151
|
Rangachari P, Mushiana SS, Herbert K. A scoping review of applications of the Consolidated Framework for Implementation Research (CFIR) to telehealth service implementation initiatives. BMC Health Serv Res 2022; 22:1450. [PMID: 36447279 PMCID: PMC9708146 DOI: 10.1186/s12913-022-08871-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The Consolidated Framework for Implementation Research (CFIR), introduced in 2009, has the potential to provide a comprehensive understanding of the determinants of implementation-effectiveness of health service innovations. Although the CFIR has been increasingly used in recent years to examine factors influencing telehealth implementation, no comprehensive reviews currently exist on the scope of knowledge gained exclusively from applications of the CFIR to telehealth implementation initiatives. This review sought to address this gap. METHODS PRISMA-ScR criteria were used to inform a scoping review of the literature. Five academic databases (PUBMED, PROQUEST, SCIDIRECT, CINAHL, and WoS) were searched for eligible sources of evidence from 01.01.2010 through 12.31.2021. The initial search yielded a total of 18,388 records, of which, 64 peer-reviewed articles met the inclusion criteria for the review. Included articles were reviewed in full to extract data, and data collected were synthesized to address the review questions. RESULTS Most included articles were published during or after 2020 (64%), and a majority (77%) were qualitative or mixed-method studies seeking to understand barriers or facilitators to telehealth implementation using the CFIR. There were few comparative- or implementation-effectiveness studies containing outcome measures (5%). The database search however, revealed a growing number of protocols for implementation-effectiveness studies published since 2020. Most articles (91%) reported the CFIR Inner Setting domain (e.g., leadership engagement) to have a predominant influence over telehealth implementation success. By comparison, few articles (14%) reported the CFIR Outer Setting domain (e.g., telehealth policies) to have notable influence. While more (63%) telehealth initiatives were focused on specialty (vs primary) care, a vast majority (78%) were focused on clinical practice over medical education, healthcare administration, or population health. CONCLUSIONS Organized provider groups have historically paid considerable attention to advocating for telehealth policy (Outer Setting) reform. However, results suggest that for effective telehealth implementation, provider groups need to refocus their efforts on educating individual providers on the complex inter-relationships between Inner Setting constructs and telehealth implementation-effectiveness. On a separate note, the growth in implementation-effectiveness study protocols since 2020, suggests that additional outcome measures may soon be available, to provide a more nuanced understanding of the determinants of effective telehealth implementation based on the CFIR domains and constructs.
Collapse
Affiliation(s)
- Pavani Rangachari
- grid.266831.80000 0001 2168 8754Department of Population Health and Leadership, School of Health Sciences, University of New Haven, 300 Boston Post Road, West Haven, CT 06516 USA
| | - Swapandeep S. Mushiana
- grid.410372.30000 0004 0419 2775Veterans Affairs (VA) Quality Scholars Program - San Francisco VA Healthcare System, San Francisco, CA 94121 USA
| | - Krista Herbert
- Portland Veterans Affairs (VA) Healthcare System, Portland, OR 97239 USA
| |
Collapse
|
152
|
Damschroder LJ, Miech EJ, Freitag MB, Evans R, Burns JA, Raffa SD, Goldstein MG, Annis A, Spohr SA, Wiitala WL. Facility-level program components leading to population impact: a coincidence analysis of obesity treatment options within the Veterans Health Administration. Transl Behav Med 2022; 12:1029-1037. [PMID: 36408955 DOI: 10.1093/tbm/ibac051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Obesity is a well-established risk factor for increased morbidity and mortality. Comprehensive lifestyle interventions, pharmacotherapy, and bariatric surgery are three effective treatment approaches for obesity. The Veterans Health Administration (VHA) offers all three domains but in different configurations across medical facilities. Study aim was to explore the relationship between configurations of three types of obesity treatments, context, and population impact across VHA using coincidence analysis. This was a cross-sectional analysis of survey data describing weight management treatment components linked with administrative data to compute population impact for each facility. Coincidence analysis was used to identify combinations of treatment components that led to higher population impact. Facilities with higher impact were in the top two quintiles for (1) reach to eligible patients and (2) weight outcomes. Sixty-nine facilities were included in the analyses. The final model explained 88% (29/33) of the higher-impact facilities with 91% consistency (29/32) and was comprised of five distinct pathways. Each of the five pathways depended on facility complexity-level plus factors from one or more of the three domains of weight management: comprehensive lifestyle interventions, pharmacotherapy, and/or bariatric surgery. Three pathways include components from multiple treatment domains. Combinations of conditions formed "recipes" that lead to higher population impact. Our coincidence analyses highlighted both the importance of local context and how combinations of specific conditions consistently and uniquely distinguished higher impact facilities from lower impact facilities for weight management.
