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Eaton TA, Kowalkowski M, Burns R, Tapp H, O'Hare K, Taylor SP. Pre-implementation planning for a sepsis intervention in a large learning health system: a qualitative study. BMC Health Serv Res 2024; 24:996. [PMID: 39192331 DOI: 10.1186/s12913-024-11344-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 07/23/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Sepsis survivors experience high morbidity and mortality. Though recommended best practices have been established to address the transition and early post hospital needs and promote recovery for sepsis survivors, few patients receive recommended post-sepsis care. Our team developed the Sepsis Transition and Recovery (STAR) program, a multicomponent transition intervention that leverages virtually-connected nurses to coordinate the application of evidence-based recommendations for post-sepsis care with additional clinical support from hospitalist and primary care physicians. In this paper, we present findings from a qualitative pre-implementation study, guided by the Consolidated Framework for Implementation Research (CFIR), of factors to inform successful STAR implementation at a large learning health system prior to effectiveness testing as part of a Type I Hybrid trial. METHODS We conducted semi-structured qualitative interviews (n = 16) with 8 administrative leaders and 8 clinicians. Interviews were transcribed and analyzed in ATLAS.ti using a combination deductive/inductive strategy based on CFIR domains and constructs and the Constant Comparison Method. RESULTS Six facilitators and five implementation barriers were identified spanning all five CFIR domains (Intervention Characteristics, Outer Setting, Inner Setting, Characteristics of Individuals and Process). Facilitators of STAR included alignment with health system goals, fostering stakeholder engagement, sharing STAR outcomes data, good communication between STAR navigators and patient care teams/PCPs, clinician promotion of STAR with patients, and good rapport and effective communication between STAR navigators and patients, caregivers, and family members. Barriers of STAR included competing demands for staff time and resources, insufficient communication and education of STAR's value and effectiveness, underlying informational and technology gaps among patients, lack of patient access to community resources, and patient distrust of the program and/or health care. CONCLUSIONS CFIR proved to be a robust framework for examining facilitators and barriers for pre-implementation planning of post-sepsis care programs within diverse hospital and community settings in a large LHS. Conducting a structured pre-implementation evaluation helps researchers design with implementation in mind prior to effectiveness studies and should be considered a key component of Type I hybrid trials when feasible. TRIAL REGISTRATION Clinicaltrials.gov, NCT04495946 . Registered August 3, 2020.
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Affiliation(s)
- Tara A Eaton
- Center for Health System Sciences, Atrium Health, 1300 Scott Ave, Charlotte, NC, 28203, USA.
| | - Marc Kowalkowski
- Center for Health System Sciences, Atrium Health, 1300 Scott Ave, Charlotte, NC, 28203, USA
- Department of Internal Medicine, Medical Center Boulevard, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - Ryan Burns
- Department of Community Health, Atrium Health, 4135 South Stream Blvd, Charlotte, NC, 28217, USA
| | - Hazel Tapp
- Department of Family Medicine, Atrium Health, 2001 Vail Ave., Suite 400B, Charlotte, NC, 28207, USA
| | - Katherine O'Hare
- Center for Outcomes Research and Evaluation, Yale New Haven Health, 195 Church Street, New Haven, CT, 06510, USA
| | - Stephanie P Taylor
- Department of Internal Medicine, Taubman Center, University of Michigan, 1500 East Medical Center Drive, 3110SPC 5368, Ann Arbor, MI, 48109-5368, USA
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Thoonsen AC, van Schoten SM, Merten H, van Beusekom I, Schoonmade LJ, Delnoij DMJ, de Bruijne MC. Stimulating implementation of clinical practice guidelines in hospital care from a central guideline organization perspective: A systematic review. Health Policy 2024; 148:105135. [PMID: 39128438 DOI: 10.1016/j.healthpol.2024.105135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 06/11/2024] [Accepted: 07/18/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND The uptake of guidelines in care is inconsistent. This review focuses on guideline implementation strategies used by guideline organizations (governmental agencies, scientific/professional societies and other umbrella organizations), experienced implementation barriers and facilitators and impact of their implementation efforts. METHODS We searched PUBMED, EMBASE and CINAHL and conducted snowballing. Eligibility criteria included guidelines focused on hospital care and OECD countries. Study quality was assessed using the Mixed Methods Appraisal Tool. We used framework analysis, narrative synthesis and summary statistics. RESULTS Twenty-six articles were included. Sixty-two implementation strategies were reported, used in different combinations and ranged between 1 and 16 strategies per initiative. Most frequently reported strategies were educational session(s) and implementation supporting materials. The most commonly reported barrier and facilitator were respectively insufficient healthcare professionals' time and resources; and guideline's credibility, evidence base and relevance. Eighty-five percent of initiatives that measured impact achieved improvements in adoption, knowledge, behavior and/or clinical outcomes. No clear optimal approach for improving guideline uptake and impact was found. However, we found indications that employing multiple active implementation strategies and involving external organizations and hospital staff were associated with improvements. CONCLUSION Guideline organizations employ diverse implementation strategies and encounter multiple barriers and facilitators. Our study uncovered potential effective implementation practices. However, further research is needed on effective tailoring of implementation approaches to increase uptake and impact of guidelines.
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Affiliation(s)
- Andrea C Thoonsen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, the Netherlands.
| | - Steffie M van Schoten
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, the Netherlands
| | - Hanneke Merten
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, the Netherlands
| | - Ilse van Beusekom
- Zorginstituut Nederland, Department of Care, Willem Dudokhof 1, NL-1112 ZA Diemen, the Netherlands
| | - Linda J Schoonmade
- Vrije Universiteit Amsterdam, Medical Library, De Boelelaan 1117, NL-1081 HV Amsterdam, the Netherlands
| | - Diana M J Delnoij
- Zorginstituut Nederland, Department of Care, Willem Dudokhof 1, NL-1112 ZA Diemen, the Netherlands; Erasmus Universiteit Rotterdam, Erasmus School of Health Policy & Management Health Care Governance, Burgemeester Oudlaan 50, NL-3062 PA Rotterdam, the Netherlands
| | - Martine C de Bruijne
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, the Netherlands
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Pires D, Duarte S, Rodrigues AM, Caeiro C, Canhão H, Branco J, Alves J, Marques M, Aguiar P, Fernandes R, Sousa RD, Cruz EB. MyBack - effectiveness and implementation of a behavior change informed exercise programme to prevent low back pain recurrences: a hybrid effectiveness-implementation randomized controlled study protocol. BMC Musculoskelet Disord 2024; 25:440. [PMID: 38840084 PMCID: PMC11151631 DOI: 10.1186/s12891-024-07542-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 05/24/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is a common health condition and the leading cause of years lived with disability worldwide. Most LBP episodes have a favourable prognosis, but recurrences within a year are common. Despite the individual and societal impact related to LBP recurrences, there is limited evidence on effective strategies for secondary prevention of LBP and successful implementation of intervention programmes in a real-world context. The aim of this study is to analyse the effectiveness of a tailored exercise and behavioural change programme (MyBack programme) in the secondary prevention of LBP; and evaluate acceptability, feasibility and determinants of implementation by the different stakeholders, as well as the implementation strategy of the MyBack programme in real context. METHODS This protocol describes a hybrid type I, randomized controlled trial to evaluate the effectiveness and implementation of MyBack programme in the context of primary health care. The Behaviour Change Wheel framework and FITT-VP principles will inform the development of the behaviour change and exercise component of MyBack programme, respectively. Patients who have recently recovered from an episode of non-specific LBP will be randomly assigned to MyBack and usual care group or usual care group. The primary outcome will be the risk of LBP recurrence. The secondary outcomes will include disability, pain intensity, musculoskeletal health, and health-related quality of life. Participants will be followed monthly for 1 year. Costs data related to health care use and the MyBack programme will be also collected. Implementation outcomes will be assessed in parallel with the effectiveness study using qualitative methods (focus groups with participants and health providers) and quantitative data (study enrolment and participation data; participants adherence). DISCUSSION To our knowledge, this is the first study assessing the effectiveness and implementation of a tailored exercise and behaviour change programme for prevention of LBP recurrences. Despite challenges related to hybrid design, it is expected that data on the effectiveness, cost-effectiveness, and implementation of the MyBack programme may contribute to improve health care in patients at risk of LBP recurrences, contributing to direct and indirect costs reduction for patients and the health system. TRIAL REGISTRATION NUMBER NCT05841732.
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Affiliation(s)
- Diogo Pires
- Instituto Politécnico de Setúbal, Escola Superior de Saúde, Setúbal, Portugal.
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.
| | - Susana Duarte
- Instituto Politécnico de Setúbal, Escola Superior de Saúde, Setúbal, Portugal
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisboa, Portugal
| | - Ana Maria Rodrigues
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- EpiDoC Unit, NOVA Medical School, NOVA University of Lisbon, Lisboa, Portugal
- Unidade de Reumatologia, Hospital dos Lusíadas, Lisboa, Portugal
| | - Carmen Caeiro
- Instituto Politécnico de Setúbal, Escola Superior de Saúde, Setúbal, Portugal
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Helena Canhão
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- EpiDoC Unit, NOVA Medical School, NOVA University of Lisbon, Lisboa, Portugal
- Unidade de Reumatologia, CHULC Hospital Santo António dos Capuchos, Lisboa, Portugal
| | - Jaime Branco
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- EpiDoC Unit, NOVA Medical School, NOVA University of Lisbon, Lisboa, Portugal
- Serviço de Reumatologia do Hospital Egas Moniz-Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Joana Alves
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisboa, Portugal
| | - Marta Marques
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Pedro Aguiar
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisboa, Portugal
| | - Rita Fernandes
- Instituto Politécnico de Setúbal, Escola Superior de Saúde, Setúbal, Portugal
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- LBMF, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, Dafundo, Portugal
| | - Rute Dinis Sousa
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Eduardo B Cruz
- Instituto Politécnico de Setúbal, Escola Superior de Saúde, Setúbal, Portugal
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
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Abell B, Rodwell D, Eagleson KJ, Parsonage W, Auld B, Bora S, Kasparian NA, Justo R, McPhail SM. "It's more than just a conversation about the heart": exploring barriers, enablers, and opportunities for improving the delivery and uptake of cardiac neurodevelopmental follow-up care. Front Pediatr 2024; 12:1364190. [PMID: 38863525 PMCID: PMC11165703 DOI: 10.3389/fped.2024.1364190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/08/2024] [Indexed: 06/13/2024] Open
Abstract
Introduction Surveillance, screening, and evaluation for neurodevelopmental delays is a pivotal component of post-surgical care for children with congenital heart disease (CHD). However, challenges exist in implementing such neurodevelopmental follow-up care in international practice. This study aimed to characterise key barriers, enablers, and opportunities for implementing and delivering outpatient cardiac neurodevelopmental follow-up care in Australia. Methods an exploratory descriptive qualitative study was conducted with healthcare professionals across Australia who had lived experience of designing, implementing, or delivering neurodevelopmental care for children with CHD. Online semi-structured interviews were conducted using a guide informed by the Consolidated Framework for Implementation Research to explore contextual influences. Interview transcripts were analysed using a rapid qualitative approach including templated summaries and hybrid deductive-inductive matrix analysis. Results fifty-two participants were interviewed. Perceived barriers and enablers were organised into six higher-order themes: factors in the broader environmental, economic, and political context; healthcare system factors; organisational-level factors; provider factors; patient and family factors; and care model factors. The largest number of barriers occurred at the healthcare system level (service accessibility, fragmentation, funding, workforce), while service providers demonstrated the most enabling factors (interprofessional relationships, skilled teams, personal characteristics). Strategies to improve practice included building partnerships; generating evidence; increasing funding; adapting for family-centred care; and integrating systems and data. Discussion Australia shares many similar barriers and enablers to cardiac neurodevelopmental care with other international contexts. However, due to unique geographical and health-system factors, care models and implementation strategies will require adaption to the local context to improve service provision.
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Affiliation(s)
- Bridget Abell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Facultyof Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - David Rodwell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Facultyof Health, Queensland University of Technology, Brisbane, QLD, Australia
- Centre for Accident Research & Road Safety—Queensland (CARRS-Q), School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Karen J. Eagleson
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, South Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - William Parsonage
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Facultyof Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ben Auld
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, South Brisbane, QLD, Australia
| | - Samudragupta Bora
- Health Services Research Center, University Hospitals Research & Education Institute and Department of Pediatrics, University Hospitals Rainbow Babies & Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Nadine A. Kasparian
- Heart and Mind Wellbeing Center, Heart Institute and the Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Robert Justo
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, South Brisbane, QLD, Australia
| | - Steven M. McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Facultyof Health, Queensland University of Technology, Brisbane, QLD, Australia
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Simula AS, Malmivaara A, Booth N, Karppinen J. Effectiveness of a classification-based approach to low back pain in primary care - a benchmarking controlled trial. J Rehabil Med 2024; 56:jrm28321. [PMID: 38643363 PMCID: PMC11151494 DOI: 10.2340/jrm.v56.28321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/03/2024] [Indexed: 04/22/2024] Open
Abstract
OBJECTIVE The aim of this study was to assess the effectiveness of classification-based approach for low back pain care in Finnish primary care. DESIGN A benchmarking controlled trial design was used. SUBJECTS/PATIENTS Three primary healthcare areas and 654 low back pain patients with or without sciatica. METHODS Classification-based care (using the STarT Back Tool) was implemented using organizational-, healthcare professional-, and patient-level interventions. The primary outcome was change in Patient-Reported Outcomes Measurement Information System, Physical Function (PROMIS PF-20) from baseline to 12 months. RESULTS No difference was found between the intervention and control in change in PROMIS PF-20 over the 12-month follow-up (mean difference 0.33 confidence interval -2.27 to 2.9, p = 0.473). Low back pain-related healthcare use, imaging, and sick leave days were significantly lower in the intervention group. Reduction in intensity of low back pain appeared to be already achieved at the 3-month follow-up (mean difference -1.3, confidence interval -2.1 to -0.5) in the intervention group, while in the control group the same level of reduction was observed at 12 months (mean difference 0.7, confidence interval -0.2 to 1.5, treatment*time p = 0.003). Conclusion: Although classification-based care did not appear to influence physical functioning, more rapid reductions in pain intensity and reductions in healthcare use and sick leave days were observed in the intervention group.
