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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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302
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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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304
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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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305
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Selick A, Durbin J, Vu N, O'Connor K, Volpe T, Lin E. Barriers and facilitators to implementing family support and education in Early Psychosis Intervention programmes: A systematic review. Early Interv Psychiatry 2017; 11:365-374. [PMID: 28418227 DOI: 10.1111/eip.12400] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 09/20/2016] [Indexed: 11/28/2022]
Abstract
Family support is a core component of the Early Psychosis Intervention (EPI) model, yet it continues to have relatively low rates of implementation in practice. This paper reports results of a literature review on facilitators and barriers to delivering family interventions in EPI programmes. A search was conducted of 4 electronic databases, Medline, EMBASE, PsycINFO and Joanna Briggs, from 2000 to 2015 using terms related to early onset psychosis, family work and implementation. Four thousand four hundred and two unique studies were identified, 7 of which met inclusion criteria. Barriers and facilitators were coded and aggregated to higher-level themes using a consensus approach. Five of 7 studies examined structured multifamily psychoeducation. Uptake by families was affected by: family/client interest and readiness to participate; ability to access supports; and support needs/preferences. Implementation by programmes was affected by staff access to training and resources to provide family support. A key finding across the identified studies was that families have different needs and preferences regarding the timing, length, intensity and content of the intervention. One size does not fit all and many families do not require the intensive psychoeducational programmes typically provided. The reviewed literature suggests that flexible, tiered approaches to care may better meet family needs and increase rates of uptake of family support. However, more research is needed on the effectiveness of different models of family support in early psychosis and how they can be successfully implemented.
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Affiliation(s)
- Avra Selick
- Provincial System Support Program Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Janet Durbin
- Provincial System Support Program Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Nhi Vu
- Provincial System Support Program Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Karen O'Connor
- Canadian Mental Health Association, Peel Dufferin Branch, Brampton, Ontario, Canada
| | - Tiziana Volpe
- Provincial System Support Program Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Elizabeth Lin
- Provincial System Support Program Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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306
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Lennox L, Doyle C, Reed JE, Bell D. What makes a sustainability tool valuable, practical and useful in real-world healthcare practice? A mixed-methods study on the development of the Long Term Success Tool in Northwest London. BMJ Open 2017; 7:e014417. [PMID: 28947436 PMCID: PMC5623390 DOI: 10.1136/bmjopen-2016-014417] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Although improvement initiatives show benefits to patient care, they often fail to sustain. Models and frameworks exist to address this challenge, but issues with design, clarity and usability have been barriers to use in healthcare settings. This work aimed to collaborate with stakeholders to develop a sustainability tool relevant to people in healthcare settings and practical for use in improvement initiatives. DESIGN Tool development was conducted in six stages. A scoping literature review, group discussions and a stakeholder engagement event explored literature findings and their resonance with stakeholders in healthcare settings. Interviews, small-scale trialling and piloting explored the design and tested the practicality of the tool in improvement initiatives. SETTING National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London (CLAHRC NWL). PARTICIPANTS CLAHRC NWL improvement initiative teams and staff. RESULTS The iterative design process and engagement of stakeholders informed the articulation of the sustainability factors identified from the literature and guided tool design for practical application. Key iterations of factors and tool design are discussed. From the development process, the Long Term Success Tool (LTST) has been designed. The Tool supports those implementing improvements to reflect on 12 sustainability factors to identify risks to increase chances of achieving sustainability over time. The Tool is designed to provide a platform for improvement teams to share their own views on sustainability as well as learn about the different views held within their team to prompt discussion and actions. CONCLUSION The development of the LTST has reinforced the importance of working with stakeholders to design strategies which respond to their needs and preferences and can practically be implemented in real-world settings. Further research is required to study the use and effectiveness of the tool in practice and assess engagement with the method over time.
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Affiliation(s)
- Laura Lennox
- Department of Medicine, CLAHRC for Northwest London, London, UK
- Department of Medicine, Imperial College London, London, UK
| | | | - Julie E Reed
- NIHR CLAHRC for Northwest London, London, UK
- Department of Public Health and Primary Care, Imperial College London, London, UK
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307
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Holt CL, Chambers DA. Opportunities and challenges in conducting community-engaged dissemination/implementation research. Transl Behav Med 2017; 7:389-392. [PMID: 28884305 PMCID: PMC5645293 DOI: 10.1007/s13142-017-0520-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Cheryl L Holt
- School of Public Health, Department of Behavioral and Community Health, University of Maryland, 1234W Public Health Building (255), College Park, MD, 20742, USA.
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, USA
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308
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Goodman MS, Sanders Thompson VL. The science of stakeholder engagement in research: classification, implementation, and evaluation. Transl Behav Med 2017; 7:486-491. [PMID: 28397159 PMCID: PMC5645283 DOI: 10.1007/s13142-017-0495-z] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
In this commentary, we discuss the science of stakeholder engagement in research. We propose a classification system with definitions to determine where projects lie on the stakeholder engagement continuum. We discuss the key elements of implementation and evaluation of stakeholder engagement in research posing key questions to consider when doing this work. We commend and critique the work of Hamilton et al. in their multilevel stakeholder engagement in a VA implementation trial of evidence-based quality improvement in women's health primary care. We also discuss the need for more work in this area to enhance the science of stakeholder engagement in research.
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Affiliation(s)
- Melody S Goodman
- College of Global Public Health, New York University, 715-719 Broadway, 10th Floor, New York, NY, 10003, USA.
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309
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Hodge LM, Turner KMT, Sanders MR, Forster M. Factors that influence evidence-based program sustainment for family support providers in child protection services in disadvantaged communities. CHILD ABUSE & NEGLECT 2017; 70:134-145. [PMID: 28609693 DOI: 10.1016/j.chiabu.2017.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 05/15/2017] [Accepted: 05/29/2017] [Indexed: 06/07/2023]
Abstract
This paper evaluates program, workplace and process factors associated with implementation and sustainment of an evidence-based parenting support program (EBP) in disadvantaged communities. Correlation analyses and binary logistic regressions were used to assess the associations between key implementation support factors and program implementation (at 18 months) and sustainment (at 36 months) post training with (N=35) Australian Aboriginal and Torres Strait Islander family support providers using the Triple P - Positive Parenting Program in Indigenous child protection agencies. This study demonstrated that for implementation at 18 months, there was a trend for implementing providers to report higher levels of partnership support, perceived program benefit, workplace support and workplace cohesion. However, the only significant relationship was with partnership support (r=.31 p<0.05), and regression analysis indicated that none of the variables were significant predictors of program implementation. For sustained implementation at 36 months, no relationship was found between sustainment and program characteristics, workplace characteristics, supervision and peer support or sustainability planning. Supportive coaching was the only significant correlate (r=0.46, p<0.01) and predictor [OR=15.63, 95% CI (1.98-123.68), p=0.009] in the program sustainment model. Overall, these findings suggest the need for further exploration of program and workplace variables and provide evidence to consider incorporating partnership support and supportive coaching in real world implementation models to improve the likelihood of EBP implementation and sustainment in Indigenous communities.
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Affiliation(s)
- Lauren M Hodge
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia.
| | - Karen M T Turner
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia.
| | - Matthew R Sanders
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia.
| | - Michell Forster
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia.
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310
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Skolarus TA, Lehmann T, Tabak RG, Harris J, Lecy J, Sales AE. Assessing citation networks for dissemination and implementation research frameworks. Implement Sci 2017; 12:97. [PMID: 28754140 PMCID: PMC5534119 DOI: 10.1186/s13012-017-0628-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 07/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A recent review of frameworks used in dissemination and implementation (D&I) science described 61 judged to be related either to dissemination, implementation, or both. The current use of these frameworks and their contributions to D&I science more broadly has yet to be reviewed. For these reasons, our objective was to determine the role of these frameworks in the development of D&I science. METHODS We used the Web of Science™ Core Collection and Google Scholar™ to conduct a citation network analysis for the key frameworks described in a recent systematic review of D&I frameworks (Am J Prev Med 43(3):337-350, 2012). From January to August 2016, we collected framework data including title, reference, publication year, and citations per year and conducted descriptive and main path network analyses to identify those most important in holding the current citation network for D&I frameworks together. RESULTS The source article contained 119 cited references, with 50 published articles and 11 documents identified as a primary framework reference. The average citations per year for the 61 frameworks reviewed ranged from 0.7 to 103.3 among articles published from 1985 to 2012. Citation rates from all frameworks are reported with citation network analyses for the framework review article and ten highly cited framework seed articles. The main path for the D&I framework citation network is presented. CONCLUSIONS We examined citation rates and the main paths through the citation network to delineate the current landscape of D&I framework research, and opportunities for advancing framework development and use. Dissemination and implementation researchers and practitioners may consider frequency of framework citation and our network findings when planning implementation efforts to build upon this foundation and promote systematic advances in D&I science.
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Affiliation(s)
- Ted A. Skolarus
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105 USA
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI 48109 USA
- Urology Section, VA Ann Arbor Healthcare System, Department of Urology, University of Michigan, Ann Arbor, MI 48109 USA
| | - Todd Lehmann
- Department of Political Science, College of Literature, Science and the Arts, University of Michigan, Ann Arbor, MI 48109 USA
| | - Rachel G. Tabak
- Department of Political Science, College of Literature, Science and the Arts, University of Michigan, Ann Arbor, MI 48109 USA
| | - Jenine Harris
- Prevention Research Center in St. Louis/George Warren Brown School of Social Work at Washington University in St. Louis, St. Louis, MO 63130 USA
| | - Jesse Lecy
- Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY 13244 USA
| | - Anne E. Sales
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105 USA
- Department of Learning Health Sciences, University of Michigan Medical School, University of Michigan, Ann Arbor, MI 48109 USA
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Weiss CH, Krishnan JA, Au DH, Bender BG, Carson SS, Cattamanchi A, Cloutier MM, Cooke CR, Erickson K, George M, Gerald JK, Gerald LB, Goss CH, Gould MK, Hyzy R, Kahn JM, Mittman BS, Mosesón EM, Mularski RA, Parthasarathy S, Patel SR, Rand CS, Redeker NS, Reiss TF, Riekert KA, Rubenfeld GD, Tate JA, Wilson KC, Thomson CC. An Official American Thoracic Society Research Statement: Implementation Science in Pulmonary, Critical Care, and Sleep Medicine. Am J Respir Crit Care Med 2017; 194:1015-1025. [PMID: 27739895 PMCID: PMC5441016 DOI: 10.1164/rccm.201608-1690st] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many advances in health care fail to reach patients. Implementation science is the study of novel approaches to mitigate this evidence-to-practice gap. METHODS The American Thoracic Society (ATS) created a multidisciplinary ad hoc committee to develop a research statement on implementation science in pulmonary, critical care, and sleep medicine. The committee used an iterative consensus process to define implementation science and review the use of conceptual frameworks to guide implementation science for the pulmonary, critical care, and sleep community and to explore how professional medical societies such as the ATS can promote implementation science. RESULTS The committee defined implementation science as the study of the mechanisms by which effective health care interventions are either adopted or not adopted in clinical and community settings. The committee also distinguished implementation science from the act of implementation. Ideally, implementation science should include early and continuous stakeholder involvement and the use of conceptual frameworks (i.e., models to systematize the conduct of studies and standardize the communication of findings). Multiple conceptual frameworks are available, and we suggest the selection of one or more frameworks on the basis of the specific research question and setting. Professional medical societies such as the ATS can have an important role in promoting implementation science. Recommendations for professional societies to consider include: unifying implementation science activities through a single organizational structure, linking front-line clinicians with implementation scientists, seeking collaborations to prioritize and conduct implementation science studies, supporting implementation science projects through funding opportunities, working with research funding bodies to set the research agenda in the field, collaborating with external bodies responsible for health care delivery, disseminating results of implementation science through scientific journals and conferences, and teaching the next generation about implementation science through courses and other media. CONCLUSIONS Implementation science plays an increasingly important role in health care. Through support of implementation science, the ATS and other professional medical societies can work with other stakeholders to lead this effort.