Collapse
Affiliation(s)
- Laura J Damschroder
- Veterans Affairs Center for Clinical Management Research, VA MIDAS QUERI Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Edward J Miech
- Veterans Affairs Center for Health Information & Communication, VA EXTEND QUERI, Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Michelle B Freitag
- Veterans Affairs Center for Clinical Management Research, VA MIDAS QUERI Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Richard Evans
- Veterans Affairs Center for Clinical Management Research, VA MIDAS QUERI Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jennifer A Burns
- Veterans Affairs Center for Clinical Management Research, VA MIDAS QUERI Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Susan D Raffa
- National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Michael G Goldstein
- National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, NC, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Ann Annis
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Stephanie A Spohr
- National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, NC, USA
| | - Wyndy L Wiitala
- Veterans Affairs Center for Clinical Management Research, VA MIDAS QUERI Ann Arbor Healthcare System, Ann Arbor, MI, USA
| |
Collapse
|
153
|
Sichel CE, Connors EH. Measurement feedback system implementation in public youth mental health treatment services: a mixed methods analysis. Implement Sci Commun 2022; 3:119. [PMID: 36415009 PMCID: PMC9682849 DOI: 10.1186/s43058-022-00356-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/28/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Prior studies indicate the effectiveness of measurement-based care (MBC), an evidence-based practice, in improving and accelerating positive outcomes for youth receiving behavioral health services. MBC is the routine collection and use of client-reported progress measures to inform shared decision-making and collaborative treatment adjustments and is a relatively feasible and scalable clinical practice, particularly well-suited for under-resourced community mental health settings. However, uptake of MBC remains low, so information on determinants related to MBC practice patterns is needed. METHODS Quantitative and qualitative data from N = 80 clinicians who implemented MBC using a measurement feedback system (MFS) were merged to understand and describe determinants of practice over three study phases. Quantitative, latent class analysis identified clinician groups based on participants' ratings of MFS acceptability, appropriateness, and feasibility and describes similarities/differences between classes in clinician-level characteristics (e.g., age; perceptions of implementation climate; reported MFS use; phase I). Qualitative analyses of clinicians' responses to open-ended questions about their MFS use and feedback about the MFS and implementation supports were conducted separately to understand multi-level barriers and facilitators to MFS implementation (phase II). Mixing occurred during interpretation, examining clinician experiences and opinions across groups to understand the needs of different classes of clinicians, describe class differences, and inform selection of implementation strategies in future research (phase III). RESULTS We identified two classes of clinicians: "Higher MFS" and "Lower MFS," and found similarities and differences in MFS use across groups. Compared to Lower MFS participants, clinicians in the Higher MFS group reported facilitators at a higher rate. Four determinants of practice were associated with the uptake of MBC and MFS in youth-serving community mental health settings for all clinicians: clarity, appropriateness, and feasibility of the MFS and its measures; clinician knowledge and skills; client preferences and behaviors; and incentives and resources (e.g., time; continuing educational support). Findings also highlighted the need for individual-level implementation strategies to target clinician needs, skills, and perceptions for future MBC and MFS implementation efforts. CONCLUSION This study has implications for the adoption of evidence-based practices, such as MBC, in the context of community-based mental health services for youth.
Collapse
Affiliation(s)
- Corianna E Sichel
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University, 1051 Riverside Drive, Mail Unit 78, New York, NY, 10032, USA.
| | - Elizabeth H Connors
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine, 389 Whitney Avenue, New Haven, CT, 06511, USA
| |
Collapse
|
154
|
Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci 2022; 17:75. [DOI: 10.1186/s13012-022-01245-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Many implementation efforts fail, even with highly developed plans for execution, because contextual factors can be powerful forces working against implementation in the real world. The Consolidated Framework for Implementation Research (CFIR) is one of the most commonly used determinant frameworks to assess these contextual factors; however, it has been over 10 years since publication and there is a need for updates. The purpose of this project was to elicit feedback from experienced CFIR users to inform updates to the framework.
Methods
User feedback was obtained from two sources: (1) a literature review with a systematic search; and (2) a survey of authors who used the CFIR in a published study. Data were combined across both sources and reviewed to identify themes; a consensus approach was used to finalize all CFIR updates. The VA Ann Arbor Healthcare System IRB declared this study exempt from the requirements of 38 CFR 16 based on category 2.
Results
The systematic search yielded 376 articles that contained the CFIR in the title and/or abstract and 334 unique authors with contact information; 59 articles included feedback on the CFIR. Forty percent (n = 134/334) of authors completed the survey. The CFIR received positive ratings on most framework sensibility items (e.g., applicability, usability), but respondents also provided recommendations for changes. Overall, updates to the CFIR include revisions to existing domains and constructs as well as the addition, removal, or relocation of constructs. These changes address important critiques of the CFIR, including better centering innovation recipients and adding determinants to equity in implementation.
Conclusion
The updates in the CFIR reflect feedback from a growing community of CFIR users. Although there are many updates, constructs can be mapped back to the original CFIR to ensure longitudinal consistency. We encourage users to continue critiquing the CFIR, facilitating the evolution of the framework as implementation science advances.
Collapse
|
155
|
Madrigal L, Manders OC, Kegler M, Haardörfer R, Piper S, Blais LM, Weber MB, Escoffery C. Inner and outer setting factors that influence the implementation of the National Diabetes Prevention Program (National DPP) using the Consolidated Framework for Implementation Research (CFIR): a qualitative study. Implement Sci Commun 2022; 3:104. [PMID: 36183133 PMCID: PMC9526531 DOI: 10.1186/s43058-022-00350-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/19/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Scaling evidence-based interventions are key to impacting population health. The National DPP lifestyle change program is one such intervention that has been scaled across the USA over the past 20 years; however, enrollment is an ongoing challenge. Furthermore, little is known about which organizations are most successful with program delivery, enrollment, and scaling. This study aims to understand more about the internal and external organization factors that impact program implementation and reach. METHODS Between August 2020 and January 2021, data were collected through semi-structured key informant interviews with 30 National DPP delivery organization implementers. This study uses a qualitative cross-case construct rating methodology to assess which Consolidated Framework for Implementation Research (CFIR) inner and outer setting constructs contributed (both in valence and magnitude) to the organization's current level of implementation reach (measured by average participant enrollment per year). A construct by case matrix was created with ratings for each CFIR construct by interviewee and grouped by implementation reach level. RESULTS Across the 16 inner and outer setting constructs and subconstructs, the interviewees with greater enrollment per year provided stronger and more positive examples related to implementation and enrollment of the program, while the lower reach groups reported stronger and more negative examples across rated constructs. Four inner setting constructs/subconstructs (structural characteristics, compatibility, goals and feedback, and leadership engagement) were identified as "distinguishing" between enrollment reach levels based on the difference between groups by average rating, the examination of the number of extreme ratings within levels, and the thematic analysis of the content discussed. Within these constructs, factors such as organization size and administrative processes; program fit with existing organization services and programs; the presence of enrollment goals; and active leadership involvement in implementation were identified as influencing program reach. CONCLUSIONS Our study identified a number of influential CFIR constructs and their impact on National DPP implementation reach. These findings can be leveraged to improve efforts in recruiting and assisting delivery organizations to increase the reach and scale of the National DPP as well as other evidence-based interventions.
