USA
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Ballengee LA, Rushton S, Lewinski AA, Hwang S, Zullig LL, Ricks KAB, Ramos K, Brahmajothi MV, Moore TS, Blalock DV, Cantrell S, Kosinski AS, Gordon A, Ear B, Williams JW, Gierisch JM, Goldstein KM. Effectiveness of Quality Improvement Coaching on Process Outcomes in Health Care Settings: A Systematic Review. J Gen Intern Med 2022; 37:885-899. [PMID: 34981354 PMCID: PMC8904663 DOI: 10.1007/s11606-021-07217-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND A culture of improvement is an important feature of high-quality health care systems. However, health care teams often need support to translate quality improvement (QI) activities into practice. One method of support is consultation from a QI coach. The literature suggests that coaching interventions have a positive impact on clinical outcomes. However, the impact of coaching on specific process outcomes, like adoption of clinical care activities, is unknown. Identifying the process outcomes for which QI coaching is most effective could provide specific guidance on when to employ this strategy. METHODS We searched multiple databases from inception through July 2021. Studies that addressed the effects of QI coaching on process of care outcomes were included. Two reviewers independently extracted study characteristics and assessed risk of bias. Certainty of evidence was assessed using GRADE. RESULTS We identified 1983 articles, of which 23 cluster-randomized trials met eligibility criteria. All but two took place in a primary care setting. Overall, interventions typically targeted multiple simultaneous processes of care activities. We found that coaching probably has a beneficial effect on composite process of care outcomes (n = 9) and ordering of labs and vital signs (n = 6), and possibly has a beneficial effect on changes in organizational process of care (n = 5), appropriate documentation (n = 5), and delivery of appropriate counseling (n = 3). We did not perform meta-analyses because of conceptual heterogeneity around intervention design and outcomes; rather, we synthesized the data narratively. Due to imprecision, inconsistency, and high risk of bias of the included studies, we judged the certainty of these results as low or very low. CONCLUSION QI coaching interventions may affect certain processes of care activities such as ordering of labs and vital signs. Future research that advances the identification of when QI coaching is most beneficial for health care teams seeking to implement improvement processes in pursuit of high-quality care will support efficient use of QI resources. PROTOCOL REGISTRATION This study was registered and followed a published protocol (PROSPERO: CRD42020165069).
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Affiliation(s)
- Lindsay A Ballengee
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 411 West Chapel Hill St., Suite 600, Durham, NC, 27701, USA.
- Department of Orthopaedic Surgery, Duke University School of Medicine, Division of Physical Therapy, Duke University, Durham, NC, USA.
| | | | - Allison A Lewinski
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 411 West Chapel Hill St., Suite 600, Durham, NC, 27701, USA
- School of Nursing, Duke University, Durham, NC, USA
| | - Soohyun Hwang
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Leah L Zullig
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 411 West Chapel Hill St., Suite 600, Durham, NC, 27701, USA
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Katharine A Ball Ricks
- Cecil G. Sheps Center for Health Service Research, University of North Carolina, Chapel Hill, NC, USA
| | - Katherine Ramos
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 411 West Chapel Hill St., Suite 600, Durham, NC, 27701, USA
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Department of Medicine Geriatrics, Duke University, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Mulugu V Brahmajothi
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, NC, USA
| | - Thomasena S Moore
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 411 West Chapel Hill St., Suite 600, Durham, NC, 27701, USA
| | - Dan V Blalock
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 411 West Chapel Hill St., Suite 600, Durham, NC, 27701, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Sarah Cantrell
- Duke University Medical Center Library, Duke University School of Medicine, Durham, NC, USA
| | - Andrzej S Kosinski
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Adelaide Gordon
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 411 West Chapel Hill St., Suite 600, Durham, NC, 27701, USA
| | - Belinda Ear
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 411 West Chapel Hill St., Suite 600, Durham, NC, 27701, USA
| | - John W Williams
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 411 West Chapel Hill St., Suite 600, Durham, NC, 27701, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer M Gierisch
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 411 West Chapel Hill St., Suite 600, Durham, NC, 27701, USA
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Karen M Goldstein
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 411 West Chapel Hill St., Suite 600, Durham, NC, 27701, USA
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