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West AL, Aparicio EM, Berlin LJ, Jones Harden B. IMPLEMENTING AN ATTACHMENT-BASED PARENTING INTERVENTION WITHIN HOME-BASED EARLY HEAD START: HOME-VISITORS’ PERCEPTIONS AND EXPERIENCES. Infant Ment Health J 2017; 38:514-522. [DOI: 10.1002/imhj.21654] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Napolitano MA, Whiteley JA, Mavredes MN, Faro J, DiPietro L, Hayman LL, Neighbors CJ, Simmens S. Using social media to deliver weight loss programming to young adults: Design and rationale for the Healthy Body Healthy U (HBHU) trial. Contemp Clin Trials 2017; 60:1-13. [PMID: 28611007 DOI: 10.1016/j.cct.2017.06.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 05/18/2017] [Accepted: 06/09/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND The transitional period from late adolescence to early adulthood is a vulnerable period for weight gain, with a twofold increase in overweight/obesity during this life transition. In the United States, approximately one-third of young adults have obesity and are at a high risk for weight gain. PURPOSE To describe the design and rationale of a National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) sponsored randomized, controlled clinical trial, the Healthy Body Healthy U (HBHU) study, which compares the differential efficacy of three interventions on weight loss among young adults aged 18-35years. METHODS The intervention is delivered via Facebook and SMS Text Messaging (text messaging) and includes: 1) targeted content (Targeted); 2) tailored or personalized feedback (Tailored); or 3) contact control (Control). Recruitment is on-going at two campus sites, with the intervention delivery conducted by the parent site. A total of 450 students will be randomly-assigned to receive one of three programs for 18months. We hypothesize that: a) the Tailored group will lose significantly more weight at the 6, 12, 18month follow-ups compared with the Targeted group; and that b) both the Tailored and Targeted groups will have greater weight loss at the 6, 12, 18month follow-ups than the Control group. We also hypothesize that participants who achieve a 5% weight loss at 6 and 18months will have greater improvements in their cardiometabolic risk factors than those who do not achieve this target. We will examine intervention costs to inform implementation and sustainability other universities. Expected study completion date is 2019. CONCLUSIONS This project has significant public health impact, as the successful translation could reach as many as 20 million university students each year, and change the current standard of practice for promoting weight management within university campus communities. ClinicalTrial.gov: NCT02342912.
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Affiliation(s)
- Melissa A Napolitano
- Department of Prevention and Community Health, The George Washington University, Milken Institute School of Public Health, 950 New Hampshire Ave NW, Suite 300, Washington, DC 20052, USA; Department of Exercise and Nutrition Sciences, The George Washington University, Milken Institute School of Public Health, 950 New Hampshire Ave NW, Suite 200, Washington, DC 20052, USA.
| | - Jessica A Whiteley
- College of Nursing and Health Sciences, University of Massachusetts Boston, Exercise and Health Sciences Program, 100 Morrissey Blvd, Science Center, 2(nd) Floor, Boston, MA 02125-3393, USA.
| | - Meghan N Mavredes
- Department of Prevention and Community Health, The George Washington University, Milken Institute School of Public Health, 950 New Hampshire Ave NW, Suite 300, Washington, DC 20052, USA.
| | - Jamie Faro
- College of Nursing and Health Sciences, University of Massachusetts Boston, Exercise and Health Sciences Program, 100 Morrissey Blvd, Science Center, 2(nd) Floor, Boston, MA 02125-3393, USA.
| | - Loretta DiPietro
- Department of Exercise and Nutrition Sciences, The George Washington University, Milken Institute School of Public Health, 950 New Hampshire Ave NW, Suite 200, Washington, DC 20052, USA.
| | - Laura L Hayman
- University of Massachusetts Boston, Department of Nursing, 100 Morrissey Blvd, Quinn Administration-01-01, Boston, MA 02125-3393, USA.
| | - Charles J Neighbors
- Columbia University, The National Center on Addiction and Substance Abuse, Health Services Research, 633 Third Avenue, 19th Floor, New York, NY 10017, USA.
| | - Samuel Simmens
- The George Washington University, Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, Science & Engineering Hall, 800 22nd St NW, Floor 7, Washington, DC 20052, USA.
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Bradley KA, Ludman EJ, Chavez LJ, Bobb JF, Ruedebusch SJ, Achtmeyer CE, Merrill JO, Saxon AJ, Caldeiro RM, Greenberg DM, Lee AK, Richards JE, Thomas RM, Matson TE, Williams EC, Hawkins E, Lapham G, Kivlahan DR. Patient-centered primary care for adults at high risk for AUDs: the Choosing Healthier Drinking Options In primary CarE (CHOICE) trial. Addict Sci Clin Pract 2017; 12:15. [PMID: 28514963 PMCID: PMC5436432 DOI: 10.1186/s13722-017-0080-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 04/28/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Most patients with alcohol use disorders (AUDs) never receive alcohol treatment, and experts have recommended management of AUDs in primary care. The Choosing Healthier Drinking Options In primary CarE (CHOICE) trial was a randomized controlled effectiveness trial of a novel intervention for primary care patients at high risk for AUDs. This report describes the conceptual and scientific foundation of the CHOICE model of care, critical elements of the CHOICE trial design consistent with the Template for Intervention Description and Replication (TIDieR), results of recruitment, and baseline characteristics of the enrolled sample. METHODS The CHOICE intervention is a multi-contact, extended counseling intervention, based on the Chronic Care Model, shared decision-making, motivational interviewing, and evidence-based options for managing AUDs, designed to be practical in primary care. Outpatients who received care at 3 Veterans Affairs primary care sites in the Pacific Northwest and reported frequent heavy drinking (≥4 drinks/day for women; ≥5 for men) were recruited (2011-2014) into a trial in which half of the participants would be offered additional alcohol-related care from a nurse. CHOICE nurses offered 12 months of patient-centered care, including proactive outreach and engagement, repeated brief motivational interventions, monitoring with and without alcohol biomarkers, medications for AUDs, and/or specialty alcohol treatment as appropriate and per patient preference. A CHOICE nurse practitioner was available to prescribe medications for AUDs. RESULTS A total of 304 patients consented to participate in the CHOICE trial. Among consenting participants, 90% were men, the mean age was 51 (range 22-75), and most met DSM-IV criteria for alcohol abuse (14%) or dependence (59%). Many participants also screened positive for tobacco use (44%), depression (45%), anxiety disorders (30-41%) and non-tobacco drug use disorders (19%). At baseline, participants had a median AUDIT score of 18 [Interquartile range (IQR) 14-24] and a median readiness to change drinking score of 5 (IQR 2.75-6.25) on a 1-10 Likert scale. CONCLUSION The CHOICE trial tested a patient-centered intervention for AUDs and recruited primary care patients at high risk for AUDs, with a spectrum of severity, co-morbidity, and readiness to change drinking. Trial registration The trial is registered at clinicaltrial.gov (NCT01400581).
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Affiliation(s)
- Katharine A. Bradley
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
- Department of Health Services, University of Washington, Seattle, WA USA
- Department of Medicine, University of Washington, Seattle, WA USA
| | - Evette Joy Ludman
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
| | - Laura J. Chavez
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH USA
- Center for Innovation in Pediatric Practice, Nationwide Children’s Hospital, Columbus, OH USA
| | - Jennifer F. Bobb
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
| | - Susan J. Ruedebusch
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
| | - Carol E. Achtmeyer
- General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
| | | | - Andrew J. Saxon
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
| | - Ryan M. Caldeiro
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
| | - Diane M. Greenberg
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
- General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
| | - Amy K. Lee
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
| | - Julie E. Richards
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
- Department of Health Services, University of Washington, Seattle, WA USA
| | - Rachel M. Thomas
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
| | - Theresa E. Matson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
- Department of Health Services, University of Washington, Seattle, WA USA
| | - Emily C. Williams
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
- Department of Health Services, University of Washington, Seattle, WA USA
| | - Eric Hawkins
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
| | - Gwen Lapham
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
| | - Daniel R. Kivlahan
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
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315
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Gupta S, Nodora J. Optimizing the Quality of the Colorectal Cancer Screening Continuum: A Call to Action. J Natl Cancer Inst 2017; 109:2740721. [PMID: 28376229 PMCID: PMC5441292 DOI: 10.1093/jnci/djw271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 10/11/2016] [Indexed: 01/01/2023] Open
Affiliation(s)
- Samir Gupta
- Affiliations of authors: Veterans Affairs San Diego Healthcare System, San Diego, CA (SG); UC San Diego Moores Cancer Center, La Jolla, CA (SG, JN); Department of Internal Medicine, Division of Gastroenterology, UC San Diego, La Jolla, CA (SG); Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA (JN)
| | - Jesse Nodora
- Affiliations of authors: Veterans Affairs San Diego Healthcare System, San Diego, CA (SG); UC San Diego Moores Cancer Center, La Jolla, CA (SG, JN); Department of Internal Medicine, Division of Gastroenterology, UC San Diego, La Jolla, CA (SG); Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA (JN)
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316
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Garbacz SA, Herman KC, Thompson AM, Reinke WM. Family engagement in education and intervention: Implementation and evaluation to maximize family, school, and student outcomes. J Sch Psychol 2017. [PMID: 28646971 DOI: 10.1016/j.jsp.2017.04.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- S Andrew Garbacz
- Department of Educational Psychology, University of Wisconsin-Madison, USA.
| | - Keith C Herman
- Department of Educational, School, and Counseling Psychology, University of Missouri, USA
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317
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Liddy C, Rowan M, Valiquette-Tessier SC, Drosinis P, Crowe L, Hogg W. Improved Delivery of Cardiovascular Care (IDOCC): Findings from Narrative Reports by Practice Facilitators. Prev Med Rep 2017; 5:214-219. [PMID: 28271017 PMCID: PMC5330620 DOI: 10.1016/j.pmedr.2016.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/10/2016] [Accepted: 12/19/2016] [Indexed: 11/26/2022] Open
Abstract
Practice facilitation can help family physicians adopt
evidence-based guidelines. However, many practices struggle to effectively implement
practice changes that result in meaningful improvement. Building on our previous
research, we examined the barriers to and enablers of implementation perceived by
practice facilitators (PF) in helping practices to adopt the Improved Delivery of
Cardiovascular Care (IDOCC) program, which took place at 84 primary care practices in
Ottawa, Canada between April 2008 and March 2012. We conducted a qualitative analysis
of PFs’ narrative reports using a multiple case study design. We used a combined
purposeful sampling approach to identify cases that 1) reflected experiences typical
of the broader sample and 2) presented sufficient breadth of experience from each
project step and family practice model. Sampling continued until data saturation was
reached. Team members conducted a qualitative analysis of reports using an open and
axial coding style and a constant comparative approach. Barriers and enablers were
divided into five constructs: structural, organizational, provider, patient, and
innovation. Narratives from 13 practice sites were reviewed. A total of 8 barriers
and 11 enablers were consistently identified across practices. Barriers were most
commonly reported at the organizational (n = 3)
and structural level, (n = 2) while enablers were
most common at the innovation level (n = 6).
While physicians responded positively to PFs’ presence and largely supported their
recommendations for practice change, organizational and structural aspects such as
lack of time, minimal staff engagement, and provider reimbursement remained too great
for practices to successfully implement practice-level changes. Trial Registration: ClinicalTrials.gov,
NCT00574808 Eight Barriers and 11 enablers to practice facilitation
emerged across constructs. Barriers were most common at the structural (n = 3) and organizational (n = 2) levels. The majority of enablers occurred at the innovation level
(n = 6). The Chaudoir framework provided a comprehensive picture of
barriers and enablers.
