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Weaver NL, Buskirk TD, Jupka K, Williams J. Organizational factors related to the adoption of an injury prevention program by U.S. children's hospitals. Transl Behav Med 2019; 9:768-776. [PMID: 30053295 DOI: 10.1093/tbm/iby038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/21/2017] [Accepted: 03/13/2018] [Indexed: 11/12/2022] Open
Abstract
Most childhood injuries can be prevented with the correct use of safety devices and appropriate supervision. Children's hospitals are well positioned to promote these behaviors with evidence-based programming; however, barriers exist to adopting such programs. The purpose of this study was to describe organizational and administrative factors related to the adoption of an efficacious injury prevention (IP) program by children's hospitals in the USA. IP specialists at 232 U.S. children's hospitals were invited to complete a baseline survey, and then offered Safe N' Sound (SNS), an efficacious computer IP program targeting parents of young children. Following this promotion period, specialists were surveyed again to assess their level of SNS adoption. Organizational and administrative factors associated with SNS adoption were identified using conditional random forest models (n = 93). Random forests identified a set of six predictors with potential utility for classifying hospitals as having SNS adoption activity or not; the final pruned classification tree indicated that four of these were best able to differentiate hospitals with and without adoption activity-having a medical director, having other hospital units that provided IP programming, the number of requests the IP unit received within the past year, and the belief of administrative leaders in their responsibility to develop programming all influence decisions. Hospitals without a medical director were most likely to demonstrate adoption activity. Medical directors, or other organizational leaders, can facilitate the adoption process for evidence-based intervention, but may need to be engaged intentionally when disseminating new products, tools, or approaches.
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Affiliation(s)
- Nancy L Weaver
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Trent D Buskirk
- Department of Management Science and Information Systems, University of Massachusetts, Boston, MA, USA.,Center for Survey Research, University of Massachusetts, Boston, MA, USA
| | - Keri Jupka
- Parents as Teachers National Center, St. Louis, MO, USA
| | - Janice Williams
- Carolinas Center for Injury Prevention, Department of Emergency Medicine, Carolinas Medical Center, Charlotte NC, USA
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252
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Jones LK, Gidding SS, Seaton TL, Goldberg A, Gregor C, Sturm AC, Brownson RC, Rahm AK, Williams MS. Developing implementation strategies to improve uptake of guideline-recommended treatments for individuals with familial hypercholesterolemia: A protocol. Res Social Adm Pharm 2019; 16:390-395. [PMID: 31229402 DOI: 10.1016/j.sapharm.2019.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Familial hypercholesterolemia (FH) affects more than one million Americans, and most individuals have not been formally diagnosed with the condition. Individuals with FH have markedly elevated serum low-density lipoprotein cholesterol (LDL-C) levels from birth that substantially increase their risk for early-onset cardiovascular (CV) events. Guideline-recommended treatments exist to lower LDL-C and reduce the risk of CV events in individuals with FH and hypercholesterolemia. This study seeks to address a significant gap in the care of individuals with FH by systematically developing an effective approach to increase the adoption of guideline-recommended treatments for FH. METHODS This developmental study will consist of three aims: 1) determine the barriers to and facilitators of treatment of FH; 2) develop a list of potential implementation strategies to promote the adoption of guideline-recommended treatment of individuals with FH, and 3) pilot one implementation strategy from Aim 2 in one health care system to evaluate implementation outcomes of the strategy. The Practical, Robust Implementation and Sustainability Model will guide this project, including the development of interview questions, implementation strategies, and evaluation of the implementation strategy. The implementation outcomes include: of individuals targeted by the implementation strategy, how many are impacted by it (reach), measure the change in knowledge, attitude, and behavior that is impacted by the implementation strategy (effectiveness), in settings targeted by the implementation strategy, how many adopt it (adoption), and fidelity and cost of the implementation strategy (implementation). Data sources will include electronic health records, administrative databases, surveys, and semi-structured interviews. DISCUSSION The inclusion of patient and organizational stakeholder experiences is a critically important step in developing efficient and effective implementation strategies. Additionally, perspectives from a variety of geographic areas and cultural perspectives should increase feasibility and fidelity of the interventional approach to improve adoption of guideline-recommended practices for FH care.
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Affiliation(s)
- Laney K Jones
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, USA.
| | | | - Terry L Seaton
- St. Louis College of Pharmacy, St. Louis, MO, USA; Mercy Clinic-East Communities, St. Louis, MO, USA
| | - Anne Goldberg
- Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Christina Gregor
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, USA
| | - Amy C Sturm
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA; Department of Surgery (Division of Public Health Sciences), Alvin J. Siteman Cancer Center, Washington University School of Medicine; Washington University in St. Louis, St. Louis, MO, USA
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253
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Gopalan G, Hooley C, Winters A, Stephens T. Perceptions Among Child Welfare Staff when Modifying A Child Mental Health Intervention to be Implemented in Child Welfare Services. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 63:366-377. [PMID: 30693961 PMCID: PMC6398163 DOI: 10.1002/ajcp.12309] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In order to increase access to child mental health evidence-based interventions (EBIs) for vulnerable and hard-to-engage families involved in the child welfare (CW) system, innovative approaches coupled with input from service providers are needed. One potential solution involves utilizing task-shifting strategies and implementation science theoretical frameworks to implement such EBIs in CW settings. This study examined perceptions among CW staff who were members of a collaborative advisory board involved in the implementation of the 4Rs and 2Ss Strengthening Families Program (4R2S) in CW placement prevention settings, utilizing task-shifting strategies and the Practical, Robust, Implementation, and Sustainability Model. Advisory board members reported difficulties in engaging families, heavy workloads, and conflicting implementation initiatives. While 4R2S was perceived as generally aligned with their organization's mission, modifications to the intervention and to agency procedures were recommended to promote implementation success. Suggested modifications to the existing 4R2S training and supervision are discussed. Findings underscore the importance of understanding the experiences of CW service providers, which can inform future efforts to implement child mental health EBIs in CW services.
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Affiliation(s)
- Geetha Gopalan
- Hunter College – Silberman School of Social Work,
2180 Third Avenue, New York, NY 10035
| | - Cole Hooley
- Brown School, Washington University in St. Louis, One
Brookings Drive, St. Louis, MO 63130
| | - Andrew Winters
- Kent School of Social Work, University of Louisville, 2217
S. Third Street, Louisville, KY 40292
| | - Tricia Stephens
- Hunter College – Silberman School of Social Work,
2180 Third Avenue, New York, NY 10035
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254
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Parker V, Engle RL, Afable MK, Tyler DA, Gormley K, Stolzmann K, Shwartz M, Sullivan JL. Staff-perceived Conflict between Resident-centered Care and Quality in the Skilled Nursing Facility: Are Both Possible? Clin Gerontol 2019; 42:267-276. [PMID: 29733754 DOI: 10.1080/07317115.2018.1467522] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The purpose of this study was to understand if and how Veterans Affairs (VA) nursing home (CLC) staff experience difficulty in providing care that is both resident-centered (RCC) and concordant with quality standards. METHODS Twelve VA CLCs were selected for site visits, stratified based on rankings on a composite quality measure (calculated from various indicators) and resident-centered care (RCC) progress (based on a culture change tool). Staff were interviewed about efforts and barriers to achieving goals in RCC and quality, and the interview transcripts systematically analyzed for themes. RESULTS We interviewed 141 participants, including senior leaders, middle managers, and front-line staff. An emergent theme was conflict between RCC and quality, although participants varied in their perceptions of its impact. Participants perceived three conflict types: 1) between resident preferences and medically indicated actions; 2) between resident preferences and the needs or safety of others; and 3) limits of staff time or authority. CONCLUSIONS CLC staff perceive conflicts between RCC and care consistent with quality imperatives. CLINICAL IMPLICATIONS Variation in perceived RCC-quality conflicts suggests that policy clarifications and additional training may provide guidance in dealing with such dilemmas. It may be prudent to clearly communicate to what boundaries exist to RCC in the evolving CLC environment.
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Affiliation(s)
- Victoria Parker
- a Center for Healthcare Organization & Implementation Research , VA Boston Healthcare System , Boston , MA.,b Peter T. Paul College of Business and Economics , University of New Hampshire , Durham , NH
| | - Ryann L Engle
- a Center for Healthcare Organization & Implementation Research , VA Boston Healthcare System , Boston , MA
| | - Melissa K Afable
- c Department of Quality, Safety & Value , Partners HealthCare , Boston , MA
| | - Denise A Tyler
- e Program on Aging, Disability, and Long-term care, RTI , Waltham , MA
| | - Katelyn Gormley
- a Center for Healthcare Organization & Implementation Research , VA Boston Healthcare System , Boston , MA
| | - Kelly Stolzmann
- a Center for Healthcare Organization & Implementation Research , VA Boston Healthcare System , Boston , MA
| | - Michael Shwartz
- a Center for Healthcare Organization & Implementation Research , VA Boston Healthcare System , Boston , MA.,f Questrom School of Business , Boston University , Boston , MA
| | - Jennifer L Sullivan
- a Center for Healthcare Organization & Implementation Research , VA Boston Healthcare System , Boston , MA.,d Department of Health Law, Policy and Management , Boston University School of Public Health , Boston , MA
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Abstract
OBJECTIVE Understanding how to successfully implement care coordination programs across diverse settings is critical for disseminating best practices. We describe how we operationalized the Practical Robust Implementation and Sustainability Model (PRISM) to guide the assessment of local context prior to implementation of the rural Transitions Nurse Program (TNP) at five facilities across the Veterans Health Administration (VHA). METHODS We operationalized PRISM to create qualitative data collection techniques (interview guides, semi-structured observations, and a group brainwriting premortem) to assess local context, the current state of care coordination, and perceptions of TNP prior to implementation at five facilities. We analyzed data using deductive-inductive framework analysis to identify themes related to PRISM. We adapted implementation strategies at each site using these findings. RESULTS We identified actionable themes within PRISM domains to address during implementation. The most commonly occurring PRISM domains were "organizational characteristics" and "implementation and sustainability infrastructure." Themes included a disconnect between primary care and hospital inpatient teams, concerns about work duplication, and concerns that one nurse could not meet the demand for the program. These themes informed TNP implementation. CONCLUSIONS The use of PRISM for pre-implementation site assessments yielded important findings that guided adaptations to our implementation approach. Further, barriers and facilitators to TNP implementation may be common to other care coordination interventions. Generating a common language of barriers and facilitators in care coordination initiatives will enhance generalizability and establish best practices. IMPACT STATEMENTS TNP is a national intensive care coordination program targeting rural Veterans. We operationalized PRISM to guide implementation efforts. We effectively elucidated facilitators, barriers, and unique contextual factors at diverse VHA facilities. The use of PRISM enhances the generalizability of findings across care settings and may optimize implementation of care coordination interventions in the VHA.
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256
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Identifying and overcoming implementation challenges: Experience of 59 noninstitutional long-term services and support pilot programs in the Veterans Health Administration. Health Care Manage Rev 2019; 43:193-205. [PMID: 28125459 PMCID: PMC5991173 DOI: 10.1097/hmr.0000000000000152] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: From 2010 to 2013, the Department of Veterans Affairs (VA) funded a large pilot initiative to implement noninstitutional long-term services and supports (LTSS) programs to support aging Veterans. Our team evaluated implementation of 59 VA noninstitutional LTSS programs. Purpose: The specific objectives of this study are to (a) examine the challenges influencing program implementation comparing active sites that remained open and inactive sites that closed during the funding period and (b) identify ways that active sites overcame the challenges they experienced. Methodology: Key informant semistructured interviews occurred between 2011 and 2013. We conducted 217 telephone interviews over four time points. Content analysis was used to identify emergent themes. The study team met regularly to define each challenge, review all codes, and discuss discrepancies. For each follow-up interview with the sites, the list of established challenges was used as a priori themes. Emergent data were also coded. Results: The challenges affecting implementation included human resources and staffing issues, infrastructure, resources allocation and geography, referrals and marketing, leadership support, and team dynamics and processes. Programs were able to overcome challenges by communicating with team members and other areas in the organization, utilizing information technology solutions, creative use of staff and flexible schedules, and obtaining additional resources. Discussion: This study highlights several common challenges programs can address during the program implementation. The most often mentioned strategy was effective communication. Strategies also targeted several components of the organization including organizational functions and processes (e.g., importance of coordination within a team and across disciplines to provide good care), infrastructure (e.g., information technology and human resources), and program fit with priorities in the organization (e.g., leadership support). Implications: Anticipating potential pitfalls of program implementation for future noninstitutional LTSS programs can improve implementation efficiency and program sustainability. Staff at multiple levels in the organization must fully support noninstitutional LTSS programs to address these challenges.
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257
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Glasgow RE, Harden SM, Gaglio B, Rabin B, Smith ML, Porter GC, Ory MG, Estabrooks PA. RE-AIM Planning and Evaluation Framework: Adapting to New Science and Practice With a 20-Year Review. Front Public Health 2019; 7:64. [PMID: 30984733 PMCID: PMC6450067 DOI: 10.3389/fpubh.2019.00064] [Citation(s) in RCA: 898] [Impact Index Per Article: 179.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/05/2019] [Indexed: 01/07/2023] Open
Abstract
The RE-AIM planning and evaluation framework was conceptualized two decades ago. As one of the most frequently applied implementation frameworks, RE-AIM has now been cited in over 2,800 publications. This paper describes the application and evolution of RE-AIM as well as lessons learned from its use. RE-AIM has been applied most often in public health and health behavior change research, but increasingly in more diverse content areas and within clinical, community, and corporate settings. We discuss challenges of using RE-AIM while encouraging a more pragmatic use of key dimensions rather than comprehensive applications of all elements. Current foci of RE-AIM include increasing the emphasis on cost and adaptations to programs and expanding the use of qualitative methods to understand "how" and "why" results came about. The framework will continue to evolve to focus on contextual and explanatory factors related to RE-AIM outcomes, package RE-AIM for use by non-researchers, and integrate RE-AIM with other pragmatic and reporting frameworks.