Collapse
Affiliation(s)
- Lillian Madrigal
- grid.189967.80000 0001 0941 6502Rollins School of Public Health Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Olivia C. Manders
- grid.189967.80000 0001 0941 6502Rollins School of Public Health Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Michelle Kegler
- grid.189967.80000 0001 0941 6502Rollins School of Public Health Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Regine Haardörfer
- grid.189967.80000 0001 0941 6502Rollins School of Public Health Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Sarah Piper
- grid.189967.80000 0001 0941 6502Rollins School of Public Health Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Linelle M. Blais
- grid.189967.80000 0001 0941 6502Rollins School of Public Health Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Mary Beth Weber
- grid.189967.80000 0001 0941 6502Rollins School of Public Health Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Cam Escoffery
- grid.189967.80000 0001 0941 6502Rollins School of Public Health Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
| |
Collapse
|
156
|
Smith J, Braithwaite J, O'Brien TA, Smith S, Tyrrell VJ, Mould EVA, Long JC, Rapport F. The Voices of Stakeholders Involved in Precision Medicine: The Co-Design and Evaluation of Qualitative Indicators of Intervention Acceptability, Fidelity and Context in PRecISion Medicine for Children With Cancer in Australia. QUALITATIVE HEALTH RESEARCH 2022; 32:1865-1880. [PMID: 36066496 DOI: 10.1177/10497323221120501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We report a novel approach of amalgamating implementation outcomes of acceptability and fidelity alongside context as a new way of qualitatively evaluating implementation outcomes and context of a precision medicine intervention. A rapid qualitative online proforma was co-designed with stakeholders and sent to a purposive sample of healthcare professionals involved in an early-phase clinical trial intervention. Data were analysed using Framework Analysis. A total of 24 out of 68 proformas were returned. Although some participants raised concerns about drug medication access issues, the main intervention was well accepted and understood across professional groups. Comprehension was enhanced through exposure to specialist multidisciplinary meeting arrangements. In conclusion, a rapid data collection tool and framework are now available to assess readily measurable, qualitative indicators of acceptability, fidelity of receipt and contextual fit within the dynamic precision medicine context.
Collapse
Affiliation(s)
- James Smith
- Centre for Healthcare Resilience and Implementation Science, 208044Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, 208044Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Tracey A O'Brien
- Faculty of Medicine, School of Women's and Children's Health, 7800University of New South Wales, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Stephanie Smith
- School of Population Health, 1649Curtin University, Perth, WA, Australia
- School of Nursing and Midwifery, Edith Cowan University, Perth, WA, Australia
- Perth Children's Hospital, Nedlands, WA, Australia
| | - Vanessa J Tyrrell
- Children's Cancer Institute, 188680Lowy Cancer Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Emily V A Mould
- Children's Cancer Institute, 188680Lowy Cancer Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Janet C Long
- Centre for Healthcare Resilience and Implementation Science, 208044Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Frances Rapport
- Centre for Healthcare Resilience and Implementation Science, 208044Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| |
Collapse
|
157
|
Logie CH, van der Merwe LLA, Scheim A. Measuring sex, gender, and sexual orientation: one step to health equity. Lancet 2022; 400:715-717. [PMID: 35908554 DOI: 10.1016/s0140-6736(22)01425-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 07/21/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada; Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; United Nations University Institute for Water, Environment and Health, Hamilton, ON, Canada.
| | - L Leigh Ann van der Merwe
- Social Health Empowerment Feminist Collective of Transgender Women of Africa, East London, South Africa
| | - Ayden Scheim
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| |
Collapse
|
158
|
Domlyn AM, Crowder C, Eisenson H, Pollak KI, Davis JM, Calhoun PS, Wilson SM. Implementation mapping for tobacco cessation in a federally qualified health center. Front Public Health 2022; 10:908646. [PMID: 36117603 PMCID: PMC9478793 DOI: 10.3389/fpubh.2022.908646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/04/2022] [Indexed: 01/22/2023] Open
Abstract
Background Implementation mapping (IM) is a promising five-step method for guiding planning, execution, and maintenance of an innovation. Case examples are valuable for implementation practitioners to understand considerations for applying IM. This pilot study aimed to determine the feasibility of using IM within a federally qualified health center (FQHC) with limited funds and a 1-year timeline. Methods An urban FQHC partnered with an academic team to employ IM for implementing a computerized strategy of tobacco cessation: the 5A's (Ask, Advise, Assess, Assist, Arrange). Each step of IM was supplemented with theory-driven methods and frameworks. Data collection included surveys and interviews with clinic staff, analyzed via rapid data analysis. Results Medical assistants and clinicians were identified as primary implementers of the 5A's intervention. Salient determinants of change included the perceived compatibility and relative priority of 5A's. Performance objectives and change objectives were derived to address these determinants, along with a suite of implementation strategies. Despite indicators of adoptability and acceptability of the 5A's, reductions in willingness to adopt the implementation package occurred over time and the intervention was not adopted by the FQHC within the study timeframe. This is likely due to the strain of the COVID-19 pandemic altering health clinic priorities. Conclusions Administratively, the five IM steps are feasible to conduct with FQHC staff within 1 year. However, this study did not obtain its intended outcomes. Lessons learned include the importance of re-assessing barriers over time and ensuring a longer timeframe to observe implementation outcomes.
Collapse
Affiliation(s)
- Ariel M. Domlyn
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, United States
| | | | - Howard Eisenson
- Lincoln Community Health Center, Durham, NC, United States
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, United States
| | - Kathryn I. Pollak
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Duke Cancer Institute, Duke University Health System, Durham, NC, United States
| | - James M. Davis
- Duke Cancer Institute, Duke University Health System, Durham, NC, United States
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Patrick S. Calhoun
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, United States
- Duke Cancer Institute, Duke University Health System, Durham, NC, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Sarah M. Wilson
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Duke Cancer Institute, Duke University Health System, Durham, NC, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| |
Collapse
|
159
|
Nelson KL, Powell BJ, Langellier B, Lê-Scherban F, Shattuck P, Hoagwood K, Purtle J. State Policies that Impact the Design of Children's Mental Health Services: A Modified Delphi Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:834-847. [PMID: 35737191 PMCID: PMC9219374 DOI: 10.1007/s10488-022-01201-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 12/22/2022]
Abstract
To identify the state-level policies and policy domains that state policymakers and advocates perceive as most important for positively impacting the use of children's mental health services (CMHS). We used a modified Delphi technique (i.e., two rounds of questionnaires and an interview) during Spring 2021 to elicit perceptions among state mental health agency officials and advocates (n = 28) from twelve states on state policies that impact the use of CMHS. Participants rated a list of pre-specified policies on a 7-point Likert scale (1 = not important, 7 = extremely important) in the following policy domains: insurance coverage and limits, mental health services, school and social. Participants added nine policies to the initial list of 24 policies. The "school" policy domain was perceived as the most important, while the "social" policy domain was perceived as the least important after the first questionnaire and the second most important policy domain after the second questionnaire. The individual policies perceived as most important were school-based mental health services, state mental health parity, and Medicaid reimbursement rates. Key stakeholders in CMHS should leverage this group of policies to understand the current policy landscape in their state and to identify gaps in policy domains and potential policy opportunities to create a more comprehensive system to address children's mental health from a holistic, evidence-based policymaking perspective.