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Affiliation(s)
- Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Margo Rowan
- Rowan Research & Evaluation, Ottawa, Ontario, Canada
| | | | - Paul Drosinis
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Lois Crowe
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - William Hogg
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
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318
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Harris M, Lawn SJ, Morello A, Battersby MW, Ratcliffe J, McEvoy RD, Tieman JJ. Practice change in chronic conditions care: an appraisal of theories. BMC Health Serv Res 2017; 17:170. [PMID: 28245813 PMCID: PMC5331688 DOI: 10.1186/s12913-017-2102-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/17/2017] [Indexed: 11/20/2022] Open
Abstract
Background Management of chronic conditions can be complex and burdensome for patients and complex and costly for health systems. Outcomes could be improved and costs reduced if proven clinical interventions were better implemented, but the complexity of chronic care services appears to make clinical change particularly challenging. Explicit use of theories may improve the success of clinical change in this area of care provision. Whilst theories to support implementation of practice change are apparent in the broad healthcare arena, the most applicable theories for the complexities of practice change in chronic care have not yet been identified. Methods We developed criteria to review the usefulness of change implementation theories for informing chronic care management and applied them to an existing list of theories used more widely in healthcare. Results Criteria related to the following characteristics of chronic care: breadth of the field; multi-disciplinarity; micro, meso and macro program levels; need for field-specific research on implementation requirements; and need for measurement. Six theories met the criteria to the greatest extent: the Consolidate Framework for Implementation Research; Normalization Process Theory and its extension General Theory of Implementation; two versions of the Promoting Action on Research Implementation in Health Services framework and Sticky Knowledge. None fully met all criteria. Involvement of several care provision organizations and groups, involvement of patients and carers, and policy level change are not well covered by most theories. However, adaptation may be possible to include multiple groups including patients and carers, and separate theories may be needed on policy change. Ways of qualitatively assessing theory constructs are available but quantitative measures are currently partial and under development for all theories. Conclusions Theoretical bases are available to structure clinical change research in chronic condition care. Theories will however need to be adapted and supplemented to account for the particular features of care in this field, particularly in relation to involvement of multiple organizations and groups, including patients, and in relation to policy influence. Quantitative measurement of theory constructs may present difficulties.
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Affiliation(s)
- Melanie Harris
- Flinders Human Behaviour & Health Research Unit, School of Medicine, Flinders University, Adelaide, SA, Australia.
| | - Sharon J Lawn
- Flinders Human Behaviour & Health Research Unit, School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Andrea Morello
- Flinders Human Behaviour & Health Research Unit, School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Malcolm W Battersby
- Flinders Human Behaviour & Health Research Unit, School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Julie Ratcliffe
- Health Economics Unit, Flinders Health Care and Workforce Innovations, School of Medicine, Flinders University, Adelaide, SA, Australia
| | - R Doug McEvoy
- Flinders Southern Adelaide Clinical School, School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Jennifer J Tieman
- Palliative & Supportive Services, School of Health Sciences, Flinders University, Adelaide, SA, Australia
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319
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Mellor-Clark J, Cross S, Macdonald J, Skjulsvik T. Leading Horses to Water: Lessons from a Decade of Helping Psychological Therapy Services Use Routine Outcome Measurement to Improve Practice. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 43:279-85. [PMID: 25179755 DOI: 10.1007/s10488-014-0587-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We summarise the recent reflections of five thought leaders in the field of routine outcome measurement (ROM) for psychological therapy, and then add our own experience of introducing a national ROM system in the UK. We highlight, in particular, the post-implementation challenge of securing data of sufficient reliability to help inform service quality improvements. We ground our conclusions and recommendations in the rapidly evolving discipline of implementation science, and offer a best practice model for applying research recommendations in practice settings. In this context we portray ROM implementation as significant organizational change that benefits from rigorous process and clearly defined, well-communicated targets.
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Affiliation(s)
- John Mellor-Clark
- CORE Information Systems Ltd. (IMS), Valiant Office Suites, Lumonics House, Valley Drive, Swift Valley, Rugby, CV21 1TQ, UK.
| | - Simone Cross
- CORE Information Systems Ltd. (IMS), Valiant Office Suites, Lumonics House, Valley Drive, Swift Valley, Rugby, CV21 1TQ, UK
| | - James Macdonald
- CORE Information Systems Ltd. (IMS), Valiant Office Suites, Lumonics House, Valley Drive, Swift Valley, Rugby, CV21 1TQ, UK
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320
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Ayele RA, Lawrence E, McCreight M, Fehling K, Peterson J, Glasgow RE, Rabin BA, Burke R, Battaglia C. Study protocol: improving the transition of care from a non-network hospital back to the patient's medical home. BMC Health Serv Res 2017; 17:123. [PMID: 28183346 PMCID: PMC5301366 DOI: 10.1186/s12913-017-2048-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/20/2017] [Indexed: 12/03/2022] Open
Abstract
Background The process of transitioning Veterans to primary care following a non-Veterans Affairs (VA) hospitalization can be challenging. Poor transitions result in medical complications and increased hospital readmissions. The goal of this transition of care quality improvement (QI) project is to identify gaps in the current transition process and implement an intervention that bridges the gap and improves the current transition of care process within the Eastern Colorado Health Care System (ECHCS). Methods We will employ qualitative methods to understand the current transition of care process back to VA primary care for Veterans who received care in a non-VA hospital in ECHCS. We will conduct in-depth semi-structured interviews with Veterans hospitalized in 2015 in non-VA hospitals as well as both VA and non-VA providers, staff, and administrators involved in the current care transition process. Participants will be recruited using convenience and snowball sampling. Qualitative data analysis will be guided by conventional content analysis and Lean Six Sigma process improvement tools. We will use VA claim data to identify the top ten non-VA hospitals serving rural and urban Veterans by volume and Veterans that received inpatient services at non-VA hospitals. Informed by both qualitative and quantitative data, we will then develop a transitions care coordinator led intervention to improve the transitions process. We will test the transition of care coordinator intervention using repeated improvement cycles incorporating salient factors in value stream mapping that are important for an efficient and effective transition process. Furthermore, we will complete a value stream map of the transition process at two other VA Medical Centers and test whether an implementation strategy of audit and feedback (the value stream map of the current transition process with the Transition of Care Dashboard) versus audit and feedback with Transition Nurse facilitation of the process using the Resource Guide and Transition of Care Dashboard improves the transition process, continuity of care, patient satisfaction and clinical outcomes. Discussion Our current transition of care process has shortcomings. An intervention utilizing a transition care coordinator has the potential to improve this process. Transitioning Veterans to primary care following a non-VA hospitalization is a crucial step for improving care coordination for Veterans
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Affiliation(s)
- Roman A Ayele
- Department of Veterans Affairs, Eastern Colorado Health Care System, 1055 Clermont Street, Research (A151), Denver, CO, 80220, USA. .,University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
| | - Emily Lawrence
- Department of Veterans Affairs, Eastern Colorado Health Care System, 1055 Clermont Street, Research (A151), Denver, CO, 80220, USA
| | - Marina McCreight
- Department of Veterans Affairs, Eastern Colorado Health Care System, 1055 Clermont Street, Research (A151), Denver, CO, 80220, USA
| | - Kelty Fehling
- Department of Veterans Affairs, Eastern Colorado Health Care System, 1055 Clermont Street, Research (A151), Denver, CO, 80220, USA
| | - Jamie Peterson
- Department of Veterans Affairs, Eastern Colorado Health Care System, 1055 Clermont Street, Research (A151), Denver, CO, 80220, USA
| | - Russell E Glasgow
- Department of Family Medicine, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Borsika A Rabin
- Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, California, USA.,Department of Family Medicine, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Robert Burke
- Department of Veterans Affairs, Eastern Colorado Health Care System, 1055 Clermont Street, Research (A151), Denver, CO, 80220, USA.,University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Catherine Battaglia
- Department of Veterans Affairs, Eastern Colorado Health Care System, 1055 Clermont Street, Research (A151), Denver, CO, 80220, USA.,University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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321
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Lewis BA, Napolitano MA, Buman MP, Williams DM, Nigg CR. Future directions in physical activity intervention research: expanding our focus to sedentary behaviors, technology, and dissemination. J Behav Med 2017; 40:112-126. [PMID: 27722907 PMCID: PMC5296224 DOI: 10.1007/s10865-016-9797-8] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 09/20/2016] [Indexed: 12/22/2022]
Abstract
Despite the increased health risks of a sedentary lifestyle, only 49 % of American adults participate in physical activity (PA) at the recommended levels. In an effort to move the PA field forward, we briefly review three emerging areas of PA intervention research. First, new intervention research has focused on not only increasing PA but also on decreasing sedentary behavior. Researchers should utilize randomized controlled trials, common terminology, investigate which behaviors should replace sedentary behaviors, evaluate long-term outcomes, and focus across the lifespan. Second, technology has contributed to an increase in sedentary behavior but has also led to innovative PA interventions. PA technology research should focus on large randomized trials with evidence-based components, explore social networking and innovative apps, improve PA monitoring, consider the lifespan, and be grounded in theory. Finally, in an effort to maximize public health impact, dissemination efforts should address the RE-AIM model, health disparities, and intervention costs.
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Affiliation(s)
- Beth A Lewis
- School of Kinesiology, University of Minnesota, 1900 University Avenue SE, Cooke Hall, Minneapolis, MN, 55455, USA.
| | - Melissa A Napolitano
- Departments of Prevention and Community Health/Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, 3rd Floor, Washington, DC, 20052, USA
| | - Matthew P Buman
- School of Nutrition and Health Promotion, College of Health Solutions, 500 North 3rd Street, Phoenix, AZ, 85004, USA
| | - David M Williams
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-4, Providence, RI, 02912, USA
| | - Claudio R Nigg
- Department of Public Health Sciences, University of Hawaii, 1960 East-West Road, Honolulu, HI, 96822, USA
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322
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Magee M, Bardsley JK, Wallia A, Smith KM. Transitioning the Adult with Type 2 Diabetes From the Acute to Chronic Care Setting: Strategies to Support Pragmatic Implementation Success. Curr Diab Rep 2017; 17:6. [PMID: 28138821 DOI: 10.1007/s11892-017-0830-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Scientific evidence is available to guide the how to of medications management when patients with diabetes are hospitalized or present to the Emergency Department. However, few clinical trials in the diabetes field have addressed the execution, coupled with established implementation effectiveness evaluation frameworks to help inform and assess implementation practices to support the transition in care. These deficiencies may be overcome by (1) applying the principles of implementation and delivery systems science; (2) engaging the principles of human factors (HF) throughout the design, development, and evaluation planning activities; and (3) utilizing mixed methods to design the intervention, workflow processes, and evaluate the intervention for sustainability within existing care delivery models. This article provides a discussion of implementation science and human factors science including an overview of commonly used frameworks which can be applied to structure design and implementation of sustainable and generalizable interventions.
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Affiliation(s)
- Michelle Magee
- MedStar Diabetes Institute, 100 Irving St, NW, #4114, Washington, DC, USA.
- MedStar Health Research Institute, 6525 Belcrest Rd., Ste. 700, Hyattsville, MD, 20782, USA.