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Affiliation(s)
- Russell E. Glasgow
- Dissemination and Implementation Science Program of ACCORDS, Department of Family Medicine, School of Medicine, University of Colorado, Aurora, CO, United States,*Correspondence: Russell E. Glasgow
| | - Samantha M. Harden
- Physical Activity Research and Community Implementation, Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Bridget Gaglio
- Patient-Centered Outcomes Research Institute, Washington, DC, United States
| | - Borsika Rabin
- Dissemination and Implementation Science Program of ACCORDS, Department of Family Medicine, School of Medicine, University of Colorado, Aurora, CO, United States,Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M University, College Station, TX, United States,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, United States,Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA, United States
| | - Gwenndolyn C. Porter
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Marcia G. Ory
- Center for Population Health and Aging, Texas A&M University, College Station, TX, United States,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, United States
| | - Paul A. Estabrooks
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
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258
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Nilsen P, Bernhardsson S. Context matters in implementation science: a scoping review of determinant frameworks that describe contextual determinants for implementation outcomes. BMC Health Serv Res 2019; 19:189. [PMID: 30909897 PMCID: PMC6432749 DOI: 10.1186/s12913-019-4015-3] [Citation(s) in RCA: 378] [Impact Index Per Article: 75.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 03/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relevance of context in implementation science is reflected in the numerous theories, frameworks, models and taxonomies that have been proposed to analyse determinants of implementation (in this paper referred to as determinant frameworks). This scoping review aimed to investigate and map how determinant frameworks used in implementation science were developed, what terms are used for contextual determinants for implementation, how the context is conceptualized, and which context dimensions that can be discerned. METHODS A scoping review was conducted. MEDLINE and EMBASE were searched from inception to October 2017, and supplemented with implementation science text books and known published overviews. Publications in English that described a determinant framework (theory, model, taxonomy or checklist), of which context was one determinant, were eligible. Screening and inclusion were done in duplicate. Extracted data were analysed to address the study aims. A qualitative content analysis with an inductive approach was carried out concerning the development and core context dimensions of the frameworks. The review is reported according to the PRISMA guidelines. RESULTS The database searches yielded a total of 1113 publications, of which 67 were considered potentially relevant based on the predetermined eligibility criteria, and retrieved in full text. Seventeen unique determinant frameworks were identified and included. Most were developed based on the literature and/or the developers' implementation experiences. Six of the frameworks explicitly referred to "context", but only four frameworks provided a specific definition of the concept. Instead, context was defined indirectly by description of various categories and sub-categories that together made up the context. Twelve context dimensions were identified, pertaining to different aggregation levels. The most widely addressed context dimensions were organizational support, financial resources, social relations and support, and leadership. CONCLUSIONS The findings suggest variation with regard to how the frameworks were developed and considerable inconsistency in terms used for contextual determinants, how context is conceptualized, and which contextual determinants are accounted for in frameworks used in implementation science. Common context dimensions were identified, which can facilitate research that incorporates a theory of context, i.e. assumptions about how different dimensions may influence each other and affect implementation outcomes. A thoughtful application of the concept and a more consistent terminology would enhance transparency, simplify communication among researchers, and facilitate comparison across studies.
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Affiliation(s)
- Per Nilsen
- Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, SE-581 83, Linköping, Sweden
| | - Susanne Bernhardsson
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Unit of Physiotherapy, University of Gothenburg, The Sahlgrenska Academy, Gothenburg, Sweden.
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259
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Brainwriting Premortem: A Novel Focus Group Method to Engage Stakeholders and Identify Preimplementation Barriers. J Nurs Care Qual 2019; 34:94-100. [PMID: 30148746 PMCID: PMC6493673 DOI: 10.1097/ncq.0000000000000360] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many health care interventions encounter implementation challenges because of inadequate stakeholder engagement and identification of barriers. The brainwriting premortem technique is the silent sharing of written ideas about why an intervention failed. The method can engage stakeholders and identify barriers more efficiently than traditional brainstorming focus groups. PURPOSE We evaluated the method during a transition of care intervention in the Veterans Health Administration (VA). Clinicians from 10 VA facilities participated in 10 brainwriting premortem sessions. METHODS Using descriptive and content analytic methods, we assessed the quantity and quality of ideas generated, facilitator experience, and participant psychological safety. RESULTS In total, 217 unique ideas were generated. Many were deemed high quality. The written data were immediately available for analysis, allowing rapid feedback and real-time decision making. Participants reported high satisfaction and psychological safety. CONCLUSION The brainwriting premortem approach is a novel, efficient alternative to brainstorming focus groups that can rapidly inform program implementation at minimal cost.
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260
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Urquhart R, Kendell C, Geldenhuys L, Ross A, Rajaraman M, Folkes A, Madden LL, Sullivan V, Rayson D, Porter GA. The role of scientific evidence in decisions to adopt complex innovations in cancer care settings: a multiple case study in Nova Scotia, Canada. Implement Sci 2019; 14:14. [PMID: 30755221 PMCID: PMC6371509 DOI: 10.1186/s13012-019-0859-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/21/2019] [Indexed: 11/30/2022] Open
Abstract
Background Health care delivery and outcomes can be improved by using innovations (i.e., new ideas, technologies, and practices) supported by scientific evidence. However, scientific evidence may not be the foremost factor in adoption decisions and is rarely sufficient. The objective of this study was to examine the role of scientific evidence in decisions to adopt complex innovations in cancer care. Methods Using an explanatory, multiple case study design, we examined the adoption of complex innovations in five purposively sampled cases in Nova Scotia, Canada. Data were collected via documents and key informant interviews. Data analysis involved an in-depth analysis of each case, followed by a cross-case analysis to develop theoretically informed, generalizable knowledge on the role of scientific evidence in innovation adoption that may be applied to similar settings and contexts. Results The analyses identified key concepts alongside important caveats and considerations. Key concepts were (1) scientific evidence underpinned the adoption process, (2) evidence from multiple sources informed decision-making, (3) decision-makers considered three key issues when making decisions, and (4) champions were essential to eventual adoption. Caveats and considerations related to the presence of urgent problems and short-term financial pressures and minimizing risk. Conclusions The findings revealed the different types of issues decision-makers consider while making these decisions and why different sources of evidence are needed in these processes. Future research should examine how different types of evidence are legitimized and why some types are prioritized over others. Electronic supplementary material The online version of this article (10.1186/s13012-019-0859-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Urquhart
- Department of Surgery, Dalhousie University, Room 8-032, Centennial Building, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada. .,Nova Scotia Health Authority, Halifax, Nova Scotia, Canada. .,Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - C Kendell
- Department of Surgery, Dalhousie University, Room 8-032, Centennial Building, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - L Geldenhuys
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - A Ross
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,Department of Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - M Rajaraman
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - A Folkes
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - L L Madden
- Department of Surgery, Dalhousie University, Room 8-032, Centennial Building, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - V Sullivan
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - D Rayson
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,Department of Medical Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - G A Porter
- Department of Surgery, Dalhousie University, Room 8-032, Centennial Building, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada.,Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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261
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Developing management pathways for hypertensive disorders of pregnancy (HDP) in Indonesian primary care: a study protocol. Reprod Health 2019; 16:12. [PMID: 30709408 PMCID: PMC6359831 DOI: 10.1186/s12978-019-0674-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 01/20/2019] [Indexed: 01/15/2023] Open
Abstract
Background National and international guidelines for the management of hypertensive disorders of pregnancy (HDP) are available in developing countries. However, more detailed clinical pathways for primary care settings are limited. This study focuses on Indonesia, where 72% of women who died from HDP and its complications had received less appropriate treatment according to international guidelines. There is an urgent need to develop primary care focused pathways that enable general practitioners (GPs), midwives and other relevant providers to manage HDP better. Objectives This paper describes a study protocol for the development of HDP management pathways for Indonesian primary care settings. Methods This study design is informed by Implementation Science theories and consists of three phases. The exploratory phase will involve conducting semi-structured interviews with key Indonesian primary care stakeholders to explore their experiences and views on HDP management. The development phase will apply evidence from the literature review and results of the exploratory phase to develop HDP management pathways contextualised to Indonesian primary care settings. Consensus will be sought from approximately 50 experts, consist of general practitioners (GPs), midwives, obstetricians, nurses and policy makers using Delphi technique survey. The evaluation phase will involve a pilot study to evaluate the pathways’ acceptability and feasibility in a sample of Indonesian primary care practices using mixed methods. Discussion The implementation science frameworks inform and guide the phases in this study. Qualitative interviews in the exploratory phase are conducive to eliciting opinions from key stakeholders. Using Delphi technique at the development phase is suitable to seek participants’ consensus on HDP management in primary care. Observations, focus group discussions, interviews as well as analysis of patients’ medical records at the evaluation phase are expected to provide a comprehensive investigation of the implementation of the pathways in practice settings.
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262
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Prihodova L, Guerin S, Tunney C, Kernohan WG. Key components of knowledge transfer and exchange in health services research: Findings from a systematic scoping review. J Adv Nurs 2019; 75:313-326. [PMID: 30168164 PMCID: PMC7379521 DOI: 10.1111/jan.13836] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 06/28/2018] [Accepted: 08/06/2018] [Indexed: 12/22/2022]
Abstract
AIMS To identify the key common components of knowledge transfer and exchange in existing models to facilitate practice developments in health services research. BACKGROUND There are over 60 models of knowledge transfer and exchange designed for various areas of health care. Many of them remain untested and lack guidelines for scaling-up of successful implementation of research findings and of proven models ensuring that patients have access to optimal health care, guided by current research. DESIGN A scoping review was conducted in line with PRISMA guidelines. Key components of knowledge transfer and exchange were identified using thematic analysis and frequency counts. DATA SOURCES Six electronic databases were searched for papers published before January 2015 containing four key terms/variants: knowledge, transfer, framework, health care. REVIEW METHODS Double screening, extraction and coding of the data using thematic analysis were employed to ensure rigour. As further validation stakeholders' consultation of the findings was performed to ensure accessibility. RESULTS Of the 4,288 abstracts, 294 full-text articles were screened, with 79 articles analysed. Six key components emerged: knowledge transfer and exchange message, Stakeholders and Process components often appeared together, while from two contextual components Inner Context and the wider Social, Cultural and Economic Context, with the wider context less frequently considered. Finally, there was little consideration of the Evaluation of knowledge transfer and exchange activities. In addition, specific operational elements of each component were identified. CONCLUSIONS The six components offer the basis for knowledge transfer and exchange activities, enabling researchers to more effectively share their work. Further research exploring the potential contribution of the interactions of the components is recommended.
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Affiliation(s)
- Lucia Prihodova
- UCD School of PsychologyUniversity College DublinDublinIreland
- Palliative Care Research NetworkAll Ireland Institute for Hospice and Palliative CareDublinIreland
| | - Suzanne Guerin
- UCD School of PsychologyUniversity College DublinDublinIreland
- Palliative Care Research NetworkAll Ireland Institute for Hospice and Palliative CareDublinIreland
- UCD Centre for Disability StudiesUniversity College DublinDublinIreland
| | - Conall Tunney
- UCD Centre for Disability StudiesUniversity College DublinDublinIreland
| | - W. George Kernohan
- Palliative Care Research NetworkAll Ireland Institute for Hospice and Palliative CareDublinIreland
- Institute of Nursing and Health ResearchUlster UniversityBelfastNorthern Ireland
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Pannebakker NM, Fleuren MAH, Vlasblom E, Numans ME, Reijneveld SA, Kocken PL. Determinants of adherence to wrap-around care in child and family services. BMC Health Serv Res 2019; 19:76. [PMID: 30691460 PMCID: PMC6350391 DOI: 10.1186/s12913-018-3774-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 11/28/2018] [Indexed: 11/30/2022] Open
Abstract
Background The aim of this study is to understand the determinants of adherence to wrap-around care (WAC) by professional care providers working in child and family services. WAC is a care coordination method targeting families with complex needs. The core components of WAC involve activating family members and the social network, integrating the care provider network, and assessing, planning and evaluating the care process. WAC was introduced in the Netherlands using two approaches: the network approach (NA) and the team approach (TA). Methods A cross-sectional study was conducted using a digital questionnaire targeted at care providers. After imputation of missing data, univariate and multilevel regression analyses were conducted to study the associations between adherence to the core components of WAC, the determinants of adherence and background characteristics. Results In total 145 out of 275 care providers (52.7%) responded to the questionnaire. Multilevel regression analysis showed that self-efficacy of the care providers and the way WAC is organised (NA versus TA region) were significantly associated with adherence to core components of WAC. Self-efficacy was significantly associated with all WAC core components (activating family members and the social network: β (95% confidence interval, CI) = .27(.04–.50), integrating the network of care providers: β (95% CI) = .27(.05–.50) and assessing, planning and evaluating the care process: β (95% CI) = .30(.08–.52)). The way WAC is organised was significantly associated to two core components (activating family members and the social network: β (95% CI) = .18(0.1–.37) and integrating the network of care providers: β (95% CI) = .25(.09–.42)). Conclusion The way WAC is organised and the self-efficacy of care providers who use WAC are factors that are relevant for the redesign of the strategy for introducing WAC. Longitudinal research into the predictive value of determinants of adherence to WAC is advised. Electronic supplementary material The online version of this article (10.1186/s12913-018-3774-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Noortje M Pannebakker
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands. .,Department Child Health, TNO, P.O. Box 3005, 2301 DA, Leiden, The Netherlands.
| | - Margot A H Fleuren
- Department Child Health, TNO, P.O. Box 3005, 2301 DA, Leiden, The Netherlands.,Department of Clinical, Neuro- and developmental Psychology, Faculty of Behavioural and Movement Sciences, Amsterdam Public Health (APH) research institute, Free University Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Eline Vlasblom
- Department Child Health, TNO, P.O. Box 3005, 2301 DA, Leiden, The Netherlands
| | - Mattijs E Numans
- Department of Public Health and Primary Care and Leiden University Medical Center Campus The Hague, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - Paul L Kocken
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Department Child Health, TNO, P.O. Box 3005, 2301 DA, Leiden, The Netherlands
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264
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Huebschmann AG, Leavitt IM, Glasgow RE. Making Health Research Matter: A Call to Increase Attention to External Validity. Annu Rev Public Health 2019; 40:45-63. [PMID: 30664836 DOI: 10.1146/annurev-publhealth-040218-043945] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Most of the clinical research conducted with the goal of improving health is not generalizable to nonresearch settings. In addition, scientists often fail to replicate each other's findings due, in part, to lack of attention to contextual factors accounting for their relative effectiveness or failure. To address these problems, we review the literature on assessment of external validity and summarize approaches to designing for generalizability. When investigators conduct systematic reviews, a critical need is often unmet: to evaluate the pragmatism and context of interventions, as well as their effectiveness. Researchers, editors, and grant reviewers can implement key changes in how they consider and report on external validity issues. For example, the recently published expanded CONSORT figure may aid scientists and potential program adopters in summarizing participation in and representativeness of a program across different settings, staff, and patients. Greater attention to external validity is needed to increase reporting transparency, improve program dissemination, and reduce failures to replicate research.