Collapse
Affiliation(s)
- Katherine L Nelson
- Department of Health Management and Policy, Drexel University Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA.
| | - Byron J Powell
- Brown School and School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Brent Langellier
- Department of Health Management and Policy, Drexel University Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Félice Lê-Scherban
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | | | - Kimberly Hoagwood
- Department of Child and Adolescent Psychiatry, New York University Langone School of Medicine, New York, USA
| | - Jonathan Purtle
- Department of Public Health Policy and Management, New York University School of Global Public Health, New York, USA
| |
Collapse
|
160
|
Majjouti K, Küppers L, Thielmann A, Redaélli M, Vitinius F, Funke C, van der Arend I, Pilic L, Hessbrügge M, Stock S, Weltermann B, Wild D. Family doctors’ attitudes toward peer support programs for type 2 diabetes and/or coronary artery disease: an exploratory survey among German practitioners. BMC PRIMARY CARE 2022; 23:220. [PMID: 36045339 PMCID: PMC9427433 DOI: 10.1186/s12875-022-01827-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022]
Abstract
Background Type 2 diabetes (T2D) and coronary artery disease (CAD) are chronic illnesses where adherence to a healthy lifestyle is crucial. If organisational and cultural factors are well managed, Peer support programs (PSP) can improve self-management, quality of life, and health outcomes. In preparation for launching a PSP, we surveyed family doctors (FD) about their attitudes toward such a program and about potential barriers, and facilitators. Methods In March 2020 we surveyed 896 FDs from five university teaching practice networks in North-Rhine Westphalia, Germany, via an anonymous web-based survey. The questionnaire addressed details of PSPs, including suitable patients and FDs‘role. Data were analysed using descriptive and inferential statistics; qualitative material underwent content analysis by two researchers. Results A total of 165 FDs responded (response rate: 18.4%), 97% were practice owners. Respondents viewed PSPs positively (T2D: 92.0%, CAD 89.9%), especially for patients with poor self-structuring (82.7%), low motivation (76.3%) and few social contacts (67.6%). On average, FDs were able to identify 4.0 ± 3.2 patients as potential group leaders. Major facilitators reported included motivation by peers (92.5%), exercise (79.1%), and social contacts (70.1%). Waning interest over time (73.1%) and poor motivation (70.9%) were considered barriers. The majority of FDs would recommend PSPs to their patients (89.5%). They considered such a program a valuable addition to current care (79.7%). The percentage of FDs’ who expected long-term benefits for their workload was relatively low (37.6%). Conclusions In an exploratory survey among German FDs on PSPs, respondents viewed PSPs as a valuable add-on for T2D and CAD patients, while not expecting a positive impact on their workload. Communication with FDs on PSPs may need to highlight anticipated implementation outcomes such as benefits of PSPs to the practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01827-3.
Collapse
|
161
|
Thusini S, Milenova M, Nahabedian N, Grey B, Soukup T, Henderson C. Identifying and understanding benefits associated with return-on-investment from large-scale healthcare Quality Improvement programmes: an integrative systematic literature review. BMC Health Serv Res 2022; 22:1083. [PMID: 36002852 PMCID: PMC9404657 DOI: 10.1186/s12913-022-08171-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND We previously developed a Quality Improvement (QI) Return-on-Investment (ROI) conceptual framework for large-scale healthcare QI programmes. We defined ROI as any monetary or non-monetary value or benefit derived from QI. We called the framework the QI-ROI conceptual framework. The current study describes the different categories of benefits covered by this framework and explores the relationships between these benefits. METHODS We searched Medline, Embase, Global health, PsycInfo, EconLit, NHS EED, Web of Science, Google Scholar, organisational journals, and citations, using ROI or returns-on-investment concepts (e.g., cost-benefit, cost-effectiveness, value) combined with healthcare and QI. Our analysis was informed by Complexity Theory in view of the complexity of large QI programmes. We used Framework analysis to analyse the data using a preliminary ROI conceptual framework that was based on organisational obligations towards its stakeholders. Included articles discussed at least three organisational benefits towards these obligations, with at least one financial or patient benefit. We synthesized the different QI benefits discussed. RESULTS We retrieved 10 428 articles. One hundred and two (102) articles were selected for full text screening. Of these 34 were excluded and 68 included. Included articles were QI economic, effectiveness, process, and impact evaluations as well as conceptual literature. Based on these literatures, we reviewed and updated our QI-ROI conceptual framework from our first study. Our QI-ROI conceptual framework consists of four categories: 1) organisational performance, 2) organisational development, 3) external outcomes, and 4) unintended outcomes (positive and negative). We found that QI benefits are interlinked, and that ROI in large-scale QI is not merely an end-outcome; there are earlier benefits that matter to organisations that contribute to overall ROI. Organisations also found positive aspects of negative unintended consequences, such as learning from failed QI. DISCUSSION AND CONCLUSION Our analysis indicated that the QI-ROI conceptual framework is made-up of multi-faceted and interconnected benefits from large-scale QI programmes. One or more of these may be desirable depending on each organisation's goals and objectives, as well as stage of development. As such, it is possible for organisations to deduce incremental benefits or returns-on-investments throughout a programme lifecycle that are relevant and legitimate.