- Georgetown University School of Medicine and Healthcare Sciences, Washington, DC, USA.
| | - Joan K Bardsley
- MedStar Health Research Institute, 6525 Belcrest Rd., Ste. 700, Hyattsville, MD, 20782, USA
- MedStar Health Corporate Nursing, 6525 Belcrest Rd., Ste. 700, Hyattsville, MD, 20782, USA
| | - Amisha Wallia
- Northwestern University Feinberg School of Medicine, Suite 530 645N, Michigan Avenue, Chicago, IL, 60611, USA
| | - Kelly M Smith
- MedStar Health Research Institute, 6525 Belcrest Rd., Ste. 700, Hyattsville, MD, 20782, USA
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323
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Stirman SW, Pontoski K, Creed T, Xhezo R, Evans AC, Beck AT, Crits-Christoph P. A Non-randomized Comparison of Strategies for Consultation in a Community-Academic Training Program to Implement an Evidence-Based Psychotherapy. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 44:55-66. [PMID: 26577646 PMCID: PMC5293547 DOI: 10.1007/s10488-015-0700-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Despite the central role of training and consultation in the implementation of evidence-based psychological interventions (EBPIs), comprehensive reviews of research on training have highlighted serious gaps in knowledge regarding best practices. Consultation after initial didactic training appears to be of critical importance, but there has been very little research to determine optimal consultation format or interventions. This observational study compared two consultation formats that included review of session audio and feedback in the context of a program to train clinicians (n = 85) in community mental health clinics to deliver cognitive therapy (CT). A "gold standard" condition in which clinicians received individual feedback after expert consultants reviewed full sessions was compared to a group consultation format in which short segments of session audio were reviewed by a group of clinicians and an expert consultant. After adjusting for potential baseline differences between individuals in the two consultation conditions, few differences were found in terms of successful completion of the consultation phase or in terms of competence in CT at the end of consultation or after a 2 year follow-up. However, analyses did not support hypotheses regarding non-inferiority of the group consultation condition. While both groups largely maintained competence, clinicians in the group consultation condition demonstrated increases in competence over the follow-up period, while a sub-group of those in the individual condition experienced decreases. These findings, if replicated, have important implications for EBP implementation programs, as they suggest that observation and feedback is feasible in community mental health setting, and that employing this method in a group format is an effective and efficient consultation strategy that may enhance the implementation and sustainability of evidence-based psychotherapies.
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Affiliation(s)
- Shannon Wiltsey Stirman
- Dissemination and Training Division, National Center for PTSD and Department of Psychiatry and Behavioral Sciences, VA Palo Alto Healthcare System and Stanford University, 795 Willow Road (NC-PTSD), Menlo Park, CA, 94025, USA.
| | - Kristin Pontoski
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., Philadelphia, PA, 19104, USA
| | - Torrey Creed
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., Philadelphia, PA, 19104, USA
| | - Regina Xhezo
- Department of Behavioral Health and Intellectual DisAbility Services, 801 Market Street, 7th Floor, Philadelphia, PA, 19107, USA
| | - Arthur C Evans
- Department of Behavioral Health and Intellectual DisAbility Services, 801 Market Street, 7th Floor, Philadelphia, PA, 19107, USA
| | - Aaron T Beck
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., Philadelphia, PA, 19104, USA
| | - Paul Crits-Christoph
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., Philadelphia, PA, 19104, USA
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324
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Benzer JK, Charns MP, Hamdan S, Afable M. The role of organizational structure in readiness for change: A conceptual integration. Health Serv Manage Res 2016; 30:34-46. [PMID: 28166670 DOI: 10.1177/0951484816682396] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this review is to extend extant conceptualizations of readiness for change as an individual-level phenomenon. This review-of-reviews focuses on existing conceptual frameworks from the dissemination, implementation, quality improvement, and organizational transformation literatures in order to integrate theoretical rationales for how organization structure, a key dimension of the organizational context, may impact readiness for change. We propose that the organization structure dimensions of differentiation and integration impact readiness for change at the individual level of analysis by influencing four key concepts of relevance, legitimacy, perceived need for change, and resource allocation. We identify future research directions that focus on these four key concepts.
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Affiliation(s)
- Justin K Benzer
- 1 Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research, Boston, MA, USA.,2 Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning Veterans, Waco, TX, USA.,3 Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Martin P Charns
- 1 Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research, Boston, MA, USA.,4 Department of Health Policy, Law, and Management, School of Public Health, Boston University, Boston, MA, USA
| | - Sami Hamdan
- 1 Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research, Boston, MA, USA.,5 School of Medicine, Tufts University, Boston, MA, USA
| | - Melissa Afable
- 1 Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research, Boston, MA, USA.,4 Department of Health Policy, Law, and Management, School of Public Health, Boston University, Boston, MA, USA
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Chor KHB, Wisdom JP, Olin SCS, Hoagwood KE, Horwitz SM. Measures for Predictors of Innovation Adoption. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 42:545-73. [PMID: 24740175 DOI: 10.1007/s10488-014-0551-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Building on a narrative synthesis of adoption theories by Wisdom et al. (2013), this review identifies 118 measures associated with the 27 adoption predictors in the synthesis. The distribution of measures is uneven across the predictors and predictors vary in modifiability. Multiple dimensions and definitions of predictors further complicate measurement efforts. For state policymakers and researchers, more effective and integrated measurement can advance the adoption of complex innovations such as evidence-based practices.
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Affiliation(s)
- Ka Ho Brian Chor
- Center for Mental Health Implementation and Dissemination Science in States for Children, Adolescents, and Families (IDEAS Center), Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York University School of Medicine, 1 Park Avenue, 7th Floor, New York, NY, 10016, USA,
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326
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Kanzaria HK, Booker-Vaughns J, Itakura K, Yadav K, Kane BG, Gayer C, Lin G, LeBlanc A, Gibson R, Chen EH, Williams P, Carpenter CR. Dissemination and Implementation of Shared Decision Making Into Clinical Practice: A Research Agenda. Acad Emerg Med 2016; 23:1368-1379. [PMID: 27561951 DOI: 10.1111/acem.13075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/22/2016] [Accepted: 08/23/2016] [Indexed: 12/13/2022]
Abstract
Shared decision making (SDM) is essential to advancing patient-centered care in emergency medicine. Despite many documented benefits of SDM, prior research has demonstrated persistently low levels of patient engagement by clinicians across many disciplines, including emergency medicine. An effective dissemination and implementation (D&I) framework could be used to alter the process of delivering care and to facilitate SDM in routine clinical emergency medicine practice. Here we outline a research and policy agenda to support the D&I strategy needed to integrate SDM into emergency care.
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Affiliation(s)
- Hemal K. Kanzaria
- Department of Emergency Medicine; University of California at San Francisco; San Francisco CA
| | - Juanita Booker-Vaughns
- Harbor-UCLA Medical Center; LA Biomedical Research Institute; Community Council; Torrance CA
| | | | | | - Bryan G. Kane
- Department of Emergency Medicine; Lehigh Valley Health Network; Allentown PA
- University of South Florida Morsani College of Medicine; Tampa FL
| | | | - Grace Lin
- Department of Medicine and Philip R. Lee Institute for Health Policy Studies; University of California at San Francisco; San Francisco CA
| | - Annie LeBlanc
- Division of Health Care Policy and Research; Department of Health Sciences Research; Knowledge and Evaluation Research Unit; Mayo Clinic; Rochester MN
| | - Robert Gibson
- Department of Emergency Medicine; Augusta University
| | - Esther H. Chen
- Department of Emergency Medicine; University of California at San Francisco; San Francisco CA
| | - Pluscedia Williams
- Charles R. Drew University of Medicine and Science; Health African American Families II; Harbor-UCLA Medical Center; LA Biomedical Research Institute; Torrance CA
| | - Christopher R. Carpenter
- Division of Emergency Medicine; Washington University School of Medicine; St. Louis MO
- Washington University Emergency Care Research Core; St. Louis MO
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327
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Kogan JN, Schuster J, Nikolajski C, Schake P, Carney T, Morton SC, Kang C, Reynolds CF. Challenges encountered in the conduct of Optimal Health: A patient-centered comparative effectiveness study of interventions for adults with serious mental illness. Clin Trials 2016; 14:5-16. [PMID: 27681658 DOI: 10.1177/1740774516670895] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of patient-centered comparative effectiveness research is to conduct stakeholder-driven investigations that identify which interventions are most effective for which patients under specific circumstances. Conducting this research in real-world settings comes with unique experiences and challenges. We provide the study design, challenges confronted, and the solutions we devised for Optimal Health, a stakeholder-informed patient-centered comparative effectiveness study focused on the needs of seriously mentally ill individuals receiving case management services in community mental health centers across Pennsylvania. METHODS Optimal Health, supported by the Patient-Centered Outcomes Research Institute, is a cluster-randomized trial of two evidence-based interventions for improving health and wellness across 11 provider sites. Participants were followed for 18-24 months, with repeated measurements of self-reported health status and activation in care and administrative measurements of primary and specialty health service utilization. Health-related quality of life, engagement in care, and service utilization are to be compared via random effects mixed models. Stakeholders were, and continue to be, engaged via focus groups, interviews, and stakeholder advisory board meetings. A learning collaborative model was used to support shared learning and implementation fidelity across provider sites. RESULTS From 1 November 2013 through 15 July 2014, we recruited 1229 adults with serious mental illness, representing 85.1% of those eligible for study participation. Of these, 713 are in the Provider-Supported arm of the study and 516 in Patient Self-Directed Care. Across five data collection time points, we retained 86% and 83% of the participants in the Provider-Supported and Self-Directed arms, respectively. LESSONS LEARNED Lessons learned relate to estimation of the size of our study population, the value of multiple data sources, and intervention training and implementation. The use of historical claims data can lead to an overestimation of eligible participants and, subsequently, a reduced study sample and an imbalance between intervention arms. Disruptions in continuity of care in real-world settings can pose challenges to on-site self-report data collection, although the inclusion of multiple data sources in study design can improve data completeness. Geographic dispersion of rural provider sites and staff turnover can lead to training and intervention fidelity challenges that can be overcome with the use of a "train-the-trainer" model, "wellness champions," and the use of a Learning Collaborative approach. Stakeholder engagement in mitigating these challenges proved to be critical to study progress. CONCLUSION Conducting real-world patient-centered comparative effectiveness research in healthcare systems that care for seriously mentally ill persons is an important yet challenging undertaking, one which requires flexibility in identifying potential adaptations within all major study phases. Advice from a wide range of stakeholders is critical in development of successful strategies.
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Affiliation(s)
- Jane N Kogan
- 1 UPMC Center for High-Value Health Care, Pittsburgh, PA, USA.,2 Community Care Behavioral Health, UPMC Insurance Services Division, Pittsburgh, PA, USA
| | - James Schuster
- 1 UPMC Center for High-Value Health Care, Pittsburgh, PA, USA.,2 Community Care Behavioral Health, UPMC Insurance Services Division, Pittsburgh, PA, USA
| | - Cara Nikolajski
- 1 UPMC Center for High-Value Health Care, Pittsburgh, PA, USA
| | - Patricia Schake
- 2 Community Care Behavioral Health, UPMC Insurance Services Division, Pittsburgh, PA, USA
| | - Tracy Carney
- 2 Community Care Behavioral Health, UPMC Insurance Services Division, Pittsburgh, PA, USA.,3 Columbia Montour Snyder Union Counties of Central Pennsylvania Service System, Danville, PA, USA
| | - Sally C Morton
- 4 Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chaeryon Kang
- 4 Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Charles F Reynolds
- 5 School of Medicine and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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328
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McAlearney AS, Walker DM, Livaudais-Toman J, Parides M, Bickell NA. Challenges of implementation and implementation research: Learning from an intervention study designed to improve tumor registry reporting. SAGE Open Med 2016; 4:2050312116666215. [PMID: 27635248 PMCID: PMC5011387 DOI: 10.1177/2050312116666215] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 07/26/2016] [Indexed: 11/21/2022] Open
Abstract
Objectives: Implementation of interventions designed to improve the quality of medical care often proceeds differently from what is planned. Improving existing conceptual models to better understand the sources of these differences can help future projects avoid these pitfalls and achieve desired effectiveness. To inform an adaptation of an existing theoretical model, we examined unanticipated changes that occurred in an intervention designed to improve reporting of adjuvant therapies for breast cancer patients at a large, urban academic medical center. Methods: Guided by the complex innovation implementation conceptual framework, our study team observed and evaluated the implementation of an intervention designed to improve reporting to a tumor registry. Findings were assessed against the conceptual framework to identify boundary conditions and modifications that could improve implementation effectiveness. Results: The intervention successfully increased identification of the managing medical oncologist and treatment reporting. During implementation, however, unexpected external challenges including hospital acquisitions of community practices and practices’ responses to government incentives to purchase electronic medical record systems led to unanticipated changes and associated threats to implementation. We present a revised conceptual model that incorporates the sources of these unanticipated challenges. Conclusion: This report of our experience highlights the importance of monitoring implementation over time and accounting for changes that affect both implementation and measurement of intervention impact. In this article, we use our study to examine the challenges of implementation research in health care, and our experience can help future implementation efforts.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Daniel M Walker
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Jennifer Livaudais-Toman
- Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Parides
- Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nina A Bickell
- Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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329
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Munoz-Plaza CE, Parry C, Hahn EE, Tang T, Nguyen HQ, Gould MK, Kanter MH, Sharp AL. Integrating qualitative research methods into care improvement efforts within a learning health system: addressing antibiotic overuse. Health Res Policy Syst 2016; 14:63. [PMID: 27527079 PMCID: PMC4986245 DOI: 10.1186/s12961-016-0122-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 06/17/2016] [Indexed: 01/21/2023] Open
Abstract
Background Despite reports advocating for integration of research into healthcare delivery, scant literature exists describing how this can be accomplished. Examples highlighting application of qualitative research methods embedded into a healthcare system are particularly needed. This article describes the process and value of embedding qualitative research as the second phase of an explanatory, sequential, mixed methods study to improve antibiotic stewardship for acute sinusitis. Methods Purposive sampling of providers for in-depth interviews improved understanding of unwarranted antibiotic prescribing and elicited stakeholder recommendations for improvement. Qualitative data collection, transcription and constant comparative analyses occurred iteratively. Results Emerging themes and sub-themes identified primary drivers of unwarranted antibiotic prescribing patterns and recommendations for improving practice. These findings informed the design of a health system intervention to improve antibiotic stewardship for acute sinusitis. Core components of the intervention are also described. Conclusion Qualitative research can be effectively applied in learning healthcare systems to elucidate quantitative results and inform improvement efforts. Electronic supplementary material The online version of this article (doi:10.1186/s12961-016-0122-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Corrine E Munoz-Plaza
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, United States of America.
