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Trebble TM, Heyworth N, Clarke N, Powell T, Hockey PM. Managing hospital doctors and their practice: what can we learn about human resource management from non-healthcare organisations? BMC Health Serv Res 2014; 14:566. [PMID: 25412841 PMCID: PMC4245740 DOI: 10.1186/s12913-014-0566-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 10/27/2014] [Indexed: 12/03/2022] Open
Abstract
Background Improved management of clinicians’ time and practice is advocated to address increasing demands on healthcare provision in the UK National Health Service (NHS). Human resource management (HRM) is associated with improvements in organisational performance and outcomes within and outside of healthcare, but with limited use in managing individual clinicians. This may reflect the absence of effective and transferrable models. Methods The current systems of managing the performance of individual clinicians in a secondary healthcare organisation were reviewed through the study of practice in 10 successful partnership organisations, including knowledge worker predominant, within commercial, public and voluntary sector operating environments. Reciprocal visits to the secondary healthcare environment were undertaken. Results Six themes in performance related HRM were identified across the external organisations representing best practice and considered transferrable to managing clinicians in secondary care organisations. These included: performance measurement through defined outcomes at the team level with decision making through local data interpretation; performance improvement through empowered formal leadership with organisational support; individual performance review (IPR); and reward, recognition and talent management. The role of the executive was considered essential to support and implement effective HRM, with management of staff performance, behaviour and development integrated into organisational strategy, including through the use of universally applied values and effective communication. These approaches reflected many of the key aspects of high performance work systems and strategic HRM. Conclusions There is the potential to develop systems of HRM of individual clinicians in secondary healthcare to improve practice. This should include both performance measurement and performance improvement but also engagement at an organisational level. This suggests that effective HRM and performance management of individual clinicians may be possible but requires an alternative approach for the NHS.
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Tiedemann A, Sturnieks DL, Hill AM, Lovitt L, Clemson L, Lord SR, Harvey L, Sherrington C. Does a fall prevention educational programme improve knowledge and change exercise prescribing behaviour in health and exercise professionals? A study protocol for a randomised controlled trial. BMJ Open 2014; 4:e007032. [PMID: 25410607 PMCID: PMC4244414 DOI: 10.1136/bmjopen-2014-007032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Falling in older age is a serious and costly problem. At least one in three older people fall annually. Although exercise is recognised as an effective fall prevention intervention, low numbers of older people engage in suitable programmes. Health and exercise professionals play a crucial role in addressing fall risk in older adults. This trial aims to evaluate the effect of participation in a fall prevention educational programme, compared with a wait-list control group, on health and exercise professionals' knowledge about fall prevention and the effect on fall prevention exercise prescription behaviour and confidence to prescribe the exercises to older people. METHODS AND ANALYSIS A randomised controlled trial involving 220 consenting health and exercise professionals will be conducted. Participants will be individually randomised to an intervention group (n=110) to receive an educational workshop plus access to internet-based support resources, or a wait-list control group (n=110). The two primary outcomes, measured 3 months after randomisation, are: (1) knowledge about fall prevention and (2) self-perceived change in fall prevention exercise prescription behaviour. Secondary outcomes include: (1) participants' confidence to prescribe fall prevention exercises; (2) the proportion of people aged 60+ years seen by trial participants in the past month who were prescribed fall prevention exercise; and (3) the proportion of fall prevention exercises prescribed by participants to older people in the past month that comply with evidence-based guidelines. Outcomes will be measured with a self-report questionnaire designed specifically for the trial. ETHICS AND DISSEMINATION The trial protocol was approved by the Human Research Ethics Committee, The University of Sydney, Australia. Trial results will be disseminated via peer reviewed journals, presentations at international conferences and participants' newsletters. TRIAL REGISTRATION NUMBER Trial protocol was registered with the Australian and New Zealand Clinical Trials Registry (Number ACTRN12614000224628) on 3 March 2014.
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Affiliation(s)
- A Tiedemann
- Musculoskeletal Division, The George Institute for Global Health, Sydney, New South Wales, Australia Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - D L Sturnieks
- Neuroscience Research Australia, The University of New South Wales, Randwick, New South Wales, Australia
| | - A-M Hill
- The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - L Lovitt
- Clinical Excellence Commission, New South Wales Ministry of Health, Sydney, New South Wales, Australia
| | - L Clemson
- Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
| | - S R Lord
- Neuroscience Research Australia, The University of New South Wales, Randwick, New South Wales, Australia
| | - L Harvey
- Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - C Sherrington
- Musculoskeletal Division, The George Institute for Global Health, Sydney, New South Wales, Australia Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
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153
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Sales AE, Schalm C, Baylon MAB, Fraser KD. Data for improvement and clinical excellence: report of an interrupted time series trial of feedback in long-term care. Implement Sci 2014; 9:161. [PMID: 25384801 PMCID: PMC4230368 DOI: 10.1186/s13012-014-0161-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 10/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is considerable evidence about the effectiveness of audit coupled with feedback for provider behavior change, although few feedback interventions have been conducted in long-term care settings. The primary purpose of the Data for Improvement and Clinical Excellence-Long-Term Care (DICE-LTC) project was to assess the effects of a feedback intervention delivered to all direct care providers on resident outcomes. Our objective in this report is to assess the effect of feedback reporting on rates of pain assessment, depression screening, and falls over time. METHODS The intervention consisted of monthly feedback reports delivered to all direct care providers, facility and unit administrators, and support staff, delivered over 13 months in nine LTC units across four facilities. Data for feedback reports came from the Resident Assessment Instrument Minimum Data Set (RAI) version 2.0, a standardized instrument mandated in LTC facilities throughout Alberta. The primary evaluation used an interrupted time series design with a comparison group (units not included in the feedback intervention) and a comparison condition (pressure ulcers). We used segmented regression analysis to assess the effect of the feedback intervention. RESULTS The primary outcome of the study, falls, showed little change over the period of the intervention, except for a small increase in the rate of falls during the intervention period. The only outcome that improved during the intervention period was the proportion of residents with high pain scores, which decreased at the beginning of the intervention. The proportion of residents with high depression scores appeared to worsen during the intervention. CONCLUSIONS Maintaining all nine units in the study for its 13-month duration was a positive outcome. The feedback reports, without any other intervention included, did not achieve the desired reduction in proportion of falls and elevated depression scores. The survey on intention to change pain assessment practice which was conducted shortly after most of the feedback distribution cycles may have acted as a co-intervention supporting a reduction in pain scores. The processing and delivery of feedback reports could be accomplished at relatively low cost because the data are mandated and could be added to other intervention approaches to support implementation of evidence-based practices.
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Affiliation(s)
- Anne E Sales
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. .,Division of Nursing Business and Health Systems, School of Nursing, University of Michigan, 400 N. Ingalls Street, Ann Arbor, MI, 48109-5482, USA.
| | | | | | - Kimberly D Fraser
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
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Ramos-Morcillo AJ, Ruzafa-Martínez M, Fernández-Salazar S, del-Pino-Casado R, Armero Barranco D. [Attitudes of physicians and nurses towards health prevention and promotion activities in Primary Care]. Aten Primaria 2014; 46:483-91. [PMID: 24768655 PMCID: PMC6985606 DOI: 10.1016/j.aprim.2014.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 02/05/2014] [Accepted: 02/05/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the attitudes of physicians and registered nurses in the Andalusian Public Health System towards preventive and health promotion (PHP) interventions in the context of Primary Health Care and the relationship with occupational variables and self-reported competence in PHP. DESIGN Multicenter, observational, descriptive study. LOCATION Primary Health Care (PHC), Andalusia, Spain. PARTICIPANTS A total of 282 professionals (physicians and nurses) from 22 Healthcare centers of the Andalusian public health system and who participated in the validation of CAPPAP were included. PRINCIPAL MEASUREMENTS The attitude of physicians and registered nurses towards PHP activities consisted of five dimensions: improvements necessary, perception of peers attitude, importance, obstacles, and improvement opportunities. The validated CAPPAP questionnaire was used. Occupational variables and questions about self-reported competence in PHP were also included. RESULTS All dimensions of CAPPAP exceeded the midpoint of the scale (2.5), with their values varying between 3.06 (SD: 0.76) in "improvement necessary", and 4.39 (SD: 0.49) in "importance". The self-declared social, occupational, and competences variables have a statistically significant relationship with the dimensions of the attitude of the professionals except: job experience in PHC, training and implementation of scheduled PHP activities. CONCLUSIONS The attitudes of physicians and registered nurses towards PHP activities are acceptable, and work must be done to sustain it. Healthcare organizations should implement interventions adapted to different professional profiles. They should also increase activities to improve professional skills in order to provide the appropriate care.
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Affiliation(s)
| | | | - Serafín Fernández-Salazar
- Hospital de Alta Resolución Sierra de Segura, Agencia Sanitaria Alto Guadalquivir, Puente de Génave, Jaén, España
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Barnett KN, Bennie M, Treweek S, Robertson C, Petrie DJ, Ritchie LD, Guthrie B. Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) a pragmatic three-arm cluster randomised trial: designing the intervention (ClinicalTrials.gov registration NCT01602705). Implement Sci 2014; 9:133. [PMID: 25304255 PMCID: PMC4201916 DOI: 10.1186/s13012-014-0133-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 09/19/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND High-risk prescribing in primary care is common and causes considerable harm. Feedback interventions have small/moderate effects on clinical practice, but few trials explicitly compare different forms of feedback. There is growing recognition that intervention development should be theory-informed, and that comprehensive reporting of intervention design is required by potential users of trial findings. The paper describes intervention development for the Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) study, a pragmatic three-arm cluster randomised trial in 262 Scottish general practices. METHODS The NHS chose to implement a feedback intervention to utilise a new resource, new Prescribing Information System (newPIS). The development phase required selection of high-risk prescribing outcome measures and design of intervention components: (1) educational material (the usual care comparison), (2) feedback of practice rates of high-risk prescribing received by both intervention arms and (3) a theory-informed behaviour change component to be received by one intervention arm. Outcome measures, educational material and feedback design, were developed with a National Health Service Advisory Group. The behaviour change component was informed by the Theory of Planned Behaviour and the Health Action Process Approach. A focus group elicitation study and an email Delphi study with general practitioners (GPs) identified key attitudes and barriers of responding to the prescribing feedback. Behaviour change techniques were mapped to the psychological constructs, and the content was informed by the results of the elicitation and Delphi study. RESULTS Six high-risk prescribing measures were selected in a consensus process based on importance and feasibility. Educational material and feedback design were based on current NHS Scotland practice and Advisory Group recommendations. The behaviour change component was resource constrained in development, mirroring what is feasible in an NHS context. Four behaviour change interventions were developed and embedded in five quarterly rounds of feedback targeting attitudes, subjective norms, perceived behavioural control and action planning (2×). CONCLUSIONS The paper describes a process which is feasible to use in the resource-constrained environment of NHS-led intervention development and documents the intervention to make its design and implementation explicit to potential users of the trial findings. TRIAL REGISTRATION ClinicalTrials.gov: NCT01602705.