Collapse
Affiliation(s)
| | | | | | - Barbara Grey
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | | |
Collapse
|
162
|
Baumann AA, Hooley C, Kryzer E, Morshed AB, Gutner CA, Malone S, Walsh-Bailey C, Pilar M, Sandler B, Tabak RG, Mazzucca S. A scoping review of frameworks in empirical studies and a review of dissemination frameworks. Implement Sci 2022; 17:53. [PMID: 35945548 PMCID: PMC9361268 DOI: 10.1186/s13012-022-01225-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The field of dissemination and implementation (D&I) research has grown immensely in recent years. However, the field of dissemination research has not coalesced to the same degree as the field of implementation research. To advance the field of dissemination research, this review aimed to (1) identify the extent to which dissemination frameworks are used in dissemination empirical studies, (2) examine how scholars define dissemination, and (3) identify key constructs from dissemination frameworks. METHODS To achieve aims 1 and 2, we conducted a scoping review of dissemination studies published in D&I science journals. The search strategy included manuscripts published from 1985 to 2020. Articles were included if they were empirical quantitative or mixed methods studies about the dissemination of information to a professional audience. Studies were excluded if they were systematic reviews, commentaries or conceptual papers, scale-up or scale-out studies, qualitative or case studies, or descriptions of programs. To achieve aim 1, we compiled the frameworks identified in the empirical studies. To achieve aim 2, we compiled the definitions from dissemination from frameworks identified in aim 1 and from dissemination frameworks identified in a 2021 review (Tabak RG, Am J Prev Med 43:337-350, 2012). To achieve aim 3, we compile the constructs and their definitions from the frameworks. FINDINGS Out of 6017 studies, 89 studies were included for full-text extraction. Of these, 45 (51%) used a framework to guide the study. Across the 45 studies, 34 distinct frameworks were identified, out of which 13 (38%) defined dissemination. There is a lack of consensus on the definition of dissemination. Altogether, we identified 48 constructs, divided into 4 categories: process, determinants, strategies, and outcomes. Constructs in the frameworks are not well defined. IMPLICATION FOR D&I RESEARCH This study provides a critical step in the dissemination research literature by offering suggestions on how to define dissemination research and by cataloging and defining dissemination constructs. Strengthening these definitions and distinctions between D&I research could enhance scientific reproducibility and advance the field of dissemination research.
Collapse
Affiliation(s)
- Ana A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, USA.
| | - Cole Hooley
- School of Social Work, Brigham Young University, Provo, USA
| | - Emily Kryzer
- BJC HealthCare, Community Health Improvement, St. Louis, USA
| | | | - Cassidy A Gutner
- ViiV Healthcare, Research Triangle Park, NC, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Sara Malone
- Brown School of Social Work, Washington University in St. Louis, St. Louis, USA
| | - Callie Walsh-Bailey
- Brown School of Social Work, Washington University in St. Louis, St. Louis, USA
| | - Meagan Pilar
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Brittney Sandler
- Bernard Becker Medical Library, School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Rachel G Tabak
- Brown School of Social Work, Washington University in St. Louis, St. Louis, USA
| | - Stephanie Mazzucca
- Brown School of Social Work, Washington University in St. Louis, St. Louis, USA
| |
Collapse
|
163
|
Li DH, Benbow N, Keiser B, Mongrella M, Ortiz K, Villamar J, Gallo C, Deskins JS, Hall CX, Miller C, Mustanski B, Smith JD. Determinants of Implementation for HIV Pre-exposure Prophylaxis Based on an Updated Consolidated Framework for Implementation Research: A Systematic Review. J Acquir Immune Defic Syndr 2022; 90:S235-S246. [PMID: 35703776 PMCID: PMC10161203 DOI: 10.1097/qai.0000000000002984] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Delivery and use of HIV pre-exposure prophylaxis (PrEP) are suboptimal in the United States. Previous reviews of barriers and facilitators have not used an implementation science lens, limiting comprehensiveness and the link to implementation strategies. To summarize the state of the science, we systematically reviewed determinants of PrEP implementation using the updated Consolidated Framework for Implementation Research (CFIR 2.0). SETTING PrEP-eligible communities and delivery settings in the United States. METHODS In January 2021, we searched Ovid MEDLINE, PsycINFO, and Web of Science for peer-reviewed articles related to HIV/AIDS, interventions, implementation, and determinants or strategies. We identified 286 primary research articles published after 1999 about US-based PrEP implementation. Team members extracted discrete "mentioned" and "measured" determinants, coding each by setting, population, valence, measurement, and CFIR 2.0 construct. RESULTS We identified 1776 mentioned and 1952 measured determinants from 254 to 239 articles, respectively. Two-thirds of measured determinants were of PrEP use by patients as opposed to delivery by providers. Articles contained few determinants in the inner setting or process domains (ie, related to the delivery context), even among studies of specific settings. Determinants across priority populations also focused on individual patients and providers rather than structural or logistical factors. CONCLUSION Our findings suggest substantial knowledge in the literature about general patient-level barriers to PrEP use and thus limited need for additional universal studies. Instead, future research should prioritize identifying determinants, especially facilitators, unique to understudied populations and focus on structural and logistical features within current and promising settings (eg, pharmacies) that support integration of PrEP into clinical practice.
Collapse
Affiliation(s)
- Dennis H. Li
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
- Center for Prevention Implementation Methodology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nanette Benbow
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL
- Center for Prevention Implementation Methodology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Brennan Keiser
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
| | - Melissa Mongrella
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
| | - Kasim Ortiz
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
| | - Juan Villamar
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL
- Center for Prevention Implementation Methodology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Carlos Gallo
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL
- Center for Prevention Implementation Methodology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jasmine S. Deskins
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
| | - Casey Xavier Hall
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Corinne Miller
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Brian Mustanski
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
- Center for Prevention Implementation Methodology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Justin D. Smith
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT
| |
Collapse
|
164
|
Connolly SL, Sullivan JL, Lindsay JA, Shimada SL, Heyworth L, Weaver KR, Miller CJ. Factors influencing uptake of telemental health via videoconferencing at high and low adoption sites within the Department of Veterans Affairs during COVID-19: a qualitative study. Implement Sci Commun 2022; 3:66. [PMID: 35725642 PMCID: PMC9207848 DOI: 10.1186/s43058-022-00318-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic dramatically increased the use of telemental health via videoconferencing (TMH-V). While TMH-V has been found to be effective and satisfactory to both patients and providers, little is known regarding factors that influence site-level uptake. We examined facilitators and barriers to TMH-V uptake at higher and lower adoption sites within the US Department of Veterans Affairs (VA). METHODS We conducted twenty-four semi-structured qualitative interviews at four northeastern VA medical centers (two with higher TMH-V adoption and two with lower adoption). Six interviews were conducted per site (one member of mental health leadership, one facility telehealth coordinator/technician, and four mental health providers per site). We performed directed content analysis, guided by the Consolidated Framework for Implementation Research (CFIR), followed by a matrix rating process to rank the degree of influence of each of the 19 included CFIR constructs at the four sites. Positive overall influences, negative overall influences, and differentiators were then identified based on patterns in ratings across sites. RESULTS Five CFIR constructs had positive overall influences across sites: Relative advantage, Patient needs and resources, Relative priority, Knowledge and beliefs, and Self-efficacy. Complexity had a negative overall influence across sites. Four constructs significantly differentiated between higher and lower adoption sites with regards to TMH-V use: Quality, Compatibility, Leadership engagement, and Champions. CONCLUSIONS Several positive overall influences on TMH-V uptake were identified across sites; respondents acknowledged multiple advantages of TMH-V (e.g., convenience), and providers' attitudes towards TMH-V improved as they gained experience. In contrast, complexity was a negative overall influence; TMH-V platforms and processes must be simple and user friendly to promote use. The emergence of Quality, Leadership engagement, and Champions as differentiators speaks to the importance of educating frontline staff and leadership at lower adoption sites about the evidence base demonstrating that TMH-V is high-quality care. Compatibility also emerged as a differentiator; if TMH-V is not easily integrated into provider workflows, uptake will falter. Future work should draw from these findings to develop implementation strategies aiming to increase TMH-V uptake at lower adoption sites, thereby increasing access to high-quality mental health care.