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Affiliation(s)
- Amy G Huebschmann
- Division of General Internal Medicine, Center for Women's Health Research, School of Medicine, University of Colorado, Aurora, Colorado 80045, USA; .,Dissemination and Implementation Science Program of Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Aurora, Colorado 80045, USA
| | - Ian M Leavitt
- Department of Social and Behavioral Sciences, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115, USA;
| | - Russell E Glasgow
- Dissemination and Implementation Science Program of Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Aurora, Colorado 80045, USA.,Department of Family Medicine, School of Medicine, University of Colorado, Aurora, Colorado 80045, USA;
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265
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Munthe-Kaas H, Nøkleby H, Nguyen L. Systematic mapping of checklists for assessing transferability. Syst Rev 2019; 8:22. [PMID: 30642403 PMCID: PMC6330740 DOI: 10.1186/s13643-018-0893-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 11/22/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Systematic reviews of research evidence have become an expected basis for decisions about practice guidelines and policy decisions in the health and welfare sectors. Review authors define inclusion criteria to help them determine which studies to search for and include in their reviews. However, these studies may still vary in the extent to which they reflect the context of interest in the review question. While most review authors would agree that systematic reviews should be relevant and useful for decision makers, there appears to be few well known, if any, established methods for supporting review authors to assess the transferability of review findings to the context of interest in the review. With this systematic mapping and content analysis, we aim to identify whether there exists checklists to support review authors in considering transferability early in the systematic review process. The secondary aim was to develop a comprehensive list of factors that influence transferability as discussed in existing checklists. METHODS We conducted a systematic mapping of checklists and performed a content analysis of the checklist criteria included in the identified checklists. In June 2016, we conducted a systematic search of eight databases to identify checklists to assess transferability of findings from primary or secondary research, without limitations related to publication type, status, language, or date. We also conducted a gray literature search and searched the EQUATOR repository of checklists for any relevant document. We used search terms such as modified versions of the terms "transferability," "applicability," "generalizability," etc. and "checklist," "guideline," "tool," "criteria," etc. We did not include papers that discussed transferability at a theoretical level or checklists to assess the transferability of guidelines to local contexts. RESULTS Our search resulted in 11,752 titles which were screened independently by two review authors. The 101 articles which were considered potentially relevant were subsequently read by two authors, independently in full text and assessed for inclusion. We identified 31 relevant checklists. Six of these examined transferability of economic evaluations, and 25 examined transferability of primary or secondary research findings in health (n = 23) or social welfare (n = 2). The content analysis is based on the 25 health and social welfare checklists. We identified seven themes under which we grouped categories of checklist criteria: population, intervention, implementation context (immediate), comparison intervention, outcomes, environmental context, and researcher conduct. CONCLUSIONS We identified a variety of checklists intended to support end users (researchers, review authors, practitioners, etc.) to assess transferability or related concepts. While four of these checklists are intended for use in systematic reviews of effectiveness, we found no checklists for qualitative evidence syntheses or for the field of social welfare practice or policy. Furthermore, none of the identified checklists for review authors included guidance to on how to assess transferability, or present assessments in a systematic review. The results of the content analysis can serve as the basis for developing a comprehensive list of factors to be used in an approach to support review authors in systematically and transparently considering transferability from the beginning of the review process.
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Affiliation(s)
| | - Heid Nøkleby
- Norwegian Institute of Public Health, Oslo, Norway
| | - Lien Nguyen
- Norwegian Institute of Public Health, Oslo, Norway
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266
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Esses SA, Small S, Rodemann A, Hartman ME. Post-Intensive Care Syndrome: Educational Interventions for Parents of Hospitalized Children. Am J Crit Care 2019; 28:19-27. [PMID: 30600223 DOI: 10.4037/ajcc2019151] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Targeted education to help parents and caregivers recognize the signs and symptoms of post-intensive care syndrome may increase their awareness and willingness to seek support during their child's admission. The optimal strategy for this education has not been established. METHODS A pilot study to test 3 educational strategies for caregivers of pediatric intensive care unit patients. The 3 strategies were compared using the Practical, Robust Implementation and Sustainability Model framework for effectiveness of the education, the effect of each educational intervention on the intensive care unit nursing environment, and costs. Nursing responses were scored on a 3-point Likert scale. RESULTS A total of 62 caregivers randomly received 1 of 3 educational strategies: brochures (n = 22), scripted conversation (n = 20), or a 3-minute video (n = 20). All 3 strategies were associated with a notable improvement in understanding of post-intensive care syndrome, with no single strategy being superior. Nineteen bedside nurses completed a survey on how daily workflow was affected and education was perceived. The survey indicated that all 3 interventions minimally disrupted workflow and all were recognized as useful. Final analysis indicated that brochures have the greatest likelihood of successful and sustainable implementation in the study hospital. CONCLUSION Simple, low-cost education can improve caregivers' knowledge of post-intensive care syndrome and can be well supported by nursing staff. To ensure sustainable implementation, the characteristics of the unit should be considered when selecting an educational program.
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Affiliation(s)
- Stephanie A. Esses
- Stephanie A. Esses is a lead pediatric nurse practitioner in the pediatric intensive care unit, St Louis Children’s Hospital, St Louis, Missouri. Ashley Rodemann is a social worker. Sara Small is a social worker and Mary E. Hart-man is an assistant professor, Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | - Sara Small
- Stephanie A. Esses is a lead pediatric nurse practitioner in the pediatric intensive care unit, St Louis Children’s Hospital, St Louis, Missouri. Ashley Rodemann is a social worker. Sara Small is a social worker and Mary E. Hart-man is an assistant professor, Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | - Ashley Rodemann
- Stephanie A. Esses is a lead pediatric nurse practitioner in the pediatric intensive care unit, St Louis Children’s Hospital, St Louis, Missouri. Ashley Rodemann is a social worker. Sara Small is a social worker and Mary E. Hart-man is an assistant professor, Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
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267
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Magee MF, Baker KM, Fernandez SJ, Huang CC, Mete M, Montero AR, Nassar CM, Sack PA, Smith K, Youssef GA, Evans SR. Redesigning ambulatory care management for uncontrolled type 2 diabetes: a prospective cohort study of the impact of a Boot Camp model on outcomes. BMJ Open Diabetes Res Care 2019; 7:e000731. [PMID: 31798894 PMCID: PMC6861097 DOI: 10.1136/bmjdrc-2019-000731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/23/2019] [Accepted: 09/30/2019] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Type 2 diabetes care management (DCM) is challenging. Few studies report meaningful improvements in clinical care settings, warranting DCM redesign. We developed a Boot Camp to provide timely, patient-centered, technology-enabled DCM. Impact on hemoglobin A1c (HbA1c), emergency department (ED) visits and hospitalizations among adults with uncontrolled type 2 diabetes were examined. RESEARCH DESIGN AND METHODS The intervention was designed using the Practical Robust Implementation and Sustainability Model to embed elements of the chronic care model. Adults with HbA1c>9% (75 mmol/mol) enrolled between November 2014 and November 2017 received diabetes education and medication management by diabetes educators and nurse practitioners via initial clinic and subsequent weekly virtual visits, facilitated by near-real-time blood glucose transmission for 90 days. HbA1c and risk for ED visits and hospitalizations at 90 days, and potential savings from reducing avoidable medical utilizations were examined. Boot Camp completers were compared with concurrent, propensity-matched chart controls receiving usual DCM in primary care practices. RESULTS A cohort of 366 Boot Camp participants plus 366 controls was analyzed. Participants were 79% African-American, 63% female and 59% Medicare-insured or Medicaid-insured and mean age 56 years. Baseline mean HbA1c for cases and controls was 11.2% (99 mmol/mol) and 11.3% (100 mmol/mol), respectively. At 90 days, HbA1c was 8.1% (65 mmol/mol) and 9.9% (85 mmol/mol), p<0.001, respectively. Risk for 90-day all-cause hospitalizations decreased 77% for participants and increased 58% for controls, p=0.036. Mean potential for monetization of US$3086 annually per participant for averted hospitalizations were calculated. CONCLUSIONS Redesigning diabetes care management using a pragmatic technology-enabled approach supported translation of evidence-based best practices across a mixed-payer regional healthcare system. Diabetes educators successfully participated in medication initiation and titration. Improvement in glycemic control, reduction in hospitalizations and potential for monetization was demonstrated in a high-risk cohort of adults with uncontrolled type 2 diabetes. TRIAL REGISTRATION NUMBER NCT02925312.
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Affiliation(s)
- Michelle F Magee
- MedStar Health Research Institute, Hyattsville, Maryland, USA
- Department of Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
- MedStar Diabetes Institute, MedStar Health, Columbia, Maryland, USA
| | - Kelley M Baker
- MedStar Institute for Quality and Safety, Columbia, Maryland, USA
| | - Stephen J Fernandez
- Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Hyattsville, Maryland, USA
| | - Chun-Chi Huang
- Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Hyattsville, Maryland, USA
| | - Mihriye Mete
- Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Hyattsville, Maryland, USA
| | - Alex R Montero
- Department of Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
- MedStar Diabetes Institute, MedStar Health, Columbia, Maryland, USA
| | - Carine M Nassar
- MedStar Health Research Institute, Hyattsville, Maryland, USA
- MedStar Diabetes Institute, MedStar Health, Columbia, Maryland, USA
| | - Paul A Sack
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
- School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Kelly Smith
- MedStar Institute for Quality and Safety, Columbia, Maryland, USA
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268
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Czaja SJ, Lee CC, Perdomo D, Loewenstein D, Bravo M, Moxley PhD JH, Schulz R. Community REACH: An Implementation of an Evidence-Based Caregiver Program. THE GERONTOLOGIST 2018; 58:e130-e137. [PMID: 29562361 DOI: 10.1093/geront/gny001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background and Objectives Family caregivers (CGs) are critical to the provision of long-term services and support for older adults. Numerous intervention programs to alleviate CG distress have been developed and evaluated yet few have been implemented in community settings. This paper describes and presents outcomes from Community REACH, a community implementation of the evidence-based Resources for Enhancing Alzheimer's Caregiver Health (REACH) II program. Research Design and Methods Community REACH involved a partnership between REACH II investigators and United HomeCare Services (UHCS), a nonprofit home health organization that provides home health, personal care, companion, and respite services. The intervention program, an adapted version of an evidence-based program, was a 6-month multicomponent psychosocial intervention, which involved six individual face-to-face and six individual telephone sessions, and telephone support groups. One hundred and forty-six CGs who were primarily female (76%) and Latino, and providing care for an individual with Alzheimer's disease (AD) were enrolled. Program effectiveness was assessed by examining changes in perceived social support, burden, and depression, and CG self-efficacy. Results At 6 months, CGs reported significant decreases in depression, burden, being and bothered by the care recipient's memory problems. There was also a significant decline in the number of CGs at risk for clinical depression. These improvements were maintained at 12 months and there was an increase in feelings of social support. Discussion and Implications The findings indicate that evidence-based CG programs can be successfully implemented in community settings and benefit CGs of AD patients. A continued partnership between the program developers and community partners is key to implementation success.
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Affiliation(s)
- Sara J Czaja
- Department of Psychiatry and Behavioral Sciences/Center on Aging
| | - Chin Chin Lee
- Center on Aging, University of Miami Miller School of Medicine, Florida
| | - Dolores Perdomo
- Department of Psychiatry and Behavioral Sciences/Center on Aging
| | | | | | | | - Richard Schulz
- University Center for Social and Urban Research, University of Pittsburgh, Pennsylvania
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269
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Ratcliff CG, Vinson CA, Milbury K, Badr H. Moving family interventions into the real world: What matters to oncology stakeholders? J Psychosoc Oncol 2018; 37:264-284. [PMID: 30421667 DOI: 10.1080/07347332.2018.1498426] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Family interventions targeting patients and/or informal caregivers are beneficial, but few have been integrated in oncology clinical care. Understanding diverse stakeholder perspectives may inform implementation and dissemination efforts. METHODS We are currently conducting a randomized controlled trial of CareSTEPS, a telephone-based intervention for caregivers of advanced lung cancer patients. CareSTEPS seeks to improve caregiver and patient self-care behaviors, quality of life, and satisfaction with care. With an eye toward integrating CareSTEPS into clinical care, semi-structured interviews were conducted with 7 experts in integrated care [practice thought leaders] and 26 individuals representing different oncology stakeholder groups (i.e., potential end users of CareSTEPS including counselors, social workers, nurse specialists, and psychologists) [N = 13], decision-makers, including physicians and administrators [N = 6], and key dissemination partners, including representatives from cancer and caregiving advocacy groups [N = 7]). Questions focused on existing caregiver support services, barriers to integrating care for caregivers in routine patient care, and possible models for clinical uptake and dissemination. Interviews were transcribed and analyzed using directed content analysis. RESULTS Stakeholders noted a mismatch between caregiver needs and services offered, and expressed interest in broader service offerings. Barriers for integrating caregiver support into clinical care included inadequate funding, lack of interdisciplinary training among providers, and concern that research-based interventions are often not flexible enough to roll out into clinical practice. To secure buy-in, stakeholders noted the importance of evaluating intervention cost, cost savings, and revenue generation. Possible avenues for dissemination, through bottom-up and top-down (e.g., policy change) approaches, were also discussed. CONCLUSIONS Findings highlight the importance of evaluating outcomes important to diverse oncology stakeholder groups to speed translation of research into practice. They also suggest that pragmatic trials are needed that allow for flexibility in the delivery of family interventions and that consider the resource limitations of clinical care.