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Affiliation(s)
- Anna Sofia Simula
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of General
Medicine, Wellbeing services county of South Savo (ELOISA), Mikkeli, Finland.
| | - Antti Malmivaara
- Finnish Institute for Health and Welfare, Helsinki, Finland; Orton Orthopaedic Hospital, Helsinki, Finland
| | - Neill Booth
- Faculty of Social Sciences (Health Sciences), Tampere University, Tampere, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Knight S, Rodda J, Tavender E, Anderson V, Lannin NA, Scheinberg A. Understanding factors that influence goal setting in rehabilitation for paediatric acquired brain injury: a qualitative study using the Theoretical Domains Framework. BRAIN IMPAIR 2024; 25:IB23103. [PMID: 38593747 DOI: 10.1071/ib23103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 03/14/2024] [Indexed: 04/11/2024]
Abstract
Background While goal setting with children and their families is considered best practice during rehabilitation following acquired brain injury, its successful implementation in an interdisciplinary team is not straightforward. This paper describes the application of a theoretical framework to understand factors influencing goal setting with children and their families in a large interdisciplinary rehabilitation team. Methods A semi-structured focus group was conducted with rehabilitation clinicians and those with lived experience of paediatric acquired brain injury (ABI). The 90-min focus group was audio-recorded and transcribed verbatim. Data were thematically coded and mapped against the Theoretical Domains Framework (TDF) to understand influencing factors, which were then linked to the Capability, Opportunity, Motivation - Behaviour (COM-B) model. Results A total of 11 participants (nine paediatric rehabilitation clinicians, one parent and one young person with lived experience of paediatric ABI) participated in the focus group. Factors influencing collaborative goal setting mapped to the COM-B and six domains of the TDF: Capabilities (Skills, Knowledge, Beliefs about capabilities, and Behavioural regulation), Opportunities (Environmental context and resources), and Motivation (Social/professional role and identity). Results suggest that a multifaceted intervention is needed to enhance rehabilitation clinicians' and families' skills and knowledge of goal setting, restructure the goal communication processes, and clarify the roles clinicians play in goal setting within the interdisciplinary team. Conclusion The use of the TDF and COM-B enabled a systematic approach to understanding the factors influencing goal setting for children with acquired brain injury in a large interdisciplinary rehabilitation team, and develop a targeted, multifaceted intervention for clinical use. These represent important considerations for the improvement of collaborative goal setting in paediatric rehabilitation services to ensure that best practice approaches to goal setting are implemented effectively in clinical practice.
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Affiliation(s)
- Sarah Knight
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia; and Melbourne School of Psychological Sciences, The University of Melbourne, Vic., Australia; and Department of Paediatrics, The University of Melbourne, Vic., Australia; and Victorian Paediatric Rehabilitation Service, The Royal Children's Hospital Melbourne, Vic., Australia
| | - Jill Rodda
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - Emma Tavender
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia; and Melbourne School of Psychological Sciences, The University of Melbourne, Vic., Australia; and Department of Paediatrics, The University of Melbourne, Vic., Australia
| | - Natasha A Lannin
- Department of Neuroscience, Monash University, Melbourne, Vic., Australia; and Alfred Health, Melbourne, Vic., Australia
| | - Adam Scheinberg
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia; and Department of Paediatrics, The University of Melbourne, Vic., Australia; and Victorian Paediatric Rehabilitation Service, The Royal Children's Hospital Melbourne, Vic., Australia; and Department of Neuroscience, Monash University, Melbourne, Vic., Australia
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Dopp AR, Hindmarch G, Osilla KC, Meredith LS, Manuel JK, Becker K, Tarhuni L, Schoenbaum M, Komaromy M, Cassells A, Watkins KE. Mis-implementation of evidence-based behavioural health practices in primary care: lessons from randomised trials in Federally Qualified Health Centers. EVIDENCE & POLICY : A JOURNAL OF RESEARCH, DEBATE AND PRACTICE 2024; 20:15-35. [PMID: 38911233 PMCID: PMC11192460 DOI: 10.1332/17442648y2023d000000016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Background Implementing evidence-based practices (EBPs) within service systems is critical to population-level health improvements - but also challenging, especially for complex behavioral health interventions in low-resource settings. "Mis-implementation" refers to poor outcomes from an EBP implementation effort; mis-implementation outcomes are an important, but largely untapped, source of information about how to improve knowledge exchange. Aims and objectives We present mis-implementation cases from three pragmatic trials of behavioral health EBPs in U.S. Federally Qualified Health Centers (FQHCs). Methods We adapted the Consolidated Framework for Implementation Research and its Outcomes Addendum into a framework for mis-implementation and used it to structure the case summaries with information about the EBP and trial, mis-implementation outcomes, and associated determinants (barriers and facilitators). We compared the three cases to identify shared and unique mis-implementation factors. Findings Across cases, there was limited adoption and fidelity to the interventions, which led to eventual discontinuation. Barriers contributing to mis-implementation included intervention complexity, low buy-in from overburdened providers, lack of alignment between providers and leadership, and COVID-19-related stressors. Mis-implementation occurred earlier in cases that experienced both patient- and provider-level barriers, and that were conducted during the COVID-19 pandemic. Discussion and conclusion Multi-level determinants contributed to EBP mis-implementation in FQHCs, limiting the ability of these health systems to benefit from knowledge exchange. To minimize mis-implementation, knowledge exchange strategies should be designed around common, core barriers but also flexible enough to address a variety of site-specific contextual factors and should be tailored to relevant audiences such as providers, patients, and/or leadership.
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van Grootel JWM, Bor P, Veenhof C, Valkenet K. Development of a goal-directed movement intervention (GOAL) using a movement sensor for hospitalized patients: An intervention mapping approach. Clin Rehabil 2024; 38:251-262. [PMID: 37644843 PMCID: PMC10725127 DOI: 10.1177/02692155231198173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To describe the development of a goal-directed movement intervention in two medical wards, including recommendations for implementation and evaluation. DESIGN Implementation Research. SETTING Pulmonology and nephrology/gastroenterology wards of the University Medical Centre Utrecht, The Netherlands. PARTICIPANTS Seven focus groups were executed including 28 nurses, 7 physical therapists and 15 medical specialists. Patients' perceptions were repeatedly assessed during the iterative steps of the intervention development. INTERVENTION Interventions were targeted to each ward's specific character, following an Intervention Mapping approach using literature and research meetings. Main measures: Intervention components were linked to Behavior Change Techniques and implementation strategies will be selected using the Expert Recommendation Implementing Change tool. Evaluation outcomes like number of patients using the movement intervention will be measured, based on the taxonomy of Proctor. RESULTS The developed intervention consists of: insight in patients movement behavior (monitoring & feedback), goal setting (goals & planning) and adjustments to the environment (associations & antecedents). The following implementation strategies are recommended: to conduct educational meetings, prepare & identify champions and audit & provide feedback. To measure service and client outcomes, the mean level of physical activity per ward can be evaluated and the Net Promoter Score can be used. CONCLUSION(S) This study shows the development of a goal-directed movement intervention aligned with the needs of healthcare professionals. This resulted in an intervention consisting of feedback & monitoring of movement behavior, goal setting and adjustments in the environment. Using a step-by-step iterative implementation model to guide development and implementation is recommended.
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Affiliation(s)
- JWM van Grootel
- HU University of Applied Sciences Utrecht, Research Center of Healthy and Sustainable Living, Research Group Innovation of Movement Care, Utrecht, The Netherlands
- University Medical Centre Utrecht, Department of Rehabilitation Physiotherapy Science & Sport, UMC Utrecht Brain Center, Utrecht, The Netherlands
| | - P Bor
- University Medical Centre Utrecht, Department of Rehabilitation Physiotherapy Science & Sport, UMC Utrecht Brain Center, Utrecht, The Netherlands
| | - C Veenhof
- HU University of Applied Sciences Utrecht, Research Center of Healthy and Sustainable Living, Research Group Innovation of Movement Care, Utrecht, The Netherlands
- University Medical Centre Utrecht, Department of Rehabilitation Physiotherapy Science & Sport, UMC Utrecht Brain Center, Utrecht, The Netherlands
| | - K Valkenet
- HU University of Applied Sciences Utrecht, Research Center of Healthy and Sustainable Living, Research Group Innovation of Movement Care, Utrecht, The Netherlands
- University Medical Centre Utrecht, Department of Rehabilitation Physiotherapy Science & Sport, UMC Utrecht Brain Center, Utrecht, The Netherlands
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Kirk JW, Lindstroem MB, Stefánsdóttir NT, Andersen O, Powell BJ, Nilsen P, Tjørnhøj-Thomsen T. Influences of specialty identity when implementing a new emergency department in Denmark: a qualitative study. BMC Health Serv Res 2024; 24:162. [PMID: 38302985 PMCID: PMC10836004 DOI: 10.1186/s12913-024-10604-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/15/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND The Danish Health Authority recommended the implementation of new types of emergency departments. Organizational changes in the hospital sector challenged the role, identity, and autonomy of medical specialists. They tend to identify with their specialty, which can challenge successful implementation of change. However, investigations on specialty identity are rare in implementation science, and how the co-existence of different specialty identities influences the implementation of new emergency departments needs to be explored for the development of tailored implementation strategies. The aim of this study was to examine how medical specialty identity influences collaboration between physicians when implementing a new emergency department in Denmark. METHODS Qualitative methods in the form of participants' observations at 13 oilcloth sessions (a micro-simulation method) were conducted followed up by 53 individual semi-structured interviews with participants from the oilcloth sessions. Out of the 53 interviews, 26 were conducted with specialists. Data from their interviews are included in this study. Data were analysed deductively inspired by Social Identity Theory. RESULTS The analysis yielded three overarching themes: [1] ongoing creation and re-creation of specialty identity through boundary drawing; [2] social categorization and power relations; and [3] the patient as a boundary object. CONCLUSIONS Specialty identity is an important determinant of collaboration among physicians when implementing a new emergency department. Specialty identity involves social categorization, which entails ongoing creation and re-creation of boundary drawing and exercising of power among the physicians. In some situations, the patient became a positive boundary object, increasing the possibility for a successful collaboration and supporting successful implementation, but direct expressions of boundaries and mistrust were evident. Both were manifested through a dominating power expressed through social categorization in the form of in- and out-groups and in an "us and them" discourse, which created distance and separation among physicians from different specialties. This distancing and separation became a barrier to the implementation of the new emergency department.
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Affiliation(s)
- Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark.
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Mette Bendtz Lindstroem
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
| | | | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
- Emergency Department, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, 2200, Copenhagen, Denmark
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School and School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Tine Tjørnhøj-Thomsen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Odense, Denmark
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Moniz A, Duarte ST, Aguiar P, Caeiro C, Pires D, Fernandes R, Moço D, Marques MM, Sousa R, Canhão H, Branco J, Rodrigues AM, Cruz EB. Physiotherapists' barriers and facilitators to the implementation of a behaviour change-informed exercise intervention to promote the adoption of regular exercise practice in patients at risk of recurrence of low back pain: a qualitative study. BMC PRIMARY CARE 2024; 25:39. [PMID: 38279123 PMCID: PMC10811813 DOI: 10.1186/s12875-024-02274-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/12/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Recurrences of low back pain (LBP) are frequent and associated with high levels of disability and medical costs. Regular exercise practice may be an effective strategy to prevent recurrences of LBP, however, the promotion of this behaviour by physiotherapists seems to be challenging. This study aims to explore physiotherapists' perceived barriers and facilitators to the implementation of a behaviour change-informed exercise intervention to promote the adoption of regular exercise practice by patients at risk of recurrence of low back pain. METHODS Two focus groups with primary healthcare physiotherapists were conducted, based on a semi-structured interview schedule informed by the Behaviour Change Wheel, including the Capability, Opportunity, Motivation-Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). All focus groups were held through videoconference, audio and video recorded and transcribed verbatim. A deductive content analysis, using a coding matrix based on the COM-B and TDF, was performed by two independent researchers. A third researcher was approached to settle disagreements. RESULTS In total, 14 physiotherapists participated in the focus groups. The analysis revealed a total of 13 barriers (4 COM-B components and 7 TDF domains) and 23 facilitators (5 COM-B and 13 TDF) to physiotherapists' implementation of a behaviour change-informed exercise intervention. The most common barriers were the lack of skills and confidence to implement the proposed intervention. These were explained by the fact that it differs from the usual practice of most participants and requires the learning of new skills applied to their contexts. However, for those who had already implemented other similar interventions or whose rationale is aligned with the new intervention, there seemed to exist more positive determinants, such as potential benefits for physiotherapists and the profession, improvement of quality of care and willingness to change clinical practice. For others who did not previously succeed in implementing these types of interventions, more context-related barriers were mentioned, such as lack of time to implement the intervention, schedule incompatibilities and lack of material and human resources. CONCLUSIONS This study identified modifiable barriers and facilitators to physiotherapists' implementation of a behaviour change-informed exercise intervention for patients at risk of recurrence of LBP in primary healthcare. The findings of this study will allow the systematic and theory-based development of a behaviour change-informed training programme, aimed at physiotherapists and supporting the successful implementation of the exercise intervention.
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Affiliation(s)
- Alexandre Moniz
- Comprehensive Health Research Center (CHRC), NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade NOVA de Lisboa, Lisbon, Portugal.
- EpiDoc Unit, NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade Nova de Lisboa, Lisbon, Portugal.