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Butow P, Shepherd HL, Cuddy J, Rankin N, Harris M, He S, Grimison P, Girgis A, Faris M, Shaw J. Staff perspectives on the feasibility of a clinical pathway for anxiety and depression in cancer care, and mid-implementation adaptations. BMC Health Serv Res 2022; 22:192. [PMID: 35164772 PMCID: PMC8842573 DOI: 10.1186/s12913-022-07532-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/14/2021] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Clinical pathways (CPs) are intended to standardise and improve care but do not always produce positive outcomes, possibly because they were not adapted to suit the specific context in which they were enacted. This qualitative study aimed to explore staff perspectives of implementation of a CP for routine screening, assessment, referral and management of anxiety and depression (the ADAPT CP) for patients with cancer, focussing on perceived feasibility of the CP and negotiated adaptations made during the implementation phase. METHODS The ADAPT CP was implemented in 12 urban and regional oncology services in Australia. Services were randomised to receive core versus enhanced implementation strategies. Core sites received support until implementation commencement and could access progress reports. Enhanced sites received proactive, ongoing support during the 12-month implementation. Purposively selected staff were interviewed prior to implementation (n = 88) and 6 months later, half-way through the implementation period (n = 89). Monthly meetings with lead multi-disciplinary teams at the eight enhanced sites were recorded. Data were thematically analysed. RESULTS Six overarching themes were identified: ADAPT is of high value; timing for introducing the CP and screening is difficult; online screening is challenging; a burden too much; no-one to refer patients to; and micro-logistics are key. While early screening was deemed desirable, diverse barriers meant this was complex, with adaptations made to time and screening location. Online screening prompted by email, seen as time-saving and efficient, also proved unsuccessful in some services, with adaptations made to in-clinic or phone screening, or repeated email reminders. Staff negative attitudes to ADAPT, time constraints, and perceived poor fit of ADAPT to work roles and flows, all impacted implementation, with key tasks often devolving to a few key individuals. Nevertheless, services remained committed to the ADAPT CP, and worked hard to create, review and adapt strategies to address challenges to optimise success. CONCLUSIONS This study demonstrates the interactive nature of health service change, with staff actively engaging with, forming views on, and problem-solving adaptations of the ADAPT CP to overcome barriers. Obtaining staff feedback is critical to ensure health service change is sustainable, meaningful and achieves its promise of improving patient outcomes. TRIAL REGISTRATION The study was registered prospectively with the ANZCTR on 22/3/2017. Trial ID ACTRN12617000411347.
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Affiliation(s)
- Phyllis Butow
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, NSW, 2006, Australia
| | - Heather L Shepherd
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, NSW, 2006, Australia.
| | - Jessica Cuddy
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, NSW, 2006, Australia
| | - Nicole Rankin
- The University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Marnie Harris
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, NSW, 2006, Australia
| | - Sharon He
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, NSW, 2006, Australia
| | | | - Afaf Girgis
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Kensington, Australia
| | - Mona Faris
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, NSW, 2006, Australia
| | - Joanne Shaw
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, NSW, 2006, Australia
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Lobczowska K, Banik A, Romaniuk P, Forberger S, Kubiak T, Meshkovska B, Neumann-Podczaska A, Kaczmarek K, Scheidmeir M, Wendt J, Scheller DA, Wieczorowska-Tobis K, Steinacker JM, Zeeb H, Luszczynska A. Frameworks for implementation of policies promoting healthy nutrition and physically active lifestyle: systematic review. Int J Behav Nutr Phys Act 2022; 19:16. [PMID: 35151330 PMCID: PMC8841124 DOI: 10.1186/s12966-021-01242-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/23/2021] [Indexed: 12/21/2022] Open
Abstract
Abstract
Background
Policy frameworks focusing on policy implementation may vary in terms of their scope, included constructs, relationships between the constructs, and context factors. Although multiple policy implementation frameworks exist, the overarching synthesis characterizing differences between the frameworks is missing. This study investigated frameworks guiding implementation of policies aiming at healthy nutrition, physical activity promotion, and a reduction of sedentary behavior. In particular, we aimed at examining the scope of the frameworks and the content of included constructs (e.g., referring to implementation processes, determinants, or implementation evaluation), the level at which these constructs operate (e.g., the individual level, the organizational/community level), relationships between the constructs, and the inclusion of equity factors.
Methods
A systematic review (the PROSPERO registration no. CRD42019133251) was conducted using 9 databases and 8 stakeholder websites. The content of 38 policy implementation frameworks was coded and analyzed.