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Affiliation(s)
- Karen N Barnett
- />Centre of Population Health Sciences, University of Edinburgh Medical Quad, Teviot Place, Edinburgh EH8 9AG UK
| | - Marion Bennie
- />Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, The John Arbuthnott Building, 161 Cathedral Street, Glasgow, G4 ORE UK
| | - Shaun Treweek
- />Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD UK
| | - Christopher Robertson
- />Department of Mathematics and Statistics, University of Strathclyde, Livingstone Tower 26 Richmond Street, Glasgow, G1 1XH UK
| | - Dennis J Petrie
- />Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Victoria, 3010 Australia
| | - Lewis D Ritchie
- />Centre of Academic Primary Care, School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD UK
| | - Bruce Guthrie
- />Quality, Safety and Informatics Research Group, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF UK
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Lorencatto F, Stanworth SJ, Gould NJ. Bridging the research to practice gap in transfusion: the need for a multidisciplinary and evidence-based approach. Transfusion 2014; 54:2588-92. [DOI: 10.1111/trf.12793] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Fabiana Lorencatto
- Division of Health Services Research and Management; City University London; London UK
| | - Simon J. Stanworth
- NHS Blood and Transplant/Oxford University Hospitals NHS Trust; John Radcliffe Hospital
- Radcliffe Department of Medicine; University of Oxford; Oxford UK
| | - Natalie J. Gould
- Division of Health Services Research and Management; City University London; London UK
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Squires JE, Sullivan K, Eccles MP, Worswick J, Grimshaw JM. Are multifaceted interventions more effective than single-component interventions in changing health-care professionals' behaviours? An overview of systematic reviews. Implement Sci 2014; 9:152. [PMID: 25287951 PMCID: PMC4194373 DOI: 10.1186/s13012-014-0152-6] [Citation(s) in RCA: 211] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 09/25/2014] [Indexed: 12/30/2022] Open
Abstract
Background One of the greatest challenges in healthcare is how to best translate research evidence into clinical practice, which includes how to change health-care professionals’ behaviours. A commonly held view is that multifaceted interventions are more effective than single-component interventions. The purpose of this study was to conduct an overview of systematic reviews to evaluate the effectiveness of multifaceted interventions in comparison to single-component interventions in changing health-care professionals’ behaviour in clinical settings. Methods The Rx for Change database, which consists of quality-appraised systematic reviews of interventions to change health-care professional behaviour, was used to identify systematic reviews for the overview. Dual, independent screening and data extraction was conducted. Included reviews used three different approaches (of varying methodological robustness) to evaluate the effectiveness of multifaceted interventions: (1) effect size/dose-response statistical analyses, (2) direct (non-statistical) comparisons of multifaceted to single interventions and (3) indirect comparisons of multifaceted to single interventions. Results Twenty-five reviews were included in the overview. Three reviews provided effect size/dose-response statistical analyses of the effectiveness of multifaceted interventions; no statistical evidence of a relationship between the number of intervention components and the effect size was found. Eight reviews reported direct (non-statistical) comparisons of multifaceted to single-component interventions; four of these reviews found multifaceted interventions to be generally effective compared to single interventions, while the remaining four reviews found that multifaceted interventions had either mixed effects or were generally ineffective compared to single interventions. Twenty-three reviews indirectly compared the effectiveness of multifaceted to single interventions; nine of which also reported either a statistical (dose-response) analysis (N = 2) or a non-statistical direct comparison (N = 7). The majority (N = 15) of reviews reporting indirect comparisons of multifaceted to single interventions showed similar effectiveness for multifaceted and single interventions when compared to controls. Of the remaining eight reviews, six found single interventions to be generally effective while multifaceted had mixed effectiveness. Conclusion This overview of systematic reviews offers no compelling evidence that multifaceted interventions are more effective than single-component interventions. Electronic supplementary material The online version of this article (doi:10.1186/s13012-014-0152-6) contains supplementary material, which is available to authorized users.
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Salam RA, Lassi ZS, Das JK, Bhutta ZA. Evidence from district level inputs to improve quality of care for maternal and newborn health: interventions and findings. Reprod Health 2014; 11 Suppl 2:S3. [PMID: 25208460 PMCID: PMC4160920 DOI: 10.1186/1742-4755-11-s2-s3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
District level healthcare serves as a nexus between community and district level facilities. Inputs at the district level can be broadly divided into governance and accountability mechanisms; leadership and supervision; financial platforms; and information systems. This paper aims to evaluate the effectivness of district level inputs for imporving maternal and newborn health. We considered all available systematic reviews published before May 2013 on the pre-defined district level interventions and included 47 systematic reviews. Evidence suggests that supervision positively influenced provider’s practice, knowledge and client/provider satisfaction. Involving local opinion leaders to promote evidence-based practice improved compliance to the desired practice. Audit and feedback mechanisms and tele-medicine were found to be associated with improved immunization rates and mammogram uptake. User-directed financial schemes including maternal vouchers, user fee exemption and community based health insurance showed significant impact on maternal health service utilization with voucher schemes showing the most significant positive impact across all range of outcomes including antenatal care, skilled birth attendant, institutional delivery, complicated delivery and postnatal care. We found insufficient evidence to support or refute the use of electronic health record systems and telemedicine technology to improve maternal and newborn health specific outcomes. There is dearth of evidence on the effectiveness of district level inputs to improve maternal newborn health outcomes. Future studies should evaluate the impact of supervision and monitoring; electronic health record and tele-communication interventions in low-middle-income countries.
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Fàbregas M, Berges I, Fina F, Hermosilla E, Coma E, Méndez L, Medina M, Calero S, Serrano E, Morros R, Monteagudo M, Bolíbar B. Effectiveness of an intervention designed to optimize statins use: a primary prevention randomized clinical trial. BMC FAMILY PRACTICE 2014; 15:135. [PMID: 25027229 PMCID: PMC4112648 DOI: 10.1186/1471-2296-15-135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 07/08/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although hypercholesterolemia is considered a cardiovascular risk factor, in isolation it is not necessarily sufficient cause for a cardiovascular event. To improve event prediction, cardiovascular risk calculators have been developed; the REGICOR calculator has been validated for use in our population. The objective of this project is to develop an intervention with general practitioners (GPs) and evaluate its impact on prescription adequacy of cholesterol-lowering drugs in primary prevention of cardiovascular disease and in controlling the costs associated with this disease. METHODS This nonblinded, cluster-randomized clinical trial analyzes data from primary care electronic medical records (ECAP) and other databases. Inclusion criteria are patients aged 35 to 74 years with no known cardiovascular disease and a new prescription for cholesterol-lowering drugs during the 2-year study period. Dependent variables include the following: RETIRA, defined as new cholesterol-lowering drugs initiated during the year preceding the intervention, considered inadequate, and withdrawn during the study period; EVITA, defined as new cholesterol-lowering drugs initiated during the study period and considered inadequate; COST, defined as the total cost of inadequate new treatments prescribed; and REGISTER, defined as the recording of cardiovascular risk factors. Independent variables include the GP's quality-of-care indicators and randomly assigned study group (intervention vs control), patient demographics, and clinical variables. Aggregated descriptive analysis will be done at the GP level and multilevel analysis will be performed to estimate the intervention effect, adjusted for individual and GP variables. DISCUSSION The study objective is to generate evidence about the effectiveness of implementing feedback information programs directed to GPs in the context of Primary Care. The goal is to improve the prescription adequacy of lipid-lowering therapies for primary prevention. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01997671. November 28, 2013.
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Affiliation(s)
- Mireia Fàbregas
- ABS La Marina, SAP Esquerra, Institut Català de la Salut, Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | | | - Francesc Fina
- Sistemes d’Informació d’Atenció Primària (SISAP) – Sistema d’Informació per al Desenvolupament de la Investigació en Atenció Primària (SIDIAP), Institut Català de la Salut, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Eduardo Hermosilla
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Ermengol Coma
- Sistemes d’Informació d’Atenció Primària (SISAP) – Sistema d’Informació per al Desenvolupament de la Investigació en Atenció Primària (SIDIAP), Institut Català de la Salut, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Leonardo Méndez
- Sistemes d’Informació d’Atenció Primària (SISAP) – Sistema d’Informació per al Desenvolupament de la Investigació en Atenció Primària (SIDIAP), Institut Català de la Salut, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Manuel Medina
- Sistemes d’Informació d’Atenció Primària (SISAP) – Sistema d’Informació per al Desenvolupament de la Investigació en Atenció Primària (SIDIAP), Institut Català de la Salut, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Sebastià Calero
- Àrea de Desenvolupament Clínic, Direcció Adjunta d’Afers Assistencials, Institut Català de la Salut, Institut Universitari d'investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Elena Serrano
- Centre d’Atenció Primària Baix a Mar, Consell comarcal del Garraf, Vilanova i la Geltrú, Barcelona, Spain
| | - Rosa Morros
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Mònica Monteagudo
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Bonaventura Bolíbar
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
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Bergh AM, Kerber K, Abwao S, de-Graft Johnson J, Aliganyira P, Davy K, Gamache N, Kante M, Ligowe R, Luhanga R, Mukarugwiro B, Ngabo F, Rawlins B, Sayinzoga F, Sengendo NH, Sylla M, Taylor R, van Rooyen E, Zoungrana J. Implementing facility-based kangaroo mother care services: lessons from a multi-country study in Africa. BMC Health Serv Res 2014; 14:293. [PMID: 25001366 PMCID: PMC4104737 DOI: 10.1186/1472-6963-14-293] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 07/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some countries have undertaken programs that included scaling up kangaroo mother care. The aim of this study was to systematically evaluate the implementation status of facility-based kangaroo mother care services in four African countries: Malawi, Mali, Rwanda and Uganda. METHODS A cross-sectional, mixed-method research design was used. Stakeholders provided background information at national meetings and in individual interviews. Facilities were assessed by means of a standardized tool previously applied in other settings, employing semi-structured key-informant interviews and observations in 39 health care facilities in the four countries. Each facility received a score out of a total of 30 according to six stages of implementation progress. RESULTS Across the four countries 95 per cent of health facilities assessed demonstrated some evidence of kangaroo mother care practice. Institutions that fared better had a longer history of kangaroo mother care implementation or had been developed as centres of excellence or had strong leaders championing the implementation process. Variation existed in the quality of implementation between facilities and across countries. Important factors identified in implementation are: training and orientation; supportive supervision; integrating kangaroo mother care into quality improvement; continuity of care; high-level buy in and support for kangaroo mother care implementation; and client-oriented care. CONCLUSION The integration of kangaroo mother care into routine newborn care services should be part of all maternal and newborn care initiatives and packages. Engaging ministries of health and other implementing partners from the outset may promote buy in and assist with the mobilization of resources for scaling up kangaroo mother care services. Mechanisms for monitoring these services should be integrated into existing health management information systems.
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Affiliation(s)
- Anne-Marie Bergh
- MRC Unit for Maternal and Infant Health Care Strategies, University of Pretoria, Private Bag X323, Arcadia 0007, South Africa
| | | | - Stella Abwao
- Save the Children, Washington, DC, USA
- Maternal and Child Health Integrated Program (MCHIP), Washington, DC, USA
| | - Joseph de-Graft Johnson
- Save the Children, Washington, DC, USA
- Maternal and Child Health Integrated Program (MCHIP), Washington, DC, USA
| | | | - Karen Davy
- MRC Unit for Maternal and Infant Health Care Strategies, University of Pretoria, Private Bag X323, Arcadia 0007, South Africa
| | | | | | | | | | - Béata Mukarugwiro
- Maternal and Child Health Integrated Program (MCHIP), Kigali, Rwanda
- Jhpiego, Washington, DC, USA
| | | | - Barbara Rawlins
- Maternal and Child Health Integrated Program (MCHIP), Washington, DC, USA
- Jhpiego, Washington, DC, USA
| | | | | | - Mariam Sylla
- Department of Paediatrics, Gabriel Toure Teaching Hospital, Bamako, Mali
| | - Rachel Taylor
- Save the Children, Washington, DC, USA
- Maternal and Child Health Integrated Program (MCHIP), Washington, DC, USA
| | - Elise van Rooyen
- MRC Unit for Maternal and Infant Health Care Strategies, University of Pretoria, Private Bag X323, Arcadia 0007, South Africa
| | - Jeremie Zoungrana
- Maternal and Child Health Integrated Program (MCHIP), Kigali, Rwanda
- Jhpiego, Washington, DC, USA
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Management of hospital infection control in iran: a need for implementation of multidisciplinary approach. Osong Public Health Res Perspect 2014; 5:179-86. [PMID: 25379367 PMCID: PMC4214997 DOI: 10.1016/j.phrp.2014.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/01/2014] [Accepted: 06/02/2014] [Indexed: 11/28/2022] Open
Abstract
Nosocomial, or hospital-acquired, infections are considered the most common complications affecting hospitalized patients. According to results obtained from studies conducted in the Children Medical Center Hospital, a teaching children's hospital and a tertiary care referral unit in Tehran, Iran, improvements in infection control practices in our hospital seem necessary. The aim of this study was to identify risk management and review potential hospital hazards that may pose a threat to the health as well as safety and welfare of patients in an Iranian referral hospital. Barriers to compliance and poor design of facilities, impractical guidelines and policies, lack of a framework for risk management, failure to apply behavioral-change theory, and insufficient obligation and enforcement by infection control personnel highlight the need of management systems in infection control in our hospital. In addition, surveillance and early reporting of infections, evaluation of risk-based interventions, and production of evidence-based guidelines in our country are recommended.