Collapse
Affiliation(s)
- Samantha L Connolly
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA. .,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Jennifer L Sullivan
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA.,Brown University School of Public Health, Providence, RI, USA
| | - Jan A Lindsay
- Michael E. DeBakey VA Medical Center, HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA.,South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Stephanie L Shimada
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA.,Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Leonie Heyworth
- Veterans Health Administration Office of Connected Care/Telehealth, Washington, D.C, USA.,Department of Health Sciences, University of California San Diego, San Diego, CA, USA
| | - Kendra R Weaver
- Clinical Operations, Veterans Health Administration Office of Mental Health and Suicide Prevention, Washington, D.C, USA
| | - Christopher J Miller
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
165
|
Wideman TH, Bostick G, Miller J, Thomas A, Bussières A, Walton D, Tousignant-Laflamme Y, Carlesso L, Hunter J, Perreault K, Shay B. The development of a stakeholder-endorsed national strategic plan for advancing pain education across Canadian physiotherapy programs. Can J Pain 2022; 6:21-32. [PMID: 35694143 PMCID: PMC9176229 DOI: 10.1080/24740527.2022.2056006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The Canadian Pain Task Force recently advanced an action plan calling for improved entry-level health professional pain education. However, there is little research to inform the collaboration and coordination across stakeholders that is needed for its implementation. Aims This article reports on the development of a stakeholder-generated strategic plan to improve pain education across all Canadian physiotherapy (PT) programs. Methods Participants included representatives from the following stakeholder groups: people living with pain (n = 1), PT students and recent graduates (n = 2), educators and directors from every Canadian PT program (n = 24), and leaders of Canada's national PT professional association (n = 2). Strategic priorities were developed through three steps: (1) stakeholder-generated data were collected and analyzed, (2) a draft strategic plan was developed and refined, and (3) stakeholder endorsement of the final plan was assessed. The project was primarily implemented online between 2016 and 2018. Results The plan was developed through five iterative versions. Stakeholders unanimously endorsed a plan that included five priorities focusing on uptake of best evidence across (1) national PT governance groups and (2) within individual PT programs; (3) partnering with people living with pain in pain education; (4) advocacy for the PT role in pain management; and (5) advancing pain education research. Conclusion This plan is expected to help Canadian stakeholders work toward national improvements in PT pain education and to serve as a useful template for informing collaboration on entry-level pain education within other professions and across different geographic regions.
Collapse
Affiliation(s)
- Timothy H. Wideman
- School of Physical and Occupational Therapy McGill University, Montreal, Quebec, Canada,CONTACT Timothy H. Wideman School of Physical and Occupational Therapy Faculty of Medicine, McGill University, Hosmer House, Room 303B, 3630 Promenade Sir-William-Osler, Montreal, QCH3G 1Y5, Canada
| | - Geoffrey Bostick
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
| | - Aliki Thomas
- School of Physical and Occupational Therapy McGill University, Montreal, Quebec, Canada,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal
| | - André Bussières
- School of Physical and Occupational Therapy McGill University, Montreal, Quebec, Canada
| | - David Walton
- School of Physical Therapy, Western University, London, Ontario, Canada
| | | | - Lisa Carlesso
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster UniversityHamilton, Ontario, Canada
| | - Judith Hunter
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Kadija Perreault
- Department of Rehabilitation Science, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Barbara Shay
- Department of Physical Therapy, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
166
|
Gordon EJ, Uriarte JJ, Anderson N, Romo E, Caicedo JC, Shumate M. Implementation and modification of an organizational-level intervention: a prospective analysis. Implement Sci Commun 2022; 3:59. [PMID: 35659156 PMCID: PMC9164326 DOI: 10.1186/s43058-022-00296-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/05/2022] [Indexed: 11/12/2022] Open
Abstract
Background Modifications to interventions can jeopardize intervention outcomes. Pre-existing perceived barriers and facilitators to the intervention arising in the implementation preparation phase may help explain why modifications to the intervention may occur during the implementation phase. This two-site comparative case study describes modifications made to a complex organizational-level intervention and examines how known implementation science factors may have enabled such changes to occur. Methods Northwestern Medicine’sTM Hispanic Kidney Transplant Program (HKTP) is a culturally competent transplant center-based intervention designed to reduce disparities in living donor kidney transplantation among Hispanics. In-depth qualitative interviews and discussions were longitudinally conducted with transplant stakeholders (i.e., physicians, administrators, clinicians) at two kidney transplant programs with large Hispanic populations during implementation preparation and implementation phases. The Consolidated Framework for Implementation Research (CFIR) guided interview design and qualitative analysis, and Stirman’s Framework for Reporting Adaptations and Modifications-Expanded (FRAME) guided modification classification. Results Across sites, 57 stakeholders participated in an interview, group discussion, and/or learning collaborative discussion. Site-B made more modifications than Site-A (n = 29 versus n = 18). Sites differed in the proportions of delaying/skipping (Site-A 50% versus Site-B 28%) and adding (Site-A 11% versus Site-B 28%) but had comparable substituting (Site-A 17% versus Site-B 17%) and tweaking (Site-A 17% versus Site-B 14%) modification types. Across sites, the transplant team consistently initiated the most modifications (Site-A 66%; Site-B 62%). While individuals initiated slightly more modifications at Site-B (21% versus Site-A 17%), institutions instigated proportionately slightly more modifications at Site-A (17% versus Site-B 10%). CFIR inner setting factors (i.e., structural characteristics, culture, available resources, implementation climate) that prominently emerged during the implementation preparation phase explained similarities and differences in sites’ modification numbers, types, and agents in the implementation phase. Conclusion Organizations implementing a culturally competent care intervention made modifications. CFIR inner setting factors emerging in the implementation preparation phase largely explained similarities and differences in study sites’ modifications. Identifying factors contributing to modifications may help institutions become better prepared to implement an intervention by addressing known factors in advance, which may foster greater fidelity leading to desired outcomes. Trial registration ClinicalTrials.govNCT03276390. We registered the study retrospectively on 9-7-17. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00296-0.