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Affiliation(s)
- Chelsea G Ratcliff
- a Department of Psychology , Sam Houston State University , Huntsville , Texas, USA.,b Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , Texas, USA
| | - Cynthia A Vinson
- c Division of Cancer Control and Population Sciences , National Cancer Institute , Rockville , Maryland, USA
| | - Kathrin Milbury
- d Department of Palliative Care, Rehabilitation and Integrative Medicine , The University of Texas MD Anderson Cancer Center , Houston , Texas, USA
| | - Hoda Badr
- e Department of Medicine , Baylor College of Medicine , Houston , Texas, USA
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Pedersen NH, Koch S, Larsen KT, Kristensen PL, Troelsen J, Møller NC, Brønd JC, Hjelmborg JVB, Brage S, Grøntved A. Protocol for evaluating the impact of a national school policy on physical activity levels in Danish children and adolescents: the PHASAR study - a natural experiment. BMC Public Health 2018; 18:1245. [PMID: 30409171 PMCID: PMC6225578 DOI: 10.1186/s12889-018-6144-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/23/2018] [Indexed: 12/17/2022] Open
Abstract
Background In 2014 the Danish Government introduced a wide-ranging school reform that applies to all public schools in Denmark. The reform involves changes in several aspects of the school structure and content. In a physical activity promotion perspective, a distinctive feature of the school reform is that it has become mandatory to integrate an average of 45 min of daily physical activity in the regular school day. The overarching objective of the PHASAR study is to evaluate the implementation and effect of this ambitious policy-driven physical activity promotion initiative on physical activity and overweight. This paper describes in detail the study protocol. Methods The evaluation is divided into a quantitative effect evaluation and a combined quantitative and qualitative process evaluation. A total of 31 schools are enrolled in the PHASAR study including more than 2,000 school-aged children. Objectively measured physical activity data are obtained in the PHASAR study in 2017/18 and compared to repeated cross sectional data collected in four historical school-based studies from 1998 to 2012. Body mass index data from 2012 to 2018 will be collected from The Child Database, which includes repeated cross-sectional assessments on approximately 100,000 children annually. In the absence of a control group, interrupted time-series analysis will be used to evaluate pre- and post-reform physical activity and body mass index levels and trends. A characterization of the school environment for physical activity promotion on a political, environmental, organizational and individual level and school implementation processes will be conducted to evaluate the implementation process. Data will be collected using interviews, surveys, document analyses and observations. Discussion The PHASAR study is a rare opportunity to evaluate the effectiveness of a nation-wide policy-driven school-based physical activity promotion initiative. The use of objectively measured pre- and post-reform physical activity and body mass index data combined with a characterization of the school implementation processes for physical activity promotion will provide a comprehensive source to evaluate the school reform. The study findings have the potential to influence national and international policy makers, health professionals and school staff.
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Affiliation(s)
- Natascha Holbæk Pedersen
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Sofie Koch
- Research unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Kristian Traberg Larsen
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Peter Lund Kristensen
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Jens Troelsen
- Research unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Niels Christian Møller
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Jan Christian Brønd
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Jacob von Bornemann Hjelmborg
- The Danish Twin Registry, Epidemiology, Biostatistics and Biodemography, SDU eScience Centre, J. B. Winsløws Vej 9, 5000, Odense C, Denmark
| | - Søren Brage
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.,MRC Epidemiology Unit, Cambridge School of Clinical Medicine, Institute of Metabolic Science, University of Cambridge, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Anders Grøntved
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
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Karki P, Prabandari YS, Probandari A, Banjara MR. Feasibility of school-based health education intervention to improve the compliance to mass drug administration for lymphatic Filariasis in Lalitpur district, Nepal: A mixed methods among students, teachers and health program manager. PLoS One 2018; 13:e0203547. [PMID: 30216390 PMCID: PMC6138383 DOI: 10.1371/journal.pone.0203547] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 08/22/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Ensuring reduction in transmission of lymphatic Filariasis (LF) and addressing the compliance of people to mass drug administration (MDA) has led to renewed efforts in the field. School-based health education (SBHE) intervention, considered a cost-effective strategy with potential to reach the wider public through young people, was adopted as a strategy for social mobilization. This study assessed SBHE perceptions, implementation barriers, and factors in the supporting environment as well as its efficiency to successfully change LF MDA-related knowledge and practice. METHODS This mixed methods study was conducted in four sites of Lalitpur district, Nepal. Classroom-based interactive health education sessions were used as the main intervention strategy in the study. In total, 572 students were assigned to intervention and control groups. Questionnaires were distributed before and after the intervention. Mann-Whitney and McNemar tests were used for analysis. Focus-group discussions with teachers and students and in-depth interviews with the district LF program manager as well as Education Office and school management authorities were conducted. Qualitative thematic analysis approach was adopted. RESULTS Intervention curriculum played a significant role in increasing children's knowledge and practice (p<0.001). Barriers for school-based interventions were budget constraints, human resource deficiencies, lack of opportunities to conduct practical classes under the curriculum, and lack of collaboration with parents. Supportive factors were training provision, monitoring and evaluation practice, adequate facilities and equipment, positive parental attitudes, presence of interested teachers and students, and prioritization by program implementers. CONCLUSION Effective program planning practices such as proper fiscal management, human resource management, training mechanisms, and efforts to promote practical classes and coordination with parents are required to develop and institutionalize the intervention. Effective learning and a supportive school environment appear to be important components to support implementation. The SBHE intervention is a feasible and promising intervention for accelerating compliance towards MDA to eliminate LF.
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Affiliation(s)
- Prativa Karki
- Department of Public Health, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Ari Probandari
- Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Indonesia
- Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
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272
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Colldén C, Hellström A. Value-based healthcare translated: a complementary view of implementation. BMC Health Serv Res 2018; 18:681. [PMID: 30176866 PMCID: PMC6122703 DOI: 10.1186/s12913-018-3488-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 08/22/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Interest in the implementation of various innovations (e.g. medical interventions and organizational approaches) has increased rapidly, and management innovations (MIs) are considered particularly complex to implement. In contrast to a traditional view that innovations are implemented, some scholars have promoted the view that innovations are translated into contexts, a view referred to as translation theory. The aim of this paper is to investigate how a translation theory perspective can inform the Consolidated Framework of Implementation Research (CFIR) to increase understanding of the complex process of putting MIs into practice. The empirical base is a two-year implementation of the MI Value-Based Health Care (VBHC) to a psychiatric department in a large Swedish hospital. METHODS In this longitudinal case study, a qualitative approach was applied using an insider researcher with unique access to data, who followed the implementation starting in 2015. Data sources includes field notes, documents, and audio recordings of meetings and group reflections which were abridged into an event data file structured by CFIR domains. In a joint analysis, an outsider researcher was added to strengthen the analysis and mitigate potential bias. RESULTS Two themes were identified, for which CFIR did not satisfactorily explain the findings. First, the intervention characteristics (i.e. the content of the MI) were modified along the process and, second, the process did not follow predefined plans. However, the project was still perceived to be successful by internal and external stakeholders. CONCLUSIONS The paper proposes three ways in which translation theory can inform CFIR when applied to MIs: 1) strength of evidence is not as important for MIs as for medical and technical innovations; 2) adaptability of the MI can be emphasized more strongly, and 3) it can be more fruitful to view implementation as a dynamic process rather than seeing it as a matter of planning and execution. For managers, this implies encouragement to seize the opportunity to translate MIs to fit their organization, rather than to aim to be true to an original concept.
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Affiliation(s)
- Christian Colldén
- Department of Technology, Management, and Economics, Chalmers University of Technology, Gothenburg, Sweden
- Department of Psychotic Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Hellström
- Department of Technology, Management, and Economics, Chalmers University of Technology, Gothenburg, Sweden
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Naidoo N, Zuma N, Khosa NS, Marincowitz G, Railton J, Matlakala N, Jobson GA, Igumbor JO, McIntyre JA, Struthers HE, Peters RPH. Qualitative assessment of facilitators and barriers to HIV programme implementation by community health workers in Mopani district, South Africa. PLoS One 2018; 13:e0203081. [PMID: 30161208 PMCID: PMC6117027 DOI: 10.1371/journal.pone.0203081] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/14/2018] [Indexed: 11/18/2022] Open
Abstract
South Africa has implemented a community-based HIV programme (CBHP) in its primary healthcare (PHC) re-engineering strategy that aims to improve public healthcare delivery. This CBHP is delivered by ward-based outreach teams (WBOTs); provision of community HIV services comprises an important component of this programme. We conducted an exploratory study to determine the facilitators and barriers to successful implementation of this CBHP in rural Mopani District, South Africa. Focus group discussions were conducted with the community health workers (CHWs) and PHC nurses; participant interviews were conducted with community members who access these health services, community leaders, and social workers. We conducted a thematic content analysis and based on the key themes reported, we identified the Consolidated Framework for Implementation Research, consisting of five domains, as the most appropriate model to interpret our findings. First, in terms of intervention characteristics, community members generally valued the HIV services provided, but the variable needs impacted on programme implementation. Outer setting challenges include inability to meet the need of patients as a result of stigma, non-disclosure of HIV status and social factors. In terms of the inner setting, CHWs were grateful for the equipment and training received but expressed the need for better support of management and the provision of additional resources. With regard to characteristics of the implementers, the CHWs expressed the desire for further training despite reporting having sufficient knowledge to conduct their HIV work. Finally, in terms of the implementation process, the importance of relationship building between CHWs and community members was emphasised. In conclusion, these data underline the positive receipt and potential of the CBHP in this rural district and identify areas to further strengthen the programme. The success and sustainability of the CBHP requires ongoing commitment of resources, training, supervision, and organisational support in order to operate effectively and efficiently.
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Affiliation(s)
- Nireshni Naidoo
- Anova Health Institute, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Gert Marincowitz
- Mopani DCST, Department of Health, Limpopo Province, Giyani, South Africa
| | - Jean Railton
- Anova Health Institute, Johannesburg, South Africa
| | | | | | - Jude O. Igumbor
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - James A. McIntyre
- Anova Health Institute, Johannesburg, South Africa
- School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Helen E. Struthers
- Anova Health Institute, Johannesburg, South Africa
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Remco P. H. Peters
- Anova Health Institute, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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274
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Khoong EC, Cherian R, Smith DE, Schillinger D, Wolf MS, Sarkar U. Implementation of patient-centered prescription labeling in a safety-net ambulatory care network. Am J Health Syst Pharm 2018; 75:1227-1238. [PMID: 29950392 DOI: 10.2146/ajhp170821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE An initiative to implement patient-centered medication labeling at 4 pharmacies within a publicly funded safety-net healthcare system is described. SUMMARY Medication nonadherence negatively affects patient outcomes and safety. Nonadherence has been attributed to poor understanding of instructions on medication labels. Research has demonstrated that patient-centered labeling (PCL) can improve adherence and produce safer medication-taking practices. As part of a mixed-methods study by a safety-net health system, audits of nearly 9,000 prescription labels generated at 4 pharmacy sites, as well as interviews with 6 stakeholder informants, were conducted to determine PCL adoption rates and factors contributing to success. Descriptive statistics were used to analyze audit data; constructs of the Consolidated Framework for Implementation Research were used to analyze interview data. Among the 4 sites, 3 pharmacies successfully converted more than 85% of audited prescriptions to a PCL format; 1 pharmacy converted less than 25% of prescriptions. Barriers to implementation included pharmacists' reluctance to modify prescriber instructions and inadequate real-time data on conversion rates. Interviewees perceived that leadership and policy directives promoted PCL conversion efforts. Successful pharmacies used adaptable software, had closer communication networks with prescribers, and/or used automation to facilitate PCL conversion. CONCLUSION Three pharmacies successfully converted more than 85% of labels for audited prescriptions to a PCL format; 1 pharmacy converted less than 25% of prescriptions. Barriers to implementation included pharmacists' reluctance to modify prescriber instructions, inadequate real-time data on conversation rates, and lack of customizable software to automate changes.
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Affiliation(s)
- Elaine C Khoong
- UCSF Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA.
| | - Roy Cherian
- UCSF Center for Vulnerable Populations and UCSF Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - David E Smith
- San Francisco Department of Public Health, San Francisco, CA, and UCSF Department of Pharmacy, San Francisco, CA
| | - Dean Schillinger
- UCSF Center for Vulnerable Populations and UCSF Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Michael S Wolf
- Department of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Urmimala Sarkar
- UCSF Center for Vulnerable Populations and UCSF Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA
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275
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Sullivan JL, Shin MH, Engle RL, Yaksic E, VanDeusen Lukas C, Paasche-Orlow MK, Starr LM, Restuccia JD, Holmes SK, Rosen AK. Evaluating the Implementation of Project Re-Engineered Discharge (RED) in Five Veterans Health Administration (VHA) Hospitals. Jt Comm J Qual Patient Saf 2018; 44:663-673. [PMID: 30097383 DOI: 10.1016/j.jcjq.2018.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/16/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Improving the process of hospital discharge is a critical priority. Interventions to improve care transitions have been shown to reduce the rate of early unplanned readmissions, and consequently, there is growing interest in improving transitions of care between hospital and home through appropriate interventions. Project Re-Engineered Discharge (RED) has shown promise in strengthening the discharge process. Although studies have analyzed the implementation of RED among private-sector hospitals, little is known about how hospitals in the Veterans Health Administration (VHA) have implemented RED. The RED implementation process was evaluated in five VHA hospitals, and contextual factors that may impede or facilitate the undertaking of RED were identified. METHODS A qualitative evaluation of VHA hospitals' implementation of RED was conducted through semistructured telephone interviews with personnel involved in RED implementation. Qualitative data from these interviews were coded and used to compare implementation activities across the five sites. In addition guided by the Practical, Robust Implementation and Sustainability Model (PRISM), cross-site analyses of the contextual factors were conducted using a consensus process. RESULTS Progress and adherence to the RED toolkit implementation steps and intervention components varied across study sites. A majority of contextual factors identified were positive influences on sites' implementation. CONCLUSION Although the study sites were able to tailor and implement RED because of its adaptability, redesigning discharge processes is a significant undertaking, requiring additional support/resources to incorporate into an organization's existing practices. Lessons learned from the study should be useful to both VHA and private-sector hospitals interested in implementing RED and undertaking a care transition intervention.
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276
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Battaglia C, Glasgow RE. Pragmatic dissemination and implementation research models, methods and measures and their relevance for nursing research. Nurs Outlook 2018; 66:430-445. [PMID: 30093135 DOI: 10.1016/j.outlook.2018.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 06/19/2018] [Accepted: 06/25/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Pragmatic dissemination and implementation (D&I) research approaches can benefit patient care because they emphasize real-world settings and populations. Nurse scientists have an opportunity to reduce the gap between science and practice by using pragmatic D&I research and sustainability strategies. PURPOSE This article discusses pragmatic models, methods, and measures used in D&I research and their relevance for nursing research and enhancing population health. METHODS Summary of pragmatic D&I models and related methods for designing a pragmatic studies. We discuss the RE-AIM framework and the PRECIS-2 planning aid and figure in detail. A case study is provided and application to nursing research is discussed. DISCUSSION Successful translation of pragmatic D&I research demands an approach that addresses external validity, and customization at multiple levels including the patient, clinician, and setting. Context is critically important, and it is never too early to design for dissemination. CONCLUSIONS Pragmatic D&I approaches are needed to speed research translation, reduce avoidable waste of funding, improve clinical care, and enhance population health. Pragmatic D&I research is an area of tremendous opportunity for the nursing science community.