- Departamento de Fisioterapia, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal.
| | - Susana T Duarte
- Departamento de Fisioterapia, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
- Comprehensive Health Research Center (CHRC), National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Pedro Aguiar
- Comprehensive Health Research Center (CHRC), National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Carmen Caeiro
- Departamento de Fisioterapia, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Diogo Pires
- Departamento de Fisioterapia, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Rita Fernandes
- Departamento de Fisioterapia, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Diogo Moço
- Departamento de Fisioterapia, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
| | - Marta M Marques
- Comprehensive Health Research Center (CHRC), National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Rute Sousa
- Comprehensive Health Research Center (CHRC), NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
- EpiDoc Unit, NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Helena Canhão
- Comprehensive Health Research Center (CHRC), NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
- EpiDoc Unit, NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Jaime Branco
- Comprehensive Health Research Center (CHRC), NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
- EpiDoc Unit, NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- Serviço de Reumatologia Do Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental (CHLO), Lisbon, Portugal
| | - Ana Maria Rodrigues
- Comprehensive Health Research Center (CHRC), NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
- EpiDoc Unit, NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- Serviço de Reumatologia Do Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental (CHLO), Lisbon, Portugal
- Rheumatology Unit, Hospital Dos Lusíadas, Lisbon, Portugal
| | - Eduardo B Cruz
- Departamento de Fisioterapia, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
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Verma AA, Trbovich P, Mamdani M, Shojania KG. Grand rounds in methodology: key considerations for implementing machine learning solutions in quality improvement initiatives. BMJ Qual Saf 2024; 33:121-131. [PMID: 38050138 DOI: 10.1136/bmjqs-2022-015713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/04/2023] [Indexed: 12/06/2023]
Abstract
Machine learning (ML) solutions are increasingly entering healthcare. They are complex, sociotechnical systems that include data inputs, ML models, technical infrastructure and human interactions. They have promise for improving care across a wide range of clinical applications but if poorly implemented, they may disrupt clinical workflows, exacerbate inequities in care and harm patients. Many aspects of ML solutions are similar to other digital technologies, which have well-established approaches to implementation. However, ML applications present distinct implementation challenges, given that their predictions are often complex and difficult to understand, they can be influenced by biases in the data sets used to develop them, and their impacts on human behaviour are poorly understood. This manuscript summarises the current state of knowledge about implementing ML solutions in clinical care and offers practical guidance for implementation. We propose three overarching questions for potential users to consider when deploying ML solutions in clinical care: (1) Is a clinical or operational problem likely to be addressed by an ML solution? (2) How can an ML solution be evaluated to determine its readiness for deployment? (3) How can an ML solution be deployed and maintained optimally? The Quality Improvement community has an essential role to play in ensuring that ML solutions are translated into clinical practice safely, effectively, and ethically.
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Affiliation(s)
- Amol A Verma
- Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Patricia Trbovich
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Centre for Quality Improvement and Patient Safety, Department of Medicine, University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
| | - Muhammad Mamdani
- Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Kaveh G Shojania
- Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Franz B, Dhanani LY, Hall OT, Brook DL, Fenstemaker C, Simon JE, Miller WC. Buprenorphine misinformation and willingness to treat patients with opioid use disorder among primary care-aligned health care professionals. Addict Sci Clin Pract 2024; 19:7. [PMID: 38243307 PMCID: PMC10797921 DOI: 10.1186/s13722-024-00436-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Buprenorphine is a highly effective medication for opioid use disorder that is underused by health care professionals (HCPs). Medications for opioid use disorder (MOUD) misinformation may be an important barrier to buprenorphine access, but most implementation strategies have aimed to reduce negative attitudes towards patients with opioid use disorder (OUD) rather than misinformation specific to buprenorphine use. In this study, we assessed the degree to which HCPs endorsed misinformation related to buprenorphine, and whether this is associated with willingness to provide care to patients with OUD. METHODS In September-December of 2022, we surveyed HCPs practicing in Ohio (n = 409). Our primary outcomes included a previously validated 5-item measure of HCP willingness to treat patients with OUD, and three other measures of willingness. Our key independent variable was a study-developed 5-item measure of endorsement of misinformation related to buprenorphine, which assessed beliefs in buprenorphine's efficacy in managing withdrawal symptoms and reducing overdose deaths as well as beliefs about the role of buprenorphine in achieving remission. We computed descriptive and bivariable statistics and fit regression models predicting each outcome of interest. RESULTS On average, HCPs scored 2.34 out of 5.00 (SD = 0.80) on the composite measure of buprenorphine misinformation. 48.41% of participants endorsed at least one piece of misinformation. The most endorsed items were that buprenorphine is ineffective at reducing overdose deaths (M = 2.75, SD =0 .98), and that its use substitutes one drug for another (M = 2.41, SD = 1.25). HCP endorsement of buprenorphine misinformation significantly and negatively predicted willingness to work with patients with OUD (b = - 0.34; 95% CI - 0.46, - 0.21); intentions to increase time spent with this patient population (b = - 0.36; 95% CI - 5.86, - 1.28); receipt of an X-waiver (OR = 0.54, 95% CI 0.38, 0.77); and intention to get an X-waiver (OR: 0.56; 95% CI: 0.33-0.94). CONCLUSIONS Misinformation is common among HCPs and associated with lower willingness to treat patients with OUD. Implementation strategies to increase MOUD use among HCPs should specifically counter misinformation related to buprenorphine. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov, NCT05505227. Registered 17 August 2022, https://clinicaltrials.gov/ct2/show/NCT05505227.
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Affiliation(s)
- Berkeley Franz
- Ohio University Heritage College of Osteopathic Medicine, Department of Social Medicine, Ohio University Athens, Heritage Hall 1, Athens, OH, 45701-2979, USA.
- Appalachian Institute to Advance Health Equity Science, Athens, OH, USA.
| | - Lindsay Y Dhanani
- Rutgers University School of Management and Labor Relations, Piscataway, NJ, USA
| | - O Trent Hall
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel L Brook
- Ohio State University College of Public Health, Columbus, OH, USA
| | - Cheyenne Fenstemaker
- Ohio University Heritage College of Osteopathic Medicine, Department of Social Medicine, Ohio University Athens, Heritage Hall 1, Athens, OH, 45701-2979, USA
- Appalachian Institute to Advance Health Equity Science, Athens, OH, USA
| | - Janet E Simon
- Ohio University College of Health Sciences and Professions, Athens, OH, USA
| | - William C Miller
- Gillings School of Public Health , University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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Elwakil W, El Gaafary M, El Miedany Y. Screening and management of osteoporosis: a survey of knowledge, attitude, and practice among healthcare professionals in Egypt-a study by the Egyptian Academy of Bone Health. Osteoporos Int 2024; 35:93-103. [PMID: 37721557 PMCID: PMC10786960 DOI: 10.1007/s00198-023-06914-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/05/2023] [Indexed: 09/19/2023]
Abstract
Secondary-level healthcare professionals, mainly rheumatologists and orthopedic surgeons, were invited to participate in an online survey questionnaire to assess knowledge and compliance with osteoporosis management guidelines and strategies, as well as self-reported quality of care. About 51% of the participants admit that they do not implement specific guidelines for the management of osteoporosis in their standard practice and depend on their experience and their clinical judgments. Moreover, although a good percentage (58%) had satisfactory knowledge levels in domains on the risk of osteoporotic fractures and investigations of osteoporosis, 47.5% of the participants did not score satisfactorily in questions on pharmacotherapy, especially for those patients at high risk for fractures. INTRODUCTION A recently published study demonstrated a treatment gap among those eligible for osteoporosis therapy in Egypt of about 82.1% in postmenopausal women and 100% in men. The current survey aimed to address some of the factors that may contribute to this wide gap. METHODS This was a cross-sectional study of secondary care healthcare professionals (both physicians and orthopedic surgeons) who were invited to complete an online questionnaire, which gathered information about physicians' socio-demographic data, knowledge, and compliance with osteoporosis management guidelines and strategies, as well as self-reported quality of care. Additionally, a knowledge score was calculated for all the participants. RESULTS A good percentage (58%) had a satisfactory knowledge level in domains on the risk of osteoporotic fractures and investigations of osteoporosis; however, 47.5% did not score satisfactorily in questions on pharmacotherapy, especially for those patients at high risk for fractures. CONCLUSIONS This work has identified some of the barriers to implementing guidelines for osteoporosis and fragility fracture management. In the meantime, it highlights the urgency of intensifying efforts to develop the knowledge and attitude of the healthcare professionals dealing with this condition in Egypt.
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Affiliation(s)
- Walaa Elwakil
- Rheumatology, Rehabilitation and Physical Medicine, Alexandria University, Alexandria, Egypt.
| | - Maha El Gaafary
- Community and Public Health, Ain Shams University, Cairo, Egypt
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IJzerman RVH, van der Vaart R, Breeman LD, Arkenbout K, Keesman M, Kraaijenhagen RA, Evers AWM, Scholte Op Reimer WJM, Janssen VR. An iterative approach to developing a multifaceted implementation strategy for a complex eHealth intervention within clinical practice. BMC Health Serv Res 2023; 23:1455. [PMID: 38129824 PMCID: PMC10740292 DOI: 10.1186/s12913-023-10439-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The number of complex eHealth interventions has increased considerably. Despite available implementation theory outlining well-designed strategies, implementing complex interventions within practice proves challenging and often does not lead to sustainable use. To improve sustainability, theory and practice should be addressed during the development of an implementation strategy. By subsequently transparently reporting the executed theory-based steps and their corresponding practice findings, others can learn from these valuable lessons learned. This study outlines the iterative approach by which a multifaceted implementation strategy for a complex eHealth intervention in clinical practice was developed, tested and refined. METHODS We implemented the BENEFIT program, an advanced eHealth platform with Personal Health Portal facilitating healthy living in cardiac patients. In six iterative phases alternating between theory and practice, the implementation strategy was developed, tested and refined. The initial implementation strategy (phase 1) was drawn up using the Implementation model and RE-AIM. Subsequently, this strategy was further updated in brainstorming sessions and group discussions with twenty key stakeholders from three cardiac care centres and then evaluated in a pilot (phases 2 and 3). RESULTS The pilot of the program led to the identification of (context-specific) key challenges in practice (phase 4), which were subsequently connected back to broader theory (phase 5) using the Consolidated Framework of Implementation Research (CFIR). In the final phase, practice recommendations tackling the key challenges were formulated (phase 6) based on CFIR theory, the CFIR-ERIC Matching Tool, and stakeholders' input and feedback. These recommendations were then added to the refined strategy. Thus, executing this approach led to the realisation and use of a multifaceted theory-informed practice-based implementation strategy. CONCLUSION This case study gives an in-depth description of an iterative approach to developing an evidence-based, practice-tailored strategy for implementing a complex eHealth intervention in cardiac care. As such, this study may serve as a blueprint for other researchers aspiring to implement complex eHealth interventions within clinical practice sustainably.
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Affiliation(s)
- Renée V H IJzerman
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, Leiden, 2333, the Netherlands.
| | - Rosalie van der Vaart
- Centre of expertise Health Innovation, The Hague University of Applied Sciences, Den Haag, the Netherlands
| | - Linda D Breeman
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, Leiden, 2333, the Netherlands
| | - Karin Arkenbout
- Department of Cardiology, Tergooi MC, Blaricum and Hilversum, the Netherlands
| | - Mike Keesman
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, Leiden, 2333, the Netherlands
| | | | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, Leiden, 2333, the Netherlands
| | | | - Veronica R Janssen
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
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Allen MJ, Carter HE, Cyarto E, Meyer C, Dwyer T, Oprescu F, Aitken C, Farrington A, Shield C, Rowland J, Lee XJ, Graves N, Parkinson L, Harvey G. From pilot to a multi-site trial: refining the Early Detection of Deterioration in Elderly Residents (EDDIE +) intervention. BMC Geriatr 2023; 23:811. [PMID: 38057722 PMCID: PMC10698876 DOI: 10.1186/s12877-023-04491-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Early Detection of Deterioration in Elderly Residents (EDDIE +) is a multi-modal intervention focused on empowering nursing and personal care workers to identify and proactively manage deterioration of residents living in residential aged care (RAC) homes. Building on successful pilot trials conducted between 2014 and 2017, the intervention was refined for implementation in a stepped-wedge cluster randomised trial in 12 RAC homes from March 2021 to May 2022. We report the process used to transition from a small-scale pilot intervention to a multi-site intervention, detailing the intervention to enable future replication. METHODS The EDDIE + intervention used the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to guide the intervention development and refinement process. We conducted an environmental scan; multi-level context assessments; convened an intervention working group (IWG) to develop the program logic, conducted a sustainability assessment and deconstructed the intervention components into fixed and adaptable elements; and subsequently refined the intervention for trial. RESULTS The original EDDIE pilot intervention included four components: nurse and personal care worker education; decision support tools; diagnostic equipment; and facilitation and clinical support. Deconstructing the intervention into core components and what could be flexibly tailored to context was essential for refining the intervention and informing future implementation across multiple sites. Intervention elements considered unsustainable were updated and refined to enable their scalability. Refinements included: an enhanced educational component with a greater focus on personal care workers and interactive learning; decision support tools that were based on updated evidence; equipment that aligned with recipient needs and available organisational support; and updated facilitation model with local and external facilitation. CONCLUSION By using the i-PARIHS framework in the scale-up process, the EDDIE + intervention was tailored to fit the needs of intended recipients and contexts, enabling flexibility for local adaptation. The process of transitioning from a pilot to larger scale implementation in practice is vastly underreported yet vital for better development and implementation of multi-component interventions across multiple sites. We provide an example using an implementation framework and show it can be advantageous to researchers and health practitioners from pilot stage to refinement, through to larger scale implementation. TRIAL REGISTRATION The trial was prospectively registered with the Australia New Zealand Clinical Trial Registry (ACTRN12620000507987, registered 23/04/2020).