Results
Across the frameworks, 47.4% (18 in 38) addressed three aims: description of the process, determinants, and the evaluation of implementation. The majority of frameworks (65.8%; 25 in 38) accounted for constructs from three levels: individual, organizational/community, and the system level. System-level constructs were included less often (76.3%; 29 in 38) than individual-level or organizational/community-level constructs (86.8% [33 in 38 frameworks] and 94.7% [36 in 38 frameworks] respectively). The majority of frameworks (84.2%, 32 in 38) included at least some sections that were solely of descriptive character (a list of unassociated constructs); 50.0% (19 in 38) included sections of prescriptive character (general steps of implementation); 60.5% (23 in 38) accounted for explanatory sections (assuming bi- or uni-directorial associations). The complex system approach was accounted for only in 21.1% (8 in 38) of frameworks. More than half (55.3%; 21 in 38) of frameworks did not account for any equity constructs (e.g., socioeconomic status, culture).
Conclusions
The majority of policy implementation frameworks have two or three aims (combining processes, determinants and/or the evaluation of implementation), include multi-level constructs (although the system-level determinants are less frequently included than those from the individual- or organizational/community-level), combine sections of purely descriptive character with sections accounting for prescriptive and/or explanatory associations, and are likely to include a little or no equity constructs.
Registration
PROSPERO, #CRD42019133251.
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Weiting H, Karthik G, Chua T, Graves N. Is a novel diagnostic pathway for cardiology outpatient clinics in Singapore lower cost than existing practice: a cost modelling study. BMJ Open 2022; 12:e050553. [PMID: 35105569 PMCID: PMC8808421 DOI: 10.1136/bmjopen-2021-050553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 01/13/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the potential for change to costs from a decision to adopt a novel diagnostic pathway for referrals to cardiology outpatients with symptoms of chest pain. DESIGN Costs modelling study using existing observational data, with a cost year of 2018. SETTING Specialist Heart Centre in Singapore. PARTICIPANTS All new referrals (n=10 622) to the outpatient clinics for investigation between January 2017 and December 2017. INTERVENTIONS Two competing testing regimes are compared in a decision tree model. Current practice includes classification of patients by their risk and the use of treadmill tests, calcium scores, functional testing and CT angiogram. New practice offers a fundamental difference in use of diagnostics for patients, with some offered angiogram directly and for low-risk patients a calcium score is used to refine risk stratification. OUTCOME MEASURES The expected cost difference between testing alternatives. RESULTS The expected cost saving from 'New Practice' as compared with 'Current Practice' is $S764 per patient. There is a 50% probability the savings per patient range between $S764 and $S824 and a 90% probability they are between $S616 and $S912. The expected savings to Singapore national health services are $S26.8 million annually, with a range of $S16.2 to $S41.1 million. CONCLUSIONS We find some evidence that using a coronary calcium score, which can be performed with a fraction of the time and cost of a CT coronary angiogram, saves costs to health services.
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Affiliation(s)
- Huang Weiting
- Cardiology, National Heart Centre Singapore, Singapore
| | | | - Terrance Chua
- Cardiology, National Heart Centre Singapore, Singapore
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Yue J, Liu J, Zhao Y, Williams S, Zhang B, Zhang L, Zhang Q, Liu X, Wall S, Zhao G. Evaluating factors that influenced the successful implementation of an evidence-based neonatal care intervention in Chinese hospitals using the PARIHS framework. BMC Health Serv Res 2022; 22:104. [PMID: 35078471 PMCID: PMC8787972 DOI: 10.1186/s12913-022-07493-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Evidence based interventions (EBIs) can improve patient care and outcomes. Understanding the process for successfully introducing and implementing EBIs can inform effective roll-out and scale up. The Promoting Action on Research Implementation in Health Services (PARIHS) framework can be used to evaluate and guide the introduction and implementation of EBIs. In this study, we used kangaroo mother care (KMC) as an example of an evidence-based neonatal intervention recently introduced in selected Chinese hospitals, to identify the factors that influenced its successful implementation. We also explored the utility of the PARIHS framework in China and investigated how important each of its constructs (evidence, context and facilitation) and sub-elements were perceived to be to successful implementation of EBIs in a Chinese setting. Method We conducted clinical observations and semi-structured interviews with 10 physicians and 18 nurses in five tertiary hospitals implementing KMC. Interview questions were organized around issues including knowledge and beliefs, resources, culture, implementation readiness and climate. We used directed content analysis to analyze the interview transcript, amending the PARIHS framework to incorporate emerging sub-themes. We also rated the constructs and sub-elements on a continuum from “low (weak)”, “moderate” or “high (strong)” highlighting the ones considered most influential for hospital level implementation by study participants. Results Using KMC as an example, our finding suggest that clinical experience, culture, leadership, evaluation, and facilitation are highly influential elements for EBI implementation in China. External evidence had a moderate impact, especially in the initial awareness raising stages of implementation and resources were also considered to be of moderate importance, although this may change as implementation progresses. Patient experience was not seen as a driver for implementation at hospital level. Conclusion Based on our findings examining KMC implementation as a case example, the PARIHS framework can be a useful tool for planning and evaluating EBI implementation in China. However, it’s sub-elements should be assessed and adapted to the implementation setting. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07493-6.