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Affiliation(s)
- Catherine Battaglia
- Department of Veterans Affairs Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (COIN), Denver, CO; Department of Health System Management & Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Russell E Glasgow
- Department of Veterans Affairs Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (COIN), Denver, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Family Medicine, School of Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO; Geriatric Research, Education and Clinical Center (GRECC), Department of Veterans Affairs Eastern Colorado Health Care System, Denver, CO
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277
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Ssewamala FM, Sensoy Bahar O, McKay MM, Hoagwood K, Huang KY, Pringle B. Strengthening mental health and research training in Sub-Saharan Africa (SMART Africa): Uganda study protocol. Trials 2018; 19:423. [PMID: 30081967 PMCID: PMC6080393 DOI: 10.1186/s13063-018-2751-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children in Sub-Saharan Africa (SSA) comprise half of the total regional population, yet existing mental health services are severely under-equipped to meet their needs. Although effective interventions for the treatment of disruptive behavioral disorders (DBDs) in youth have been tested in high-poverty and high-stress communities in developed countries, and are relevant for widespread dissemination in low- and middle-income countries (LMICs), most of these evidence-based practices (EBPs) have not been utilized in SSA, a region heavily impacted by poverty, diseases including HIV/AIDS, and violence. Thus, this paper presents a protocol for a scale-up longitudinal experimental study that uses a mixed-methods, hybrid type II, effectiveness implementation design to test the effectiveness of an EBP, called Multiple Family Group (MFG) aimed at improving child behavioral challenges in Uganda while concurrently examining the multi-level factors that influence uptake, implementation, sustainment, and youth outcomes. METHODS The MFG intervention will be implemented and tested via a longitudinal experimental study conducted across 30 public primary schools located in both semi-urban and rural communities. The schools will be randomly assigned to three study conditions (n = 10 per study condition): (1) MFG delivered by trained family peers; (2) MFG delivered by community health workers; or; (3) comparison: usual care comprising mental health care support materials, bolstered with school support materials. A total of 3000 children (ages 8 to 13 years; grades 2 to 7) and their caregivers (N = 3000 dyads); 60 parent peers, and 60 community health workers will be recruited. Each study condition will comprise of 1000 child-caregiver dyads. Data will be collected at baseline, 8 and 16 weeks, and 6-month follow-up. DISCUSSION This project is the first to test the effectiveness of the MFG intervention while concurrently examining multi-level factors that influence overall implementation of a family-based intervention provided in schools and aimed at reaching the large child population with mental health service needs in Uganda. Moreover, the study draws upon an EBP that has already been tested for delivery by parent peers and community facilitators, and hence will take advantage of the advancing science behind task-shifting. If successful, the project has great potential to address global child mental health needs. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03081195 . Registered on 16 March 2017.
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Affiliation(s)
- Fred M. Ssewamala
- Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Mary M. McKay
- Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Kimberly Hoagwood
- Department of Child and Adolescent Psychiatry, School of Medicine, New York University, 550 First Avenue, New York, NY 10016 USA
| | - Keng-Yen Huang
- Department of Child and Adolescent Psychiatry, School of Medicine, New York University, 550 First Avenue, New York, NY 10016 USA
| | - Beverly Pringle
- National Institute of Mental Health, 6001 Executive Boulevard, Bethesda, MD 20892 USA
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278
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Lorthios-Guilledroit A, Parisien M, Nour K, Fournier B, Guay D, Bier N. Cognitive Health Promotion Program for Community-Dwelling Seniors: Who Are We Reaching? J Appl Gerontol 2018; 39:588-600. [PMID: 30051745 DOI: 10.1177/0733464818790190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This exploratory study examines the reach of Jog Your Mind, a multifactorial community-based program promoting cognitive vitality among seniors with no known cognitive impairment. The aim was to determine whether the program successfully reached its target population and to compare the characteristics of participants (sociodemographic, health, lifestyle, attitudes, and cognitive profile) with the general population of seniors. Twenty-three community organizations recruited 294 community-dwelling seniors willing to participate in the program. Descriptive analyses revealed that the participants were mostly Canadian-born educated women living alone. Participants' health profile and lifestyle behaviors were fairly similar to those of seniors in Québec and Canada. A large proportion of the participants were concerned about their memory. These results suggest that the program did not attract many hard-to-reach members of the population and reached seniors who may have had some cognitive challenges. Cues to action for improving the reach of cognitive health promotion programs are discussed.
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Affiliation(s)
- Agathe Lorthios-Guilledroit
- Centre for Research and Expertise in Social Gerontology (CREGÉS), Integrated Health and Social Services University Network for West-Central Montreal, Montreal, Québec, Canada
| | - Manon Parisien
- Centre for Research and Expertise in Social Gerontology (CREGÉS), Integrated Health and Social Services University Network for West-Central Montreal, Montreal, Québec, Canada
| | - Kareen Nour
- Direction de santé publique, CISSS Montérégie-centre, Longueuil, Québec, Canada
| | | | - Danielle Guay
- Centre for Research and Expertise in Social Gerontology (CREGÉS), Integrated Health and Social Services University Network for West-Central Montreal, Montreal, Québec, Canada
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279
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Sullivan JL, Engle RL, Tyler D, Afable MK, Gormley K, Shwartz M, Adjognon O, Parker VA. Is Variation in Resident-Centered Care and Quality Performance Related to Health System Factors in Veterans Health Administration Nursing Homes? INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2018; 55:46958018787031. [PMID: 30047811 PMCID: PMC6073824 DOI: 10.1177/0046958018787031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this research was to explore and compare common health system factors for 5 Community Living Centers (ie Veterans Health Administration nursing homes) with high performance on both resident-centered care and clinical quality and for 5 Community Living Centers (CLC) with low performance on both resident-centered care and quality. In particular, we were interested in “how” and “why” some Community Living Centers were able to deliver high levels of resident-centered care and high quality of care, whereas others did not demonstrate this ability. Sites were identified based on their rankings on a composite quality measure calculated from 28 Minimum Data Set version 2.0 quality indicators and a resident-centered care summary score calculated from 6 domains of the Artifacts of Culture Change Tool. Data were from fiscal years 2009-2012. We selected high- and low-performing sites on quality and resident-centered care and conducted 12 in-person site visits in 2014-2015. We used systematic content analysis to code interview transcripts for a priori and emergent health system factor domains. We then assessed variations in these domains across high and low performers using cross-site summaries and matrixes. Our final sample included 108 staff members at 10 Veterans Health Administration CLCs. Staff members included senior leaders, middle managers, and frontline employees. Of the health system factors identified, high and low performers varied in 5 domains, including leadership support, organizational culture, teamwork and communication, resident-centered care recognition and awards, and resident-centered care training. Organizations must recognize that making improvements in the factors identified in this article will require dedicated resources from leaders and support from staff throughout the organization.
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Affiliation(s)
- Jennifer L Sullivan
- 1 Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, MA, USA.,2 Boston University, MA, USA
| | - Ryann L Engle
- 1 Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, MA, USA
| | - Denise Tyler
- 3 RTI International, Waltham, MA, USA.,4 Brown University, Providence, RI, USA
| | | | - Katelyn Gormley
- 1 Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, MA, USA
| | - Michael Shwartz
- 1 Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, MA, USA.,2 Boston University, MA, USA
| | - Omonyêlé Adjognon
- 1 Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, MA, USA
| | - Victoria A Parker
- 1 Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, MA, USA.,5 University of New Hampshire, Durham, NH
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280
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Tan ASL, Mazor KM, McDonald D, Lee SJ, McNeal D, Matlock DD, Glasgow RE. Designing Shared Decision-Making Interventions for Dissemination and Sustainment: Can Implementation Science Help Translate Shared Decision Making Into Routine Practice? MDM Policy Pract 2018; 3:2381468318808503. [PMID: 30560204 PMCID: PMC6291870 DOI: 10.1177/2381468318808503] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 09/20/2018] [Indexed: 12/23/2022] Open
Abstract
Shared decision making (SDM) is not widely practiced in routine care due to a variety of organizational, provider, patient, and contextual factors. This article explores how implementation science-which encourages attention to the multilevel contextual factors that influence the adoption, implementation, and sustainment of health care practices-can provide useful insights for increasing SDM use in routine practice. We engaged with stakeholders representing different organizations and geographic locations over three phases: 1) multidisciplinary workgroup meeting comprising researchers and clinicians (n = 11); 2) survey among a purposive sample of 47 patient advocates, clinicians, health care system leaders, funders, policymakers, and researchers; and 3) working session among diverse stakeholders (n = 30). The workgroup meeting identified priorities for action and research, which included targeting multiple audiences and levels, shifting culture toward valuing and supporting SDM, and considering contextual factors influencing SDM implementation. Survey respondents provided recommendations for increasing adoption, implementation, and maintenance of SDM in practice including providing tools to support SDM, obtaining stakeholders' involvement, and raising awareness of the importance of SDM. Stakeholders in the working session provided recommendations on the design of a guide for implementation of SDM in clinical settings, strategies to disseminate educational curricula on SDM, and strategies to influence policies to increase SDM use. These specific recommendations serve as a call to action to pursuing specific promising strategies aimed at increasing SDM use in practice and enhance understanding of the perspectives of diverse stakeholders at multiple levels from an implementation science perspective that appear fruitful for further study and application.
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Affiliation(s)
- Andy S. L. Tan
- Dana-Farber Cancer Institute, Population Sciences Division, Center for Community-Based Research, Boston, MA
- Harvard University, T.H. Chan School of Public Health, Boston, MA
| | - Kathleen M. Mazor
- Meyers Primary Care Institute, a joint Endeavor of the University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, NA
| | - Daniel McDonald
- Dana-Farber Cancer Institute, Population Sciences Division, Center for Community-Based Research, Boston, MA
| | - Stella J. Lee
- Dana-Farber Cancer Institute, Population Sciences Division, Center for Community-Based Research, Boston, MA
- Harvard University, T.H. Chan School of Public Health, Boston, MA
| | - Demetria McNeal
- Dissemination and Implementation Science Program, Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
| | - Daniel D. Matlock
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO
- Dissemination and Implementation Science Program, Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
| | - Russell E. Glasgow
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO
- Dissemination and Implementation Science Program, Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
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281
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Meissner P. LADDERS: A dynamic paradigm for planning, implementing, and evaluating sustainable change in learning health systems. Learn Health Syst 2018; 2:e10058. [PMID: 31245586 PMCID: PMC6508793 DOI: 10.1002/lrh2.10058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 05/10/2018] [Accepted: 05/12/2018] [Indexed: 11/12/2022] Open
Abstract
The science of learning health systems borrows and adapts models from many fields. One in particular is implementation science which has been experiencing a flourishing of new theories, models, and frameworks, some of which are generating sufficient evidence as to their effectiveness and applicability to emerge as candidates for wide adoption as useful tools for the field. In reviewing these, a common paradigm can be described which is a synthesis of those elements regularly cited by health systems implementing successful transformational change activities. As a paradigm, it offers a practical bridge to these models, concepts, and frameworks that are often hard to operationalize and are used with varying degrees of completeness. These elements can be arranged in a memorable acronym-LADDERS-Leadership, Alignment, Data, Demonstration, Evaluation, Replication, and Sustainability. LADDERS identifies the multiple elements and dimensions recognized by persons involved in leading health system change activities. It provides a simple, useful way to assess progress by health systems in planning, implementing, evaluating, and sustaining change. There is ample organizational and systems change literature to fully describe the actual LADDERS elements individually; therefore, this article describes characteristics and functions of each element and the dynamics represented in a DNA image to reflect that in learning health systems change is recursive, constant, and happens in complex environments that are always readjusting to new stimuli and directions, and this is often not accounted for in a framework, model, or theory. It concludes with several examples of application of the LADDERS paradigm and suggests how it is a complementary approach to accomplishing Institute of Medicine Learning Health Systems goals.
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282
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Schloemer T, Schröder-Bäck P. Criteria for evaluating transferability of health interventions: a systematic review and thematic synthesis. Implement Sci 2018. [PMID: 29941011 DOI: 10.1186/sl3012-018-0751-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Improving the public's health in different countries requires the consideration of diverse health care systems and settings. For evidence-based public health, decision-makers need to consider the transferability of effective health interventions from a primary context to their specific target context. The aim of this systematic review was to develop a model for the assessment of transferability of health interventions through identification and systematization of influencing criteria, including facilitators and barriers. METHODS A systematic literature search was performed in the databases PubMed, Embase, CINAHL, and PsycINFO. Articles were eligible if they were published in English or German and provided a description of transferability criteria. Included articles were ranked based on their thematic relevance and methodological support of transferability criteria. Using a qualitative approach, a thematic synthesis was conducted. RESULTS Thirty-seven articles were included in the review. The thematic synthesis revealed 44 criteria, covered by 4 overarching themes, which influence transferability of health interventions: The population (P), the intervention (I), and the environment (E) represent 30 conditional transferability criteria, and the transfer of the intervention (T) represents 14 process criteria for transferring the intervention to the target context. Transferability (-T) depends on the dynamic interaction of conditional criteria in the primary and target context as well as on the process of transfer. The description of facilitators and barriers deepens the understanding of the criteria. The synthesis resulted in two related models: the conceptual PIET-T model explains the underlying mechanism of transferability of health interventions and the PIET-T process model provides practical guidance for a transferability assessment. CONCLUSIONS Transferability of health interventions is a complex concept, which needs systematic consideration of the primary and target context. It should be anticipated before and evaluated after an intervention is implemented in the target context. Therefore, decision-makers need systematic and practically relevant knowledge on transferability. The synthesized PIET-T conceptual and process models with systematized criteria, facilitators, and barriers are intended as a theoretical basis to determine transferability of health interventions. Further research is needed to develop a practical tool for the PIET-T models and to evaluate the tool's usefulness for decision-making processes and intervention transfer.