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Affiliation(s)
- Michelle J Allen
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
| | - Hannah E Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Elizabeth Cyarto
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Claudia Meyer
- Bolton Clarke Research Institute, Forest Hill, Victoria, Australia
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Australia
- Centre for Health Communication and Participation, La Trobe University, Bundoora, Australia
| | - Trudy Dwyer
- Central Queensland University, Norman Gardens, Australia
| | - Florin Oprescu
- School of Health, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Christopher Aitken
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Alison Farrington
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Carla Shield
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Jeffrey Rowland
- Faculty of Medicine, University of Queensland, Herston, Australia
- Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove, Australia
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Xing J Lee
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | | | - Lynne Parkinson
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Gillian Harvey
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Im EO, Yi JS, Chee W. A Decision Tree Analysis on Symptom Experience of Asian American Breast Cancer Survivors. West J Nurs Res 2023; 45:1076-1084. [PMID: 37882470 DOI: 10.1177/01939459231204294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND Mainly due to their cultural attitudes toward symptoms and breast cancer, Asian American breast cancer survivors tend to suffer from symptoms and often delay in getting treatments, information, and support. To improve their symptom management, it would be important to determine risk groups among them. Decision tree analyses reportedly help determine risk groups by identifying the characteristics that are directly associated with target health outcomes. OBJECTIVE Using a decision tree analysis, this study aimed at identifying the characteristics that were closely linked to the symptom experience of Asian American breast cancer survivors. METHODS This was a part of a parent randomized controlled trial among Asian American breast cancer survivors. Only the data from 135 women at the pre-test were included. Multiple instruments were used to collect the data: the Memorial Symptom Assessment Scale-Short Form, the Cancer Behavior Inventory, the PRQ-2000, the Perceived Isolation Scale, and the Supportive Care Needs Survey-Short Form 34. The data were analyzed using latent profile analysis and decision tree analyses. RESULTS Two most frequently found profiles included the low symptom experience profile (72.6%) and the high symptom experience profile (27.4%). The high symptom experience profile was predicted by 2 combined characteristics; (a) high psychological needs for help (over 60.00 points), and (b) low psychological needs for help (cut point = 60.00), high perceived barriers (cut point = 1.62), and high social isolation (social support) (cut point = 2.33). CONCLUSIONS These characteristics linked to Asian American breast cancer survivors with high symptom experience need to be considered in future intervention development.
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Affiliation(s)
| | - Jee-Seon Yi
- Emory University, Atlanta, GA, USA
- College of Nursing, Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
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Jacobsen SS, Vilhelmsen M, Lottrup L, Brandt M. Facilitators and barriers for using outdoor areas in the primary work tasks of eldercare workers in nursing homes. BMC Health Serv Res 2023; 23:1300. [PMID: 38001468 PMCID: PMC10675903 DOI: 10.1186/s12913-023-10308-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Eldercare workers in nursing homes report high musculoskeletal disorders, stressful work, and sickness absence. Initiatives that can accommodate these issues are needed. Current studies point out that nature contact may offer a range of human health benefits, potentially promoting healthier work among eldercare workers. Therefore, this study aimed to investigate facilitators and barriers for using outdoor areas as part of the daily work among eldercare workers in Danish nursing homes. METHODS In this multiple case study, we collected data from three nursing homes, conducting three semi-structured focus group interviews with eldercare workers and three individual interviews with nursing home managers. Furthermore, we conducted observations of the daily work and mappings of the nursing homes' outdoor environments to gain in-depth knowledge of eldercare workers' and managers' perspectives on using outdoor areas in their daily work. The data was thematically analysed using 'The Behaviour Change Wheel' (BCW), more specifically the COM-B model, as a theoretical foundation for exploring facilitators and barriers for the use of outdoor areas. RESULTS Frequently mentioned facilitators were facilities, traditions or repetitive events, positive experiences with residents ('star moments'), and knowledge about the residents. Frequently mentioned barriers were insufficient staffing, hierarchy in the work tasks, professional identity, and lack of ideas. CONCLUSIONS The identified facilitators and barriers should be considered when designing initiatives for increased use of outdoor areas or activities of eldercare workers. TRIAL REGISTRATION According to the Danish ethics committee (Law of committee, (komitéloven) paragraph 14, Sect. 2), qualitative interviews, which do not include human biological materials, do not need neither approval by ethical and scientific committee or informed consent (The Danish National Centre for Ethics).
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Affiliation(s)
- Sandra Schade Jacobsen
- National Research Centre for the Working Environment, Lersø Parkalle 105, Copenhagen, Denmark
| | - Maja Vilhelmsen
- National Research Centre for the Working Environment, Lersø Parkalle 105, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Frederiksberg, Denmark
| | - Lene Lottrup
- Outdoor Institute, Silkeborg, Denmark
- Sundhedslandskab, Aarhus, Denmark
| | - Mikkel Brandt
- National Research Centre for the Working Environment, Lersø Parkalle 105, Copenhagen, Denmark.
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Bahns C, Scheffler B, Kopkow C. Guideline-Adherent Physiotherapy for Patients With Hip and Knee Osteoarthritis in Germany: Protocol for an Implementation Research Project Using the Theoretical Domains Framework and the Behavior Change Wheel. JMIR Res Protoc 2023; 12:e47834. [PMID: 37971802 PMCID: PMC10690534 DOI: 10.2196/47834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/07/2023] [Accepted: 07/25/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Hip and knee osteoarthritis is common and leads to pain, stiffness, and disability. Clinical practice guidelines provide recommendations based on the best available evidence to assist health care professionals and patients in clinical decision-making. However, several studies have reported a gap between guideline recommendations and clinical practice in physiotherapy. Improved implementation strategies and the removal of existing barriers may facilitate the transfer of evidence into clinical practice and contribute to optimized quality of care. OBJECTIVE This paper presents the protocol for a study that aims to describe the current physiotherapy practice in patients with hip and knee osteoarthritis and to investigate physiotherapists' adherence to clinical practice guidelines, to identify and specify barriers to and facilitators of guideline use and implementation, and to develop and pilot test a theory-based tailored implementation intervention aiming to increase guideline use in osteoarthritis care. METHODS The research project is divided into 4 parts. During the first part, we will conduct a nationwide web-based survey among German physiotherapists to evaluate the current management of hip and knee osteoarthritis and to evaluate whether treatment aligns with guideline recommendations. Subsequently, semistructured interviews will be conducted to specify barriers to and facilitators of guideline use and implementation among physiotherapists (part 2). On the basis of these findings, in part 3, we will develop a theory-driven implementation intervention based on the Theoretical Domains Framework and the Behavior Change Wheel, which will be evaluated in a controlled pilot study in terms of effectiveness, feasibility, and acceptability (part 4). RESULTS Data collection of the web-based survey among German physiotherapists (part 1) was completed in December 2021. The semistructured interviews (part 2) were conducted between January and September 2023. Recruitment of physiotherapy practices to participate in the development of the implementation intervention is expected to start in January 2024. CONCLUSIONS This research project aims to develop a theory-driven implementation intervention to facilitate the transfer of evidence from hip and knee osteoarthritis guidelines in physiotherapy practice. We hypothesize that successful implementation will lead to increased guideline adherence in physiotherapists, which in turn will improve the quality of care. The results from our project will provide valuable knowledge concerning the development process and effectiveness of tailored implementation interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47834.
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Affiliation(s)
- Carolin Bahns
- Department of Therapy Science I, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Bettina Scheffler
- Department of Therapy Science I, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Christian Kopkow
- Department of Therapy Science I, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
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Wortham WK, Rodwin AH, Purtle J, Munson MR, Raghavan R. Revisiting the policy ecology framework for implementation of evidence-based practices in mental health settings. Implement Sci 2023; 18:58. [PMID: 37936123 PMCID: PMC10629012 DOI: 10.1186/s13012-023-01309-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/01/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Over the past three decades, policy actors and actions have been highly influential in supporting the implementation of evidence-based practices (EBPs) in mental health settings. An early examination of these actions resulted in the Policy Ecology Framework (PEF), which was originally developed as a tactical primer for state and local mental health regulators in the field of child mental health. However, the policy landscape for implementation has evolved significantly since the original PEF was published. An interrogation of the strategies originally proposed in the PEF is necessary to provide an updated menu of strategies to improve our understanding of the mechanisms of policy action and promote system improvement. OBJECTIVES This paper builds upon the original PEF to address changes in the policy landscape for the implementation of mental health EBPs between 2009 and 2022. We review the current state of policy strategies that support the implementation of EBPs in mental health care and outline key areas for policy-oriented implementation research. Our review identifies policy strategies at federal, state, agency, and organizational levels, and highlights developments in the social context in which EBPs are implemented. Furthermore, our review is organized around some key changes that occurred across each PEF domain that span organizational, agency, political, and social contexts along with subdomains within each area. DISCUSSION We present an updated menu of policy strategies to support the implementation of EBPs in mental health settings. This updated menu of strategies considers the broad range of conceptual developments and changes in the policy landscape. These developments have occurred across the organizational, agency, political, and social contexts and are important for policymakers to consider in the context of supporting the implementation of EBPs. The updated PEF expands and enhances the specification of policy levers currently available, and identifies policy targets that are underdeveloped (e.g., de-implementation and sustainment) but are becoming visible opportunities for policy to support system improvement. The updated PEF clarifies current policy efforts within the field of implementation science in health to conceptualize and better operationalize the role of policy in the implementation of EBPs.
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Affiliation(s)
- Whitney K Wortham
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA.
| | - Aaron H Rodwin
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
| | - Jonathan Purtle
- Department of Public Health Policy & Management, Global Center for Implementation Science, School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA
| | - Michelle R Munson
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
| | - Ramesh Raghavan
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
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Quasdorf T, Manietta C, Rommerskirch-Manietta M, Braunwarth JI, Roßmann C, Roes M. Implementation of interventions to maintain and promote the functional mobility of nursing home residents - a scoping review. BMC Geriatr 2023; 23:600. [PMID: 37752436 PMCID: PMC10523713 DOI: 10.1186/s12877-023-04213-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/02/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND To provide an overview of the available evidence on the implementation of direct and capacity-building interventions to promote and maintain the functional mobility of nursing home residents. METHODS We conducted a scoping review following the methodological guidance for the conduct of scoping reviews as described by the Joanna Briggs Institute. We searched for studies in MEDLINE (via PubMed) and CINAHL (via EBSCO). We conducted a qualitative content analysis of the included studies with deductive categories based on the Consolidated Framework for Implementation Research (CFIR). RESULTS Ultimately, we included 8 studies on direct interventions, 6 studies on capacity-building interventions, and 2 studies on both types of interventions in our review. Seven studies provided evidence on implementation strategies comprising discrete as well as multifaceted, multilevel strategies. Most of the studies did not systematically evaluate the strategies but remained at a descriptive level. All 16 studies provided evidence of influencing factors. We identified 32 of the 37 influencing factors of the CFIR. The five most frequent influencing factors were available resources (n = 14), access to knowledge and information (n = 12), patient needs and resources (n = 10), knowledge and beliefs about the intervention (n = 10) and compatibility (n = 9). CONCLUSIONS The available evidence on the implementation of functional mobility interventions in nursing homes is rather limited. This emphasizes the need for further research. Regarding implementation strategies, the systematic evaluation and further development of the reported promising approaches might be a starting point.
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Affiliation(s)
- Tina Quasdorf
- School of Health Science, Institute of Nursing, ZHAW Zürich University of Applied Science, Winterthur, Switzerland.
| | - Christina Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Standort Witten, Witten, Germany
- Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
| | - Mike Rommerskirch-Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Standort Witten, Witten, Germany
- Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
| | - Jana Isabelle Braunwarth
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Standort Witten, Witten, Germany
- Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
| | - Christin Roßmann
- Bundeszentrale für gesundheitliche Aufklärung (BZgA), Köln, Germany
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Standort Witten, Witten, Germany
- Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
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Aloisio LD, Graham N, Grinspun D, Naik S, Coughlin M, Medeiros C, McConnell H, Sales A, McNeill S, Santos WJ, Squires JE. Indicators to measure implementation and sustainability of nursing best practice guidelines: A mixed methods analysis. Heliyon 2023; 9:e19983. [PMID: 37809679 PMCID: PMC10559663 DOI: 10.1016/j.heliyon.2023.e19983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Background The use of best practice guidelines (BPGs) has the potential to decrease the gap between best evidence and nursing and healthcare practices. We conducted an exploratory mixed method study to identify strategies, processes, and indicators relevant to the implementation and sustainability of two Registered Nurses' Association of Ontario (RNAO) BPGs at Best Practice Spotlight Organizations® (BPSOs). Methods Our study had four phases. In Phase 1, we triangulated two qualitative studies: a) secondary analysis of 126 narrative reports detailing implementation progress from 21 BPSOs spanning four sectors to identify strategies and processes used to support the implementation and sustainability of BPGs and b) interviews with 25 guideline implementers to identify additional strategies and processes. In Phase 2, we evaluated correlations between strategies and processes identified from the narrative reports and one process and one outcome indicator for each of the guideline. In Phase 3, the results from Phases 1 and 2 informed indicator development, led by an expert panel. In Phase 4, the indicators were assessed internally by RNAO staff and externally by Ontario Health Teams. A survey was used to validate proposed indicators to determine relevance, feasibility, readability, and usability with knowledge users and BPSO leaders. Results Triangulation of the two qualitative studies revealed 46 codes of implementation and sustainability of BPGs, classified into eight overarching themes: Stakeholder Engagement, Practice Interventions, Capacity Building, Evidence-Based Culture, Leadership, Evaluation & Monitoring, Communication, and Governance. A total of 28 structure, process, or outcome indicators were developed. End users and BPSO leaders were agreeable with the indicators according to the validation survey. Conclusions Many processes and strategies can influence the implementation and sustainability of BPGs at BPSOs. We have developed indicators that can help BPSOs promote evidence-informed practice implementation of BPGs.