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Buchanan H, Siegfried N, Jelsma J, Lombard C. Comparison of an interactive with a didactic educational intervention for improving the evidence-based practice knowledge of occupational therapists in the public health sector in South Africa: a randomised controlled trial. Trials 2014; 15:216. [PMID: 24916176 PMCID: PMC4061109 DOI: 10.1186/1745-6215-15-216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 05/23/2014] [Indexed: 11/10/2022] Open
Abstract
Background Despite efforts to identify effective interventions to implement evidence-based practice (EBP), uncertainty remains. Few existing studies involve occupational therapists or resource-constrained contexts. This study aimed to determine whether an interactive educational intervention (IE) was more effective than a didactic educational intervention (DE) in improving EBP knowledge, attitudes and behaviour at 12 weeks. Methods A matched pairs design, randomised controlled trial was conducted in the Western Cape of South Africa. Occupational therapists employed by the Department of Health were randomised using matched-pair stratification by type (clinician or manager) and knowledge score. Allocation to an IE or a DE was by coin-tossing. A self-report questionnaire (measuring objective knowledge and subjective attitudes) and audit checklist (measuring objective behaviour) were completed at baseline and 12 weeks. The primary outcome was EBP knowledge at 12 weeks while secondary outcomes were attitudes and behaviour at 12 weeks. Data collection occurred at participants’ places of employment. Audit raters were blinded, but participants and the provider could not be blinded. Results Twenty-one of 28 pairs reported outcomes, but due to incomplete data for two participants, 19 pairs were included in the analysis. There was a median increase of 1.0 points (95% CI = -4.0, 1.0) in the IE for the primary outcome (knowledge) compared with the DE, but this difference was not significant (P = 0.098). There were no significant differences on any of the attitude subscale scores. The median 12-week audit score was 8.6 points higher in the IE (95% CI = -7.7, 27.0) but this was not significant (P = 0.196). Within-group analyses showed significant increases in knowledge in both groups (IE: T = 4.0, P <0.001; DE: T = 12.0, P = 0.002) but no significant differences in attitudes or behaviour. Conclusions The results suggest that the interventions had similar outcomes at 12 weeks and that the interactive component had little additional effect. Trial registration Pan African Controlled Trials Register PACTR201201000346141, registered 31 January 2012. Clinical Trials NCT01512823, registered 1 February 2012. South African National Clinical Trial Register DOH2710093067, registered 27 October 2009. The first participants were randomly assigned on 16 July 2008.
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Affiliation(s)
- Helen Buchanan
- Department of Health & Rehabilitation Sciences, F45 Old Groote Schuur Hospital Building, University of Cape Town, Observatory, 7925 Cape Town, South Africa.
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Meijers JM, Tan F, Schols JM, Halfens RJ. Nutritional care; do process and structure indicators influence malnutrition prevalence over time? Clin Nutr 2014; 33:459-65. [DOI: 10.1016/j.clnu.2013.06.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 04/10/2013] [Accepted: 06/24/2013] [Indexed: 10/26/2022]
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Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L, Nyquist AC, Saiman L, Yokoe DS, Maragakis LL, Kaye KS. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35:605-27. [PMID: 24799638 PMCID: PMC4267723 DOI: 10.1086/676022] [Citation(s) in RCA: 555] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their surgical site infection (SSI) prevention efforts. This document updates “Strategies to Prevent Surgical Site Infections in Acute Care Hospitals,”1 published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.2
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Affiliation(s)
| | | | | | - Dale W. Bratzler
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | - Linda Greene
- Highland Hospital and University of Rochester Medical Center, Rochester, New York
| | - Ann-Christine Nyquist
- Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
| | - Lisa Saiman
- Columbia University Medical Center, New York, New York
| | - Deborah S. Yokoe
- Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Keith S. Kaye
- Detroit Medical Center and Wayne State University, Detroit, Michigan
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Bavozet F, Mahé I. [VKA anticoagulant bridging for an invasive procedure or planned surgery: A survey of practices in general practitioners]. Presse Med 2014; 43:e221-31. [PMID: 24785139 DOI: 10.1016/j.lpm.2013.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 12/02/2013] [Accepted: 12/11/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In 2011, 1.7 % of the French population was receiving a Vitamine K Antagonist (VKA) anticoagulant therapy. VKA related adverse events are the first cause for iatrogenic events in France. Anticoagulant bridging period is a period at both increased risk for thromboembolic and bleeding events. The Haute Autorité de santé (HAS) established in 2008 recommendations in order to help physicians to manage anticoagulant therapy in case of invasive procedure or surgery, according to the procedure and the indication of VKA. PRIMARY AIM To assess anticoagulant treatment management by general physicians when an invasive procedure or a planned surgery in a patient receiving long-term VKA Data have been compared to HAS recommendations. METHODS A descriptive transversal survey performed in general physicians à at the conference held in Nice in 2012. An anonymous questionnaire was built, including questions about clinical situations and knowledge questions. RESULTS Eighty-eight out of 200 submitted questionnaires have been completed (44%). Overall, 4.5% of questioned physicians have managed fully in accordance with HAS recommendations the 6 clinical situations cliniques about patients receiving long-term VKA for atrial fibrillation, recurrent pulmonary embolism, and mechanical valvular prothesis. Bridgings using Low Molecular Weight Heparins have been excessively proposed by asked physicians and bridging prescription was most of the time wrong (9% correct). Otherwise, no physician has answered correctly all theoretical questions; patients at high and low thromboembolic risk are not well distinguished; 64% of physicians think they are influenced by specialists who have prescribed the procedure. DISCUSSION Few physicians manage VKA therapy in accordance with HAS recommendations in case of invasive procedure. There are many hypotheses: bad knowledge of recommendations, overestimation of the thromboembolic risk related to VKA stopping during the period of the invasive procedure, underestimation of the risk of bleeding related to the bridging period of time; influence of specialists. We propose a decisional algorithm in order to improve the implementation of HAS recommendations in usual care.
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Affiliation(s)
- Florent Bavozet
- AP-HP, université Paris 7, Paris Diderot, Sorbonne Paris Cité, EA Recherche clinique, coordonnée ville-hôpital, Méthodologies et Société (REMES), hôpital Louis-Mourier, service de médecine interne, 92700 Colombes, France
| | - Isabelle Mahé
- AP-HP, université Paris 7, Paris Diderot, Sorbonne Paris Cité, EA Recherche clinique, coordonnée ville-hôpital, Méthodologies et Société (REMES), hôpital Louis-Mourier, service de médecine interne, 92700 Colombes, France.
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Prior M, Elouafkaoui P, Elders A, Young L, Duncan EM, Newlands R, Clarkson JE, Ramsay CR. Evaluating an audit and feedback intervention for reducing antibiotic prescribing behaviour in general dental practice (the RAPiD trial): a partial factorial cluster randomised trial protocol. Implement Sci 2014; 9:50. [PMID: 24758164 PMCID: PMC4108126 DOI: 10.1186/1748-5908-9-50] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antibiotic prescribing in dentistry accounts for 9% of total antibiotic prescriptions in Scottish primary care. The Scottish Dental Clinical Effectiveness Programme (SDCEP) published guidance in April 2008 (2nd edition, August 2011) for Drug Prescribing in Dentistry, which aims to assist dentists to make evidence-based antibiotic prescribing decisions. However, wide variation in prescribing persists and the overall use of antibiotics is increasing. METHODS RAPiD is a 12-month partial factorial cluster randomised trial conducted in NHS General Dental Practices across Scotland. Its aim is to compare the effectiveness of individualised audit and feedback (A&F) strategies for the translation into practice of SDCEP recommendations on antibiotic prescribing. The trial uses routinely collected electronic healthcare data in five aspects of its design in order to: identify the study population; apply eligibility criteria; carry out stratified randomisation; generate the trial intervention; analyse trial outcomes. Eligibility was determined on contract status and a minimum level of recent NHS treatment provision. All eligible dental practices in Scotland were simultaneously randomised at baseline either to current audit practice or to an intervention group. Randomisation was stratified by single-handed/multi-handed practices. General dental practitioners (GDPs) working at intervention practices will receive individualised graphical representations of their antibiotic prescribing rate from the previous 14 months at baseline and an update at six months. GDPs could not be blinded to their practice allocation. Intervention practices were further randomised using a factorial design to receive feedback with or without: a health board comparator; a supplementary text-based intervention; additional feedback at nine months. The primary outcome is the total antibiotic prescribing rate per 100 courses of treatment over the year following delivery of the baseline intervention. A concurrent qualitative process evaluation will apply theory-based approaches using the Consolidated Framework for Implementation Research to explore the acceptability of the interventions and the Theoretical Domains Framework to identify barriers and enablers to evidence-based antibiotic prescribing behaviour by GDPs. DISCUSSION RAPiD will provide a robust evaluation of A&F in dentistry in Scotland. It also demonstrates that linked administrative datasets have the potential to be used efficiently and effectively across all stages of an randomised controlled trial. TRIAL REGISTRATION Current Controlled Trials ISRCTN49204710.
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Affiliation(s)
- Maria Prior
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, UK
| | - Paula Elouafkaoui
- Dental Health Services Research Unit, University of Dundee, Park Place, Dundee, UK
- NHS Education for Scotland, Dundee Dental Education Centre, Frankland Building, Dundee, UK
| | - Andrew Elders
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, UK
| | - Linda Young
- NHS Education for Scotland, Dundee Dental Education Centre, Frankland Building, Dundee, UK
| | - Eilidh M Duncan
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, UK
| | - Rumana Newlands
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, UK
| | - Jan E Clarkson
- Dental Health Services Research Unit, University of Dundee, Park Place, Dundee, UK
- NHS Education for Scotland, Dundee Dental Education Centre, Frankland Building, Dundee, UK
| | - Craig R Ramsay
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, UK
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van Leijen-Zeelenberg JE, van Raak AJA, Duimel-Peeters IGP, Kroese MEAL, Brink PRG, Ruwaard D, Vrijhoef HJM. Barriers to implementation of a redesign of information transfer and feedback in acute care: results from a multiple case study. BMC Health Serv Res 2014; 14:149. [PMID: 24694305 PMCID: PMC3974919 DOI: 10.1186/1472-6963-14-149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 03/25/2014] [Indexed: 11/10/2022] Open
Abstract
Background Accurate information transfer is an important element of continuity of care and patient safety. Despite the demonstrated urge for improvement of communication in acute care, there is a lack of data on improvements of communication. This study aims to describe the barriers to implementation of a redesign of the existing model for information transfer and feedback. Methods A case study with six cases (i.e. acute care chains), using mixed methods was carried out in the Netherlands. The redesign was implemented in one acute care chain while the five other acute care chains served as control groups. Focus group interviews were held with members of the acute care chains and questionnaires were sent to care providers working in the acute care chains. Results Respondents reported three sets of barriers for implementation of the model: (a) existing routines for information transfer and feedback in organizations within the acute care chain; (b) barriers related to the implementation method and time period; and (c) the absence of a high ‘sense of urgency’ amongst providers in the acute care chain which would aid in improving the communication process. Conclusions This study shows that organizational factors play an important role in the success or failure of redesigning a communication process. Organizational routines can hamper implementation of a redesign if it differs too much from the routines of care providers involved. Besides focussing on provider characteristics in the implementation of a redesigned process, specific attention should be paid to unlearning existing organizational routines.