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Affiliation(s)
- Tamara Schloemer
- Department of International Health, Faculty of Health, Medicine and Life Sciences, CAPHRI-Care and Public Health Research Institute, Maastricht University, Postbus 616, 6200 MD, Maastricht, The Netherlands.
| | - Peter Schröder-Bäck
- Department of International Health, Faculty of Health, Medicine and Life Sciences, CAPHRI-Care and Public Health Research Institute, Maastricht University, Postbus 616, 6200 MD, Maastricht, The Netherlands
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283
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Schloemer T, Schröder-Bäck P. Criteria for evaluating transferability of health interventions: a systematic review and thematic synthesis. Implement Sci 2018; 13:88. [PMID: 29941011 PMCID: PMC6019740 DOI: 10.1186/s13012-018-0751-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 04/18/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Improving the public's health in different countries requires the consideration of diverse health care systems and settings. For evidence-based public health, decision-makers need to consider the transferability of effective health interventions from a primary context to their specific target context. The aim of this systematic review was to develop a model for the assessment of transferability of health interventions through identification and systematization of influencing criteria, including facilitators and barriers. METHODS A systematic literature search was performed in the databases PubMed, Embase, CINAHL, and PsycINFO. Articles were eligible if they were published in English or German and provided a description of transferability criteria. Included articles were ranked based on their thematic relevance and methodological support of transferability criteria. Using a qualitative approach, a thematic synthesis was conducted. RESULTS Thirty-seven articles were included in the review. The thematic synthesis revealed 44 criteria, covered by 4 overarching themes, which influence transferability of health interventions: The population (P), the intervention (I), and the environment (E) represent 30 conditional transferability criteria, and the transfer of the intervention (T) represents 14 process criteria for transferring the intervention to the target context. Transferability (-T) depends on the dynamic interaction of conditional criteria in the primary and target context as well as on the process of transfer. The description of facilitators and barriers deepens the understanding of the criteria. The synthesis resulted in two related models: the conceptual PIET-T model explains the underlying mechanism of transferability of health interventions and the PIET-T process model provides practical guidance for a transferability assessment. CONCLUSIONS Transferability of health interventions is a complex concept, which needs systematic consideration of the primary and target context. It should be anticipated before and evaluated after an intervention is implemented in the target context. Therefore, decision-makers need systematic and practically relevant knowledge on transferability. The synthesized PIET-T conceptual and process models with systematized criteria, facilitators, and barriers are intended as a theoretical basis to determine transferability of health interventions. Further research is needed to develop a practical tool for the PIET-T models and to evaluate the tool's usefulness for decision-making processes and intervention transfer.
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Affiliation(s)
- Tamara Schloemer
- Department of International Health, Faculty of Health, Medicine and Life Sciences, CAPHRI–Care and Public Health Research Institute, Maastricht University, Postbus 616, 6200 MD Maastricht, The Netherlands
| | - Peter Schröder-Bäck
- Department of International Health, Faculty of Health, Medicine and Life Sciences, CAPHRI–Care and Public Health Research Institute, Maastricht University, Postbus 616, 6200 MD Maastricht, The Netherlands
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284
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Porte PJ, Meijs JD, Verweij LM, de Bruijne MC, van der Vleuten CP, Wagner C. Hospitals need more guidance on implementing guidelines for the safe use of medical devices. HEALTH POLICY AND TECHNOLOGY 2018. [DOI: 10.1016/j.hlpt.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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285
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Pednekar MS, Nagler EM, Gupta PC, Pawar PS, Mathur N, Adhikari K, Codeira LS, Stoddard AM, Sorensen G. Scaling up a tobacco control intervention in low resource settings: a case example for school teachers in India. HEALTH EDUCATION RESEARCH 2018; 33:218-231. [PMID: 29757377 PMCID: PMC5961014 DOI: 10.1093/her/cyy011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 04/20/2018] [Indexed: 05/09/2023]
Abstract
Research on processes of bringing effective tobacco control interventions to scale to increase quit rates among tobacco users is uncommon. This study examines processes to bring to scale one such intervention for school teachers, i.e. Tobacco Free Teacher-Tobacco Free Society (TFT-TFS). This intervention provides a foundation for an effective and low cost approach to promote cessation through schools. The present study was conducted in the states of Bihar and Maharashtra in 2014 using quantitative and qualitative methods. Focus group discussions (FGDs) were analysed using immersion crystallization method. The data presented are from a survey of 291 principals and seven FGDs. This study examined characteristics of principals and teachers, organizational environment, external environmental factors and program characteristics to determine facilitators and barriers for successful dissemination and implementation of the TFT-TFS program. Some facilitators were, incorporation of the program in existing channels like staff meetings and trainings, certification and recognition by the department of education; while some barriers were routine time bound duties (mainly teaching) of teachers and prevalence of tobacco use among teachers and administrators. Principals and teachers expressed a need and high level of interest in the adoption and implementation of the TFT-TFS program in their schools.
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Affiliation(s)
- M S Pednekar
- Healis Sekhsaria Institute for Public Health, Navi Mumbai 400701, Maharashtra, India
| | - E M Nagler
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Center for Community-Based Research, Dana Farber Cancer Institute, Boston, MA 02115, USA
| | - P C Gupta
- Healis Sekhsaria Institute for Public Health, Navi Mumbai 400701, Maharashtra, India
| | - P S Pawar
- Healis Sekhsaria Institute for Public Health, Navi Mumbai 400701, Maharashtra, India
| | - N Mathur
- Healis Sekhsaria Institute for Public Health, Navi Mumbai 400701, Maharashtra, India
| | - K Adhikari
- Healis Sekhsaria Institute for Public Health, Navi Mumbai 400701, Maharashtra, India
| | - L S Codeira
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Center for Community-Based Research, Dana Farber Cancer Institute, Boston, MA 02115, USA
| | - A M Stoddard
- Biostatistical Consultant, Pelham, MA 01002, USA
| | - G Sorensen
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Center for Community-Based Research, Dana Farber Cancer Institute, Boston, MA 02115, USA
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286
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Wiltsey Stirman S, Marques L, Creed TA, Gutner CA, DeRubeis R, Barnett PG, Kuhn E, Suvak M, Owen J, Vogt D, Jo B, Schoenwald S, Johnson C, Mallard K, Beristianos M, La Bash H. Leveraging routine clinical materials and mobile technology to assess CBT fidelity: the Innovative Methods to Assess Psychotherapy Practices (imAPP) study. Implement Sci 2018; 13:69. [PMID: 29789017 PMCID: PMC5964900 DOI: 10.1186/s13012-018-0756-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 04/19/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Identifying scalable strategies for assessing fidelity is a key challenge in implementation science. However, for psychosocial interventions, the existing, reliable ways to test treatment fidelity quality are often labor intensive, and less burdensome strategies may not reflect actual clinical practice. Cognitive behavioral therapies (CBTs) provide clinicians with a set of effective core elements to help treat a multitude of disorders, which, evidence suggests, need to be delivered with fidelity to maximize potential client impact. The current "gold standard" for rating CBTs is rating recordings of therapy sessions, which is extremely time-consuming and requires a substantial amount of initial training. Although CBTs can vary based on the target disorder, one common element employed in most CBTs is the use of worksheets to identify specific behaviors and thoughts that affect a client's ability to recover. The present study will develop and evaluate an innovative new approach to rate CBT fidelity, by developing a universal CBT scoring system based on worksheets completed in therapy sessions. METHODS To develop a scoring system for CBT worksheets, we will compile common CBT elements from a variety of CBT worksheets for a range of psychiatric disorders and create adherence and competence measures. We will collect archival worksheets from past studies to test the scoring system and assess test-retest reliability. To evaluate whether CBT worksheet scoring accurately reflects clinician fidelity, we will recruit clinicians who are engaged in a CBT for depression, anxiety, and/or posttraumatic stress disorder. Clinicians and clients will transmit routine therapy materials produced in session (e.g., worksheets, clinical notes, session recordings) to the study team after each session. We will compare observer-rated fidelity, clinical notes, and fidelity-rated worksheets to identify the most effective and efficient method to assess clinician fidelity. Clients will also be randomly assigned to either complete the CBT worksheets on paper forms or on a mobile application (app) to learn if worksheet format influences clinician and client experience or differs in terms of reflecting fidelity. DISCUSSION Scoring fidelity using CBT worksheets may allow clinics to test fidelity in a short and effective manner, enhancing continuous quality improvement in the workplace. Clinicians and clinics can use such data to improve clinician fidelity in real time, leading to improved patient outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT03479398 . Retrospectively registered March 20, 2018.
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Affiliation(s)
- Shannon Wiltsey Stirman
- National Center for PTSD, VA Palo Alto HCS and Stanford University Department of Psychiatry and Behavioral Sciences, 795 Willow Road, Menlo Park, CA 94025 USA
| | - Luana Marques
- Harvard Medical School and Massachusetts General Hospital, 70 Everett Ave., Chelsea, MA 02150 USA
| | - Torrey A. Creed
- University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3038, Philadelphia, PA 19104 USA
| | - Cassidy A. Gutner
- National Center for PTSD, VA Boston Healthcare System and Boston University School of Medicine, 150 S. Huntington Ave., Boston, MA 02130 USA
| | - Robert DeRubeis
- School of Arts and Sciences, University of Pennsylvania, 425 S. University Ave., Philadelphia, PA 19104 USA
| | - Paul G. Barnett
- Palo Alto Veterans Institute for Research, 3801 Miranda Ave., Palo Alto, CA 94304 USA
| | - Eric Kuhn
- National Center for PTSD, VA Palo Alto HCS and Stanford University Department of Psychiatry and Behavioral Sciences, 795 Willow Road, Menlo Park, CA 94025 USA
| | - Michael Suvak
- Suffolk University, 73 Tremont Street, Boston, MA 02108 USA
| | - Jason Owen
- National Center for PTSD, VA Palo Alto HCS and Stanford University Department of Psychiatry and Behavioral Sciences, 795 Willow Road, Menlo Park, CA 94025 USA
| | - Dawne Vogt
- National Center for PTSD, VA Boston Healthcare System and Boston University School of Medicine, 150 S. Huntington Ave., Boston, MA 02130 USA
| | - Booil Jo
- Stanford University, 401 Quarry Rd, Stanford, CA 94305 USA
| | | | - Clara Johnson
- National Center for PTSD, 795 Willow Road, Menlo Park, CA 94025 USA
| | - Kera Mallard
- National Center for PTSD, 795 Willow Road, Menlo Park, CA 94025 USA
| | | | - Heidi La Bash
- National Center for PTSD, 795 Willow Road, Menlo Park, CA 94025 USA
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287
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Sustained Implementation Support Scale: Validation of a Measure of Program Characteristics and Workplace Functioning for Sustained Program Implementation. J Behav Health Serv Res 2018; 44:442-464. [PMID: 27048371 DOI: 10.1007/s11414-016-9505-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
An evaluation measure of enablers and inhibitors to sustained evidence-based program (EBP) implementation may provide a useful tool to enhance organizations' capacity. This paper outlines preliminary validation of such a measure. An expert informant and consumer feedback approach was used to tailor constructs from two existing measures assessing key domains associated with sustained implementation. Validity and reliability were evaluated for an inventory composed of five subscales: Program benefits, Program burden, Workplace support, Workplace cohesion, and Leadership style. Exploratory and confirmatory factor analysis with a sample of 593 Triple P-Positive Parenting Program-practitioners led to a 28-item scale with good reliability and good convergent, discriminant, and predictive validity. Practitioners sustaining implementation at least 3 years post-training were more likely to have supervision/peer support, reported higher levels of program benefit, workplace support, and positive leadership style, and lower program burden compared to practitioners who were non-sustainers.
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288
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DeBar L, Benes L, Bonifay A, Deyo RA, Elder CR, Keefe FJ, Leo MC, McMullen C, Mayhew M, Owen-Smith A, Smith DH, Trinacty CM, Vollmer WM. Interdisciplinary team-based care for patients with chronic pain on long-term opioid treatment in primary care (PPACT) - Protocol for a pragmatic cluster randomized trial. Contemp Clin Trials 2018; 67:91-99. [PMID: 29522897 PMCID: PMC5931339 DOI: 10.1016/j.cct.2018.02.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 02/23/2018] [Accepted: 02/27/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic pain is one of the most common, disabling, and expensive public health problems in the United States. Interdisciplinary pain management treatments that employ behavioral approaches have been successful in helping patients with chronic pain reduce symptoms and regain functioning. However, most patients lack access to such treatments. We are conducting a pragmatic clinical trial to test the hypothesis that patients who receive an interdisciplinary biopsychosocial intervention, the Pain Program for Active Coping and Training (PPACT), at their primary care clinic will have a greater reduction in pain impact in the year following than patients receiving usual care. METHODS/DESIGN This is an effectiveness-implementation hybrid pragmatic clinical trial in which we randomize clusters of primary care providers and their patients with chronic pain who are on long-term opioid therapy to 1) receive an interdisciplinary behavioral intervention in conjunction with their current health care or 2) continue with current health care services. Our primary outcome is pain impact (a composite of pain intensity and pain-related interference) measured using the PEG, a validated three-item assessment. Secondary outcomes include pain-related disability, patient satisfaction, opioids dispensed and health care utilization. An economic evaluation assesses the resources and costs necessary to deliver the intervention and its cost-effectiveness compared with usual care. A formative evaluation employs mixed methods to understand the context for implementation in the participating health care systems. DISCUSSION This trial will inform the feasibility of implementing interdisciplinary behavioral approaches to pain management in the primary care setting, potentially providing a more effective, safer, and more satisfactory alternative to opioid-based chronic pain treatment. Clinical Trials Registration Number: NCT02113592.