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Affiliation(s)
- Laura D. Aloisio
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Nicole Graham
- University of Ottawa, Faculty of Health Sciences, School of Nursing, Ottawa, ON, Canada
| | - Doris Grinspun
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Shanoja Naik
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Mary Coughlin
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Christina Medeiros
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | | | - Anne Sales
- Sinclair School of Nursing and Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Susan McNeill
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Wilmer J. Santos
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Janet E. Squires
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- University of Ottawa, Faculty of Health Sciences, School of Nursing, Ottawa, ON, Canada
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Nadalin Penno L, Graham ID, Backman C, Davies B, Squires J. The SITS framework: sustaining innovations in tertiary settings. FRONTIERS IN HEALTH SERVICES 2023; 3:1102428. [PMID: 37363733 PMCID: PMC10287174 DOI: 10.3389/frhs.2023.1102428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/08/2023] [Indexed: 06/28/2023]
Abstract
Background To date, little attention has focused on what the determinants are and how evidence-based practices (EBPs) are sustained in tertiary settings (i.e., acute care hospitals). Current literature reveals several frameworks designed for implementation of EBPs (0-2 years), yet fewer exist for the sustainment of EBPs (>2 years) in clinical practice. Frameworks containing both phases generally list few determinants for the sustained use phase, but rather state ongoing monitoring or evaluation is necessary. Notably, a recent review identified six constructs and related strategies that facilitate sustainment, however, the pairing of determinants and how best to sustain EBPs in tertiary settings over time remains unclear. The aim of this paper is to present an evidence-informed framework, which incorporates constructs, determinants, and knowledge translation interventions (KTIs) to guide implementation practitioners and researchers in the ongoing use of EBPs over time. Methods We combined the results of a systematic review and theory analysis of known sustainability frameworks/models/theories (F/M/Ts) with those from a case study using mixed methods that examined the ongoing use of an organization-wide pain EBP in a tertiary care center (hospital) in Canada. Data sources included peer-reviewed sustainability frameworks (n = 8) related to acute care, semi-structured interviews with nurses at the department (n = 3) and unit (n = 16) level, chart audits (n = 200), and document review (n = 29). We then compared unique framework components to the evolving literature and present main observations. Results We present the Sustaining Innovations in Tertiary Settings (SITS) framework which consists of 7 unique constructs, 49 determinants, and 29 related KTIs that influence the sustainability of EBPs in tertiary settings. Three determinants and 8 KTIs had a continuous influence during implementation and sustained use phases. Attention to the level of application and changing conditions over time affecting determinants is required for sustainment. Use of a participatory approach to engage users in designing remedial plans and linking KTIs to target behaviors that incrementally address low adherence rates promotes sustainability. Conclusions The SITS framework provides a novel resource to support future practice and research aimed at sustaining EBPs in tertiary settings and improving patient outcomes. Findings confirm the concept of sustainability is a "dynamic ongoing phase".
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Affiliation(s)
- Letitia Nadalin Penno
- Faculty of Environment and Health Sciences, Canadore College, North Bay, ON, Canada
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Centre for Implementation Research, Ottawa Health Research Institute, Ottawa, ON, Canada
| | - Chantal Backman
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Barbara Davies
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Janet Squires
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Centre for Implementation Research, Ottawa Health Research Institute, Ottawa, ON, Canada
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Pack A, Bailey SC, Light SW, Zuleta A, Batio S, Svoboda S, Cross MW, Wolf M. Development and Validation of COVID-19 Vaccine Messaging Materials for Latinx Communities. JOURNAL OF HEALTH COMMUNICATION 2023; 28:264-271. [PMID: 37038762 PMCID: PMC10330455 DOI: 10.1080/10810730.2023.2199255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
With pervasive health misinformation and mistrust, many of those at greatest risk from COVID-19 have demonstrated lower vaccine acceptance. In Chicago, IL, surveillance data has revealed lower rates of vaccine uptake among Black and Latinx individuals compared with others. We partnered with two local federally qualified health centers (FQHCs) to develop and implement language-concordant, low literacy patient education materials to promote COVID-19 vaccine knowledge, acceptance, and uptake. Our multi-phase study included: 1) iterative content generation and refinement by health literacy experts, health center providers and staff, and community-dwelling adults; and 2) materials testing via a two-arm randomized experiment among adults from Latinx communities in the Chicagoland area. Results indicate that our English and Spanish-language COVID-19 Fact Sheets increase knowledge about COVID-19 vaccination. These materials are publicly available and can be used by health centers or community organizations to promote COVID-19 vaccination among diverse populations.
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Affiliation(s)
- Allison Pack
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA
| | - Stacy Cooper Bailey
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA
| | - Sophia W Light
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA
| | - Andrea Zuleta
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA
| | - Stephanie Batio
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA
| | - Sophia Svoboda
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA
| | | | - Michael Wolf
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA
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Kennedy E. An Evidence-Based Approach to Protecting Our Biggest Organ: Implementation of a Skin, Surface, Keep Moving, Incontinence/Moisture, and Nutrition/Hydration (SSKIN) Care Bundle. J Dr Nurs Pract 2023; 16:62-80. [PMID: 36918286 DOI: 10.1891/jdnp-2021-0040] [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: 03/15/2023]
Abstract
Background: The skin, surface, keep moving, incontinence/moisture, and nutrition/hydration (SSKIN) bundle is a resource to aid in care planning when at risk of pressure injuries. The bundle uses best practices to minimize variations in care. Objectives: The objectives of this quality improvement (QI) pilot project were as follows: (a) increase nurses' knowledge of pressure injury prevention, (b) increase nurses' knowledge of the use of the SSKIN bundle, and (c) to pilot the use of an SSKIN bundle in the clinical setting designed to standardize nursing interventions and documentation. Methods: Nurses completed a module on pressure injury prevention that included a pre- and posttest to determine knowledge. Education on the use of the SSKIN bundle was provided, followed by a posttest to establish understanding and knowledge gained. The bundle was utilized in the acute inpatient rehabilitation unit for 4 weeks, and compliance was assessed using the "all-or-none" approach (100% compliance). At the conclusion of the pilot project, staff nurses completed a post-survey created by the QI leader (Likert scale format). The survey included topics on the ease of learning to use the bundle, improved knowledge, perceived reduction in variation of care, perceived facilitation of discussion on skin, opinions on whether the bundle should be instituted hospital-wide, and incorporation of the bundle into the electronic health record (EHR). Results: There was an increase in pressure injury prevention knowledge from an average score of 88.89% on the pretest to 98.15% on the posttest. The mean score on the SSKIN bundle posttest was 93.75%. The bundle ran for 4 weeks and was initiated for ten patients during 74 shifts. Compliance with all components of the bundle was 77%. Conclusion: A pressure injury prevention initiative, such as the SSKIN bundle, can be a useful tool to help standardize nursing interventions and documentation. Implications for Nursing: Results revealed Nutrition as the component with the highest degree of noncompliance. Practice recommendations include documenting every patients nutrition information, regardless of Braden score.
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Affiliation(s)
- Erin Kennedy
- Wayne State University, College of Nursing, Detroit, Michigan, USA .,Assistant Professor, Oakland University School of Nursing, Rochester, Michigan, USA
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Protocol for a hybrid II study exploring the feasibility of delivering, evaluating, and implementing a self-management programme for people with neuromuscular diseases at a specialist neuromuscular centre. Pilot Feasibility Stud 2023; 9:4. [PMID: 36624548 PMCID: PMC9827010 DOI: 10.1186/s40814-022-01231-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Self-management support (SMS) forms a central pillar in the management of long-term conditions. It is firmly aligned with UK health policy but there is a paucity of evidence exploring how it is enacted in the context of neuromuscular diseases (NMDs). Bridges is a SMS programme originally developed in stroke. A new version of the programme (Neuromuscular Bridges) has recently been co-designed with people with lived experience of NMD and requires evaluation. The implementation of SMS is inherently complex with potential barriers at the level of the patient, provider, and wider organisation. The success of implementing programmes can be highly dependent on context, indicating a rationale for considering implementation determinants at an early stage. This study aims to explore the feasibility of (1) delivering, (2) evaluating, and (3) implementing Neuromuscular Bridges at a specialist neuromuscular centre. METHODS This study employs a hybrid II design underpinned by Normalisation Process Theory (NPT), which has been used prospectively to inform the implementation plan and will also inform the analysis. The feasibility of delivering, evaluating, and implementing Neuromuscular Bridges will be assessed using a single-arm pre-post design. In terms of delivery and evaluation, we will explore acceptability, demand within the service, performance of outcome measures, recruitment, and retention. Implementation strategies have been selected from a refined taxonomy of strategies, mapped to NPT, and targeted at known barriers and facilitators at the specialist centre that were identified from preliminary stakeholder engagement activities. The impact of the strategy bundle on fidelity, acceptability, appropriateness, and adoption will be evaluated using qualitative interviews, administrative data, surveys, and a notes audit. CONCLUSIONS This this study will provide valuable feasibility data on a co-designed SMS programme for people with NMDs that will be used to inform a larger implementation study, requirements for embedding it in a specialist centre, and rollout to other specialist centres. Using hybrid methodology at the feasibility stage is unusual and this study will provide important insights into the usefulness of taking this approach at this point in the research pipeline. TRIAL REGISTRATION ISRCTN Trial ID: ISRCTN14208138 . Date registered: 18/08/2021.
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O’Donnell A, Anderson P, Schmidt C, Braddick F, Lopez-Pelayo H, Mejía-Trujillo J, Natera G, Arroyo M, Bautista N, Piazza M, Bustamante IV, Kokole D, Jackson K, Jane-Llopis E, Gual A, Schulte B. Tailoring an evidence-based clinical intervention and training package for the treatment and prevention of comorbid heavy drinking and depression in middle-income country settings: the development of the SCALA toolkit in Latin America. Glob Health Action 2022; 15:2080344. [PMID: 35867541 PMCID: PMC9310809 DOI: 10.1080/16549716.2022.2080344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/16/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Effective interventions exist for heavy drinking and depression but to date there has been limited translation into routine practice in global health systems. This evidence-to-practice gap is particularly evident in low- and middle-income countries. The international SCALA project (Scale-up of Prevention and Management of Alcohol Use Disorders and Comorbid Depression in Latin America) sought to test the impact of multilevel implementation strategies on rates of primary health care-based measurement of alcohol consumption and identification of depression in Colombia, Mexico, and Peru. OBJECTIVE To describe the process of development and cultural adaptation of the clinical intervention and training package. METHODS We drew on Barrero and Castro's four-stage cultural adaption model: 1) information gathering, 2) preliminary adaption, 3) preliminary adaption tests, and 4) adaption refinement. The Tailored Implementation in Chronic Diseases checklist helped us identify potential factors that could affect implementation, with local stakeholder groups established to support the tailoring process, as per the Institute for Healthcare Improvement's Going to Scale Framework. RESULTS In Stage 1, international best practice guidelines for preventing heavy drinking and depression, and intelligence on the local implementation context, were synthesised to provide an outline clinical intervention and training package. In Stage 2, feedback was gathered from local stakeholders and materials refined accordingly. These materials were piloted with local trainers in Stage 3, leading to further refinements including developing additional tools to support delivery in busy primary care settings. Stage 4 comprised further adaptions in response to real-world implementation, a period that coincided with the onset of the COVID-19 pandemic, including translating the intervention and training package for online delivery, and higher priority for depression screening in the clinical pathway. CONCLUSION Our experience highlights the importance of meaningful engagement with local communities, alongside the need for continuous tailoring and adaptation, and collaborative decision-making.
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Affiliation(s)
- Amy O’Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter Anderson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Christiane Schmidt
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fleur Braddick
- Addictions Unit, Psychiatry Department, Hospital Clínic, Barcelona, Spain
| | - Hugo Lopez-Pelayo
- Addictions Unit, Psychiatry Department, Hospital Clínic, Barcelona, Spain
- Red de Trastornos Adictivos, Instituto Carlos III. Sinesio Delgado, Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS); Rosselló, Barcelona, Spain
| | | | - Guillermina Natera
- Instituto Nacional de Psiquiatría Ram´on de la Fuente, Ciudad de México, Mexico
| | - Miriam Arroyo
- Instituto Nacional de Psiquiatría Ram´on de la Fuente, Ciudad de México, Mexico
| | - Natalia Bautista
- Instituto Nacional de Psiquiatría Ram´on de la Fuente, Ciudad de México, Mexico
| | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martin de Porres, Peru
| | - Ines V. Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martin de Porres, Peru
| | - Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Katherine Jackson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eva Jane-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Institute for Mental Health Policy Research, Toronto, Ontario, Canada
- Univ. Ramon Llull, ESADE, Barcelona, Spain
| | - Antoni Gual
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS); Rosselló, Barcelona, Spain
| | - Bernd Schulte
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Baldwin LM, Tuzzio L, Cole AM, Holden E, Powell JA, Parchman ML. Tailoring Implementation Strategies for Cardiovascular Disease Risk Calculator Adoption in Primary Care Clinics. J Am Board Fam Med 2022; 35:1143-1155. [PMID: 36460353 PMCID: PMC10691203 DOI: 10.3122/jabfm.2022.210449r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/19/2022] [Accepted: 02/24/2022] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION When implementing interventions in primary care, tailoring implementation strategies to practice barriers can be effective, but additional work is needed to understand how to best select these strategies. This study sought to identify clinicians' contributions to the process of tailoring implementation strategies to barriers in clinical settings. METHODS We conducted a modified nominal group exercise involving 8 implementation scientists and 26 primary care clinicians in the WWAMI region Practice and Research Network. Each group identified implementation strategies it felt would best address barriers to using a cardiovascular disease (CVD) risk calculator previously identified across 44 primary care clinics from the Healthy Hearts Northwest pragmatic trial (2015 to 2018). These barriers had been mapped beforehand to the Consolidated Framework for Implementation Research (CFIR) domains. We examined similarities and differences in the strategies that 30% or more of each group identified (agreed-on strategies) for each barrier and for barriers in each CFIR domain. We used the results to demonstrate how strategies might be tailored to individual clinics. RESULTS Clinicians selected 23 implementation strategies to address 1 or more of the 13 barriers; implementation scientists selected 35. The 2 groups agreed on at least 1 strategy for barriers in each CFIR domain: Inner Setting, Outer Setting, Intervention Characteristics, Characteristics of Individuals, and Process. Conducting local needs assessment and assessing for readiness/identifying barriers and facilitators were the 2 most common implementation strategies chosen only by clinicians. CONCLUSIONS Clinician stakeholders identified implementation strategies that augmented those chosen by implementation scientists, suggesting that codesign of implementation processes between implementation scientists and clinicians may strengthen the process of tailoring strategies to overcome implementation barriers.