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Affiliation(s)
- Janneke E van Leijen-Zeelenberg
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
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Bannister E, Nakonezny P, Byerly M. Curricula for teaching clinical practice guidelines in US psychiatry residency and child and adolescent fellowship programs: a survey study. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2014; 38:198-204. [PMID: 24619912 DOI: 10.1007/s40596-014-0057-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 09/12/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To determine the characteristics of curricula for teaching the content of clinical practice guidelines (CPGs) in psychiatric residency and child and adolescent fellowship programs as well as to determine if and how the learning of CPG content is applied in clinical care settings. METHODS We conducted a national online survey of directors of general psychiatry residency and child and adolescent fellowship programs in the USA. The survey questionnaire included 13 brief questions about the characteristics used to teach CPGs in the programs, as well as two demographic questions about each program and director. Descriptive statistics were reported for each questionnaire item by program classification (i.e., child and adolescent vs. general psychiatry). RESULTS The survey response rate was 49.8% (146 out of 293). Just 23% of programs reported having written goals and objectives related to teaching CPGs. The most frequently taught aspect of CPGs was their content (72% of programs). Didactic sessions were the most frequently employed teaching strategy (79% of programs). Regarding the application of CPG learning in treatment care settings, just 16% of programs applied algorithms in care settings, and 15% performed evaluations to determine consistency between CPG recommendations and care delivery. Only 8% of programs utilized audit and feedback to residents about their adherence to CPGs. Faculty time constraints and insufficient interest were the leading barriers (39% and 33% of programs, respectively) to CPG teaching, although 38% reported no barriers. However, child and adolescent programs less commonly identified insufficient interest among faculty as a barrier to teaching CPGs compared to general programs (20% vs. 43%). Moreover, compared to general programs, child and adolescent fellowship programs taught more aspects of CPGs, used more educational activities to teach the content of specific CPGs, and used more methods to evaluate the teaching of CPGs. CONCLUSIONS Although the majority of programs provided some teaching of CPGs, the rigorousness of the teaching approaches was limited, especially attempts to evaluate the extent and effectiveness of their use in clinical care. Child and adolescent fellowship programs provided more extensive teaching and evaluation related to CPGs.
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Ripamonti CI, Prandi C, Costantini M, Perfetti E, Pellegrini F, Visentin M, Garrino L, De Luca A, Pessi MA, Peruselli C. The effectiveness of the quality program Pac-IficO to improve pain management in hospitalized cancer patients: a before-after cluster phase II trial. BMC Palliat Care 2014; 13:15. [PMID: 24678911 PMCID: PMC3986604 DOI: 10.1186/1472-684x-13-15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 03/19/2014] [Indexed: 11/10/2022] Open
Abstract
Background Cancer-related pain continues to be a major healthcare issue worldwide. Despite the availability of effective analgesic drugs, published guidelines and educational programs for Health Care Professionals (HCPs) the symptom is still under-diagnosed and its treatment is not appropriate in many patients. The objective of the study is to evaluate the efficacy of the Pac-IFicO programme in improving the quality of pain management in hospitalised cancer patients. Methods/design This is a before-after cluster phase II study. After the before assessment, the experimental intervention – the Pac-IFicO programme – will be implemented in ten medicine, oncology and respiratory disease hospital wards. The same assessment will be repeated after the completion of the intervention. The Pac-IFicO programme is a complex intervention with multiple components. It includes focus group with ward professionals for identifying possible local obstacles to optimal pain control, informative material for the patients, an educational program performed through guides from the wards, and an organisational intervention to the ward. The primary end-point of the study is the proportion of cancer patients with severe pain. Secondary end-points include opioids administered in the wards, knowledge in pain management, and quality of pain management. We plan to recruit about 500 cancer patients. This sample size should be sufficient, after appropriate statistical adjustments for clustering, to detect an absolute decrease in the primary end-point from 20% to 9%. Discussion This trial is aimed at exploring with an experimental approach the efficacy of a new quality improvement educational intervention. Trial registration ClinicalTrials.gov: NCT02035098
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Affiliation(s)
- Carla Ida Ripamonti
- Supportive Care in Cancer Unit, Department of Hematology and Pediatric Onco-Hematology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy.
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Clements L, Moore M, Tribble T, Blake J. Reducing Skin Breakdown in Patients Receiving Extracorporeal Membranous Oxygenation. Nurs Clin North Am 2014; 49:61-8. [DOI: 10.1016/j.cnur.2013.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Powell BJ, Proctor EK, Glass JE. A Systematic Review of Strategies for Implementing Empirically Supported Mental Health Interventions. RESEARCH ON SOCIAL WORK PRACTICE 2014; 24:192-212. [PMID: 24791131 PMCID: PMC4002057 DOI: 10.1177/1049731513505778] [Citation(s) in RCA: 157] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVE This systematic review examines experimental studies that test the effectiveness of strategies intended to integrate empirically supported mental health interventions into routine care settings. Our goal was to characterize the state of the literature and to provide direction for future implementation studies. METHODS A literature search was conducted using electronic databases and a manual search. RESULTS Eleven studies were identified that tested implementation strategies with a randomized (n = 10) or controlled clinical trial design (n = 1). The wide range of clinical interventions, implementation strategies, and outcomes evaluated precluded meta-analysis. However, the majority of studies (n = 7; 64%) found a statistically significant effect in the hypothesized direction for at least one implementation or clinical outcome. CONCLUSIONS There is a clear need for more rigorous research on the effectiveness of implementation strategies, and we provide several suggestions that could improve this research area.
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Goldner EM, Jenkins EK, Fischer B. A narrative review of recent developments in knowledge translation and implications for mental health care providers. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:160-9. [PMID: 24881165 PMCID: PMC4079124 DOI: 10.1177/070674371405900308] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Attention to knowledge translation (KT) has increased in the health care field in an effort to improve uptake and implementation of potentially beneficial knowledge. We provide an overview of the current state of KT literature and discuss the relevance of KT for health care professionals working in mental health. METHOD A systematic search was conducted using MEDLINE, PsycINFO, and CINAHL databases to identify review articles published in journals from 2007 to 2012. We selected articles on the basis of eligibility criteria and then added further articles deemed pertinent to the focus of ourpaper. RESULTS After removing duplicates, we scanned 214 review articles for relevance and, subsequently, we added 46 articles identified through hand searches of reference lists or from other sources. A total of 61 papers were retained for full review. Qualitative synthesis identified 5 main themes: defining KT and development of KT science; effective KT strategies; factors influencing the effectiveness of KT; KT frameworks and guides; and relevance of KT to health care providers. CONCLUSIONS Despite limitations in existing evidence, the concept and practice of KT holds potential value for mental health care providers. Understanding of, and familiarity with, effective approaches to KT holds the potential to enhance providers' treatment approaches and to promote the use of new knowledge in practice to enhance outcomes.
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Affiliation(s)
- Elliot M Goldner
- Professor, Centre for Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia
| | - Emily K Jenkins
- Doctoral Student, School of Nursing, University of British Columbia, Vancouver, British Columbia
| | - Benedikt Fischer
- Professor, Centre for Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia; Senior Scientist, Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario; Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario
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Murante AM, Vainieri M, Rojas D, Nuti S. Does feedback influence patient - professional communication? Empirical evidence from Italy. Health Policy 2014; 116:273-80. [PMID: 24630781 DOI: 10.1016/j.healthpol.2014.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 01/31/2014] [Accepted: 02/01/2014] [Indexed: 11/28/2022]
Abstract
Healthcare providers often look for feedback from patient surveys. Does health-professional awareness of patient survey results improve communication between patients and providers? To test this hypothesis, we analyzed the data of two surveys on organizational-climate and patient experience in Italy. The two surveys were conducted in 26 hospitals in the Tuscany region and involved 8942 employees and 5341 patients, respectively. Statistical analysis showed that the patient experience index significantly improved by 0.35 points (scale: 0-100) when the professionals' knowledge of the patient survey results increased by 1%. These findings suggest that the control systems should focus more on the dissemination phase of patient survey results among health professionals in order to improve the quality of services.
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Affiliation(s)
- Anna Maria Murante
- Scuola Superiore Sant'Anna, Istituto di Management, Laboratorio Management e Sanità, Piazza Martiri della Libertà 24, 56127 Pisa, Italy.
| | - Milena Vainieri
- Scuola Superiore Sant'Anna, Istituto di Management, Laboratorio Management e Sanità, Piazza Martiri della Libertà 24, 56127 Pisa, Italy
| | - Diana Rojas
- Scuola Superiore Sant'Anna, Istituto di Management, Laboratorio Management e Sanità, Piazza Martiri della Libertà 24, 56127 Pisa, Italy
| | - Sabina Nuti
- Scuola Superiore Sant'Anna, Istituto di Management, Laboratorio Management e Sanità, Piazza Martiri della Libertà 24, 56127 Pisa, Italy
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Meijers JMM, Halfens RJG, Mijnarends DM, Mostert H, Schols JMGA. A feedback system to improve the quality of nutritional care. Nutrition 2014; 29:1037-41. [PMID: 23759264 DOI: 10.1016/j.nut.2013.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/06/2013] [Accepted: 02/08/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The main objective of this study was to develop a feedback system that improves the translation of malnutrition performance data from the Dutch National Prevalence Measurement of Care Problems (LPZ) into relevant evidence- and practice-based interventions in care homes. METHODS The process consisted of two stages. The first was the development of a feedback system. Twenty-four interviews were held with health care professionals in care homes that participated in the LPZ to gain insight into needs regarding the translation of performance data into relevant improvement interventions. Subsequently, three multidisciplinary focus groups discussed how to develop a feedback system to deal with those needs. In the second stage, the feasibility of this system was evaluated via a questionnaire (N = 93) that was sent to care homes participating in LPZ. RESULTS It was important that performance data be more transparent regarding which information was relevant and that insight was gained into how to improve nutritional care. To address these needs, a dashboard was developed to present performance data in a transparent way. Subsequently, a decision tree was developed that links LPZ dashboard outcomes to evidence-based nutritional interventions for care homes. Forty-seven respondents (50.5%) evaluated the new feedback system (the dashboard and the decision tree) as feasible. The content and design were perceived to be very useful. Half of the participating institutions had already started working with improvement activities. CONCLUSION The developed feedback system was evaluated as useful for improving nutritional patient care in the future. This system will also be developed for other health care settings.
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Affiliation(s)
- Judith M M Meijers
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
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Stone PW, Pogorzelska-Maziarz M, Herzig CT, Weiner LM, Furuya EY, Dick A, Larson E. State of infection prevention in US hospitals enrolled in the National Health and Safety Network. Am J Infect Control 2014; 42:94-9. [PMID: 24485365 DOI: 10.1016/j.ajic.2013.10.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 09/30/2013] [Accepted: 10/07/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND This report provides a national cross-sectional snapshot of infection prevention and control programs and clinician compliance with the implementation of processes to prevent health care-associated infections (HAIs) in intensive care units (ICUs). METHODS All hospitals, except Veterans Affairs hospitals, enrolled in the National Healthcare Safety Network (NHSN) were eligible to participate. Participation involved completing a survey assessing the presence of evidence-based prevention policies and clinician adherence and joining our NHSN research group. Descriptive statistics were computed. Facility characteristics and HAI rates by ICU type were compared between respondents and nonrespondents. RESULTS Of the 3,374 eligible hospitals, 975 provided data (29% response rate) on 1,653 ICUs, and there were complete data on the presence of policies in 1,534 ICUs. The average number of infection preventionists (IPs) per 100 beds was 1.2. Certification of IP staff varied across institutions, and the average hours per week devoted to data management and secretarial support were generally low. There was variation in the presence of policies and clinician adherence to these policies. There were no differences in HAI rates between respondents and nonrespondents. CONCLUSIONS Guidelines for IP staffing in acute care hospitals need to be updated. In future work, we will analyze the associations between HAI rates and infection prevention and control program characteristics, as well as the inplementation of and clinician adherence to evidence-based policies.