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Affiliation(s)
- Lynn DeBar
- Kaiser Permanente Center for Health Research, Portland, OR, United States.
| | - Lindsay Benes
- Kaiser Permanente Center for Health Research, Portland, OR, United States; University of Portland, School of Nursing, Portland, OR, United States
| | - Allison Bonifay
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Richard A Deyo
- Oregon Health and Science University, School of Medicine, Portland, OR, United States
| | - Charles R Elder
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Francis J Keefe
- Duke University, School of Medicine, Durham, NC, United States
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Carmit McMullen
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Meghan Mayhew
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Ashli Owen-Smith
- Georgia State University, School of Public Health, Atlanta, GA, United States; Kaiser Permanente Center for Clinical and Outcomes Research, Atlanta, GA, United States
| | - David H Smith
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Connie M Trinacty
- Kaiser Permanente Center for Health Research, Honolulu, HI, United States
| | - William M Vollmer
- Kaiser Permanente Center for Health Research, Portland, OR, United States
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289
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Swinkels ICS, Huygens MWJ, Schoenmakers TM, Oude Nijeweme-D'Hollosy W, van Velsen L, Vermeulen J, Schoone-Harmsen M, Jansen YJ, van Schayck OC, Friele R, de Witte L. Lessons Learned From a Living Lab on the Broad Adoption of eHealth in Primary Health Care. J Med Internet Res 2018; 20:e83. [PMID: 29599108 PMCID: PMC5897624 DOI: 10.2196/jmir.9110] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/22/2017] [Accepted: 01/02/2018] [Indexed: 01/21/2023] Open
Abstract
Background Electronic health (eHealth) solutions are considered to relieve current and future pressure on the sustainability of primary health care systems. However, evidence of the effectiveness of eHealth in daily practice is missing. Furthermore, eHealth solutions are often not implemented structurally after a pilot phase, even if successful during this phase. Although many studies on barriers and facilitators were published in recent years, eHealth implementation still progresses only slowly. To further unravel the slow implementation process in primary health care and accelerate the implementation of eHealth, a 3-year Living Lab project was set up. In the Living Lab, called eLabEL, patients, health care professionals, small- and medium-sized enterprises (SMEs), and research institutes collaborated to select and integrate fully mature eHealth technologies for implementation in primary health care. Seven primary health care centers, 10 SMEs, and 4 research institutes participated. Objective This viewpoint paper aims to show the process of adoption of eHealth in primary care from the perspective of different stakeholders in a qualitative way. We provide a real-world view on how such a process occurs, including successes and failures related to the different perspectives. Methods Reflective and process-based notes from all meetings of the project partners, interview data, and data of focus groups were analyzed systematically using four theoretical models to study the adoption of eHealth in primary care. Results The results showed that large-scale implementation of eHealth depends on the efforts of and interaction and collaboration among 4 groups of stakeholders: patients, health care professionals, SMEs, and those responsible for health care policy (health care insurers and policy makers). These stakeholders are all acting within their own contexts and with their own values and expectations. We experienced that patients reported expected benefits regarding the use of eHealth for self-management purposes, and health care professionals stressed the potential benefits of eHealth and were interested in using eHealth to distinguish themselves from other care organizations. In addition, eHealth entrepreneurs valued the collaboration among SMEs as they were not big enough to enter the health care market on their own and valued the collaboration with research institutes. Furthermore, health care insurers and policy makers shared the ambition and need for the development and implementation of an integrated eHealth infrastructure. Conclusions For optimal and sustainable use of eHealth, patients should be actively involved, primary health care professionals need to be reinforced in their management, entrepreneurs should work closely with health care professionals and patients, and the government needs to focus on new health care models stimulating innovations. Only when all these parties act together, starting in local communities with a small range of eHealth tools, the potential of eHealth will be enforced.
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Affiliation(s)
- Ilse Catharina Sophia Swinkels
- Netherlands Institute for Health Services Research, Utrecht, Netherlands.,Centre for Care Technology Research, Maastricht, Netherlands
| | - Martine Wilhelmina Johanna Huygens
- Centre for Care Technology Research, Maastricht, Netherlands.,Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Tim M Schoenmakers
- Netherlands Institute for Health Services Research, Utrecht, Netherlands.,Centre for Care Technology Research, Maastricht, Netherlands.,Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Wendy Oude Nijeweme-D'Hollosy
- Centre for Care Technology Research, Maastricht, Netherlands.,Telemedicine, Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Lex van Velsen
- Centre for Care Technology Research, Maastricht, Netherlands.,Telemedicine, Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Roessingh Research & Development, Enschede, Netherlands
| | - Joan Vermeulen
- Centre for Care Technology Research, Maastricht, Netherlands.,Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.,Lunet Zorg, Eindhoven, Netherlands
| | - Marian Schoone-Harmsen
- Centre for Care Technology Research, Maastricht, Netherlands.,Work Health Technology Expertise Group, Netherlands Organisation for Applied Scientific Research TNO, Leiden, Netherlands
| | - Yvonne Jfm Jansen
- Centre for Care Technology Research, Maastricht, Netherlands.,Work Health Technology Expertise Group, Netherlands Organisation for Applied Scientific Research TNO, Leiden, Netherlands.,Robuust, Eindhoven, Netherlands
| | - Onno Cp van Schayck
- Centre for Care Technology Research, Maastricht, Netherlands.,Department of Family Medicine, School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Roland Friele
- Netherlands Institute for Health Services Research, Utrecht, Netherlands.,Centre for Care Technology Research, Maastricht, Netherlands.,Tranzo, Tilburg School of Social and Behavorial Sciences, Tilburg University, Tilburg, Netherlands
| | - Luc de Witte
- Centre for Care Technology Research, Maastricht, Netherlands.,Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.,Research Center Technology and Care, Zuyd University of Applied Sciences, Heerlen, Netherlands
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290
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Broder-Fingert S, Walls M, Augustyn M, Beidas R, Mandell D, Wiltsey-Stirman S, Silverstein M, Feinberg E. A hybrid type I randomized effectiveness-implementation trial of patient navigation to improve access to services for children with autism spectrum disorder. BMC Psychiatry 2018; 18:79. [PMID: 29587698 PMCID: PMC5870193 DOI: 10.1186/s12888-018-1661-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 03/12/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Significant racial, ethnic, and socioeconomic disparities exist in access to evidence-based treatment services for children with autism spectrum disorder (ASD). Patient Navigation (PN) is a theory-based care management strategy designed to reduce disparities in access to care. The purpose of this study is to test the effectiveness of PN a strategy to reduce disparities in access to evidence-based services for vulnerable children with ASD, as well as to explore factors that impact implementation. METHODS This study uses a hybrid type I randomized effectiveness/implementation design to test effectiveness and collect data on implementation concurrently. It is a two-arm comparative effectiveness trial with a target of 125 participants per arm. Participants are families of children age 15-27 months who receive a positive screen for ASD at a primary care visit at urban clinics in Massachusetts (n = 6 clinics), Connecticut (n = 1), and Pennsylvania (n = 2). The trial measures diagnostic interval (number of days from positive screen to diagnostic determination) and time to receipt of evidence-based ASD services/recommended services (number of days from date of diagnosis to receipt of services) in those with PN compared to and activated control -Conventional Care Management - which is similar to care management received in a high quality medical home. At the same time, a mixed-method implementation evaluation is being carried out. DISCUSSION This study will examine the effectiveness of PN to reduce the time to and receipt of evidence-based services for vulnerable children with ASD, as well as factors that influence implementation. Findings will tell us both if PN is an effective approach for improving access to evidence-based care for children with ASD, and inform future strategies for dissemination. TRIAL REGISTRATION NCT02359084 Registered February 1, 2015.
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Affiliation(s)
- Sarabeth Broder-Fingert
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, 02114, USA. .,Division of General Pediatrics, Boston University School of Medicine, 850 Harrison Ave, Room 310A, Boston, MA, 02118, USA.
| | - Morgan Walls
- 0000 0004 0367 5222grid.475010.7Department of Pediatrics, Boston University School of Medicine, Boston, MA 02114 USA
| | - Marilyn Augustyn
- 0000 0004 0367 5222grid.475010.7Division of Developmental and Behavioral Pediatrics, Boston University School of Medicine, Boston, MA 02114 USA
| | - Rinad Beidas
- 0000 0004 1936 8972grid.25879.31Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - David Mandell
- 0000 0004 1936 8972grid.25879.31Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA
| | | | - Michael Silverstein
- 0000 0004 0367 5222grid.475010.7Department of Pediatrics, Boston University School of Medicine, Boston, MA 02114 USA
| | - Emily Feinberg
- 0000 0004 0367 5222grid.475010.7Department of Pediatrics, Boston University School of Medicine, Boston, MA 02114 USA ,0000 0004 1936 7558grid.189504.1Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02114 USA
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291
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Harden SM, Smith ML, Ory MG, Smith-Ray RL, Estabrooks PA, Glasgow RE. RE-AIM in Clinical, Community, and Corporate Settings: Perspectives, Strategies, and Recommendations to Enhance Public Health Impact. Front Public Health 2018; 6:71. [PMID: 29623270 PMCID: PMC5874302 DOI: 10.3389/fpubh.2018.00071] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 02/22/2018] [Indexed: 11/13/2022] Open
Abstract
The RE-AIM Framework is a planning and evaluation model that has been used in a variety of settings to address various programmatic, environmental, and policy innovations for improving population health. In addition to the broad application and diverse use of the framework, there are lessons learned and recommendations for the future use of the framework across clinical, community, and corporate settings. The purposes of this article are to: (A) provide a brief overview of the RE-AIM Framework and its pragmatic use for planning and evaluation; (B) offer recommendations to facilitate the application of RE-AIM in clinical, community, and corporate settings; and (C) share perspectives and lessons learned about employing RE-AIM dimensions in the planning, implementation, and evaluation phases within these different settings. In this article, we demonstrate how the RE-AIM concepts and elements within each dimension can be applied by researchers and practitioners in diverse settings, among diverse populations and for diverse health topics.
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Affiliation(s)
- Samantha M Harden
- Physical Activity Research and Community Implementation, Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Matthew Lee Smith
- Center for Population Health and Management, Texas A&M University, College Station, TX, United States.,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, United States.,Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA, United States
| | - Marcia G Ory
- Center for Population Health and Management, Texas A&M University, College Station, TX, United States.,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, United States
| | - Renae L Smith-Ray
- Walgreens Center for Health and Wellbeing Research, Deerfield, IL, United States
| | - Paul A Estabrooks
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Russell E Glasgow
- Department of Family Medicine, School of Medicine, University of Colorado, Aurora, IL, United States
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292
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Evaluating the Implementation and Delivery of a Social Prescribing Intervention: A Research Protocol. Int J Integr Care 2018; 18:13. [PMID: 30127682 PMCID: PMC6095070 DOI: 10.5334/ijic.3087] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background In response to the increasing numbers of people with (multiple) chronic conditions, the need for integrated care is increasing too. Social prescribing is a new approach that aims to integrate the social and healthcare sector to improve the quality of care and user experience. Understanding main stakeholders' perceptions and experiences is key to the implementation of social prescription and for informing future initiatives. Objectives This paper presents the protocol of a qualitative research study to explore factors that (i) facilitate and hinder the implementation of a social prescribing pilot in the East of England, and (ii) affect the uptake, adherence, and completion rates by service users. Methods A qualitative study including semi-structured interviews with managers, health professionals, service providers, navigators, and service users. Iterative thematic analysis will be used to analyse the data. Conclusion This study will produce evidence on factors that hinder and facilitate the implementation of a social prescribing programme, as well as factors affecting the engagement, and non-engagement, of service users. Findings can contribute to the development of an evidence base for social prescription programmes in the UK, and inform practice, policy, and future research in the field.
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293
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Holtrop JS, Rabin BA, Glasgow RE. Qualitative approaches to use of the RE-AIM framework: rationale and methods. BMC Health Serv Res 2018; 18:177. [PMID: 29534729 PMCID: PMC5851243 DOI: 10.1186/s12913-018-2938-8] [Citation(s) in RCA: 163] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 02/16/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There have been over 430 publications using the RE-AIM model for planning and evaluation of health programs and policies, as well as numerous applications of the model in grant proposals and national programs. Full use of the model includes use of qualitative methods to understand why and how results were obtained on different RE-AIM dimensions, however, recent reviews have revealed that qualitative methods have been used infrequently. Having quantitative and qualitative methods and results iteratively inform each other should enhance understanding and lessons learned. METHODS Because there have been few published examples of qualitative approaches and methods using RE-AIM for planning or assessment and no guidance on how qualitative approaches can inform these processes, we provide guidance on qualitative methods to address the RE-AIM model and its various dimensions. The intended audience is researchers interested in applying RE-AIM or similar implementation models, but the methods discussed should also be relevant to those in community or clinical settings. RESULTS We present directions for, examples of, and guidance on how qualitative methods can be used to address each of the five RE-AIM dimensions. Formative qualitative methods can be helpful in planning interventions and designing for dissemination. Summative qualitative methods are useful when used in an iterative, mixed methods approach for understanding how and why different patterns of results occur. CONCLUSIONS In summary, qualitative and mixed methods approaches to RE-AIM help understand complex situations and results, why and how outcomes were obtained, and contextual factors not easily assessed using quantitative measures.
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Affiliation(s)
- Jodi Summers Holtrop
- ACCORDS Dissemination and Implementation Science Program, and Department of Family Medicine, University of Colorado Denver School of Medicine, 12631 E. 17th Avenue, Aurora, CO, 80045, USA.
| | - Borsika A Rabin
- ACCORDS Dissemination and Implementation Science Program, and Department of Family Medicine, University of Colorado Denver School of Medicine, 12631 E. 17th Avenue, Aurora, CO, 80045, USA
- University of California San Diego, La Jolla, CA, USA
| | - Russell E Glasgow
- ACCORDS Dissemination and Implementation Science Program, and Department of Family Medicine, University of Colorado Denver School of Medicine, 12631 E. 17th Avenue, Aurora, CO, 80045, USA
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294
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Promoting Action on Research Implementation in Health Services framework applied to TeamSTEPPS implementation in small rural hospitals. Health Care Manage Rev 2018; 42:2-13. [PMID: 26415078 DOI: 10.1097/hmr.0000000000000086] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND A particularly useful model for examining implementation of quality improvement interventions in health care settings is the PARIHS (Promoting Action on Research Implementation in Health Services) framework developed by Kitson and colleagues. The PARIHS framework proposes three elements (evidence, context, and facilitation) that are related to successful implementation. PURPOSES An evidence-based program focused on quality enhancement in health care, termed TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), has been widely promoted by the Agency for Healthcare Research and Quality, but research is needed to better understand its implementation. We apply the PARIHS framework in studying TeamSTEPPS implementation to identify elements that are most closely related to successful implementation. METHODOLOGY/APPROACH Quarterly interviews were conducted over a 9-month period in 13 small rural hospitals that implemented TeamSTEPPS. Interview quotes that were related to each of the PARIHS elements were identified using directed content analysis. Transcripts were also scored quantitatively, and bivariate regression analysis was employed to explore relationships between PARIHS elements and successful implementation related to planning activities. FINDINGS The current findings provide support for the PARIHS framework and identified two of the three PARIHS elements (context and facilitation) as important contributors to successful implementation. PRACTICE IMPLICATIONS This study applies the PARIHS framework to TeamSTEPPS, a widely used quality initiative focused on improving health care quality and patient safety. By focusing on small rural hospitals that undertook this quality improvement activity of their own accord, our findings represent effectiveness research in an understudied segment of the health care delivery system. By identifying context and facilitation as the most important contributors to successful implementation, these analyses provide a focus for efficient and effective sustainment of TeamSTEPPS efforts.