| | - Carla Parry
- Patient Centered Outcomes Research Institute, Washington, DC, 20036, United States of America
| | - Erin E Hahn
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, United States of America
| | - Tania Tang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, United States of America
| | - Huong Q Nguyen
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, United States of America
| | - Michael K Gould
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, United States of America
| | - Michael H Kanter
- Quality and Clinical Analysis, Kaiser Permanente Southern California, Pasadena, CA, 91101, United States of America
| | - Adam L Sharp
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, United States of America
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330
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Gopalan G. Feasibility of improving child behavioral health using task-shifting to implement the 4Rs and 2Ss program for strengthening families in child welfare. Pilot Feasibility Stud 2016; 2. [PMID: 27330826 PMCID: PMC4908965 DOI: 10.1186/s40814-016-0062-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Children whose families are involved with child welfare services manifest disproportionately high levels of behavioral difficulties, which could be addressed in community-based organizations providing services to prevent out-of-home placement. Unfortunately, few evidence-based practices have been successfully implemented in child welfare settings, especially those originally delivered by mental health providers. Given that such settings typically employ caseworkers who lack prior mental health training, this is a significant barrier to implementation. Consequently, the overall aim of the current study is to test the feasibility of shifting a mental health intervention from specialized services to community-based organizations. It uses task-shifting and the Practical, Robust, Implementation, and Sustainability model (PRISM) to implement an evidence-based intervention to reduce child behavior difficulties, originally provided by mental health practitioners, so that it can be delivered by caseworkers providing placement prevention services to child welfare-involved families. Task-shifting involves (1) modifying the intervention for provision by non-mental health providers, (2) training non-mental health providers in the modified intervention, and (3) establishing regular supervision and monitoring by mental health specialists. Methods/design This study uses the 4Rs and 2Ss Program for Strengthening Families, a multiple family group service delivery model to reduce child behavior difficulties, as the example intervention. This intervention has had prior success with child welfare-involved families. The proposed study objectives are (1) to tailor the content, training, and supervision of the intervention for delivery by caseworkers serving child welfare-involved families and (2) to assess the feasibility and acceptability of the modified intervention. Mixed quantitative and qualitative methods will assess feasibility and acceptability from key stakeholders (caseworkers, supervisors, administrators, caregivers). In phase I, a collaborative advisory board will be convened (1) to modify the intervention to be delivered by caseworkers in placement prevention service settings and (2) to develop training and supervision protocols for caseworkers. In phase 2, the modified intervention will be pilot-tested for delivery by n = 4 caseworkers to n = 20 families receiving placement preventive services (where children manifest behavior problems). Mixed quantitative/qualitative methods will be used to assess feasibility and acceptability. Discussion This protocol will be of particular interest to agency administrators, program managers, and researchers interested in developing and testing cross-setting implementation guidelines for similar evidence-based practices.
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331
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Cellucci T, Lee S, Webster F. Adapting Knowledge Translation Strategies for Rare Rheumatic Diseases. J Rheumatol 2016; 43:1462-8. [PMID: 27134255 DOI: 10.3899/jrheum.151297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2016] [Indexed: 01/22/2023]
Abstract
Rare rheumatic diseases present unique challenges to knowledge translation (KT) researchers. There is often an urgent need to transfer knowledge from research findings into clinical practice to facilitate earlier diagnosis and better outcomes. However, existing KT frameworks have not addressed the specific considerations surrounding rare diseases for which gold standard evidence is not available. Several widely adopted models provide guidance for processes and problems associated with KT. However, they do not address issues surrounding creation or synthesis of knowledge for rare diseases. Additional problems relate to lack of awareness or experience in intended knowledge users, low motivation, and potential barriers to changing practice or policy. Strategies to address the challenges of KT for rare rheumatic diseases include considering different levels of evidence available, linking knowledge creation and transfer directly, incorporating patient and physician advocacy efforts to generate awareness of conditions, and selecting strategies to address barriers to practice or policy change.
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332
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Williams L, Daggett V, Slaven JE, Yu Z, Sager D, Myers J, Plue L, Woodward-Hagg H, Damush TM. A cluster-randomised quality improvement study to improve two inpatient stroke quality indicators. BMJ Qual Saf 2016; 25:257-64. [PMID: 26303644 DOI: 10.1136/bmjqs-2015-004188] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/25/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Quality indicator collection and feedback improves stroke care. We sought to determine whether quality improvement training plus indicator feedback was more effective than indicator feedback alone in improving inpatient stroke indicators. METHODS We conducted a cluster-randomised quality improvement trial, randomising hospitals to quality improvement training plus indicator feedback versus indicator feedback alone to improve deep vein thrombosis (DVT) prophylaxis and dysphagia screening. Intervention sites received collaborative-based quality improvement training, external facilitation and indicator feedback. Control sites received only indicator feedback. We compared indicators pre-implementation (pre-I) to active implementation (active-I) and post-implementation (post-I) periods. We constructed mixed-effect logistic models of the two indicators with a random intercept for hospital effect, adjusting for patient, time, intervention and hospital variables. RESULTS Patients at intervention sites (1147 admissions), had similar race, gender and National Institutes of Health Stroke Scale scores to control sites (1017 admissions). DVT prophylaxis improved more in intervention sites during active-I period (ratio of ORs 4.90, p<0.001), but did not differ in post-I period. Dysphagia screening improved similarly in both groups during active-I, but control sites improved more in post-I period (ratio of ORs 0.67, p=0.04). In logistic models, the intervention was independently positively associated with DVT performance during active-I period, and negatively associated with dysphagia performance post-I period. CONCLUSION Quality improvement training was associated with early DVT improvement, but the effect was not sustained over time and was not seen with dysphagia screening. External quality improvement programmes may quickly boost performance but their effect may vary by indicator and may not sustain over time.
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Affiliation(s)
- Linda Williams
- Roudebush VAMC, Indianapolis, Indiana, USA Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Virginia Daggett
- Roudebush VAMC, Indianapolis, Indiana, USA VA Center for Applied Systems Engineering, Indianapolis, Indiana, USA
| | - James E Slaven
- Department of Medicine/Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Zhangsheng Yu
- Department of Medicine/Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | | | - Heather Woodward-Hagg
- Roudebush VAMC, Indianapolis, Indiana, USA VA Center for Applied Systems Engineering, Indianapolis, Indiana, USA
| | - Teresa M Damush
- Roudebush VAMC, Indianapolis, Indiana, USA Regenstrief Institute, Inc., Indianapolis, Indiana, USA Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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333
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Long ACJ, Hagermoser Sanetti LM, Collier-Meek MA, Gallucci J, Altschaefl M, Kratochwill TR. An exploratory investigation of teachers' intervention planning and perceived implementation barriers. J Sch Psychol 2016; 55:1-26. [PMID: 26931064 DOI: 10.1016/j.jsp.2015.12.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 11/09/2015] [Accepted: 12/09/2015] [Indexed: 11/26/2022]
Abstract
Increasingly teachers are the primary implementer responsible for providing evidence-based interventions to students. However, there is little knowledge regarding the extent to which teachers plan for intervention implementation, receive implementation support, or identify and address implementation barriers. This study explores survey data from over 1200 preschool through grade 12 teachers from 46 public school districts in a Northeastern state. Results indicate that teachers spend significant time engaging in intervention-related behavior and may be a primary source responsible for selecting student interventions. However, the current extent to which they plan for implementation and present levels of implementation support are inadequate to produce high levels of sustained intervention implementation. In addition, almost 60% of implementation barriers reported related to aspects of the intervention itself. Findings from this study provide guidance for future research and preliminary recommendations for ameliorating implementation barriers and proactively supporting treatment integrity in schools.
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334
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Hanson RF, Self-Brown S, Rostad WL, Jackson MC. The what, when, and why of implementation frameworks for evidence-based practices in child welfare and child mental health service systems. CHILD ABUSE & NEGLECT 2016; 53:51-63. [PMID: 26547360 PMCID: PMC4818182 DOI: 10.1016/j.chiabu.2015.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 09/10/2015] [Accepted: 09/28/2015] [Indexed: 06/01/2023]
Abstract
It is widely recognized that children in the child welfare system are particularly vulnerable to the adverse health and mental effects associated with exposure to abuse and neglect, making it imperative to have broad-based availability of evidence-based practices (EBPs) that can prevent child maltreatment and reduce the negative mental health outcomes for youth who are victims. A variety of EBPs exist for reducing child maltreatment risk and addressing the associated negative mental health outcomes, but the reach of these practices is limited. An emerging literature documents factors that can enhance or inhibit the success of EBP implementation in community service agencies, including how the selection of a theory-driven conceptual framework, or model, might facilitate implementation planning by providing guidance for best practices during implementation phases. However, limited research is available to guide decision makers in the selection of implementation frameworks that can boost implementation success for EBPs that focus on preventing child welfare recidivism and serving the mental health needs of maltreated youth. The aims of this conceptual paper are to (1) provide an overview of existing implementation frameworks, beginning with a discussion of definitional issues and the selection criteria for frameworks included in the review; and (2) offer recommendations for practice and policy as applicable for professionals and systems serving victims of child maltreatment and their families.