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McElwaine KM, Freund M, Campbell EM, Slattery C, Wye PM, Lecathelinais C, Bartlem KM, Gillham KE, Wiggers JH. Clinician assessment, advice and referral for multiple health risk behaviors: prevalence and predictors of delivery by primary health care nurses and allied health professionals. PATIENT EDUCATION AND COUNSELING 2014; 94:193-201. [PMID: 24284164 DOI: 10.1016/j.pec.2013.10.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/30/2013] [Accepted: 10/26/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Primary care clinicians have considerable potential to provide preventive care. This study describes their preventive care delivery. METHODS A survey of 384 community health nurses and allied health clinicians from in New South Wales, Australia was undertaken (2010-11) to examine the assessment of client risk, provision of brief advice and referral/follow-up regarding smoking inadequate fruit and vegetable consumption, alcohol misuse, and physical inactivity; the existence of preventive care support strategies; and the association between supports and preventive care provision. RESULTS Preventive care to 80% or more clients was least often provided for referral/follow-up (24.7-45.6% of clinicians for individual risks, and 24.2% for all risks) and most often for assessment (34.4-69.3% of clinicians for individual risks, and 24.4% for all risks). Approximately 75% reported having 9 or fewer of 17 supports. Provision of care was associated with: availability of a paper screening tool; training; GP referral letter; and number of supports. CONCLUSION The delivery of preventive care was limited, and varied according to type of care and risk. Supports were variably associated with elements of preventive care. PRACTICE IMPLICATIONS Further research is required to increase routine preventive care delivery and the availability of supports.
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Affiliation(s)
- Kathleen M McElwaine
- Population Health, Hunter New England Local Health District, Newcastle, Australia; Faculty of Health, The University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Clinical Research Centre, Newcastle, Australia.
| | - Megan Freund
- Population Health, Hunter New England Local Health District, Newcastle, Australia; Faculty of Health, The University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Clinical Research Centre, Newcastle, Australia.
| | - Elizabeth M Campbell
- Population Health, Hunter New England Local Health District, Newcastle, Australia; Faculty of Health, The University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Clinical Research Centre, Newcastle, Australia.
| | - Carolyn Slattery
- Population Health, Hunter New England Local Health District, Newcastle, Australia.
| | - Paula M Wye
- Population Health, Hunter New England Local Health District, Newcastle, Australia; Faculty of Health, The University of Newcastle, Newcastle, Australia; Faculty of Science and Information Technology, The University of Newcastle, Newcastle, Australia.
| | | | - Kate M Bartlem
- Population Health, Hunter New England Local Health District, Newcastle, Australia; Hunter Medical Research Institute, Clinical Research Centre, Newcastle, Australia; Faculty of Science and Information Technology, The University of Newcastle, Newcastle, Australia.
| | - Karen E Gillham
- Population Health, Hunter New England Local Health District, Newcastle, Australia; Hunter Medical Research Institute, Clinical Research Centre, Newcastle, Australia.
| | - John H Wiggers
- Population Health, Hunter New England Local Health District, Newcastle, Australia; Faculty of Health, The University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Clinical Research Centre, Newcastle, Australia.
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van Sonsbeek MAMS, Hutschemaekers GGJM, Veerman JW, Tiemens BBG. Effective components of feedback from Routine Outcome Monitoring (ROM) in youth mental health care: study protocol of a three-arm parallel-group randomized controlled trial. BMC Psychiatry 2014; 14:3. [PMID: 24393491 PMCID: PMC3898381 DOI: 10.1186/1471-244x-14-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 01/02/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Routine Outcome Monitoring refers to regular measurements of clients' progress in clinical practice, aiming to evaluate and, if necessary, adapt treatment. Clients fill out questionnaires and clinicians receive feedback about the results. Studies concerning feedback in youth mental health care are rare. The effects of feedback, the importance of specific aspects of feedback, and the mechanisms underlying the effects of feedback are unknown. In the present study, several potentially effective components of feedback from Routine Outcome Monitoring in youth mental health care in the Netherlands are investigated. METHODS/DESIGN We will examine three different forms of feedback through a three-arm parallel-group randomized controlled trial. 432 children and adolescents (aged 4 to 17 years) and their parents, who have been referred to mental health care institution Pro Persona, will be randomly assigned to one of three feedback conditions (144 participants per condition). Randomization will be stratified by age of the child or adolescent and by department. All participants fill out questionnaires at the start of treatment, one and a half months after the start of treatment, every three months during treatment, and at the end of treatment. Participants in the second and third feedback conditions fill out an additional questionnaire. In condition 1, clinicians receive basic feedback regarding clients' symptoms and quality of life. In condition 2, the feedback of condition 1 is extended with feedback regarding possible obstacles to a good outcome and with practical suggestions. In condition 3, the feedback of condition 2 is discussed with a colleague while following a standardized format for case consultation. The primary outcome measure is symptom severity and secondary outcome measures are quality of life, satisfaction with treatment, number of sessions, length of treatment, and rates of dropout. We will also examine the role of being not on track (not responding to treatment). DISCUSSION This study contributes to the identification of effective components of feedback and a better understanding of how feedback functions in real-world clinical practice. If the different feedback components prove to be effective, this can help to support and improve the care for youth. TRIAL REGISTRATION Dutch Trial Register NTR4234.
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Affiliation(s)
- Maartje AMS van Sonsbeek
- Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, 6525 HR Nijmegen, The Netherlands,Pro Persona Centre for Education & Science (ProCES), Tarweweg 6, 6534 AM Nijmegen, The Netherlands,Pro Persona Youth Tiel, Siependaallaan 3, 4003 LE Tiel, The Netherlands
| | - Giel GJM Hutschemaekers
- Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, 6525 HR Nijmegen, The Netherlands,Pro Persona Centre for Education & Science (ProCES), Tarweweg 6, 6534 AM Nijmegen, The Netherlands
| | - Jan Willem Veerman
- Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, 6525 HR Nijmegen, The Netherlands
| | - Bea BG Tiemens
- Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, 6525 HR Nijmegen, The Netherlands,Pro Persona Centre for Education & Science (ProCES), Tarweweg 6, 6534 AM Nijmegen, The Netherlands
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Bbosa GS, Wong G, Kyegombe DB, Ogwal-Okeng J. Effects of intervention measures on irrational antibiotics/antibacterial drug use in developing countries: A systematic review. Health (London) 2014. [DOI: 10.4236/health.2014.62027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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179
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Roughead EE, Kalisch Ellett LM, Ramsay EN, Pratt NL, Barratt JD, LeBlanc VT, Ryan P, Peck R, Killer G, Gilbert AL. Bridging evidence-practice gaps: improving use of medicines in elderly Australian veterans. BMC Health Serv Res 2013; 13:514. [PMID: 24330781 PMCID: PMC3878826 DOI: 10.1186/1472-6963-13-514] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 12/10/2013] [Indexed: 11/29/2022] Open
Abstract
Background The Australian Government Department of Veterans’ Affairs (DVA) funds an ongoing health promotion based program to improve use of medicines and related health services, which implements interventions that include audit and feedback in the form of patient-specific feedback generated from administrative claims records. We aimed to determine changes in medicine use as a result of the program. Methods The program provides targeted patient-specific feedback to medical practitioners. The feedback is supported with educational material developed by a clinical panel, subject to peer review and overseen by a national editorial committee. Veterans who meet target criteria also receive educational brochures. The program is supported by a national call centre and ongoing national consultation. Segmented regression analyses (interrupted time series) were undertaken to assess changes in medication use in targeted veterans pre and post each intervention. Results 12 interventions were included; three to increase medicine use, seven which aimed to reduce use, and two which had combination of messages to change use. All programs that aimed to increase medicine use were effective, with relative effect sizes at the time of the intervention ranging from 1% to 8%. Mixed results were seen with programs aiming to reduce inappropriate medicine use. Highly specific programs were effective, with relative effect sizes at the time of the intervention of 10% decline in use of NSAIDs in high risk groups and 14% decline in use of antipsychotics in dementia. Interventions targeting combinations of medicines, including medicine interactions and potentially inappropriate medicines in the elderly did not change practice significantly. Interventions with combinations of messages targeting multiple components of practice had an impact on one component, but not all components targeted. Conclusions The Veterans’ MATES program showed positive practice change over time, with interventions increasing use of appropriate medicines where under-use was evident and reduced use of inappropriate medicines when single medicines were targeted. Combinations of messages were less effective, suggesting specific messages focusing on single medicines are required to maximise effect. The program provides a model that could be replicated in other settings.
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Affiliation(s)
| | - Lisa M Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute, University of South Australia, Adelaide, Australia.
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Proctor EK, Powell BJ, McMillen JC. Implementation strategies: recommendations for specifying and reporting. Implement Sci 2013. [PMID: 24289295 DOI: 10.1186/1748‐5908‐8‐139] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Implementation strategies have unparalleled importance in implementation science, as they constitute the 'how to' component of changing healthcare practice. Yet, implementation researchers and other stakeholders are not able to fully utilize the findings of studies focusing on implementation strategies because they are often inconsistently labelled and poorly described, are rarely justified theoretically, lack operational definitions or manuals to guide their use, and are part of 'packaged' approaches whose specific elements are poorly understood. We address the challenges of specifying and reporting implementation strategies encountered by researchers who design, conduct, and report research on implementation strategies. Specifically, we propose guidelines for naming, defining, and operationalizing implementation strategies in terms of seven dimensions: actor, the action, action targets, temporality, dose, implementation outcomes addressed, and theoretical justification. Ultimately, implementation strategies cannot be used in practice or tested in research without a full description of their components and how they should be used. As with all intervention research, their descriptions must be precise enough to enable measurement and 'reproducibility.' We propose these recommendations to improve the reporting of implementation strategies in research studies and to stimulate further identification of elements pertinent to implementation strategies that should be included in reporting guidelines for implementation strategies.
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Affiliation(s)
- Enola K Proctor
- George Warren Brown School of Social Work, Washington University in St, Louis, One Brookings Drive, Campus Box 1196, St, Louis, MO, USA.
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181
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Proctor EK, Powell BJ, McMillen JC. Implementation strategies: recommendations for specifying and reporting. Implement Sci 2013. [PMID: 24289295 DOI: 10.1186/1748–5908–8–139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Implementation strategies have unparalleled importance in implementation science, as they constitute the 'how to' component of changing healthcare practice. Yet, implementation researchers and other stakeholders are not able to fully utilize the findings of studies focusing on implementation strategies because they are often inconsistently labelled and poorly described, are rarely justified theoretically, lack operational definitions or manuals to guide their use, and are part of 'packaged' approaches whose specific elements are poorly understood. We address the challenges of specifying and reporting implementation strategies encountered by researchers who design, conduct, and report research on implementation strategies. Specifically, we propose guidelines for naming, defining, and operationalizing implementation strategies in terms of seven dimensions: actor, the action, action targets, temporality, dose, implementation outcomes addressed, and theoretical justification. Ultimately, implementation strategies cannot be used in practice or tested in research without a full description of their components and how they should be used. As with all intervention research, their descriptions must be precise enough to enable measurement and 'reproducibility.' We propose these recommendations to improve the reporting of implementation strategies in research studies and to stimulate further identification of elements pertinent to implementation strategies that should be included in reporting guidelines for implementation strategies.