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Affiliation(s)
- Laura-Mae Baldwin
- From Department of Family Medicine, University of Washington, Seattle, WA (L-MB, AMC); Kaiser Permanente Washington Health Research Institute, Seattle, WA (LT, EH, MLP); Powell and Associates, LLC, Asheville NC (JAP)
| | - Leah Tuzzio
- From Department of Family Medicine, University of Washington, Seattle, WA (L-MB, AMC); Kaiser Permanente Washington Health Research Institute, Seattle, WA (LT, EH, MLP); Powell and Associates, LLC, Asheville NC (JAP)
| | - Allison M Cole
- From Department of Family Medicine, University of Washington, Seattle, WA (L-MB, AMC); Kaiser Permanente Washington Health Research Institute, Seattle, WA (LT, EH, MLP); Powell and Associates, LLC, Asheville NC (JAP)
| | - Erika Holden
- From Department of Family Medicine, University of Washington, Seattle, WA (L-MB, AMC); Kaiser Permanente Washington Health Research Institute, Seattle, WA (LT, EH, MLP); Powell and Associates, LLC, Asheville NC (JAP)
| | - Jennifer A Powell
- From Department of Family Medicine, University of Washington, Seattle, WA (L-MB, AMC); Kaiser Permanente Washington Health Research Institute, Seattle, WA (LT, EH, MLP); Powell and Associates, LLC, Asheville NC (JAP)
| | - Michael L Parchman
- From Department of Family Medicine, University of Washington, Seattle, WA (L-MB, AMC); Kaiser Permanente Washington Health Research Institute, Seattle, WA (LT, EH, MLP); Powell and Associates, LLC, Asheville NC (JAP)
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Elzeky MEH, Shahine NFM. Effects of an educational program using a virtual social network on nurses' knowledge and performance of blood pressure measurement: a randomized controlled trial. BMC Nurs 2022; 21:365. [PMID: 36544166 PMCID: PMC9769047 DOI: 10.1186/s12912-022-01137-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Hypertension diagnosis, treatment, and follow-up depend on accurate blood pressure measurement; however, inaccurate measurement techniques are common among healthcare providers. To improve professional performance, continuous education is necessary. Distance education through virtual social network can be used as it is easy to use and accessible. METHODS This study adopted a randomized controlled trial design and was conducted at two hospitals in Mansoura, Egypt. The subjects were selected from two hospitals using Stratified random sampling method in proportion to the total number of nurses. Seventy nurses were included in this study and were randomly divided into the intervention (n = 35) and control (n = 35) groups using block randomization. Data were gathered before and after intervention using a blood pressure measurement knowledge questionnaire and a blood pressure measurement observation checklist. The blood pressure measurement error (the difference between the BP determined by each observer and the reference BP) was calculated for the randomly selected recordings in both groups. The intervention group received 24 blood pressure measurement education sessions using WhatsApp, while the control group received only routine education using traditional lecture. RESULTS No statistically significant differences in pretest knowledge scores, performance scores, and range of error were found between both groups, whereas, after intervention, knowledge scores were higher in the intervention group than those in the control group (p < 0.001). The range of error of systolic and diastolic blood pressure values significantly reduced after the intervention in the intervention group, and the posttest performance scores were higher than the pretest performance scores; however, the difference was not statistically significant. CONCLUSIONS The blood pressure measurement education program via WhatsApp was effective in increasing nurses' knowledge and reducing the range of error; however, a multimodal approach may be required to improve performance scores. TRIAL REGISTRATION Prospectively registered with ClinicalTrials.gov on 09/03/2021; registration number NCT04789642.
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Affiliation(s)
- Mohamed E. H. Elzeky
- grid.10251.370000000103426662Medical-Surgical Nursing Department, Faculty of Nursing, Mansoura University, Dakahlia, Egypt
| | - Noha F. M. Shahine
- grid.10251.370000000103426662Gerontological Nursing Department, Faculty of Nursing, Mansoura University, Dakahlia, Egypt
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Humphries DL, Rhodes EC, Simon CL, Wang V, Spiegelman D, Ott C, Hicks D, Marcus JL, Krakower D, Rana A. Using Health Care Professionals' Perspectives to Refine a Clinical Decision Support Implementation Strategy for Increasing the Prescribing of HIV Preexposure Prophylaxis (PrEP) in Alabama. J Int Assoc Provid AIDS Care 2022; 21:23259582221144451. [PMID: 36537589 PMCID: PMC9772965 DOI: 10.1177/23259582221144451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP) is underused in the southern United States (US), a region with high HIV incidence. Clinical decision support (CDS) tools could increase PrEP prescriptions. We explored barriers to PrEP delivery and views of CDS tools to identify refinements for implementation strategies for PrEP prescribing and PrEP CDS tools. We conducted focus groups with health care providers from two federally qualified health centers in Alabama and analyzed the results using rapid qualitative methods. Barriers to PrEP included providers' lack of training in PrEP, competing priorities and time constraints during clinical visits, concerns about side effects, and intensive workload. We identified refinements to the planned implementation strategies to address the barriers, including training all clinic staff in PrEP and having CDS PrEP alerts in electronic health records sent to all staff. Development and deployment of CDS tools in collaboration with providers has potential to increase PrEP prescribing in high-priority jurisdictions.
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Affiliation(s)
- Debbie L. Humphries
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 135 College Street, New Haven, Connecticut, USA,Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut, USA,Debbie L. Humphries, P.O. Box 208034, 60 College Street, New Haven, CT 06520-0834, USA.
| | - Elizabeth C. Rhodes
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut, USA,Department of Social and Behavioral Sciences, Yale School of Public Health, 135 College Street, New Haven, Connecticut, USA
| | - Christine L. Simon
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut, USA,Department of Social and Behavioral Sciences, Yale School of Public Health, 135 College Street, New Haven, Connecticut, USA
| | - Victor Wang
- Department of Social and Behavioral Sciences, Yale School of Public Health, 135 College Street, New Haven, Connecticut, USA
| | - Donna Spiegelman
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut, USA,Department of Biostatistics, Yale School of Public Health, 135 College Street, New Haven, Connecticut, USA
| | - Corilyn Ott
- Family, Community, and Health Systems, University of Alabama-Birmingham School of Nursing, 1701 University Blvd, Birmingham, Alabama, USA
| | - David Hicks
- Jefferson County Department of Public Health, Jefferson County Department of Health, 1400 sixth Ave. S, Birmingham, Alabama, USA
| | - Julia L. Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Boston, Massachusetts, USA
| | - Doug Krakower
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Boston, Massachusetts, USA,Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Aadia Rana
- Department of Infectious Diseases, University of Alabama-Birmingham Heersink School of Medicine, 1720 second Ave. S, Birmingham, Alabama, USA
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Karabukayeva A, Hearld LR, Kelly R, Hall A, Singh J. Association between the number of adopted implementation strategies and contextual determinants: a mixed-methods study. BMC Health Serv Res 2022; 22:1518. [PMID: 36514102 PMCID: PMC9746001 DOI: 10.1186/s12913-022-08736-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 10/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The successful implementation of evidence-based innovations to improve healthcare delivery often requires a well-planned strategy to support their use. With a greater recognition of the importance of an implementation process, researchers have turned their attention to implementation strategies and their customization to target specific organizational barriers and facilitators. Further, there is a paucity of empirical evidence demonstrating the link between implementation determinants and the number of selected implementation strategies. The purpose of this mixed methods analysis is to examine how formatively assessed barriers and facilitators to implementation relate to the number and type of implementation strategies adopted to address context-specific factors. METHODS A mixed methods evaluation that included 15 rheumatology clinics throughout the United States that were planning for implementation of an evidence-based shared decision-making aid for patients with lupus. Quantitative data consisted of a count of the number of implementation strategies used by a clinic. Qualitative data collection was guided by the Consolidated Framework for Implementation Research (CFIR) and relied upon semi-structured interviews with 90 clinic members between November 2018 and August 2019. RESULTS Using the CFIR, we found that local clinic factors (Inner Setting Domain) resulted in different perceptions about Planning and Executing the DA (Process Domain); these domains were most likely to distinguish between the number and type of implementation strategies adopted by the clinics. In contrast, Intervention characteristics, Individual Characteristics, and the Outer Setting did not differentiate between the groups with different numbers of implementation strategies. The number and type of chosen strategies were not those associated with the context-specific factors. CONCLUSIONS Findings show that, despite recognition of the value of customizing implementation strategies for the contexts in which they are applied, they are too often chosen in a manner that fail to adequately reflect the diverse settings that may present unique factors associated with implementation. Our findings also highlight the importance of the inner context - both in terms of structural characteristics and existing work processes - as a driving factor for why some organizations select different numbers and types of implementation strategies.
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Affiliation(s)
- Aizhan Karabukayeva
- grid.265892.20000000106344187Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, 3201 1st Avenue North, Birmingham, AL 35222 USA
| | - Larry R. Hearld
- grid.265892.20000000106344187Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, 3201 1st Avenue North, Birmingham, AL 35222 USA
| | - Reena Kelly
- grid.266831.80000 0001 2168 8754Department of Health Administration & Policy, School of Health Sciences, University of New Haven, West Haven, CT 06516 USA
| | - Allyson Hall
- grid.265892.20000000106344187Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, 3201 1st Avenue North, Birmingham, AL 35222 USA
| | - Jasvinder Singh
- grid.265892.20000000106344187Division of Immunology and Rheumatology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35222 USA
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Peters S, Sukumar K, Blanchard S, Ramasamy A, Malinowski J, Ginex P, Senerth E, Corremans M, Munn Z, Kredo T, Remon LP, Ngeh E, Kalman L, Alhabib S, Amer YS, Gagliardi A. Trends in guideline implementation: an updated scoping review. Implement Sci 2022; 17:50. [PMID: 35870974 PMCID: PMC9308215 DOI: 10.1186/s13012-022-01223-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background Guidelines aim to support evidence-informed practice but are inconsistently used without implementation strategies. Our prior scoping review revealed that guideline implementation interventions were not selected and tailored based on processes known to enhance guideline uptake and impact. The purpose of this study was to update the prior scoping review. Methods We searched MEDLINE, EMBASE, AMED, CINAHL, Scopus, and the Cochrane Database of Systematic Reviews for studies published from 2014 to January 2021 that evaluated guideline implementation interventions. We screened studies in triplicate and extracted data in duplicate. We reported study and intervention characteristics and studies that achieved impact with summary statistics. Results We included 118 studies that implemented guidelines on 16 clinical topics. With regard to implementation planning, 21% of studies referred to theories or frameworks, 50% pre-identified implementation barriers, and 36% engaged stakeholders in selecting or tailoring interventions. Studies that employed frameworks (n=25) most often used the theoretical domains framework (28%) or social cognitive theory (28%). Those that pre-identified barriers (n=59) most often consulted literature (60%). Those that engaged stakeholders (n=42) most often consulted healthcare professionals (79%). Common interventions included educating professionals about guidelines (44%) and information systems/technology (41%). Most studies employed multi-faceted interventions (75%). A total of 97 (82%) studies achieved impact (improvements in one or more reported outcomes) including 10 (40% of 25) studies that employed frameworks, 28 (47.45% of 59) studies that pre-identified barriers, 22 (52.38% of 42) studies that engaged stakeholders, and 21 (70% of 30) studies that employed single interventions. Conclusions Compared to our prior review, this review found that more studies used processes to select and tailor interventions, and a wider array of types of interventions across the Mazza taxonomy. Given that most studies achieved impact, this might reinforce the need for implementation planning. However, even studies that did not plan implementation achieved impact. Similarly, even single interventions achieved impact. Thus, a future systematic review based on this data is warranted to establish if the use of frameworks, barrier identification, stakeholder engagement, and multi-faceted interventions are associated with impact. Trial registration The protocol was registered with Open Science Framework (https://osf.io/4nxpr) and published in JBI Evidence Synthesis. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01223-6.
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Bucher A, Blazek ES, West AB. Feasibility of a Reinforcement Learning-Enabled Digital Health Intervention to Promote Mammograms: Retrospective, Single-Arm, Observational Study. JMIR Form Res 2022; 6:e42343. [PMID: 36441579 DOI: 10.2196/42343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Preventive screenings such as mammograms promote health and detect disease. However, mammogram attendance lags clinical guidelines, with roughly one-quarter of women not completing their recommended mammograms. A scalable digital health intervention leveraging behavioral science and reinforcement learning and delivered via email was implemented in a US health system to promote uptake of recommended mammograms among patients who were 1 or more years overdue for the screening (ie, 2 or more years from last mammogram). OBJECTIVE The aim of this study was to establish the feasibility of a reinforcement learning-enabled mammography digital health intervention delivered via email. The research aims included understanding the intervention's reach and ability to elicit behavioral outcomes of scheduling and attending mammograms, as well as understanding reach and behavioral outcomes for women of different ages, races, educational attainment levels, and household incomes. METHODS The digital health intervention was implemented in a large Catholic health system in the Midwestern United States and targeted the system's existing patients who had not received a recommended mammogram in 2 or more years. From August 2020 to July 2022, 139,164 eligible women received behavioral science-based email messages assembled and delivered by a reinforcement learning model to encourage clinically recommended mammograms. Target outcome behaviors included scheduling and ultimately attending the mammogram appointment. RESULTS In total, 139,164 women received at least one intervention email during the study period, and 81.52% engaged with at least one email. Deliverability of emails exceeded 98%. Among message recipients, 24.99% scheduled mammograms and 22.02% attended mammograms (88.08% attendance rate among women who scheduled appointments). Results indicate no practical differences in the frequency at which people engage with the intervention or take action following a message based on their age, race, educational attainment, or household income, suggesting the intervention may equitably drive mammography across diverse populations. CONCLUSIONS The reinforcement learning-enabled email intervention is feasible to implement in a health system to engage patients who are overdue for their mammograms to schedule and attend a recommended screening. In this feasibility study, the intervention was associated with scheduling and attending mammograms for patients who were significantly overdue for recommended screening. Moreover, the intervention showed proportionate reach across demographic subpopulations. This suggests that the intervention may be effective at engaging patients of many different backgrounds who are overdue for screening. Future research will establish the effectiveness of this type of intervention compared to typical health system outreach to patients who have not had recommended screenings as well as identify ways to enhance its reach and impact.