Collapse
Affiliation(s)
- Elisa J Gordon
- Department of Surgery - Division of Transplantation, Center for Health Services and Outcomes Research, Center for Bioethics and Medical Humanities, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair, 20th Floor, Chicago, IL, 60611, USA.
| | - Jefferson J Uriarte
- Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Naomi Anderson
- School of Education and Policy, Northwestern University, Evanston, IL, USA
| | - Elida Romo
- Department of Neurology - Biological Sciences Division, University of Chicago, Chicago, IL, USA
| | - Juan Carlos Caicedo
- Department of Surgery - Division of Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michelle Shumate
- Department of Communication Studies, Northwestern University, Evanston, IL, USA
| |
Collapse
|
167
|
Pilar M, Elwy AR, Lushniak L, Huang G, McLoughlin GM, Hooley C, Nadesan-Reddy N, Sandler B, Moshabela M, Alonge O, Geng E, Proctor E. A Perspective on Implementation Outcomes and Strategies to Promote the Uptake of COVID-19 Vaccines. FRONTIERS IN HEALTH SERVICES 2022; 2:897227. [PMID: 36925818 PMCID: PMC10012688 DOI: 10.3389/frhs.2022.897227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022]
Abstract
Recent articles have highlighted the importance of incorporating implementation science concepts into pandemic-related research. However, limited research has been documented to date regarding implementation outcomes that may be unique to COVID-19 vaccinations and how to utilize implementation strategies to address vaccine program-related implementation challenges. To address these gaps, we formed a global COVID-19 implementation workgroup of implementation scientists who met weekly for over a year to review the available literature and learn about ongoing research during the pandemic. We developed a hierarchy to prioritize the applicability of "lessons learned" from the vaccination-related implementation literature. We identified applications of existing implementation outcomes as well as identified additional implementation outcomes. We also mapped implementation strategies to those outcomes. Our efforts provide rationale for the utility of using implementation outcomes in pandemic-related research. Furthermore, we identified three additional implementation outcomes: availability, health equity, and scale-up. Results include a list of COVID-19 relevant implementation strategies mapped to the implementation outcomes.
Collapse
Affiliation(s)
- Meagan Pilar
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - A. Rani Elwy
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Larissa Lushniak
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Grace Huang
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Gabriella M. McLoughlin
- College of Public Health, Temple University, Philadelphia, PA, United States
- Implementation Science Center for Cancer Control and Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Cole Hooley
- School of Social Work, Brigham Young University, Provo, UT, United States
| | - Nisha Nadesan-Reddy
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Brittney Sandler
- Bernard Becker Medical Library, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Olakunle Alonge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elvin Geng
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Enola Proctor
- Shanti K. Khinduka Distinguished Professor Emerita, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| |
Collapse
|
168
|
Kuske S, Willmeroth T, Schneider J, Belibasakis S, Roes M, Borgmann SO, Cartes Febrero MI. Indicators for implementation outcome monitoring of reporting and learning systems in hospitals: an underestimated need for patient safety. BMJ Open Qual 2022; 11:bmjoq-2021-001741. [PMID: 35437258 PMCID: PMC9016397 DOI: 10.1136/bmjoq-2021-001741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/30/2022] [Indexed: 11/23/2022] Open
Abstract
Objective We aimed to investigate the perception of the implementation success of reporting and learning systems in German hospitals, the perceived relevance of the implementation outcomes and whether and how these implementation outcomes are monitored. An reporting and learning system is a tool used worldwide for patient safety that identifies and analyses critical events, errors, risks and near misses in healthcare. Methods A pretested exploratory cross-sectional online survey was conducted with reporting and learning system experts from 51 acute care hospitals. For communicative validation, the results were discussed in person in an expert panel discussion (N=23). Results Fifty-three per cent (n=27) of the participants (N=51) of the online survey perceived that their reporting and learning system was being comprehensively and successfully implemented. However, no service or patient outcomes were reported to ultimately capture the concept of implementation success. Most of the participants reported a (high) relevance of the implementation outcomes’ acceptability and sustainability. In total, 44 measures were provided to monitor implementation outcomes. However, most of the quantitative measures were based on the (relative) number of entered reports. Qualitative measures were reported in relation to the ‘quality of the report’. In general, the measures were poorly specified. Conclusion There is an underestimated need to develop validated ‘implementation patient safety indicator(s) (sets)’ to monitor implementation outcomes of reporting and learning systems. We also identified a potential need to facilitate awareness of the concept of implementation success and its relevance for patient safety. Drafts of indicators that could be used as a starting point for the further development of ‘implementation patient safety indicators’ were provided.