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Affiliation(s)
- Enola K Proctor
- George Warren Brown School of Social Work, Washington University in St, Louis, One Brookings Drive, Campus Box 1196, St, Louis, MO, USA.
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Proctor EK, Powell BJ, McMillen JC. Implementation strategies: recommendations for specifying and reporting. Implement Sci 2013; 8:139. [PMID: 24289295 PMCID: PMC3882890 DOI: 10.1186/1748-5908-8-139] [Citation(s) in RCA: 1186] [Impact Index Per Article: 107.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 11/12/2013] [Indexed: 11/15/2022] Open
Abstract
Implementation strategies have unparalleled importance in implementation science, as they constitute the ‘how to’ component of changing healthcare practice. Yet, implementation researchers and other stakeholders are not able to fully utilize the findings of studies focusing on implementation strategies because they are often inconsistently labelled and poorly described, are rarely justified theoretically, lack operational definitions or manuals to guide their use, and are part of ‘packaged’ approaches whose specific elements are poorly understood. We address the challenges of specifying and reporting implementation strategies encountered by researchers who design, conduct, and report research on implementation strategies. Specifically, we propose guidelines for naming, defining, and operationalizing implementation strategies in terms of seven dimensions: actor, the action, action targets, temporality, dose, implementation outcomes addressed, and theoretical justification. Ultimately, implementation strategies cannot be used in practice or tested in research without a full description of their components and how they should be used. As with all intervention research, their descriptions must be precise enough to enable measurement and ‘reproducibility.’ We propose these recommendations to improve the reporting of implementation strategies in research studies and to stimulate further identification of elements pertinent to implementation strategies that should be included in reporting guidelines for implementation strategies.
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Affiliation(s)
- Enola K Proctor
- George Warren Brown School of Social Work, Washington University in St, Louis, One Brookings Drive, Campus Box 1196, St, Louis, MO, USA.
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Campbell L, Novak I, McIntyre S, Lord S. A KT intervention including the evidence alert system to improve clinician's evidence-based practice behavior--a cluster randomized controlled trial. Implement Sci 2013; 8:132. [PMID: 24220660 PMCID: PMC3831589 DOI: 10.1186/1748-5908-8-132] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 11/04/2013] [Indexed: 11/10/2022] Open
Abstract
Background It is difficult to foster research utilization among allied health professionals (AHPs). Tailored, multifaceted knowledge translation (KT) strategies are now recommended but are resource intensive to implement. Employers need effective KT solutions but little is known about; the impact and viability of multifaceted KT strategies using an online KT tool, their effectiveness with AHPs and their effect on evidence-based practice (EBP) decision-making behavior. The study aim was to measure the effectiveness of a multifaceted KT intervention including a customized KT tool, to change EBP behavior, knowledge, and attitudes of AHPs. Methods This is an evaluator-blinded, cluster randomized controlled trial conducted in an Australian community-based cerebral palsy service. 135 AHPs (physiotherapists, occupational therapists, speech pathologists, psychologists and social workers) from four regions were cluster randomized (n = 4), to either the KT intervention group (n = 73 AHPs) or the control group (n = 62 AHPs), using computer-generated random numbers, concealed in opaque envelopes, by an independent officer. The KT intervention included three-day skills training workshop and multifaceted workplace supports to redress barriers (paid EBP time, mentoring, system changes and access to an online research synthesis tool). Primary outcome (self- and peer-rated EBP behavior) was measured using the Goal Attainment Scale (individual level). Secondary outcomes (knowledge and attitudes) were measured using exams and the Evidence Based Practice Attitude Scale. Results The intervention group’s primary outcome scores improved relative to the control group, however when clustering was taken into account, the findings were non-significant: self-rated EBP behavior [effect size 4.97 (95% CI -10.47, 20.41) (p = 0.52)]; peer-rated EBP behavior [effect size 5.86 (95% CI -17.77, 29.50) (p = 0.62)]. Statistically significant improvements in EBP knowledge were detected [effect size 2.97 (95% CI 1.97, 3.97 (p < 0.0001)]. Change in EBP attitudes was not statistically significant. Conclusions Improvement in EBP behavior was not statistically significant after adjusting for cluster effect, however similar improvements from peer-ratings suggest behaviorally meaningful gains. The large variability in behavior observed between clusters suggests barrier assessments and subsequent KT interventions may need to target subgroups within an organization. Trial registration Registered on the Australian New Zealand Clinical Trials Registry (ACTRN12611000529943).
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Affiliation(s)
- Lanie Campbell
- School of Medicine, University of Notre Dame Australia, corner Oxford Street and Victoria Street, Darlinghurst, NSW 2010, Australia.
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Minaya-Muñoz F, Medina-Mirapeix F, Valera-Garrido F. Quality measures for the care of patients with lateral epicondylalgia. BMC Musculoskelet Disord 2013; 14:310. [PMID: 24172311 PMCID: PMC3816543 DOI: 10.1186/1471-2474-14-310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 10/23/2013] [Indexed: 11/23/2022] Open
Abstract
Background Lateral epicondylalgia (LE) defines a condition of varying degrees of pain near the lateral epicondyle. Studies on the management of LE indicated unexplained variations in the use of pharmacologic, non-pharmacological and surgical treatments. The main aim of this paper was to develop and evaluate clinical quality measures (QMs) or quality indicators, which may be used to assess the quality of the processes of examination, education and treatment of patients with LE. Methods Different QMs were developed by a multidisciplinary group of experts in Quality Management of Health Services during a period of one year. The process was based following a 3-step model: i) review and proportion of existing evidence-based recommendations; ii) review and development of quality measures; iii) pilot testing of feasibility and reliability of the indicators leading to a final consensus by the whole panel. Results Overall, a set of 12 potential indicators related to medical and physical therapy assessment and treatment were developed to measure the performance of LE care. Different systematic reviews and randomized control trials supported each of the indicators judged to be valid during the expert panel process. Application of the new indicator set was found to be feasible; only the measurement of two quality measures had light barriers. Reliability was mostly excellent (Kappa > 0.8). Conclusions A set of good practice indicators has been built and pilot tested as feasible and reliable. The chosen 3-step standardized evidence-based process ensures maximum clarity, acceptance and sustainability of the developed indicators.
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Affiliation(s)
- Francisco Minaya-Muñoz
- MVClinic, Juan Antonio Samaranch Torelló St,, 6B, Fitness Sports Center Valle de Las Cañas, 28223, Pozuelo de Alarcón, Madrid, Spain.
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185
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Schichtel M, Rose PW, Sellers C. Educational interventions for primary healthcare professionals to promote the early diagnosis of cancer: a systematic review. EDUCATION FOR PRIMARY CARE 2013; 24:274-90. [PMID: 23906171 DOI: 10.1080/14739879.2013.11494186] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Primary healthcare professionals seem to lack knowledge and skills in the area of diagnosing cancer which may lead to more advanced stage at diagnosis, poorer cancer survival figures and increased morbidity. The aim of this study was to examine the evidence of effectiveness of educational interventions for primary healthcare professionals to promote the early diagnosis of cancer. METHODS We searched bibliographic databases, the grey literature and reference lists for randomised controlled trials (RCTs) of educational interventions delivered at an individual clinician and practice level. RESULTS We found sufficient evidence that interactive education, computerised reminder systems and audit and feedback delivered to clinicians may significantly increase several cancer detection measures in the short term and some evidence that they promote early diagnosis. Whilst educational outreach and local opinion leaders had some effect, formal education alone seemed ineffectual. CONCLUSION Certain educational interventions delivered at a clinician as well as at a practice level may promote the early diagnosis of cancer in primary care. There is currently limited evidence for their long-term sustainability and effectiveness.
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Goetz MB, Hoang T, Knapp H, Burgess J, Fletcher MD, Gifford AL, Asch SM. Central implementation strategies outperform local ones in improving HIV testing in Veterans Healthcare Administration facilities. J Gen Intern Med 2013; 28:1311-7. [PMID: 23605307 PMCID: PMC3785651 DOI: 10.1007/s11606-013-2420-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 12/18/2012] [Accepted: 03/06/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pilot data suggest that a multifaceted approach may increase HIV testing rates, but the scalability of this approach and the level of support needed for successful implementation remain unknown. OBJECTIVE To evaluate the effectiveness of a scaled-up multi-component intervention in increasing the rate of risk-based and routine HIV diagnostic testing in primary care clinics and the impact of differing levels of program support. DESIGN Three arm, quasi-experimental implementation research study. SETTING Veterans Health Administration (VHA) facilities. PATIENTS Persons receiving primary care between June 2009 and September 2011 INTERVENTION: A multimodal program, including a real-time electronic clinical reminder to facilitate HIV testing, provider feedback reports and provider education, was implemented in Central and Local Arm Sites; sites in the Central Arm also received ongoing programmatic support. Control Arm sites had no intervention MAIN MEASURES Frequency of performing HIV testing during the 6 months before and after implementation of a risk-based clinical reminder (phase I) or routine clinical reminder (phase II). KEY RESULTS The adjusted rate of risk-based testing increased by 0.4 %, 5.6 % and 10.1 % in the Control, Local and Central Arms, respectively (all comparisons, p < 0.01). During phase II, the adjusted rate of routine testing increased by 1.1 %, 6.3 % and 9.2 % in the Control, Local and Central Arms, respectively (all comparisons, p < 0.01). At study end, 70-80 % of patients had been offered an HIV test. CONCLUSIONS Use of clinical reminders, provider feedback, education and social marketing significantly increased the frequency at which HIV testing is offered and performed in VHA facilities. These findings support a multimodal approach toward achieving the goal of having every American know their HIV status as a matter of routine clinical practice.
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Affiliation(s)
- Matthew Bidwell Goetz
- Infectious Diseases Section (111-F), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA,
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Choi M, Kim HS, Chung SK, Ahn MJ, Yoo JY, Park OS, Woo SR, Kim SS, Kim SA, Oh EG. Evidence-based practice for pain management for cancer patients in an acute care setting. Int J Nurs Pract 2013; 20:60-9. [DOI: 10.1111/ijn.12122] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mona Choi
- Nursing Policy Research Institute; Yonsei University College of Nursing; Seoul Korea
| | - Hee Sun Kim
- Department of Nursing; Woosuk University; Jeonbuk Korea
| | - Su Kyoung Chung
- Department of Nursing; College of Health and Welfare; Woosong University; Daejeon Korea
| | | | - Jae Yong Yoo
- Nursing Policy Research Institute; Yonsei University College of Nursing; Seoul Korea
| | - Ok Sun Park
- Yonsei University Health System; Seoul Korea
| | - So Rah Woo
- Division of Nursing; Yonsei University Health System; Seoul Korea
| | - So Sun Kim
- Nursing Policy Research Institute; Yonsei University College of Nursing; Seoul Korea
| | - Sun Ah Kim
- Nursing Policy Research Institute; Yonsei University College of Nursing; Seoul Korea
| | - Eui Geum Oh
- Nursing Policy Research Institute; Yonsei University College of Nursing; Seoul Korea
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188
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Godfrey M, Smith J, Green J, Cheater F, Inouye SK, Young JB. Developing and implementing an integrated delirium prevention system of care: a theory driven, participatory research study. BMC Health Serv Res 2013; 13:341. [PMID: 24004917 PMCID: PMC3766659 DOI: 10.1186/1472-6963-13-341] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 08/26/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Delirium is a common complication for older people in hospital. Evidence suggests that delirium incidence in hospital may be reduced by about a third through a multi-component intervention targeted at known modifiable risk factors. We describe the research design and conceptual framework underpinning it that informed the development of a novel delirium prevention system of care for acute hospital wards. Particular focus of the study was on developing an implementation process aimed at embedding practice change within routine care delivery. METHODS We adopted a participatory action research approach involving staff, volunteers, and patient and carer representatives in three northern NHS Trusts in England. We employed Normalization Process Theory to explore knowledge and ward practices on delirium and delirium prevention. We established a Development Team in each Trust comprising senior and frontline staff from selected wards, and others with a potential role or interest in delirium prevention. Data collection included facilitated workshops, relevant documents/records, qualitative one-to-one interviews and focus groups with multiple stakeholders and observation of ward practices. We used grounded theory strategies in analysing and synthesising data. RESULTS Awareness of delirium was variable among staff with no attention on delirium prevention at any level; delirium prevention was typically neither understood nor perceived as meaningful. The busy, chaotic and challenging ward life rhythm focused primarily on diagnostics, clinical observations and treatment. Ward practices pertinent to delirium prevention were undertaken inconsistently. Staff welcomed the possibility of volunteers being engaged in delirium prevention work, but existing systems for volunteer support were viewed as a barrier. Our evolving conception of an integrated model of delirium prevention presented major implementation challenges flowing from minimal understanding of delirium prevention and securing engagement of volunteers alongside practice change. The resulting Prevention of Delirium (POD) Programme combines a multi-component delirium prevention and implementation process, incorporating systems and mechanisms to introduce and embed delirium prevention into routine ward practices. CONCLUSIONS Although our substantive interest was in delirium prevention, the conceptual and methodological strategies pursued have implications for implementing and sustaining practice and service improvements more broadly. STUDY REGISTRATION ISRCTN65924234.