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Affiliation(s)
- Rochelle F. Hanson
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Shannon Self-Brown
- School of Public Health, Georgia State University, Atlanta, Georgia
- National SafeCare Training & Research Center, Georgia State University, Atlanta, Georgia
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Candas B, Jobin G, Dubé C, Tousignant M, Abdeljelil AB, Grenier S, Gagnon MP. Barriers and facilitators to implementing continuous quality improvement programs in colonoscopy services: a mixed methods systematic review. Endosc Int Open 2016; 4:E118-33. [PMID: 26878037 PMCID: PMC4751006 DOI: 10.1055/s-0041-107901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/05/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND AIM Continuous quality improvement (CQI) programs may result in quality of care and outcome improvement. However, the implementation of such programs has proven to be very challenging. This mixed methods systematic review identifies barriers and facilitators pertaining to the implementation of CQI programs in colonoscopy services and how they relate to endoscopists, nurses, managers, and patients. METHODS We developed a search strategy adapted to 15 databases. Studies had to report on the implementation of a CQI intervention and identified barriers or facilitators relating to any of the four groups of actors directly concerned by the provision of colonoscopies. The quality of the selected studies was assessed and findings were extracted, categorized, and synthesized using a generic extraction grid customized through an iterative process. RESULTS We extracted 99 findings from the 15 selected publications. Although involving all actors is the most cited factor, the literature mainly focuses on the facilitators and barriers associated with the endoscopists' perspective. The most reported facilitators to CQI implementation are perception of feasibility, adoption of a formative approach, training and education, confidentiality, and assessing a limited number of quality indicators. Receptive attitudes, a sense of ownership and perceptions of positive impacts also facilitate the implementation. Finally, an organizational environment conducive to quality improvement has to be inclusive of all user groups, explicitly supportive, and provide appropriate resources. CONCLUSION Our findings corroborate the current models of adoption of innovations. However, a significant knowledge gap remains with respect to barriers and facilitators pertaining to nurses, patients, and managers.
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Affiliation(s)
- Bernard Candas
- Institut d’excellence en santé et services sociaux du Québec, Quebec City, Quebec, Canada
- Université Laval – Department of Social and Preventive Medicine, Quebec City, Quebec, Canada
| | - Gilles Jobin
- Université de Montréal – Department of Medicine, Montreal, Quebec, Canada
- Maisonneuve-Rosemont Hospital – Gastroenterology, Montreal, Quebec, Canada
| | - Catherine Dubé
- University of Calgary – Department of Community Health Sciences, Calgary, Alberta, Canada
| | - Mario Tousignant
- CHU de Québec Research Center – Public Health and Practice-Changing Research, Quebec City, Quebec, Canada
| | - Anis Ben Abdeljelil
- CHU de Québec Research Center – Public Health and Practice-Changing Research, Quebec City, Quebec, Canada
| | - Sonya Grenier
- CHU de Québec Research Center – Public Health and Practice-Changing Research, Quebec City, Quebec, Canada
| | - Marie-Pierre Gagnon
- Université Laval – Faculty of Nursing, Quebec City, Quebec, Canada
- CHU de Québec Research Center – Population Health and Optimal Health Practices, Quebec City, Quebec, Canada
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336
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Schneider JL, Davis J, Kauffman TL, Reiss JA, McGinley C, Arnold K, Zepp J, Gilmore M, Muessig KR, Syngal S, Acheson L, Wiesner GL, Peterson SK, Goddard KAB. Stakeholder perspectives on implementing a universal Lynch syndrome screening program: a qualitative study of early barriers and facilitators. Genet Med 2016; 18:152-61. [PMID: 25880440 PMCID: PMC4608844 DOI: 10.1038/gim.2015.43] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 02/23/2015] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Evidence-based guidelines recommend that all newly diagnosed colon cancer be screened for Lynch syndrome (LS), but best practices for implementing universal tumor screening have not been extensively studied. We interviewed a range of stakeholders in an integrated health-care system to identify initial factors that might promote or hinder the successful implementation of a universal LS screening program. METHODS We conducted interviews with health-plan leaders, managers, and staff. Interviews were audio-recorded and transcribed. Thematic analysis began with a grounded approach and was also guided by the Practical Robust Implementation and Sustainability Model (PRISM). RESULTS We completed 14 interviews with leaders/managers and staff representing involved clinical and health-plan departments. Although stakeholders supported the concept of universal screening, they identified several internal (organizational) and external (environment) factors that promote or hinder implementation. Facilitating factors included perceived benefits of screening for patients and organization, collaboration between departments, and availability of organizational resources. Barriers were also identified, including: lack of awareness of guidelines, lack of guideline clarity, staffing and program "ownership" concerns, and cost uncertainties. Analysis also revealed nine important infrastructure-type considerations for successful implementation. CONCLUSION We found that clinical, laboratory, and administrative departments supported universal tumor screening for LS. Requirements for successful implementation may include interdepartmental collaboration and communication, patient and provider/staff education, and significant infrastructure and resource support related to laboratory processing and systems for electronic ordering and tracking.
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Affiliation(s)
| | - James Davis
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Tia L Kauffman
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Jacob A Reiss
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Cheryl McGinley
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Kathleen Arnold
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Jamilyn Zepp
- Northwest Permanente, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Marian Gilmore
- Northwest Permanente, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Kristin R Muessig
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Sapna Syngal
- Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Louise Acheson
- Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Georgia L Wiesner
- Vanderbilt Hereditary Cancer Program, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | - Susan K Peterson
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Katrina A B Goddard
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
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337
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Kind AJH, Brenny-Fitzpatrick M, Leahy-Gross K, Mirr J, Chapman E, Frey B, Houlahan B. Harnessing Protocolized Adaptation in Dissemination: Successful Implementation and Sustainment of the Veterans Affairs Coordinated-Transitional Care Program in a Non-Veterans Affairs Hospital. J Am Geriatr Soc 2016; 64:409-16. [PMID: 26804896 DOI: 10.1111/jgs.13935] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Department of Veterans Affairs (VA) Coordinated-Transitional Care (C-TraC) program is a low-cost transitional care program that uses hospital-based nurse case managers, inpatient team integration, and in-depth posthospital telephone contacts to support high-risk patients and their caregivers as they transition from hospital to community. The low-cost, primarily telephone-based C-TraC program reduced 30-day rehospitalizations by one-third, leading to significant cost savings at one VA hospital. Non-VA hospitals have expressed interest in launching C-TraC, but non-VA hospitals differ in important ways from VA hospitals, particularly in terms of context, culture, and resources. The objective of this project was to adapt C-TraC to the specific context of one non-VA setting using a modified Replicating Effective Programs (REP) implementation theory model and to test the feasibility of this protocolized implementation approach. The modified REP model uses a mentored phased-based implementation with intensive preimplementation activities and harnesses key local stakeholders to adapt processes and goals to local context. Using this protocolized implementation approach, an adapted C-TraC protocol was created and launched at the non-VA hospital in July 2013. In its first 16 months, C-TraC successfully enrolled 1,247 individuals with 3.2 full-time nurse case managers, achieving good fidelity for core protocol steps. C-TraC participants experienced a 30-day rehospitalization rate of 10.8%, compared with 16.6% for a contemporary comparison group of similar individuals for whom C-TraC was not available (n = 1,307) (P < .001). The new C-TraC program continues in operation. Use of a modified REP model to guide protocolized adaptation to local context resulted in a C-TraC program that was feasible and sustained in a real-world non-VA setting. A modified REP implementation framework may be an appropriate foundational step for other clinical programs seeking to harness protocolized adaptation in mentored dissemination activities.
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Affiliation(s)
- Amy J H Kind
- Geriatrics Division, Department of Medicine, School of Medicine and Public Health, William S Middleton Hospital Madison, Madison, Wisconsin.,School of Nursing, William S Middleton Hospital Madison, Madison, Wisconsin.,School of Pharmacy, William S Middleton Hospital Madison, Madison, Wisconsin.,Department of Veterans Affairs, Geriatric Research Education and Clinical Center, William S Middleton Hospital Madison, Madison, Wisconsin
| | - Maria Brenny-Fitzpatrick
- University of Wisconsin Hospitals and Clinics, William S Middleton Hospital Madison, Madison, Wisconsin
| | - Kris Leahy-Gross
- University of Wisconsin Hospitals and Clinics, William S Middleton Hospital Madison, Madison, Wisconsin
| | - Jacquelyn Mirr
- Geriatrics Division, Department of Medicine, School of Medicine and Public Health, William S Middleton Hospital Madison, Madison, Wisconsin.,Department of Veterans Affairs, Geriatric Research Education and Clinical Center, William S Middleton Hospital Madison, Madison, Wisconsin
| | - Elizabeth Chapman
- Geriatrics Division, Department of Medicine, School of Medicine and Public Health, William S Middleton Hospital Madison, Madison, Wisconsin
| | - Brooke Frey
- University of Wisconsin Hospitals and Clinics, William S Middleton Hospital Madison, Madison, Wisconsin
| | - Beth Houlahan
- University of Wisconsin Hospitals and Clinics, William S Middleton Hospital Madison, Madison, Wisconsin
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338
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Olin SCS, Hemmelgarn AL, Madenwald K, Hoagwood KE. An ARC-Informed Family Centered Care Intervention for Children's Community Based Mental Health Programs. JOURNAL OF CHILD AND FAMILY STUDIES 2016; 25:275-289. [PMID: 28781510 PMCID: PMC5542620 DOI: 10.1007/s10826-015-0220-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The experience of parents in helping their children access and use mental health services is linked to service outcomes. Parent peer support service, based on the principles of family-centered care, is one model to improve parent experience and engagement in services. Yet, little is known about how best to integrate this service into the existing array of mental health services. Integration is challenged by philosophical differences between family-centered services and traditional children's treatment services, and is influenced by the organizational social contexts in which these services are embedded. We describe an organizational and frontline team intervention that draws on research in behavior change, technology transfer, and organizational social context for youth with serious emotional disturbance. The two-pronged intervention, called FAMILY (FCC and ARC Model to Improve the Lives of Youth) is guided by the evidence-based Availability, Responsiveness, and Continuity (ARC) organizational intervention, targeted primarily at program and upper management leadership and includes a family-centered care (FCC) intervention, targeted at frontline providers. The approach employs multilevel implementation strategies to promote the uptake, implementation and sustainability of new practices. We include examples of exercises and tools, and highlight implementation challenges and lessons learned in facilitating program and staff level changes in family-centered service delivery.
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Affiliation(s)
- Su-Chin Serene Olin
- Department of Child and Adolescent Psychiatry, Center for Mental Health Implementation and Dissemination Science in States (IDEAS), New York University, One Park Avenue, 7th Floor, New York, NY 10016, USA
| | - Anthony L Hemmelgarn
- Children's Mental Health Services Research Center, University of Tennessee, 128 Henson Hall, Knoxville, TN 37996-3332, USA
| | - Kappy Madenwald
- Madenwald Consulting, LLC, Behavioral Healthcare Training and Consultation, Columbus, OH, USA
| | - Kimberly E Hoagwood
- Department of Child and Adolescent Psychiatry, Center for Mental Health Implementation and Dissemination Science in States (IDEAS), New York University, One Park Avenue, 7th Floor, New York, NY 10016, USA
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339
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Welsh WN, Knudsen HK, Knight K, Ducharme L, Pankow J, Urbine T, Lindsey A, Abdel-Salam S, Wood J, Monico L, Link N, Albizu-Garcia C, Friedmann PD. Effects of an Organizational Linkage Intervention on Inter-Organizational Service Coordination Between Probation/Parole Agencies and Community Treatment Providers. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 43:105-21. [PMID: 25559124 PMCID: PMC4492902 DOI: 10.1007/s10488-014-0623-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Weak coordination between community correctional agencies and community-based treatment providers is a major barrier to diffusion of medication-assisted treatment (MAT)--the inclusion of medications (e.g., methadone and buprenorphine) in combination with traditional counseling and behavioral therapies to treat substance use disorders. In a multisite cluster randomized trial, experimental sites (j = 10) received a 3-h MAT training plus a 12-month linkage intervention; control sites (j = 10) received the 3-h training alone. Hierarchical linear models showed that the intervention resulted in significant improvements in perceptions of interagency coordination among treatment providers, but not probation/parole agents. Implications for policy and practice are discussed.