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Ljungblad LW, Skovdahl K, McCormack B, Dahl B. "Keep It Simple"-Co-Creation of a Tailored Newborn Resuscitation Course for Midwifery Students. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:81-93. [PMID: 35082549 PMCID: PMC8785135 DOI: 10.2147/amep.s346991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE To develop a tailored newborn resuscitation course for midwifery students. PATIENTS AND METHODS A qualitative study using an explorative, abductive approach was applied. Co-creation through workshops was facilitated to develop a tailored newborn resuscitation course for midwifery students. Four workshops with midwifery students and midwives were conducted from May to October 2020. Twenty participants attended one workshop of their choice. Five out of Norway's six midwifery education programmes participated, and included midwives from across Norway. All workshops were held digitally via the Zoom platform. A seven-step framework analysis method was applied to analyse the workshop data. RESULTS We identified four themes: 1) practice guidance, 2) technical skills 3) non-technical skills 4) innovative methods. CONCLUSION Findings emphasize the importance of practice guidance, technical skills, non-technical skills and innovative methods to facilitate the learning process. However, these skills cannot be acquired without the context to facilitate them, and thus a supportive culture is essential to sustain newborn resuscitation expertise as a midwife/midwifery student. We found that midwives expressed the same need to learn, train and prepare themselves for newborn resuscitation as midwifery students. The importance of facilitating the learning of newborn resuscitation with low-dose, high-frequency training in a supportive culture thus matters to both midwifery students and expert midwives.
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Affiliation(s)
- Linda Wike Ljungblad
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Kirsti Skovdahl
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Brendan McCormack
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
- Centre for Person-Centred Practice Research, School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Bente Dahl
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
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145
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Pego-Reigosa JM, Peña-Gil C, Rodríguez-Lorenzo D, Altabás-González I, Pérez-Gómez N, Guzmán-Castro JH, Varela-Gestoso R, Díaz-Lambarri R, González-Carreró-López A, Míguez-Senra O, Bóveda-Fontán J, Charle-Crespo Á, Caramés-Casal FJ, Barbazán-Álvarez C, Hernández-Rodríguez Í, Maceiras-Pan F, Rodríguez-López M, Melero-González R, Rodríguez-Fernández JB. Analysis of the implementation of an innovative IT solution to improve waiting times, communication with primary care and efficiency in Rheumatology. BMC Health Serv Res 2022; 22:60. [PMID: 35022061 PMCID: PMC8754366 DOI: 10.1186/s12913-021-07455-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To describe in detail an innovative program based on telemedicine for semi-automated prioritization of referrals from Primary Care (PC) to Rheumatology, for reproducibility purposes, and to present the results of the implementation study. METHODS The context and situation were carefully analyzed, paying attention to all processes in place, referral numbers, waiting times, and number of complementary tests prior to discharge from Rheumatology. The composition of the team, aims, users, scope, and implementation phases were defined. Eight process indicators were established and measured before and 32 months after the program implementation. RESULTS The program, which includes IT circuits, algorithms based on response to specific guideline-based checklists, e-consultation, and appointments based on priority, was fully implemented in our health area after a pilot study in two PC centers. After implementation, 6185 rheumatology referrals showed an e-consultation response delay of 8.95 days, and to first face-to-face visit (after e-consultation) of 12.6 (previous delay before program implementation was 83.1 days). Resolution by e-consultation reached 20% (1195 patients did not need seeing the rheumatologist to have the problem solved), and 1369 patients (32%) were discharged after the first visit. The overall resolution rate was 44.0% (2564 discharges/5830 e-consultations). From a random sample of 100 visits, only 10% of patients needed additional complementary tests to make a diagnosis and decision by Rheumatology (20.9% decrease from previous period). CONCLUSION A careful analysis of the situation and processes, with implementation of simple IT circuits, allows for the improvement of the efficiency and resolution of problems in Rheumatology.