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Affiliation(s)
- Mary Godfrey
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, West Yorkshire BD9 6RJ, UK
| | - Jane Smith
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, West Yorkshire BD9 6RJ, UK
| | - John Green
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, West Yorkshire BD9 6RJ, UK
| | - Francine Cheater
- School of Nursing Sciences, Faculty of Medicine and Health Sciences, Edith Cavell Building, University of East Anglia, Norwich Research Park, Norwich, Norfolk NR4 7TJ, UK
| | - Sharon K Inouye
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School and Institute for Aging Research, Hebrew SeniorLife, 1200 Centre Street, Roslindale, MA 02131, USA
| | - John B Young
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, West Yorkshire BD9 6RJ, UK
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Raymond CB, Sproll B, Coates J, Woloschuk DMM. Evaluation of a medication order writing standards policy in a regional health authority. Can Pharm J (Ott) 2013; 146:276-83. [PMID: 24093039 PMCID: PMC3785189 DOI: 10.1177/1715163513498212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Winnipeg Regional Health Authority (WRHA) implemented a medication order writing standards (MOWS) policy (including banned abbreviations) to improve patient safety. Widespread educational campaigns and direct prescriber feedback were implemented. METHODS We audited orders within the WRHA from 2005 to 2009 and surveyed all WRHA staff in 2011 about the policy and suggestions for improving education and compliance. RESULTS Overall, orders containing banned abbreviations, acronyms or symbols numbered 2261/8565 (26.4%) preimplementation. After WRHA-wide didactic education, the proportion declined to 1358/5461 (24.9%) (p = 0.043) and then, with targeted prescriber feedback, to 1186/6198 (19.1%) (p < 0.0001). A survey of 723 employees showed frequent violations of the MOWS, despite widespread knowledge of the policy. Respondents supported ongoing efforts to enforce the policy within the WRHA. Nonprescribers were significantly more likely than prescribers to agree with statements regarding enhancing compliance by defining prescriber/transcriber responsibilities and placing sanctions on noncompliant prescribers. DISCUSSION Education, raising general awareness and targeted feedback to prescribers alone are insufficient to ensure compliance with MOWS policies. WRHA staff supported ongoing communication, improved tools such as compliant preprinted orders and reporting and feedback about medication incidents. A surprising number of respondents supported placing sanctions on noncompliant prescribers. CONCLUSION Serial audits and targeted interventions such as direct prescriber feedback improve prescription quality in inpatient hospital settings. Education plus direct prescriber feedback had a greater impact than education alone on improving compliance with a MOWS policy. Future efforts at the WRHA to improve compliance will require an expanded focus on incentives, resources and development of action plans that involve all affected staff, not just prescribers. Plans include continued advertising, MOWS summaries in all charts, all-staff education, reminders and exploration of sustainable interventions for targeted feedback for prescribers.
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Affiliation(s)
- Colette B Raymond
- Winnipeg Regional Health Authority Pharmacy Program, Winnipeg, Manitoba
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Audit-based education: a potentially effective program for improving guideline achievement in CKD patients. Kidney Int 2013; 84:436-8. [PMID: 23989357 DOI: 10.1038/ki.2013.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The achievement of treatment guidelines in patients with chronic kidney disease is poor, and more efforts are needed to improve this. Audit-based education is a program that may contribute to this improvement. de Lusignana et al. investigated whether audit-based education is effective in lowering systolic blood pressure in a primary-care setting. Although the program is inventive and promising, several adjustments are needed before it can be applied as an effective strategy.
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Flodgren G, Eccles MP, Grimshaw J, Leng GC, Shepperd S. Tools developed and disseminated by guideline producers to promote the uptake of their guidelines. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bartlem K, Bowman J, Freund M, Wye P, McElwaine K, Knight J, McElduff P, Gillham K, Wiggers J. Evaluating the effectiveness of a clinical practice change intervention in increasing clinician provision of preventive care in a network of community-based mental health services: a study protocol of a non-randomized, multiple baseline trial. Implement Sci 2013; 8:85. [PMID: 23915310 PMCID: PMC3750388 DOI: 10.1186/1748-5908-8-85] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 07/31/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND People with a mental illness experience substantial disparities in health, including increased rates of morbidity and mortality caused by potentially preventable chronic diseases. One contributing factor to such disparity is a higher prevalence of modifiable health risk behaviors, such as smoking, inadequate fruit and vegetable intake, harmful alcohol consumption, and inadequate physical activity. Evidence supports the effectiveness of preventive care in reducing such risks, and guidelines recommend that preventive care addressing such risks be incorporated into routine clinical care. Although community-based mental health services represent an important potential setting for ensuring that people with a mental illness receive such care, research suggests its delivery is currently sub-optimal. A study will be undertaken to evaluate the effectiveness of a clinical practice change intervention in increasing the routine provision of preventive care by clinicians in community mental health settings. METHODS/DESIGN A two-group multiple baseline design will be utilized to assess the effectiveness of a multi-strategic intervention implemented over 12 months in increasing clinician provision of preventive care. The intervention will be implemented sequentially across the two groups of community mental health services to increase provision of client assessment, brief advice, and referral for four health risk behaviors (smoking, inadequate fruit and vegetable consumption, harmful alcohol consumption, and inadequate physical activity). Outcome measures of interest will be collected via repeated cross-sectional computer-assisted telephone interviews undertaken on a weekly basis for 36 months with community mental health clients. DISCUSSION This study is the first to assess the effectiveness of a multi-strategic clinical practice change intervention in increasing routine clinician provision of preventive care for chronic disease behavioral risk factors within a network of community mental health services. The results will inform future policy and practice regarding the ability of clinicians within mental health settings to improve preventive care provision as a result of such interventions. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000693729.
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Affiliation(s)
- Kate Bartlem
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Jennifer Bowman
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Megan Freund
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia
| | - Paula Wye
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Kathleen McElwaine
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia
| | - Jenny Knight
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia
| | - Patrick McElduff
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia
| | - Karen Gillham
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia
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Brundage M, Foxcroft S, McGowan T, Gutierrez E, Sharpe M, Warde P. A survey of radiation treatment planning peer-review activities in a provincial radiation oncology programme: current practice and future directions. BMJ Open 2013; 3:bmjopen-2013-003241. [PMID: 23903814 PMCID: PMC3731715 DOI: 10.1136/bmjopen-2013-003241] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To describe current patterns of practice of radiation oncology peer review within a provincial cancer system, identifying barriers and facilitators to its use with the ultimate aim of process improvement. DESIGN A survey of radiation oncology programmes at provincial cancer centres. SETTING All cancer centres within the province of Ontario, Canada (n=14). These are community-based outpatient facilities overseen by Cancer Care Ontario, the provincial cancer agency. PARTICIPANTS A delegate from each radiation oncology programme filled out a single survey based on input from their multidisciplinary team. OUTCOME MEASURES Rated importance of peer review; current utilisation; format of the peer-review process; organisation and timing; case attributes; outcomes of the peer-review process and perceived barriers and facilitators to expanding peer-review processes. RESULTS 14 (100%) centres responded. All rated the importance of peer review as at least 8/10 (10=extremely important). Detection of medical error and improvement of planning processes were the highest rated perceived benefits of peer review (each median 9/10). Six centres (43%) reviewed at least 50% of curative cases; four of these centres (29%) conducted peer review in more than 80% of cases treated with curative intent. Fewer than 20% of cases treated with palliative intent were reviewed in most centres. Five centres (36%) reported usually conducting peer review prior to the initiation of treatment. Five centres (36%) recorded the outcomes of peer review on the medical record. Thirteen centres (93%) planned to expand peer-review activities; a critical mass of radiation oncologists was the most important limiting factor (median 6/10). CONCLUSIONS Radiation oncology peer-review practices can vary even within a cancer system with provincial oversight. The application of guidelines and standards for peer-review processes, and monitoring of implementation and outcomes, will require effective knowledge translation activities.
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Affiliation(s)
- Michael Brundage
- Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston General Hospital, Kingston, Ontario, Canada
- Radiation Treatment Program, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Sophie Foxcroft
- Radiation Treatment Program, Cancer Care Ontario, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Tom McGowan
- Department of Radiation Oncology, Credit Valley Hospital, Mississauga, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Eric Gutierrez
- Radiation Treatment Program, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Michael Sharpe
- Radiation Treatment Program, Cancer Care Ontario, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Padraig Warde
- Radiation Treatment Program, Cancer Care Ontario, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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Ramos-Morcillo AJ, Martínez-López EJ, Fernández-Salazar S, del-Pino-Casado R. [Design and validation of a questionnaire on attitudes to prevention and health promotion in primary care (CAPPAP)]. Aten Primaria 2013; 45:514-21. [PMID: 23891031 PMCID: PMC6985530 DOI: 10.1016/j.aprim.2013.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 05/06/2013] [Accepted: 05/13/2013] [Indexed: 12/03/2022] Open
Abstract
Objetivo Elaborar y validar un instrumento para medir las actitudes ante las actividades de prevención y promoción de la salud. Diseño Estudio descriptivo transversal para la validación de un cuestionario. Emplazamiento Atención primaria (comunidad autónoma de Andalucía, España). Participantes Se incluyeron 282 profesionales (enfermeras y médicos) pertenecientes al sistema sanitario público. Mediciones principales Validación de contenido por expertos, efectos techo y suelo, concordancia entre ítems, consistencia interna, estabilidad y análisis factorial exploratorio. Resultados Se obtiene un instrumento (CAPPAP) que agrupa en 5 dimensiones los 56 ítems recogidos a partir de la revisión de otras herramientas y de las aportaciones de los expertos. Se obtuvo un porcentaje de acuerdo entre expertos superior al 70% en todos los ítems, así como una alta concordancia entre los ítems de prevención y promoción, por lo que se eliminan los ítems duplicados quedando una herramienta final de 44 ítems. La consistencia interna del CAPPAP, medida a través de alfa de Cronbach, fue de 0,888. El test-retest nos indica concordancias entre sustanciales y casi perfectas. El análisis factorial exploratorio identifica 5 factores que explicaban un 48,92% de la varianza. Conclusiones El CAPPAP es un instrumento de fácil y rápida administración, que es bien aceptado por los profesionales y que presenta unos resultados psicométricos aceptables, tanto a nivel global como a nivel de cada dimensión.