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Affiliation(s)
| | | | | | - Lori Ducharme
- The National Institute on Alcohol Abuse and Alcoholism (NIAAA), Rockville, MD, USA
| | | | | | | | | | | | | | | | | | - Peter D Friedmann
- Providence Veteran Affairs Medical Center and Brown University, Providence, USA
- Rhode Island Hospital, Providence, USA
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340
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Wisdom JP, Chor KHB, Hoagwood KE, Horwitz SM. Innovation adoption: a review of theories and constructs. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2015; 41:480-502. [PMID: 23549911 DOI: 10.1007/s10488-013-0486-4] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Many theoretical frameworks seek to describe the dynamic process of the implementation of innovations. Little is known, however, about factors related to decisions to adopt innovations and how the likelihood of adoption of innovations can be increased. Using a narrative synthesis approach, this paper compared constructs theorized to be related to adoption of innovations proposed in existing theoretical frameworks in order to identify characteristics likely to increase adoption of innovations. The overall goal was to identify elements across adoption frameworks that are potentially modifiable and, thus, might be employed to improve the adoption of evidence-based practices. The review identified 20 theoretical frameworks that could be grouped into two broad categories: theories that mainly address the adoption process (N = 10) and theories that address adoption within the context of implementation, diffusion, dissemination, and/or sustainability (N = 10). Constructs of leadership, operational size and structure, innovation fit with norms and values, and attitudes/motivation toward innovations each are mentioned in at least half of the theories, though there were no consistent definitions of measures for these constructs. A lack of precise definitions and measurement of constructs suggests further work is needed to increase our understanding of adoption of innovations.
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Affiliation(s)
- Jennifer P Wisdom
- George Washington University, 2121 Eye Street Suite 601, Washington, DC, 20052, USA,
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341
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Yu X, Klesges LM, Smeltzer MP, Osarogiagbon RU. Measuring improvement in populations: implementing and evaluating successful change in lung cancer care. Transl Lung Cancer Res 2015; 4:373-84. [PMID: 26380178 DOI: 10.3978/j.issn.2218-6751.2015.07.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 12/17/2022]
Abstract
Improving quality of care in lung cancer, the leading cause of cancer death worldwide and in the United States, is a major public health challenge. Such improvement requires accurate and meaningful measurement of quality of care. Preliminary indicators have been derived from clinical practice guidelines and expert opinions, but there are few standard sets of quality of care measures for lung cancer in the United States or elsewhere. Research to develop validated evidence-based quality of care measures is critical in promoting population improvement initiatives in lung cancer. Furthermore, novel research designs beyond the traditional randomized controlled trials (RCTs) are needed for wide-scale applications of quality improvement and should extend into alternative designs such as quasi-experimental designs, rigorous observational studies, population modeling, and other pragmatic study designs. We discuss several study design options to aid the development of practical, actionable, and measurable quality standards for lung cancer care. We also provide examples of ongoing pragmatic studies for the dissemination and implementation of lung cancer quality improvement interventions in community settings.
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Affiliation(s)
- Xinhua Yu
- 1 Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee, USA ; 2 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee, USA
| | - Lisa M Klesges
- 1 Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee, USA ; 2 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee, USA
| | - Mathew P Smeltzer
- 1 Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee, USA ; 2 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee, USA
| | - Raymond U Osarogiagbon
- 1 Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee, USA ; 2 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee, USA
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342
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Park M. Implementing Evidence into Practice for Best Dementia Care. J Korean Acad Nurs 2015; 45:495-500. [PMID: 26364524 DOI: 10.4040/jkan.2015.45.4.495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 07/06/2015] [Accepted: 07/21/2015] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this paper was to discuss the need for translation studies in dementia care and current translational endeavors, and to provide recommendations for evolving evidence-based dementia care. METHODS A literature review yielded current evidence and translational efforts. RESULTS Dementia care interventions need to be implemented at various service levels. Barriers to translation include evidence gaps, lack of the use of a conceptual framework to explain the implementation process, and unsupportive funding mechanisms for applying innovations. CONCLUSION There is clear evidence of the need for and benefits of evidence-based dementia care for patients with dementia, family caregivers, and care professionals. The urgent need now is finding ways to advance translational activities and facilitate future research into translation science.
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Affiliation(s)
- Myonghwa Park
- College of Nursing, Chungnam National University, Daejeon, Korea.
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343
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Zhong X, Wang Z, Fisher EB, Tanasugarn C. Peer Support for Diabetes Management in Primary Care and Community Settings in Anhui Province, China. Ann Fam Med 2015; 13 Suppl 1:S50-8. [PMID: 26304972 PMCID: PMC4648136 DOI: 10.1370/afm.1799] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE We evaluated a peer leader-support program (PLSP) for diabetes self-management in China in terms of acceptability and feasibility; implementation; perceived advantages; disadvantages and barriers; reach and recruitment; effectiveness in terms of diabetes knowledge and clinical impacts; adoption; and sustainability. METHODS Within each of 3 cities in Anhui Province, 2 subcommunities were randomly assigned to usual care or PLSP. Peer leaders and staff of Community Health Service Centers (CHSCs) co-led biweekly educational meetings. Peer leaders also led biweekly discussion meetings, promoted regular care through the CHSCs, organized informal health promotion activities (eg, walking and tai chi groups), and provided informal individual support to participants through casual contact. RESULTS Qualitative evaluations indicated acceptance of and positive responses to the program among patients, peer leaders, and CHSC staff. Implementation was successful in 2 of 3 subcommunities, the third failing for lack of staff resources. Reported advantages included peer support as a bridge between CHSCs and their patients. In 2 sites where the PLSP was implemented, analyses controlling for baseline differences and site showed significant benefits for PLSP relative to controls (P <0.05) for knowledge, self-efficacy, BMI, systolic blood pressure, diastolic blood pressure, and both fasting and 2-hour post-prandial blood glucose. The Anhui Provincial Health Bureau has extended the PLSP model to other communities and to cardiovascular disease prevention and management. CONCLUSION The PLSP was well accepted, feasible given sufficient administrative and staff resources, effective for those who participated, and generalizable to other sites and health problems.
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Affiliation(s)
- Xuefeng Zhong
- Anhui Provincial Center for Disease Control and Prevention, Hefei, Anhui Province, China
| | - Zhimin Wang
- Anhui Provincial Center for Disease Control and Prevention, Hefei, Anhui Province, China
| | - Edwin B Fisher
- Department of Health Behavior, University of North Carolina at Chapel Hill Peers for Progress, American Academy of Family Physicians Foundation, Leawood, Kansas
| | - Chanuantong Tanasugarn
- Department of Health Education and Behavioral Science, Faculty of Public Health, Mahidol University, Bangkok, Thailand
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344
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Barry Hultquist T, Brown SG, Geske J, Kaiser KL, Waibel-Rycek D. Partnering With Community-Dwelling Individuals With Diabetes for Health Behavior Change Using Action Plans: An Innovation in Health Professionals Education and Practice. Health Promot Pract 2015. [PMID: 26220279 DOI: 10.1177/1524839915596309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health care practitioners support or hinder an individual's attempts to self-manage health behavior. Practitioners must understand an individual's health needs and goals to effectively partner for behavior change. Self-management support (SMS) promote efforts toward positive health behavior change. Practitioners need training to provide effective SMS, beginning with their formal education. The purpose of this educational practice project was to integrate an evidence-based intervention (SMS using action plans) into a nursing curriculum. Three sequential steps included (1) providing foundational SMS education, (2) SMS application with students' personal action plans, and (3) implementing SMS with community-dwelling individuals with diabetes. Students (n = 130) partnered with participants (n = 85), developing short- (n = 240) and long-term (n = 99) action plans during home visits. The average baseline Diabetes Empowerment Scale score measuring participant's perceived psychosocial diabetes management self-efficacy was 4.3 (1-5 scale, SD = 0.51, n = 83). Most common short-term actions related to physical activity (n = 100, 42%) and healthy eating (n = 61, 25%). Average participant confidence level was 7.7 (SD = 1.9, 0-10 scale). Short-term goal evaluation (n = 209) revealed 66% (n = 137) were met more than 50% of the time. Both participants (99%) and students (99%) expressed satisfaction with home visit and action plan experiences. This teaching-learning experience is replicable and applicable to any professional health care student.
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Affiliation(s)
| | - Sara Goomis Brown
- Nebraska Medical Center, College of Nursing, Omaha Division, Omaha, NE, USA
| | - Jenenne Geske
- University of Nebraska Medical Center, College of Medicine, Department of Family Medicine, Omaha, NE, USA
| | | | - Denise Waibel-Rycek
- University of Nebraska, College of Nursing, Kearney Division, Kearney, NE, USA
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345
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Kuiper D, Goedendorp MM, Sanderman R, Reijneveld SA, Steverink N. Identifying the determinants of use of the G&G interventions for older adults in health and social care: protocol of a multilevel approach. BMC Res Notes 2015; 8:296. [PMID: 26148775 PMCID: PMC4493806 DOI: 10.1186/s13104-015-1262-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 06/30/2015] [Indexed: 02/04/2023] Open
Abstract
Background Despite aging-related losses, many older adults are able to maintain high levels of subjective well-being. However, not all older adults are able to self-manage and adapt. The GRIP&GLEAM [Dutch: GRIP&GLANS] (G&G) interventions have shown to significantly improve self-management ability, well-being and loneliness in older adults. Actual use of the evidence-based G&G interventions, however, remains limited as long as the interplay between implementation factors at different hierarchical stakeholder levels is poorly understood. The aim of the study is to identify the determinants of successful implementation of the G&G interventions. Methods/design The study is performed in health and social care organizations in the northern part of the Netherlands. The degree of implementation success is operationalized by four parameters: use (yes/no), pace (time to initial use), performance (extent of use) and prolongation (intention to continue use). Based on the Fleuren model, factors at four hierarchical stakeholder levels (i.e. target group, professionals, organizations and financial-political context) are assessed at three measurement points in 2 years. The nested data are analyzed applying multilevel modeling techniques. Discussion In this study, health and social care organizations are considered to be part of multilevel functional systems, in which factors at different hierarchical stakeholder levels impede or facilitate use of the G&G interventions. Strengths of the study are the multifaceted measurement of use, and the multilevel approach in identifying the determinants. The study will contribute to the development of ecologically valid implementation strategies of the G&G interventions and comparable evidence-based practices. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1262-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daphne Kuiper
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Martine M Goedendorp
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Robbert Sanderman
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. .,Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Nardi Steverink
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. .,Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands.
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346
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Morrato EH, Rabin B, Proctor J, Cicutto LC, Battaglia CT, Lambert-Kerzner A, Leeman-Castillo B, Prahl-Wretling M, Nuechterlein B, Glasgow RE, Kempe A. Bringing it home: expanding the local reach of dissemination and implementation training via a university-based workshop. Implement Sci 2015; 10:94. [PMID: 26141909 PMCID: PMC4490605 DOI: 10.1186/s13012-015-0281-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 06/15/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Currently, national training programs do not have the capacity to meet the growing demand for dissemination and implementation (D&I) workforce education and development. The Colorado Research in Implementation Science Program (CRISP) developed and delivered an introductory D&I workshop adapted from national programs to extend training reach and foster a local learning community for D&I. METHODS To gauge interest and assess learning needs, a pre-registration survey was administered. Based on feedback, a 1.5-day workshop was designed. Day 1 introduced D&I frameworks, strategies, and evaluation principles. Local and national D&I experts provided ignite-style talks on key lessons followed by panel discussion. Breakout sessions discussed community engagement and applying for D&I grants. A workbook was developed to enhance the training and provided exercises for application to an individual's projects. Day 2 offered expert-led mentoring sessions with selected participants who desired advanced instruction. Two follow-up surveys (immediate post-workshop, 6 months) assessed knowledge gained from participation and utilization of workshop content. RESULTS Ninety-three workshop registrants completed an assessment survey to inform workshop objectives and curriculum design; 43 % were new and 54 % reported a basic understanding of the D&I field. Pre-registrants intended to use the training to "apply for a D&I grant" (73 %); "incorporate D&I into existing projects" (76 %), and for quality improvement (51 %). Sixty-eight individuals attended Day 1; 11 also attended Day 2 mentoring sessions. In the 1-week post-workshop survey (n = 34), 100 % strongly agreed they were satisfied with the training; 97 % strongly agreed the workshop workbook was a valuable resource. All Day 2 participants strongly agreed that working closely with faculty and experts increased their overall confidence. In the 6-month follow-up evaluation (n = 23), evidence of new D&I-related manuscripts and grant proposals was found. Training materials were published online ( www.ucdenver.edu/implementation/workshops ) and disseminated via the National Institutes of Health (NIH) Clinical and Translational Science Awards Consortium. To sustain reach, CRISP adapted the materials into an interactive e-book ( www.CRISPebooks.org ) and launched a new graduate course. CONCLUSIONS Local D&I training workshops can extend the reach of national training programs.