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Fridberg H, Wallin L, Tistad M. Tracking, naming, specifying, and comparing implementation strategies for person-centred care in a real-world setting: a case study with seven embedded units. BMC Health Serv Res 2022; 22:1409. [PMID: 36424611 PMCID: PMC9685853 DOI: 10.1186/s12913-022-08846-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The implementation of person-centred care (PCC) is advocated worldwide. Stakeholders in charge of implementing PCC as a broad-scale change across the health care sector face two intertwined and complex challenges. First, making sense of PCC as an intervention with complex innovation characteristics and second, staging implementation of PCC by choosing appropriate implementation strategies. We aimed to explore one of these challenges by tracking, naming, specifying, and comparing which strategies and how strategies were enacted to support the implementation of more PCC in a real-world setting represented by one health care region in Sweden. METHODS A case study with seven embedded units at two organisational levels within a health care region was conducted from 2016 to 2019. Data were collected from three sources: activity logs, interviews, and written documents. Strategies were identified from all sources and triangulated deductively by name, definition, and cluster in line with the taxonomy Expert Recommendations for Implementing Change (ERIC) and specified according to recommendations by Proctor and colleagues as actor, action, action target, temporality, dose, outcome, and justification. RESULTS Four hundred thirteen activities were reported in logs, representing 43 discrete strategies identified in ERIC (n = 38), elsewhere (n = 1), or as emerging strategies (n = 4). The highest reported frequencies of discrete strategies were identified as belonging to two clusters: Train and educate stakeholders (40%) and Develop stakeholder interrelationships (38%). We identified a limited number of strategies belonging to the cluster Use evaluative and iterative strategies (4.6%) and an even smaller number of strategies targeting information to patients about the change initiative (0.8%). Most of the total dose of 11,076 person-hours in the 7 units was spent on strategies targeting health care professionals who provide PCC (81.5%) while the dose of strategies targeting support functions was 18.5%. CONCLUSIONS Our findings show both challenges and merits when strategies for implementation of PCC are conducted in a real-world setting. The results can be used to support and guide both scientists and practitioners in future implementation initiatives.
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Affiliation(s)
- Helena Fridberg
- grid.411953.b0000 0001 0304 6002School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Lars Wallin
- grid.411953.b0000 0001 0304 6002School of Health and Welfare, Dalarna University, Falun, Sweden ,grid.8761.80000 0000 9919 9582Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Malin Tistad
- grid.411953.b0000 0001 0304 6002School of Health and Welfare, Dalarna University, Falun, Sweden ,grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Dontje ML, Kruitwagen-van Reenen E, van Wijk E, Baars E, Visser-Meily JMA, Beelen A. Evaluation of the nation-wide implementation of ALS home monitoring & coaching: an e-health innovation for personalized care for patients with motor neuron disease. BMC Health Serv Res 2022; 22:1389. [PMID: 36419109 PMCID: PMC9682770 DOI: 10.1186/s12913-022-08724-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/23/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To improve the care for patients with motor neuron disease an e-health innovation for continuous monitoring of disease progression and patients' well-being (ALS H&C) was implemented in 10 multidisciplinary rehabilitation settings. The first aim was to evaluate the implementation of ALS H&C by assessing several implementation outcomes, technology acceptance and usability of the innovation according to the end users. The secondary aim was to explore differences in these outcomes between the teams with sustainable and unsustainable implementation. METHODS The chosen implementation strategy was a combination of the implementation process model by Grol & Wensing and a participatory action research approach. In three meetings with multidisciplinary project groups the innovation was introduced, the expected barriers/facilitators identified, and action plans to resolve each barrier developed. After a 3-month pilot phase, patients and their healthcare providers were asked to complete an online evaluation survey to assess implementation outcomes, based on Proctor's evaluation framework (i.e., acceptability, feasibility, fidelity, sustainability). Telemedicine technology acceptance was assessed according the technology acceptance model of Chau, and user experiences with the System Usability Scale (SUS). Implementation outcomes of teams with sustainable implementation (continuation after completion of the pilot phase) and unsustainable implementation (discontinuation after the pilot phase) were compared. RESULTS The implementation outcomes from the patients' perspective (N = 71) were positive; they found ALS H&C to be an acceptable and feasible care concept. Patients' technology acceptance was high, with positive attitudes towards ALS H&C, and positive views on perceived technology control, usefulness, and ease of use. Patients rated their satisfaction with the (web) app on a scale from 1 (not satisfied at all) to 10 (very satisfied) with a 7.0 (median; IQR 1.0). Healthcare providers (N = 76) also found ALS H&C acceptable and appropriate as well, but were less positive about the feasibility and usability of ALS H&C (mean SUS 58.8 [SD 11.3]). ALS H&C has largely been implemented as intended and the implementation was sustainable in 7 teams. Teams who discontinued ALS H&C after the pilot phase (N = 2) had more fidelity issues. CONCLUSIONS A participatory action research approach supported by theoretical approaches used in implementation science led to a sustainable implementation of ALS H&C in 7 of the participating teams. To improve implementation success, additional implementation strategies to increase feasibility, usability and fidelity are necessary. TRIAL REGISTRATION Trial NL8542 registered at Netherlands Trial Register (trialregister.nl) on 15th April 2020.
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Affiliation(s)
- M. L. Dontje
- grid.7692.a0000000090126352Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Centre, University Medical Centre, Utrecht, the Netherlands ,grid.7692.a0000000090126352Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - E. Kruitwagen-van Reenen
- grid.7692.a0000000090126352Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Centre, University Medical Centre, Utrecht, the Netherlands ,grid.7692.a0000000090126352Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - E. van Wijk
- Department of Rehabilitation, Northwest Clinics, Alkmaar/Den Helder, Alkmaar, The Netherlands
| | - E. Baars
- De Vogellanden centre for rehabilitation, Zwolle, The Netherlands
| | - J. M. A. Visser-Meily
- grid.7692.a0000000090126352Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Centre, University Medical Centre, Utrecht, the Netherlands ,grid.7692.a0000000090126352Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - A. Beelen
- grid.7692.a0000000090126352Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Centre, University Medical Centre, Utrecht, the Netherlands ,grid.7692.a0000000090126352Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
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Pulia MS, Schwei RJ, Hesse SP, Werner NE. Characterizing barriers to antibiotic stewardship for skin and soft-tissue infections in the emergency department using a systems engineering framework. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e180. [PMID: 36386011 PMCID: PMC9641503 DOI: 10.1017/ash.2022.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Skin and soft-tissue infections (SSTIs) account for 3% of all emergency department (ED) encounters and are frequently associated with inappropriate antibiotic prescribing. We characterized barriers and facilitators to optimal antibiotic use for SSTIs in the ED using a systems engineering framework and matched them with targeted stewardship interventions. DESIGN AND PARTICIPANTS We conducted semistructured interviews with a purposefully selected sample of emergency physicians. METHODS An interview guide was developed using the Systems Engineering Initiative for Patient Safety (SEIPS) framework. Interviews were recorded, transcribed, and analyzed iteratively until conceptual saturation was achieved. Themes were identified using deductive directed content analysis guided by the SEIPS model. RESULTS We conducted 20 interviews with physicians of varying experience and from different practice settings. Identified barriers to optimal antibiotic prescribing for SSTIs included poor access to follow-up (organization), need for definitive diagnostic tools (tools and technology) and fear over adverse outcomes related to missed infections (person). Identified potential interventions included programs to enhance follow-up care; diagnostic aides (eg, rapid MRSA assays for purulent infections and surface thermal imaging for cellulitis); and shared decision-making tools. CONCLUSIONS Using a systems engineering informed qualitative approach, we successfully characterized barriers and developed targeted antibiotic stewardship interventions for SSTIs managed in the ED work system. The interventions span multiple components of the ED work system and should inform future efforts to improve antibiotic stewardship for SSTIs in this challenging care setting.
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Affiliation(s)
- Michael S. Pulia
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin—Madison School of Medicine and Public Health, Madison, Wisconsin
- Department of Industrial and Systems Engineering, University of Wisconsin—Madison, Madison, Wisconsin
| | - Rebecca J. Schwei
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin—Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Steven P. Hesse
- University of Wisconsin—Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Nicole E. Werner
- Department of Industrial and Systems Engineering, University of Wisconsin—Madison, Madison, Wisconsin
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Tewari P, Sweeney BF, Lemos JL, Shapiro L, Gardner MJ, Morris AM, Baker LC, Harris AS, Kamal RN. Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures: A Systematic Review. JAMA Netw Open 2022; 5:e2231911. [PMID: 36112373 PMCID: PMC9482052 DOI: 10.1001/jamanetworkopen.2022.31911] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Longer time to surgery (TTS) for hip fractures has been associated with higher rates of postoperative complications and mortality. Given that more than 300 000 adults are hospitalized for hip fractures in the United States each year, various improvement programs have been implemented to reduce TTS with variable results, attributed to contextual patient- and system-level factors. OBJECTIVE To catalog TTS improvement programs, identify their results, and categorize program strategies according to Expert Recommendations for Implementing Change (ERIC), highlighting components of successful improvement programs within their associated contexts and seeking to guide health care systems in implementing programs designed to reduce TTS. EVIDENCE REVIEW A systematic review was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline. Three databases (MEDLINE/PubMed, EMBASE, and Cochrane Trials) were searched for studies published between 2000 and 2021 that reported on improvement programs for hip fracture TTS. Observational studies in high-income country settings, including patients with surgical, low-impact, nonpathological hip fractures aged 50 years or older, were considered for review. Improvement programs were assessed for their association with decreased TTS, and ERIC strategies were matched to improvement program components. FINDINGS Preliminary literature searches yielded 1683 articles, of which 69 articles were included for final analysis. Among the 69 improvement programs, 49 were associated with significantly decreased TTS, and 20 programs did not report significant decreases in TTS. Among 49 successful improvement programs, the 5 most common ERIC strategies were (1) assess for readiness and identify barriers and facilitators, (2) develop a formal implementation blueprint, (3) identify and prepare champions, (4) promote network weaving, and (5) develop resource-sharing agreements. CONCLUSIONS AND RELEVANCE In this systematic review, certain components (eg, identifying barriers and facilitators to program implementation, developing a formal implementation blueprint, preparing intervention champions) are common among improvement programs that were associated with reducing TTS and may inform the approach of hospital systems developing similar programs. Other strategies had mixed results, suggesting local contextual factors (eg, operating room availability) may affect their success. To contextualize the success of a given improvement program across different clinical settings, subsequent investigation must elucidate the association between interventional success and facility-level factors influencing TTS, such as hospital census and type, teaching status, annual surgical volume, and other factors.
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Affiliation(s)
- Pariswi Tewari
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Brian F. Sweeney
- Stanford University School of Medicine, Mountain View, California
| | - Jacie L. Lemos
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Lauren Shapiro
- Department of Orthopaedic Surgery, University of California, San Francisco
| | - Michael J. Gardner
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Arden M. Morris
- Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University, Stanford, California
| | - Laurence C. Baker
- Department of Health Research and Policy, Stanford University, Stanford, California
| | - Alex S. Harris
- Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University, Stanford, California
| | - Robin N. Kamal
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
- VOICES Health Policy Research Center, Stanford University, Stanford, California
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Scheffler B, Schimböck F, Schöler A, Rösner K, Spallek J, Kopkow C. Current physical therapy practice and implementation factors regarding the evidence-based 'Rehabilitation of Mobility after Stroke (ReMoS)' guideline in Germany: a cross-sectional online survey. BMC Neurol 2022; 22:284. [PMID: 35907809 PMCID: PMC9338587 DOI: 10.1186/s12883-022-02780-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/24/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Evaluation of the current physical therapy practice for German stroke rehabilitation with respect to the 'Rehabilitation of Mobility after Stroke (ReMoS)' guideline recommendations and the associated implementation factors. METHODS A descriptive cross-sectional study employing an online survey was performed among German physical therapists in 2019. The survey consisted of three sections with open and closed questions: 1) self-reported use of ReMoS recommendations, 2) barriers of guideline use and 3) socio-demographic characteristics. The benchmark level for guideline adherent physical therapy was set at > 80%. RESULTS Data from 170 questionnaires were eligible for analysis. Participants' mean age was 41.6 years, 69.4% were female, while 60.1% had no academic degree. The ReMoS guideline was unknown to 52.9% of the responders. Out of all the 46 ReMoS guideline recommendations, only 'intensive walking training without a treadmill' was reported to be performed in a guideline adherent manner. Respondents usually denied any personal limitations, such as limited knowledge, or that the ReMoS guideline did not fit their routine practice. CONCLUSIONS Among German physical therapists, the ReMoS guideline is not well-known and many interventions are not performed as recommended, illustrating the discrepancies between the ReMoS guideline recommendations and current physical therapy practice. Interventions aimed at overcoming this gap should consider both knowledge of existing barriers and facilitators of guideline usage. TRIAL REGISTRATION The study was retrospectively registered to the German Clinical Trials Register ( DRKS00026681 ).