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295
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Lennox L, Maher L, Reed J. Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare. Implement Sci 2018; 13:27. [PMID: 29426341 PMCID: PMC5810192 DOI: 10.1186/s13012-017-0707-4] [Citation(s) in RCA: 187] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/29/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Improvement initiatives offer a valuable mechanism for delivering and testing innovations in healthcare settings. Many of these initiatives deliver meaningful and necessary changes to patient care and outcomes. However, many improvement initiatives fail to sustain to a point where their full benefits can be realised. This has led many researchers and healthcare practitioners to develop frameworks, models and tools to support and monitor sustainability. This work aimed to identify what approaches are available to assess and influence sustainability in healthcare and to describe the different perspectives, applications and constructs within these approaches to guide their future use. METHODS A systematic review was carried out following PRISMA guidelines to identify publications that reported approaches to support or influence sustainability in healthcare. Eligibility criteria were defined through an iterative process in which two reviewers independently assessed 20% of articles to test the objectivity of the selection criteria. Data were extracted from the identified articles, and a template analysis was undertaken to identify and assess the sustainability constructs within each reported approach. RESULTS The search strategy identified 1748 publications with 227 articles retrieved in full text for full documentary analysis. In total, 62 publications identifying a sustainability approach were included in this review (32 frameworks, 16 models, 8 tools, 4 strategies, 1 checklist and 1 process). Constructs across approaches were compared and 40 individual constructs for sustainability were found. Comparison across approaches demonstrated consistent constructs were seen regardless of proposed interventions, setting or level of application with 6 constructs included in 75% of the approaches. Although similarities were found, no approaches contained the same combination of the constructs nor did any single approach capture all identified constructs. From these results, a consolidated framework for sustainability constructs in healthcare was developed. CONCLUSIONS Choosing a sustainability method can pose a challenge because of the diverse approaches reported in the literature. This review provides a valuable resource to researchers, healthcare professionals and improvement practitioners by providing a summary of available sustainability approaches and their characteristics. TRIAL REGISTRATION This review was registered on the PROSPERO database: CRD42016040081 in June 2016.
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Affiliation(s)
- L. Lennox
- NIHR CLAHRC North West London, 369 Fulham Road, London, SW10 9NH United Kingdom
- Department of Primary Care and Public Health, Imperial College London, 369 Fulham Road, London, United Kingdom
| | - L. Maher
- Ko Awatea I Health System Innovation and Improvement, Middlemore Hospital, 100 Hospital Road, Otahuhu, New Zealand
| | - J. Reed
- NIHR CLAHRC North West London, 369 Fulham Road, London, SW10 9NH United Kingdom
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296
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Mayer KH, Chan PA, R Patel R, Flash CA, Krakower DS. Evolving Models and Ongoing Challenges for HIV Preexposure Prophylaxis Implementation in the United States. J Acquir Immune Defic Syndr 2018; 77:119-127. [PMID: 29084044 PMCID: PMC5762416 DOI: 10.1097/qai.0000000000001579] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The use of preexposure prophylaxis (PrEP) for HIV prevention was approved by the Food and Drug Administration in 2012, but delivery to at-risk persons has lagged. This critical review analyzes the current state of PrEP implementation in the United States, by reviewing barriers and innovative solutions to enhance PrEP access and uptake. SETTING Clinical care settings, public health programs, and community-based organizations (CBOs). METHODS Critical review of recent peer-reviewed literature. RESULTS More than 100 papers were reviewed. PrEP is currently provided in diverse settings. Care models include sexually transmitted disease clinics, community health centers, CBOs, pharmacies, and private primary care providers (PCPs). Sexually transmitted disease clinics have staff trained in sexual health counseling and are linked to public health programs (eg, partner notification services), whereas PCPs and community health centers may be less comfortable counseling and feel time-constrained in managing PrEP. However, PCPs may be ideal PrEP providers, given their long-term relationships with patients, integrating PrEP into routine care. Collaborations with CBOs can expand PrEP care through adherence support and insurance navigation. Pharmacies can deliver PrEP, given their experience with medication dispensing and counseling, and may be more accessible for some patients, but to address other health concerns, liaisons with PCPs may be needed. CONCLUSIONS PrEP implementation in the United States is moving forward with the development of diverse models of delivery. Optimal scale-up will require learning about the best features of each model and providing choices to consumers that enhance engagement and uptake.
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Affiliation(s)
- Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Philip A Chan
- Department of Medicine, Brown University, Providence, RI
| | - Rupa R Patel
- Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO
| | - Charlene A Flash
- Section of Infectious Diseases, Division of Internal Medicine, Baylor College of Medicine, Houston, TX
| | - Douglas S Krakower
- The Fenway Institute, Fenway Health, Boston, MA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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297
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Damian AJ, Gallo J, Leaf P, Mendelson T. Organizational and provider level factors in implementation of trauma-informed care after a city-wide training: an explanatory mixed methods assessment. BMC Health Serv Res 2017; 17:750. [PMID: 29157241 PMCID: PMC5696731 DOI: 10.1186/s12913-017-2695-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 11/07/2017] [Indexed: 11/18/2022] Open
Abstract
Background While there is increasing support for training youth-serving providers in trauma-informed care (TIC) as a means of addressing high prevalence of U.S. childhood trauma, we know little about the effects of TIC training on organizational culture and providers’ professional quality of life. This mixed-methods study evaluated changes in organizational- and provider-level factors following participation in a citywide TIC training. Methods Government workers and nonprofit professionals (N = 90) who participated in a nine-month citywide TIC training completed a survey before and after the training to assess organizational culture and professional quality of life. Survey data were analyzed using multiple regression analyses. A subset of participants (n = 16) was interviewed using a semi-structured format, and themes related to organizational and provider factors were identified using qualitative methods. Results Analysis of survey data indicated significant improvements in participants’ organizational culture and professional satisfaction at training completion. Participants’ perceptions of their own burnout and secondary traumatic stress also increased. Four themes emerged from analysis of the interview data, including “Implementation of more flexible, less-punitive policies towards clients,” “Adoption of trauma-informed workplace design,” “Heightened awareness of own traumatic stress and need for self-care,” and “Greater sense of camaraderie and empathy for colleagues.” Conclusion Use of a mixed-methods approach provided a nuanced understanding of the impact of TIC training and suggested potential benefits of the training on organizational and provider-level factors associated with implementation of trauma-informed policies and practices. Future trainings should explicitly address organizational factors such as safety climate and morale, managerial support, teamwork climate and collaboration, and individual factors including providers’ compassion satisfaction, burnout, and secondary traumatic stress, to better support TIC implementation.
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Affiliation(s)
- April Joy Damian
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 North Broadway Street, 8th Floor, Baltimore, MD, 21205, USA.
| | - Joseph Gallo
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 North Broadway Street, 8th Floor, Baltimore, MD, 21205, USA
| | - Philip Leaf
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 North Broadway Street, 8th Floor, Baltimore, MD, 21205, USA
| | - Tamar Mendelson
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 North Broadway Street, 8th Floor, Baltimore, MD, 21205, USA
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298
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Leonard C, Lawrence E, McCreight M, Lippmann B, Kelley L, Mayberry A, Ladebue A, Gilmartin H, Côté MJ, Jones J, Rabin BA, Ho PM, Burke R. Implementation and dissemination of a transition of care program for rural veterans: a controlled before and after study. Implement Sci 2017; 12:123. [PMID: 29058640 PMCID: PMC5651587 DOI: 10.1186/s13012-017-0653-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 10/03/2017] [Indexed: 12/18/2022] Open
Abstract
Background Adapting promising health care interventions to local settings is a critical component in the dissemination and implementation process. The Veterans Health Administration (VHA) rural transitions nurse program (TNP) is a nurse-led, Veteran-centered intervention designed to improve transitional care for rural Veterans funded by VA national offices for dissemination to other VA sites serving a predominantly rural Veteran population. Here, we describe our novel approach to the implementation and evaluation = the TNP. Methods This is a controlled before and after study that assesses both implementation and intervention outcomes. During pre-implementation, we assessed site context using a mixed method approach with data from diverse sources including facility-level quantitative data, key informant and Veteran interviews, observations of the discharge process, and a group brainstorming activity. We used the Practical Robust Implementation and Sustainability Model (PRISM) to inform our inquiries, to integrate data from all sources, and to identify factors that may affect implementation. In the implementation phase, we will use internal and external facilitation, paired with audit and feedback, to encourage appropriate contextual adaptations. We will use a modified Stirman framework to document adaptations. During the evaluation phase, we will measure intervention and implementation outcomes at each site using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). We will conduct a difference-in-differences analysis with propensity-matched Veterans and VA facilities as a control. Our primary intervention outcome is 30-day readmission and Emergency Department visit rates. We will use our findings to develop an implementation toolkit that will inform the larger scale-up of the TNP across the VA. Discussion The use of PRISM to inform pre-implementation evaluation and synthesize data from multiple sources, coupled with internal and external facilitation, is a novel approach to engaging sites in adapting interventions while promoting fidelity to the intervention. Our application of PRISM to pre-implementation and midline evaluation, as well as documentation of adaptations, provides an opportunity to identify and address contextual factors that may impede or enhance implementation and sustainability of health interventions and inform dissemination.
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Affiliation(s)
- Chelsea Leonard
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VA Eastern Colorado Healthcare System, 1055 Clermont Street, Denver, 80220, CO, USA.
| | - Emily Lawrence
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VA Eastern Colorado Healthcare System, 1055 Clermont Street, Denver, 80220, CO, USA
| | - Marina McCreight
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VA Eastern Colorado Healthcare System, 1055 Clermont Street, Denver, 80220, CO, USA
| | - Brandi Lippmann
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VA Eastern Colorado Healthcare System, 1055 Clermont Street, Denver, 80220, CO, USA
| | - Lynette Kelley
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VA Eastern Colorado Healthcare System, 1055 Clermont Street, Denver, 80220, CO, USA
| | - Ashlea Mayberry
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VA Eastern Colorado Healthcare System, 1055 Clermont Street, Denver, 80220, CO, USA
| | - Amy Ladebue
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VA Eastern Colorado Healthcare System, 1055 Clermont Street, Denver, 80220, CO, USA
| | - Heather Gilmartin
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VA Eastern Colorado Healthcare System, 1055 Clermont Street, Denver, 80220, CO, USA
| | - Murray J Côté
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, 77843, TX, USA
| | - Jacqueline Jones
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VA Eastern Colorado Healthcare System, 1055 Clermont Street, Denver, 80220, CO, USA.,College of Nursing, University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, 80045, CO, USA
| | - Borsika A Rabin
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, 92093, CA, USA
| | - P Michael Ho
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VA Eastern Colorado Healthcare System, 1055 Clermont Street, Denver, 80220, CO, USA.,Division of Cardiology, Department of Medicine, School of Medicine, University of Colorado Denver, 13001 E 17th Pl, Aurora, 80045, CO, USA
| | - Robert Burke
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VA Eastern Colorado Healthcare System, 1055 Clermont Street, Denver, 80220, CO, USA.,Hospital Medicine Section, Denver VA Medical Center, 1055 Clermont St, Denver, 80220, CO, USA
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Fianu A, Villeval M, Naty N, Favier F, Lang T. [To analyse the transferability of an intervention : applying the functions/implementation/context model on a diabetes prevention programme]. SANTE PUBLIQUE 2017; 29:525-534. [PMID: 29034667 DOI: 10.3917/spub.174.0525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION A type 2 diabetes primary prevention programme that was shown to be feasible and effective in 2003 was transferred to another vulnerable district of Reunion Island in 2004, but its short-term effectiveness could not be reproduced. Based on this example, this article analyses whether the key functions/implementation/context model can be useful to : 1- more accurately describe an evaluated intervention ; and 2- identify the factors involved in the transferability of this intervention. METHODS The causality model of the initial programme is described. We then identified the key functions (or theoretical processes) of this initial programme, implementation of these functions, and the context in which the intervention took place. Transfer was analysed by focusing on the differences between the initial programme and the transferred programme in terms of key functions, implementation and context. RESULTS The causality model involves individual, meso-social, and environmental health determinants. Our analysis of programme transfer highlights differences in : key functions (two key functions dropped, one key function added, one key function modified), implementation (failure to implement, loss/improvement of quality), and context (population and socioeconomic level of the district concerned). CONCLUSION This work supports the hypothesis that the key functions/implementation/context model can be useful to improve the description of an intervention, and analyse the factors involved in its transferability.
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Prendergast M, Welsh WN, Stein L, Lehman W, Melnick G, Warda U, Shafer M, Ulaszek W, Rodis E, Abdel-Salam S, Duvall J. Influence of Organizational Characteristics on Success in Implementing Process Improvement Goals in Correctional Treatment Settings. J Behav Health Serv Res 2017; 44:625-646. [PMID: 27520366 PMCID: PMC5303686 DOI: 10.1007/s11414-016-9531-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Although research indicates that organizational characteristics substantially influence the adoption and use of evidence-based practices (EBPs), there has been little empirical research on organizational factors most likely to influence successful implementation of EBPs, particularly in criminal justice settings. This study examined organizational characteristics related to the success of change teams in achieving improvements in assessment and case-planning procedures for persons leaving correctional settings and receiving community services. In this evaluation of the Organizational Process Improvement Intervention (OPII), part of the National Institute on Drug Abuse's (NIDA's) Criminal Justice Drug Abuse Treatment Studies (CJDATS) cooperative, 21 sites were randomized to an early-start or a delayed-start condition. For this analysis, data from both conditions were combined. Agencies with fewer program needs, good communication, adequate staffing levels, good supervision, positive attitude toward rehabilitation, and higher institutional capacity for change were better able to implement planned changes in assessment and case-planning procedures. Such agencies may be better candidates for implementation improvement strategies, whereas other agencies could benefit from pre-intervention efforts aimed at strengthening these characteristics before attempting to improve assessment procedures.
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Affiliation(s)
| | | | | | | | - Gerald Melnick
- National Development and Research Institutes, New York City, USA
| | - Umme Warda
- University of California, Los Angeles, USA
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