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Affiliation(s)
- Elaine H Morrato
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 E. 17th Place, Mail Stop B119, Aurora, CO, 80045, USA.
- Colorado Research in Implementation Science Program, Adult and Child Center for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Borsika Rabin
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 E. 17th Place, Mail Stop B119, Aurora, CO, 80045, USA
- Colorado Research in Implementation Science Program, Adult and Child Center for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- VA Eastern Colorado Health Care System, Denver, CO, USA
- Denver Seattle Center for Veteran-centric Value-based Research (DiSCoVVR), Denver, CO, USA
| | - Jeff Proctor
- The Evaluation Center, School of Education and Human Development, University of Colorado Denver, Denver, CO, USA
| | - Lisa C Cicutto
- Clinical Science Graduate Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- National Jewish Health, Denver, CO, USA
| | - Catherine T Battaglia
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 E. 17th Place, Mail Stop B119, Aurora, CO, 80045, USA
- VA Eastern Colorado Health Care System, Denver, CO, USA
- Denver Seattle Center for Veteran-centric Value-based Research (DiSCoVVR), Denver, CO, USA
- Clinical Science Graduate Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anne Lambert-Kerzner
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 E. 17th Place, Mail Stop B119, Aurora, CO, 80045, USA
- VA Eastern Colorado Health Care System, Denver, CO, USA
- Denver Seattle Center for Veteran-centric Value-based Research (DiSCoVVR), Denver, CO, USA
| | | | - Michelle Prahl-Wretling
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 E. 17th Place, Mail Stop B119, Aurora, CO, 80045, USA
| | - Bridget Nuechterlein
- The Evaluation Center, School of Education and Human Development, University of Colorado Denver, Denver, CO, USA
| | - Russell E Glasgow
- Colorado Research in Implementation Science Program, Adult and Child Center for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Allison Kempe
- Colorado Research in Implementation Science Program, Adult and Child Center for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Warriner AH, Outman RC, Allison JJ, Curtis JR, Markward NJ, Redden DT, Safford MM, Stanek EJ, Steinkellner AR, Saag KG. An Internet-based Controlled Trial Aimed to Improve Osteoporosis Prevention among Chronic Glucocorticoid Users. J Rheumatol 2015; 42:1478-83. [PMID: 26136484 DOI: 10.3899/jrheum.141238] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2015] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To address the low prevention and treatment rates for those at risk of glucocorticoid-induced osteoporosis (GIOP), we evaluated the influence of a direct-to-patient, Internet-based educational video intervention using "storytelling" on rates of antiosteoporosis medication use among chronic glucocorticoid users who were members of an online pharmacy refill service. METHODS We identified members who refilled ≥ 5 mg/day of prednisone (or equivalent) for 90 contiguous days and had no GIOP therapy for ≥ 12 months. Using patient stories, we developed an online video addressing risk factors and treatment options, and delivered it to members refilling a glucocorticoid prescription. The intervention consisted of two 45-day "Video ON" periods, during which the video automatically appeared at the time of refill, and two 45-day "Video OFF" periods, during which there was no video. Members could also "self-initiate" watching the video by going to the video link. We used an interrupted time series design to evaluate the effectiveness of this intervention on GIOP prescription therapies over 6 months. RESULTS Among 3017 members (64.8%) exposed to the intervention, 59% had measurable video viewing time, of which 3% "self-initiated" the video. The GIOP prescription rate in the "Video ON" group was 2.9% versus 2.7% for the "Video OFF" group. There was a nonsignificant trend toward greater GIOP prescription in members who self-initiated the video versus automated viewing (5.7% vs 2.9%, p = 0.1). CONCLUSION Among adults at high risk of GIOP, prescription rates were not significantly affected by an online educational video presented at the time of glucocorticoid refill. ClinicalTrials.gov Identifier: NCT01378689.
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Affiliation(s)
- Amy H Warriner
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Ryan C Outman
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Jeroan J Allison
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Jeffrey R Curtis
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Nathan J Markward
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - David T Redden
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Monika M Safford
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Eric J Stanek
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Amy R Steinkellner
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Kenneth G Saag
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham.
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348
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Rotteau L, Webster F, Salkeld E, Hellings C, Guttmann A, Vermeulen MJ, Bell RS, Zwarenstein M, Rowe BH, Nigam A, Schull MJ. Ontario's emergency department process improvement program: the experience of implementation. Acad Emerg Med 2015; 22:720-9. [PMID: 25996451 PMCID: PMC5032978 DOI: 10.1111/acem.12688] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 01/21/2015] [Accepted: 01/28/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In recent years, Lean manufacturing principles have been applied to health care quality improvement efforts to improve wait times. In Ontario, an emergency department (ED) process improvement program based on Lean principles was introduced by the Ministry of Health and Long-Term Care as part of a strategy to reduce ED length of stay (LOS) and to improve patient flow. This article aims to describe the hospital-based teams' experiences during the ED process improvement program implementation and the teams' perceptions of the key factors that influenced the program's success or failure. METHODS A qualitative evaluation was conducted based on semistructured interviews with hospital implementation team members, such as team leads, medical leads, and executive sponsors, at 10 purposively selected hospitals in Ontario, Canada. Sites were selected based, in part, on their changes in median ED LOS following the implementation period. A thematic framework approach as used for interviews, and a standard thematic coding framework was developed. RESULTS Twenty-four interviews were coded and analyzed. The results are organized according to participants' experience and are grouped into four themes that were identified as significantly affecting the implementation experience: local contextual factors, relationship between improvement team and support players, staff engagement, and success and sustainability. The results demonstrate the importance of the context of implementation, establishing strong relationships and communication strategies, and preparing for implementation and sustainability prior to the start of the project. CONCLUSIONS Several key factors were identified as important to the success of the program, such as preparing for implementation, ensuring strong executive support, creation of implementation teams based on the tasks and outcomes of the initiative, and using multiple communication strategies throughout the implementation process. Explicit incorporation of these factors into the development and implementation of future similar interventions in health care settings could be useful.
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Affiliation(s)
- Leahora Rotteau
- The Centre for Quality Improvement and Patient Safety University of Toronto Toronto Ontario Canada
| | - Fiona Webster
- The Department of Family and Community Medicine University of Toronto Toronto Ontario Canada
| | - Erin Salkeld
- The Institute for Clinical Evaluative Sciences Toronto Ontario Canada
| | - Chelsea Hellings
- The Institute for Clinical Evaluative Sciences Toronto Ontario Canada
| | - Astrid Guttmann
- The Institute for Health Policy, Management and Evaluation University of Toronto Toronto Ontario Canada
- The Department of Paediatrics Division of Paediatric and Emergency Medicine Hospital for Sick Children University of Toronto Toronto Ontario Canada
- The Institute for Clinical Evaluative Sciences Toronto Ontario Canada
| | | | - Robert S. Bell
- The Department of Surgery University of Toronto Toronto Ontario Canada
| | - Merrick Zwarenstein
- The Institute for Clinical Evaluative Sciences Toronto Ontario Canada
- The Centre for Studies in Family Medicine Schulich School of Medicine and Dentistry Western University London Ontario Canada
| | - Brian H. Rowe
- The Department of Emergency Medicine University of Alberta Edmonton Alberta Canada
| | - Amit Nigam
- Cass Business School City University London UK
| | - Michael J. Schull
- The Institute for Health Policy, Management and Evaluation University of Toronto Toronto Ontario Canada
- The Department of Medicine Division of Emergency Medicine University of Toronto Toronto Ontario Canada
- The Institute for Clinical Evaluative Sciences Toronto Ontario Canada
- The Trauma, Emergency and Critical Care Program Sunnybrook Health Sciences Centre Toronto Ontario Canada
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349
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Davison CM, Ndumbe-Eyoh S, Clement C. Critical examination of knowledge to action models and implications for promoting health equity. Int J Equity Health 2015; 14:49. [PMID: 26022369 PMCID: PMC4460698 DOI: 10.1186/s12939-015-0178-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 05/22/2015] [Indexed: 11/09/2022] Open
Abstract
Introduction Knowledge and effective interventions exist to address many current global health inequities. However, there is limited awareness, uptake, and use of knowledge to inform action to improve the health of disadvantaged populations. The gap between knowledge and action to improve health equity is of concern to health researchers and practitioners. This study identifies and critically examines the usefulness of existing knowledge to action models or frameworks for promoting health equity. Methods We conducted a scoping review of existing literature to identify knowledge to action (KTA) models or frameworks and critiqued the models using a health equity support rubric. Results We identified forty-eight knowledge to action models or frameworks. Six models scored between eight and ten of a maximum 12 points on the health equity support rubric. These high scoring models or frameworks all mentioned equity-related concepts. Attention to multisectoral approaches was the factor most often lacking in the low scoring models. The concepts of knowledge brokering, integrative processes, such as those in some indigenous health research, and Ecohealth applied to KTA all emerged as promising areas. Conclusions Existing knowledge to action models or frameworks can help guide knowledge translation to support action on the social determinants of health and health equity. There is a need to further test existing models or frameworks. This process should be informed by participatory and integrative research. There is room to develop more robust equity supporting models. Electronic supplementary material The online version of this article (doi:10.1186/s12939-015-0178-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Colleen M Davison
- Department Public Health Sciences, Queen's University, 63 Fifth Field Company Lane, Kingston, ON, K7L 3N6, Canada.
| | - Sume Ndumbe-Eyoh
- National Collaborating Centre for Determinants of Health, St Francis Xavier University, P.O. Box 5000, Antigonish, NS, B2G 2WG, Canada.
| | - Connie Clement
- National Collaborating Centre for Determinants of Health, St Francis Xavier University, P.O. Box 5000, Antigonish, NS, B2G 2WG, Canada.
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350
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Practice-level quality improvement interventions in primary care: a review of systematic reviews. Prim Health Care Res Dev 2015; 16:556-77. [PMID: 26004929 DOI: 10.1017/s1463423615000274] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIM To present an overview of effective interventions for quality improvement in primary care at the practice level utilising existing systematic reviews. BACKGROUND Quality improvement in primary care involves a range of approaches from the system-level to patient-level improvement. One key setting in which quality improvement needs to occur is at the level of the basic unit of primary care--the individual general practice. Therefore, there is a need for practitioners to have access to an overview of the effectiveness of quality improvement interventions available in this setting. METHODS DESIGN A tertiary evidence synthesis was conducted (a review of systematic reviews). A systematic approach was used to identify and summarise published literature relevant to understanding primary-care quality improvement at the practice level. Quality assessment was via the Critical Appraisal Skills Programme tool for systematic reviews, with data extraction identifying evidence of effect for the examined interventions. SCOPE Included reviews had to be relevant to quality improvement at the practice level and relevant to the UK primary-care context. Reviews were excluded if describing system-level interventions. OUTCOME MEASURES A range of measures across care structure, process and outcomes were defined and interpreted across the quality improvement interventions. FINDINGS Audit and feedback, computerised advice, point-of-care reminders, practice facilitation, educational outreach and processes for patient review and follow-up all demonstrated evidence of a quality improvement effect. Evidence of an improvement effect was higher where baseline performance was low and was particularly demonstrated across process measures and measures related to prescribing. Evidence was not sufficient to suggest that multifaceted approaches were more effective than single interventions. CONCLUSION Evidence exists for a range of quality improvement interventions at the primary-care practice level. More research is required to determine the use and impact of quality improvement interventions using theoretical frameworks and cost-effectiveness analysis.
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