Collapse
Affiliation(s)
- Silke Kuske
- Fliedner Fachhochschule Dusseldorf, Dusseldorf, Germany
| | | | | | | | - Martina Roes
- German Centre for Neurodegenerative Diseases, Witten, Germany
| | | | | |
Collapse
|
169
|
Sustainment of a Complex Culturally Competent Care Intervention for Hispanic Living Donor Kidney Transplantation: A Longitudinal Analysis of Adaptations. J Clin Transl Sci 2022; 6:e38. [PMID: 35574156 PMCID: PMC9066322 DOI: 10.1017/cts.2022.378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/02/2022] [Accepted: 03/19/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Sustainment refers to continued intervention delivery over time, while continuing to produce intended outcomes, often with ongoing adaptations, which are purposeful changes to the design or delivery of an intervention to improve its fit or effectiveness. The Hispanic Kidney Transplant Program (HKTP), a complex, culturally competent intervention, was implemented in two transplant programs to reduce disparities in Hispanic/Latinx living donor kidney transplant rates. This study longitudinally examined the influence of adaptations on HKTP sustainment. Methods: Qualitative interviews, learning collaborative calls, and telephone meetings with physicians, administrators, and staff (n = 55) were conducted over three years of implementation to identify HKTP adaptations. The Framework for Reporting Adaptations and Modifications-Expanded was used to classify adaptation types and frequency, which were compared across sites over time. Results: Across sites, more adaptations were made in the first year (n = 47), then fell and plateaued in the two remaining years (n = 35). Adaptations at Site-A were consistent across years (2017: n = 18, 2018: n = 17, 2019: n = 14), while Site-B made considerably fewer adaptations after the first year (2017: n = 29, 2018: n = 18, 2019: n = 21). Both sites proportionally made mostly skipping (32%), adding (20%), tweaking (20%), and substituting (16%) adaptation types. Skipping- and substituting-type adaptations were made due to institutional structural characteristics and lack of available resources, respectively. However, Site-A’s greater proportion of skipping-type adaptations was attributed to greater system complexity, and Site-B’s greater proportion of adding-type adaptation was attributed to the egalitarian team-based culture. Conclusion: Our findings can help prepare implementers to expect certain context-specific adaptations and preemptively avoid those that hinder sustainment.
Collapse
|
170
|
Ezezika O, Mengistu M, Opoku E, Farheen A, Chauhan A, Barrett K. What are the barriers and facilitators to polio vaccination and eradication programs? A systematic review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001283. [PMID: 36962654 PMCID: PMC10022167 DOI: 10.1371/journal.pgph.0001283] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/21/2022] [Indexed: 11/17/2022]
Abstract
Global efforts to eradicate polio by the Global Polio Eradication Initiative agency partners and country-level stakeholders have led to the implementation of global polio vaccination programs. This study presents the findings of existing studies regarding the barriers and facilitators that countries face when implementing polio interventions. A comprehensive search was conducted in OVID Medline, OVID Embase, EBSCO CINAHL Plus, and Web of Science. Eligible studies underwent quality assessment. A qualitative evidence synthesis approach was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR). The search identified 4147 citations, and following the removal of duplicates and screening according to our inclusion/exclusion criteria, 20 articles were eligible for inclusion in the review. Twelve countries were represented in this review, with India, Nigeria, Pakistan, Ethiopia, and Afghanistan having the most representation of available studies. We identified 36 barriers and 16 facilitators. Seven themes emerged from these barriers and facilitators: fear, community trust, infrastructure, beliefs about the intervention, influential opinions, intervention design, and geo-politics. The most frequently cited CFIR constructs for the facilitators and barriers were knowledge and beliefs about the intervention, followed by available resources. This study identified a wide range of barriers and facilitators to polio vaccination implementation across the globe, adding to the scarce body of literature on these barriers and facilitators from an implementation perspective and using a determinant framework. The diversity of factors among different groups of people or countries highlights the relevance of contexts. Implementers should be conversant with the contexts within which polio eradication programs boost intervention coverage and capacity. This study provides policymakers, practitioners, and researchers with a tool for planning and designing polio immunization programs. Trial registration: A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD42020222115).
Collapse
Affiliation(s)
- Obidimma Ezezika
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, Canada
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
- African Centre for Innovation and Leadership Development, Abuja, Nigeria
| | - Meron Mengistu
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
- London School of Hygiene & Tropical Medicine, Keppel St, London, United Kingdom
| | - Eric Opoku
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Aiman Farheen
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
| | - Anuradha Chauhan
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
| | - Kathryn Barrett
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, Canada
- University of Toronto Scarborough Library, Toronto, Canada
| |
Collapse
|
171
|
Haverhals LM, Magid KH, Kononowech J. Applying the Tailored Implementation in Chronic Diseases framework to inform implementation of the Preferences Elicited and Respected for Seriously Ill Veterans through enhanced decision-making program in the United States Veterans Health Administration. FRONTIERS IN HEALTH SERVICES 2022; 2:935341. [PMID: 36925825 PMCID: PMC10012641 DOI: 10.3389/frhs.2022.935341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022]
Abstract
In 2017, the National Center for Ethics in Health Care for the United States Department of Veterans Affairs (VA) commenced national roll-out of the Life-Sustaining Treatment Decisions Initiative. This national VA initiative aimed to promote personalized, proactive, patient-driven care for seriously ill Veterans by documenting Veterans' goals and preferences for life-sustaining treatments in a durable electronic health record note template known as the life-sustaining treatment template. The Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision-Making (PERSIVED) quality improvement program was created to address the high variation in life-sustaining treatment template completion in VA Home Based Primary Care (HBPC) and Community Nursing Home programs. This manuscript describes the program that focuses on improving life sustaining treatment template completion rates amongst HBPC programs. To increase life-sustaining treatment template completion for Veterans receiving care from HBPC programs, the PERSIVED team applies two implementation strategies: audit with feedback and implementation facilitation. The PERSIVED team conducts semi-structured interviews, needs assessments, and process mapping with HBPC programs in order to identify barriers and facilitators to life-sustaining treatment template completion to inform tailored facilitation. Our interview data is analyzed using the Tailored Implementation in Chronic Diseases (TICD) framework, which identifies 57 determinants that might influence practice or implementation of interventions. To quickly synthesize and use baseline data to inform the tailored implementation plan, we adapted a rapid analysis process for our purposes. This paper describes a six-step process for conducting and analyzing baseline interviews through applying the TICD that can be applied and adapted by implementation scientists to rapidly inform tailoring of implementation facilitation.
Collapse
Affiliation(s)
- Leah M Haverhals
- Denver-Seattle VA Center of Innovation for Value Driven and Veteran-Centric Care, Rocky Mountain Regional VA Medical Center at VA Eastern Colorado Health Care System, Aurora, CO, United States.,Health Care Policy and Research, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kate H Magid
- Denver-Seattle VA Center of Innovation for Value Driven and Veteran-Centric Care, Rocky Mountain Regional VA Medical Center at VA Eastern Colorado Health Care System, Aurora, CO, United States
| | | |
Collapse
|