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Affiliation(s)
- José María Pego-Reigosa
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
- IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | - Carlos Peña-Gil
- Cardiology Department, Santiago de Compostela Health Area, Santiago de Compostela, Spain
- Service of Research, Education, and Innovation, Galician Health Service, Santiago de Compostela, Spain
| | | | - Irene Altabás-González
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
- IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | - Naír Pérez-Gómez
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
- IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | - John Henry Guzmán-Castro
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | | | | | | | | | | | | | | | - Ceferino Barbazán-Álvarez
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | - Íñigo Hernández-Rodríguez
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | - Francisco Maceiras-Pan
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
- IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | - Marina Rodríguez-López
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | - Rafael Melero-González
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
- IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, Alto do Meixoeiro s/n, 36200 Vigo, Spain
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146
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What Does a Systems Approach to Quality Improvement Look Like in Practice? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020747. [PMID: 35055568 PMCID: PMC8775800 DOI: 10.3390/ijerph19020747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/02/2022] [Indexed: 12/10/2022]
Abstract
Universally improving healthcare systems is difficult to achieve in practice with organisations implementing a range of quality improvement (QI) approaches, in varying and changing contexts, and efforts ranging from project-based improvements to whole system change. This study aimed to identify how organisations overcome the challenges to improving the quality of the services they deliver. Drawing on the eight challenges from the ‘Quality and Safety in Europe by Research (QUASER) hospital guide, we assessed eight cases reported by the UK-based regulator Care Quality Commission as improving their performance. A thematic analysis of these secondary data established that all eight challenges had been addressed or considered in varying degrees. Education and physical and technological challenges seemed less prominent than developments made to address other challenges such as developing leadership, structure, and culture to support improving quality. This paper relies on the analysis of secondary case data and one framework to assess improvement efforts. Further research is required to consider other models and frameworks and to collate longitudinal data to capture the dynamics and increasing the maturity of improving healthcare systems in practice.
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147
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Steinberg A, Grayek E, Arnold RM, Callaway C, Fischhoff B, Krishnamurti T, Mohan D, White DB, Elmer J. Physicians' cognitive approach to prognostication after cardiac arrest. Resuscitation 2022; 173:112-121. [PMID: 35017011 PMCID: PMC8983442 DOI: 10.1016/j.resuscitation.2022.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 12/02/2021] [Accepted: 01/03/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Elucidate how physicians formulate a neurological prognosis after cardiac arrest and compare differences between experts and general providers. METHODS We performed semi-structured interviews with experts in post-arrest care and general physicians. We created an initial model and interview guide based on professional society guidelines. Two authors independently coded interviews based on this initial model, then identified new topics not included in it. To describe individual physicians' cognitive approach to prognostication, we created a graphical representation. We summarized these individual "mental models" into a single overall model, as well as two models stratified by expertise. RESULTS We performed 36 interviews (17 experts and 19 generalists), most of whom practice in Europe (23) or North America (12). Participants described their approach to prognosis formulation as complex and iterative, with sequential and repeated data acquisition, interpretation, and prognosis formulation. Eventually, this cycle results in a final prognosis and treatment recommendation. Commonly mentioned factors were diagnostic test performance, time from arrest, patient characteristics. Participants also discussed factors rarely discussed in prognostication research including physician and hospital characteristics. We found no substantial differences between experts and general physicians. CONCLUSION Physicians' cognitive approach to neurologic prognostication is complex and influenced by many factors, including some rarely considered in current research. Understanding these processes better could inform interventions designed to aid physicians in prognostication.