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Breimaier HE, Halfens RJG, Wilborn D, Meesterberends E, Haase Nielsen G, Lohrmann C. Implementation Interventions Used in Nursing Homes and Hospitals: A Descriptive, Comparative Study between Austria, Germany, and The Netherlands. ISRN NURSING 2013; 2013:706054. [PMID: 23956875 PMCID: PMC3727135 DOI: 10.1155/2013/706054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 06/23/2013] [Indexed: 11/17/2022]
Abstract
Translating guidelines into nursing practice remains a considerable challenge. Until now, little attention has been paid to which interventions are used in practice to implement guidelines on changing clinical nursing practice. This cross-sectional study determined the current ranges and rates of implementation-related interventions in Austria, Germany, and The Netherlands and explored possible differences between these countries. An online questionnaire based on the conceptual framework of implementation interventions (professional, organizational, financial, and regulatory) from the Cochrane Effective Practice and Organization of Care (EPOC) data collection checklist was used to gather data from nursing homes and hospitals. Provision of written materials is the most frequently used professional implementation intervention (85%), whereas changes in the patient record system rank foremost among organisational interventions (78%). Financial incentives for nurses are rarely used. More interventions were used in Austria and Germany than in The Netherlands (20.3/20.2/17.3). Professional interventions are used more frequently in Germany and financial interventions more frequently in The Netherlands. Implementation efforts focus mainly on professional and organisational interventions. Nurse managers and other responsible personnel should direct their focus to a broader array of implementation interventions using the four different categories of EPOC's conceptual framework.
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Affiliation(s)
- Helga E. Breimaier
- Institute of Nursing Science, Medical University of Graz, Billrothgaße 6, 8010 Graz, Austria
| | - Ruud J. G. Halfens
- Department of Health Services Research Focusing on Chronic Care and Ageing, Section of Nursing Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Doris Wilborn
- Department of Nursing and Management, Faculty of Business & Social Sciences, Hamburg University of Applied Sciences, Alexanderstraße 1, 20099 Hamburg, Germany
| | - Esther Meesterberends
- Department of Health Services Research Focusing on Chronic Care and Ageing, Section of Nursing Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Gunnar Haase Nielsen
- Department of Nursing and Health Sciences, Protestant University of Applied Sciences, Zweifalltorweg 12, 64293 Darmstadt, Germany
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Billrothgaße 6, 8010 Graz, Austria
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Dumont A, Fournier P, Abrahamowicz M, Traoré M, Haddad S, Fraser WD. Quality of care, risk management, and technology in obstetrics to reduce hospital-based maternal mortality in Senegal and Mali (QUARITE): a cluster-randomised trial. Lancet 2013; 382:146-57. [PMID: 23721752 DOI: 10.1016/s0140-6736(13)60593-0] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Maternal mortality is higher in west Africa than in most industrialised countries, so the development and validation of effective interventions is essential. We did a trial to assess the effect of a multifaceted intervention to promote maternity death reviews and onsite training in emergency obstetric care in referral hospitals with high maternal mortality rates in Senegal and Mali. METHODS We did a pragmatic cluster-randomised controlled trial, with hospitals as the units of randomisation and patients as the unit of analysis. 46 public first-level and second-level referral hospitals with more than 800 deliveries a year were enrolled, stratified by country and hospital type, and randomly assigned to either the intervention group (n=23) or the control group with no external intervention (n=23). All women who delivered in each of the participating facilities during the baseline and post-intervention periods were included. The intervention, implemented over a period of 2 years at the hospital level, consisted of an initial interactive workshop and quarterly educational clinically-oriented and evidence-based outreach visits focused on maternal death reviews and best practices implementation. The primary outcome was reduction of risk of hospital-based mortality. Analysis was by intention-to-treat and relied on the generalised estimating equations extension of the logistic regression model to account for clustering of women within hospitals. This study is registered with ClinicalTrials.gov, number ISRCTN46950658. FINDINGS 191,167 patients who delivered in the participating hospitals were analysed (95,931 in the intervention groups and 95,236 in the control groups). Overall, mortality reduction in intervention hospitals was significantly higher than in control hospitals (odds ratio [OR] 0·85, 95% CI 0·73-0·98, p=0·0299), but this effect was limited to capital and district hospitals, which mainly acted as first-level referral hospitals in this trial. There was no effect in second-level referral (regional) hospitals outside the capitals (OR 1·02, 95% CI 0·79-1·31, p=0·89). No hospitals were lost to follow-up. Concrete actions were implemented comprehensively to improve quality of care in intervention hospitals. INTERPRETATION Regular visits by a trained external facilitator and onsite training can provide health-care professionals with the knowledge and confidence to make quality improvement suggestions during audit sessions. Maternal death reviews, combined with best practices implementation, are effective in reducing hospital-based mortality in first-level referral hospitals. Further studies are needed to determine whether the benefits of the intervention are generalisable to second-level referral hospitals. FUNDING Canadian Institutes of Health Research.
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Affiliation(s)
- Alexandre Dumont
- Research Institute for Development, Université Paris Descartes, Sorbonne Paris Cité, UMR 216, Paris, France.
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Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, McNaught CE, Macfie J, Liberman AS, Soop M, Hill A, Kennedy RH, Lobo DN, Fearon K, Ljungqvist O. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS(®)) Society recommendations. World J Surg 2013; 37:259-84. [PMID: 23052794 DOI: 10.1007/s00268-012-1772-0] [Citation(s) in RCA: 819] [Impact Index Per Article: 74.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Liu B, Almaawiy U, Moore JE, Chan WH, Straus SE. Evaluation of a multisite educational intervention to improve mobilization of older patients in hospital: protocol for mobilization of vulnerable elders in Ontario (MOVE ON). Implement Sci 2013; 8:76. [PMID: 23822563 PMCID: PMC3704763 DOI: 10.1186/1748-5908-8-76] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 06/28/2013] [Indexed: 01/29/2023] Open
Abstract
Background Functional decline is a common adverse outcome of hospitalization in older people. Often, this decline is not related to the illness that precipitated admission, but to the process of care delivered in hospital. The association between immobility and adverse consequences is well established, yet older inpatients spend significant amounts of time supine in bed. We aim to implement and evaluate the impact of an evidence-based strategy to promote early mobilization and prevent functional decline in older patients admitted to university-affiliated acute care hospitals in Ontario, Canada. We will implement a multi-component educational intervention to support a change in practice to enhance mobilization of older patients. Methods/design Implementation of our early mobilization strategy is guided by the Knowledge to Action Cycle. Through focus groups with frontline staff, we will identify barriers and facilitators to early mobilization. We will tailor the intervention at each site to the identified barriers and facilitators, focusing on the following key messages: to complete a mobility assessment and care plan within 24 hours of the decision to admit patients aged 65 years and older; to achieve mobilization at least 3 times per day; and, to ensure that mobilization is scaled and progressive. The primary outcome, number of patients observed out of bed, will be documented three times per day (in the morning, at lunch and in the afternoon), two days each week. This data collection will occur over 3 phases: pre-implementation (10 weeks), implementation (8 weeks), and post-implementation (20 weeks). Discussion This is the first large, multisite study to evaluate the impact of a multi-component knowledge translation strategy on rates of mobilization of older patients in hospital. Our implementation is framed by the Knowledge to Action Cycle, and the intervention is being adapted to the local context. These unique features render our intervention approach more generalizable to multiple practice settings. Contextualization of the intervention has also facilitated engagement of participants from multiple hospitals. Upon completion of this study, we will better understand the barriers and facilitators to implementing an early mobilization strategy across a spectrum of hospitals, as well as the impact of a mobilization strategy.
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Milner KM, Duke T, Bucens I. Reducing newborn mortality in the Asia-Pacific region: Quality hospital services and community-based care. J Paediatr Child Health 2013; 49:511-8. [PMID: 23713996 DOI: 10.1111/jpc.12249] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2013] [Indexed: 11/29/2022]
Abstract
Improving newborn health and survival is an essential part of progression toward Millennium Development Goal 4 in the World Health Organization Western Pacific and South East Asian regions. Both community and facility-based services are required. Strategies to improve the quality of care provided for newborns in health clinics and district- and referral-level hospitals have been relatively neglected in most countries in the region and in the published literature. Indirect historical evidence suggests that improving facility-based care will be an increasing priority for improving newborn survival in Asia and the Pacific as newborn mortality rates decrease and health systems contexts change. There are deficiencies in many aspects of newborn care, including immediate care and care for seriously ill newborns, which contribute substantially to regional newborn morbidity and mortality. We propose a practical quality improvement approach, based on models and standards of newborn care for primary-, district- and referral-level heath facilities and incorporated within existing maternal, newborn and child health programmes. There are examples where such approaches are being used effectively. There is a need to produce more nurses, community health workers and doctors with skills in care of the well and the sick newborn, and there are World Health Organization models of training to support this, including guidelines on emergency obstetric and newborn care and the Pocket Book of Hospital Care for Children. There are also simple data collection and analysis programmes that can assist in auditing outcomes, problem identification and health services planning. Finally, with increased survival rates there are gaps in follow-up care for newborns at high risk of long-term health and developmental impairments, and addressing this will be necessary to ensure optimal developmental and health outcomes for these children.
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Affiliation(s)
- Kate M Milner
- Centre for International Child Health, Department of Paediatrics, University of Melbourne, VIC 3052, Australia.
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Grant A, Sullivan F, Dowell J. An ethnographic exploration of influences on prescribing in general practice: why is there variation in prescribing practices? Implement Sci 2013; 8:72. [PMID: 23799906 PMCID: PMC3693908 DOI: 10.1186/1748-5908-8-72] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 06/14/2013] [Indexed: 11/23/2022] Open
Abstract
Background Prescribing is a core activity for general practitioners, yet significant variation in the quality of prescribing has been reported. This suggests there may be room for improvement in the application of the current best research evidence. There has been substantial investment in technologies and interventions to address this issue, but effect sizes so far have been small to moderate. This suggests that prescribing is a decision-making process that is not sufficiently understood. By understanding more about prescribing processes and the implementation of research evidence, variation may more easily be understood and more effective interventions proposed. Methods An ethnographic study in three Scottish general practices with diverse organizational characteristics. Practices were ranked by their performance against Audit Scotland prescribing quality indicators, incorporating established best research evidence. Two practices of high prescribing quality and one practice of low prescribing quality were recruited. Participant observation, formal and informal interviews, and a review of practice documentation were employed. Results Practices ranked as high prescribing quality consistently made and applied macro and micro prescribing decisions, whereas the low-ranking practice only made micro prescribing decisions. Macro prescribing decisions were collective, policy decisions made considering research evidence in light of the average patient, one disease, condition, or drug. Micro prescribing decisions were made in consultation with the patient considering their views, preferences, circumstances and other conditions (if necessary). Although micro prescribing can operate independently, the implementation of evidence-based, quality prescribing was attributable to an interdependent relationship. Macro prescribing policy enabled prescribing decisions to be based on scientific evidence and applied consistently where possible. Ultimately, this influenced prescribing decisions that occur at the micro level in consultation with patients. Conclusion General practitioners in the higher prescribing quality practices made two different ‘types’ of prescribing decision; macro and micro. Macro prescribing informs micro prescribing and without a macro basis to draw upon the low-ranked practice had no effective mechanism to engage with, reflect on and implement relevant evidence. Practices that recognize these two levels of decision making about prescribing are more likely to be able to implement higher quality evidence.
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Affiliation(s)
- Aileen Grant
- Population Health Sciences, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, Scotland DD2 4BF, UK.
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