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Affiliation(s)
- Alexis Steinberg
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Emily Grayek
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Robert M Arnold
- Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Clifton Callaway
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Baruch Fischhoff
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA; Institute for Politics and Strategy, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Tamar Krishnamurti
- Department of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Deepika Mohan
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Douglas B White
- Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jonathan Elmer
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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148
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Pestka DL, White KM, DeRoche KK, Benson BJ, Beebe TJ. 'Trying to fly the plane while we were building it'. Applying a learning health systems approach to evaluate early-stage barriers and facilitators to implementing primary care transformation: a qualitative study. BMJ Open 2022; 12:e053209. [PMID: 34980618 PMCID: PMC8724704 DOI: 10.1136/bmjopen-2021-053209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE A learning health system (LHS) uses data to generate evidence and answer questions required to continually improve system performance and patient care. Given the complexities of practice transformation, an area where LHS is particularly important is the study of primary care transformation (PCT) as PCT generates several practice-level questions that require study where the findings can be readily implemented. In May 2019, a large integrated health delivery system in Minnesota began implementation of a population management PCT in two of its 40 primary care clinics. In this model of care, patients are grouped into one of five service bundles based on their complexity of care; patient appointment lengths and services provided are then tailored to each service bundle. The objective of this study was to examine the use of a LHS in PCT by utilising the Consolidated Framework for Implementation Research (CFIR) to categorise implementation lessons from the initial two PCT clinics to inform further implementation of the PCT within the health system. DESIGN This was a formative evaluation in which semistructured qualitative interviews were carried out. Observational field notes were also taken. Inductive coding of the data was performed and resultant codes were mapped to the CFIR. SETTING Two suburban primary care clinics in the Twin Cities, Minnesota. PARTICIPANTS Twenty-two care team members from the first two clinics to adopt the PCT. RESULTS Seventeen codes emerged to describe care team members' perceived implementation influences. Codes occurred in each of the five CFIR domains (intervention characteristics, outer setting, inner setting, characteristics of individuals and process), with most codes occurring in the 'inner setting' domain. CONCLUSIONS Using an LHS approach to determine early-stage implementation influences is key to guiding further PCT implementation, understanding modifications that need to be made and additional research that needs to occur.
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Affiliation(s)
- Deborah L Pestka
- College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Katie M White
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Bradley J Benson
- School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Timothy J Beebe
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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Subramanian L, Desai M, Miller KA, Healey AJ, Henrich N. The Atlas Context Data Repository: A Feasible, Acceptable, and Useful Prototype for Context Data Collection and Future Predictive Analysis. Jt Comm J Qual Patient Saf 2022; 48:250-261. [DOI: 10.1016/j.jcjq.2022.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 11/25/2022]
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150
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He S, Lim CYS, Dhillon HM, Shaw J. Australian oncology health professionals' knowledge, perceptions, and clinical practice related to cancer-related cognitive impairment and utility of a factsheet. Support Care Cancer 2022; 30:4729-4738. [PMID: 35122530 PMCID: PMC9046357 DOI: 10.1007/s00520-022-06868-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/24/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Cancer-related cognitive impairment (CRCI) can have debilitating effects on cancer survivors' quality of life. Despite this, patients often report a lack of information provided by health professionals (HPs) to assist with understanding and managing cognitive changes. This study aimed to explore Australian oncology HPs' understanding of and clinical practice related to CRCI including the use of a Cancer Council Australia CRCI factsheet. METHODS Australian oncology HPs (medical oncologists, cancer nurses, and clinical psychologists) completed a questionnaire that assessed CRCI knowledge, prior to receiving the factsheet. Semi-structured interviews were conducted to explore their perceptions of CRCI and the factsheet. Interviews were recorded, transcribed, and analyzed using framework analysis to identify key themes. RESULTS Questionnaires were completed by twenty-nine HPs. Most HPs had moderate to high knowledge of CRCI, yet low knowledge of the relationship between CRCI and cancer. Twenty-six (response rate 90%) HPs; medical oncologists (n = 7), cancer nurses (n = 12), and clinical psychologists (n = 7), consented to be interviewed. Three main themes were identified: (1) Is CRCI impact real or over-rated?; (2) If it is important, they will tell me: identifying and responding to CRCI in clinical practice; and (3) Using a factsheet in clinical practice. CONCLUSION This study's multi-disciplinary exploration of Australian oncology HPs' perceptions of CRCI highlighted that health professional perceptions drive CRCI discussions with patients. Further education to support clinicians to discuss CRCI is required. Consideration of the barriers and facilitators within healthcare settings is important for successful integration of the factsheet into routine care.
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Affiliation(s)
- Sharon He
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW Australia ,Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW Australia
| | - Chloe Yi Shing Lim
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW Australia ,Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW Australia
| | - Haryana M. Dhillon
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW Australia ,Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW Australia ,Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW Australia
| | - Joanne Shaw
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW Australia ,Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW Australia
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