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Affiliation(s)
- Bettina Scheffler
- Department of Therapy Sciences I, Brandenburg University of Technology Cottbus-Senftenberg, Universitaetsplatz 1, 01968, Senftenberg, Germany.
| | - Florian Schimböck
- Department of Nursing Sciences and Clinical Nursing, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Almut Schöler
- Department of Therapy Sciences I, Brandenburg University of Technology Cottbus-Senftenberg, Universitaetsplatz 1, 01968, Senftenberg, Germany
| | - Katrin Rösner
- Institute of Health Sciences, Department of Physiotherapy, University of Luebeck, Lübeck, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Christian Kopkow
- Department of Therapy Sciences I, Brandenburg University of Technology Cottbus-Senftenberg, Universitaetsplatz 1, 01968, Senftenberg, Germany
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Kakar E, van Ruler O, van Straten B, Hoogteijling B, de Graaf EJR, Ista E, Lange JF, Jeekel J, Klimek M. Implementation of music in colorectal perioperative standard care-barriers and facilitators among patients and healthcare professionals. Colorectal Dis 2022; 24:868-875. [PMID: 35194930 PMCID: PMC9544166 DOI: 10.1111/codi.16102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/26/2022] [Accepted: 02/12/2022] [Indexed: 02/08/2023]
Abstract
AIM Perioperative anxiety and pain are still prevalent among patients undergoing surgery. Inflammatory bowel disease and colorectal cancer patients are known to have higher anxiety rates than the general population. Perioperatively applied music intervention has been proven to be effective in reducing perioperative anxiety and pain, resulting in a decrease of intra-operative sedative use, postoperative opioid requirement and neurohormonal stress response. IMPROVE evaluates the adherence to music intervention in colorectal perioperative standard care during systematic implementation. METHOD The Consolidated Framework for Implementation Research (CFIR) was used for implementation in three steps. This study addresses the first step in which barriers and facilitators for implementing perioperative music were identified by surveying patients who underwent colorectal surgery and healthcare professionals involved in perioperative care. Also, perioperative anxiety scores were assessed and data on perioperative pain was collected from the patients' medical records. RESULTS Fifty patients and 69 professionals (response rate 68.3%) were surveyed. For patients, all domains of the CFIR were facilitating implementation. The median reported preoperative and postoperative anxiety scores were 4.5 (1.0-7.0) and 3.0 (1.0-5.75) respectively. The median postoperative pain score on the first postoperative day was 2.8 (2.0-3.7). Also, for professionals most domains were facilitating, except for some factors related to work climate and culture among nurses. CONCLUSIONS In this study it was identified that facilitating factors for implementing music in standard perioperative care were more prominent in both patients and healthcare professionals and therefore successful implementation is probable. Also, this study provides a guideline for assessing facilitators and barriers in other settings.
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Affiliation(s)
- Ellaha Kakar
- Department of Surgery and Intensive Care UnitErasmus MCUniversity Medical CentreRotterdamThe Netherlands
| | - Oddeke van Ruler
- Department of SurgeryIJsselland HospitalCapelle aan den IJsselThe Netherlands
| | | | - Bas Hoogteijling
- Department of AnesthesiologyIJsselland HospitalCapelle aan den IJsselThe Netherlands
| | | | - Erwin Ista
- Department of Internal MedicineSection Nursing ScienceUniversity Medical CentreErasmus MCRotterdamThe Netherlands
| | - Johan F. Lange
- Department of SurgeryUniversity Medical CentreErasmus MCRotterdamThe Netherlands
| | - Johannes Jeekel
- Department of SurgeryUniversity Medical CentreErasmus MCRotterdamThe Netherlands
| | - Markus Klimek
- Department of AnesthesiologyUniversity Medical CentreErasmus MCRotterdamThe Netherlands
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Pritchard-Wiart L, Thompson-Hodgetts S, McKillop AB, Rosychuk R, Mrklas K, Zwaigenbaum L, Zwicker J, Andersen J, King G, Firouzeh P. A multi-center, pragmatic, effectiveness-implementation (hybrid I) cluster randomized controlled trial to evaluate a child-oriented goal-setting approach in paediatric rehabilitation (the ENGAGE approach): a study protocol. BMC Pediatr 2022; 22:375. [PMID: 35764983 PMCID: PMC9241221 DOI: 10.1186/s12887-022-03381-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Child-oriented goal-setting in pediatric rehabilitation may improve child motivation, engagement in therapy, child outcomes related to therapy, and service delivery efficiency. The primary objective of this trial is to determine the effectiveness of a principles-driven, child-focused approach to goal-setting, Enhancing Child Engagement in Goal-Setting (ENGAGE), on pediatric rehabilitation outcomes compared to usual practice. The three secondary objectives are to 1) compare costs and secondary outcomes of the ENGAGE approach to usual practice, 2) determine the influence of child, parent and therapist characteristics on child engagement in therapy and rehabilitation outcomes, and 3) identify barriers and facilitators to the implementation of ENGAGE. METHODS This research protocol describes a pragmatic, multi-site, cluster, effectiveness-implementation (hybrid type 1 design) randomized controlled trial. Therapists (n = 12 clusters of two therapists) at participating sites (n = 6) will be randomized to 1) the ENGAGE intervention group, or 2) usual care (control) using a computer-generated, permuted-block randomization sequence with site as a stratification variable designed by a statistician (RR). Each therapist will recruit four children 5-12 years old with neurodevelopmental conditions (n = 96), who will receive ENGAGE or usual care, according to therapist group allocation. ENGAGE therapists will be trained to use a 'toolbox' of evidence-driven, theory-informed principles to optimize child and parent motivation, engagement in the goal-setting process, and performance feedback strategies. Outcomes include goal performance (primary outcome), engagement in therapy, functional abilities, participation, and parent and child quality of life. Qualitative interviews with children, parents, ENGAGE therapists, and managers will explore challenges to implementation and potential mitigation strategies. Mixed effects multiple linear regression models will be developed for each outcome to assess group differences adjusted for clustering. A cost-effectiveness analysis will combine cost and a measure of effectiveness into an incremental cost-effectiveness ratio. Qualitative data on implementation will be analyzed inductively (thematic analysis) and deductively using established implementation science frameworks. DISCUSSION This study will evaluate the effects of collaborative goal-setting in pediatric rehabilitation and inform effective implementation of child-focused goal-setting practices. TRIAL REGISTRATION NCT05017363 (registered August 23, 2021 on ClinicalTrials.gov).
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Affiliation(s)
- Lesley Pritchard-Wiart
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, University of Alberta, 3-60 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
| | - Sandy Thompson-Hodgetts
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 3-20 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Ashley B McKillop
- Faculty of Rehabilitation Medicine, University of Alberta, University of Alberta, 3-78 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Rhonda Rosychuk
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 3-524 Edmonton Clinic Health Academy, 11405 87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Kelly Mrklas
- System Innovation and Programs, Alberta Health Services and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Strategic Clinical Networks, Provincial Clinical Excellence, Alberta Health Services and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada, 1403 29th St NW, T2N 2T9
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 10230 111 Ave NW, Edmonton, AB, T5G 0B7, Canada
| | - Jennifer Zwicker
- Director School of Public Policy, Cumming School of Medicine, University of Calgary, NW University of Calgary, 135 376 Collegiate Blvd 2500 University Drive, NW, Calgary, AB, T2N 1N4, Canada
| | - John Andersen
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 10230 111 Ave NW, Edmonton, AB, T5G 0B7, Canada
| | - Gillian King
- Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Rd, East York, ON, M4G 1R8, Canada
| | - Pegah Firouzeh
- Faculty of Rehabilitation Medicine, University of Alberta, University of Alberta, 3-70 Corbett Hall, Edmonton, T6G 2G4, Canada
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Wang L, Huang R, Shen C, Li G. Hospital Employee Performance Evaluation Based on Knowledge Map. INTERNATIONAL JOURNAL OF INFORMATION SYSTEMS AND SUPPLY CHAIN MANAGEMENT 2022. [DOI: 10.4018/ijisscm.306251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
With the deepening of theoretical research and social practice, hospital employee performance management has developed into a mature knowledge system. Therefore, systematic review of the research results in this field is conducive to fully understand its research history, grasp the research hotspots and frontier issues, which is of great significance to theoretical innovation in the field of hospital employee performance evaluation.iteSpace 5.3.R4 was used as the visualization tool draw a knowledge map to systematically sort out the distribution of relevant literature of hospital employee performance evaluation, including time distribution, journal distribution, author distribution, etc., and conduct a systematic research on the research hotspots and research frontiers in the field of hospital employee performance evaluation, which provides a beneficial reference for the theoretical research and practical innovation of domestic hospital employee performance evaluation.
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Affiliation(s)
- Lei Wang
- Hefei University of Technology, China
| | | | | | - Guofu Li
- Anhui Polytechnic University, China
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Dopp AR, Hunter SB, Godley MD, Pham C, Han B, Smart R, Cantor J, Kilmer B, Hindmarch G, González I, Passetti LL, Wright KL, Aarons GA, Purtle J. Comparing two federal financing strategies on penetration and sustainment of the adolescent community reinforcement approach for substance use disorders: protocol for a mixed-method study. Implement Sci Commun 2022; 3:51. [PMID: 35562836 PMCID: PMC9099033 DOI: 10.1186/s43058-022-00298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/21/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Sustained, widespread availability of evidence-based practices (EBPs) is essential to address the public health and societal impacts of adolescent substance use disorders (SUD). There remains a particularly significant need to identify effective financing strategies, which secure and direct financial resources to support the costs associated with EBP implementation and sustainment. This protocol describes a new project comparing two types of U.S. federal grant mechanisms (i.e., a type of financing strategy), which supported the implementation of the Adolescent Community Reinforcement Approach (A-CRA) EBP for SUD, through either organization-focused or state-focused granting of funds. The Exploration-Preparation-Implementation-Sustainment (EPIS) framework will guide our study aims, hypotheses, and selection of measures. METHOD We will employ a longitudinal, mixed-method (i.e., web surveys, semi-structured interviews, document review, focus groups, administrative data), quasi-experimental design to compare the grant types' outcomes and examine theoretically informed mediators and moderators. Aim 1 will examine the proportion of eligible clinicians certified in A-CRA with adequate fidelity levels (i.e., penetration outcomes) at the end of grant funding. Aim 2 will examine the sustainment of A-CRA up to 5 years post-funding, using a 10-element composite measure of treatment delivery and supervision activities. We will integrate the new data collected from state-focused grant recipients (~85 organizations in 19 states) with previously collected data from organization-focused grant recipients (Hunter et al., Implement Sci 9:104, 2014) (82 organizations in 26 states) for analysis. We will also use sensitivity analyses to characterize the effects of observed and unobserved secular trends in our quasi-experimental design. Finally, aim 3 will use comparative case study methods (integrating diverse quantitative and qualitative measures) to identify and disseminate policy implications about the roles of state- and organization-focused federal grants in efforts to promote adolescent SUD EBP implementation and sustainment. DISCUSSION The proposed research will have direct, practical implications for behavioral health administrators, policymakers, implementation experts, and the public. It will offer new knowledge that can directly inform financing strategies to support large-scale, sustained EBP delivery in behavioral health-while advancing implementation science through the use of novel methods to study financing strategies and sustainment.
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Affiliation(s)
- Alex R Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Sarah B Hunter
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Mark D Godley
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Chau Pham
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Bing Han
- Department of Research and Evaluation, Division of Biostatistics Research, Kaiser Permanente Southern California, 100 South Los Robles Avenue 2nd Floor, Pasadena, CA, 91101, USA
| | - Rosanna Smart
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Jonathan Cantor
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Beau Kilmer
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Grace Hindmarch
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Isabelle González
- RAND Corporation, 1200 South Hayes Street, Arlington, VA, 22202, USA
| | - Lora L Passetti
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Kelli L Wright
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Gregory A Aarons
- Department of Psychiatry, 9500 Gilman Dr. (0812), University of California San Diego, La Jolla, CA, 92093, USA
- UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, 92093, USA
| | - Jonathan Purtle
- Department of Public Health Policy & Management and Global Center for Implementation Science, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
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Lawrie L, Duncan EM, Jansen JO, Campbell MK, Brunsdon D, Skea Z, Coffey T, Cochran C, Gillies K. Behavioural optimisation to address trial conduct challenges: case study in the UK-REBOA trial. Trials 2022; 23:398. [PMID: 35550599 PMCID: PMC9097042 DOI: 10.1186/s13063-022-06341-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/23/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Clinical trials comprise multiple processes at various stages of the trial lifecycle. These processes often involve complex behaviours such as recruiting vulnerable patient populations and clinicians having to deliver complex trial interventions successfully. Few studies have utilised a behavioural framework to assess challenges and develop strategies for effective trial recruitment and delivery of trial interventions. This study reports the application of an innovative methodological approach to understand core trial processes, namely recruitment and intervention delivery, using a behavioural science approach to develop strategies designed to mitigate trial process problems. METHODS The UK-REBOA trial aims to evaluate the clinical and cost-effectiveness of resuscitative endovascular balloon occlusion of the aorta (a novel intervention) in injured patients with exsanguinating haemorrhage. A behavioural investigation ('diagnosis') was conducted using theory-informed (Theoretical Domains Framework, TDF) semi-structured interviews with site staff from the UK-REBOA trial to examine trial processes which could be improved in relation to trial recruitment and delivery of the intervention. Interviews were analysed using the TDF to identify influences on behaviour, which were then mapped to techniques for behaviour change and developed into potential solutions. RESULTS The behavioural diagnosis of the challenges experienced during trial processes highlighted factors relevant to a range of TDF domains: Skills, Environmental context and resources, Beliefs about capabilities, Beliefs about consequences, Social influences, and Memory, attention, and decision-making processes. Within the solution development phase, we identified 24 suitable behaviour change techniques that were developed into proposed solutions to target reported process problems with the aim of changing behaviour to improve recruitment and/or intervention delivery. Proposed solutions included targeted changes to trial training content, suggestions to restructure the environment (e.g. reinforced the purpose of the trial with information about the social and environmental consequences) and other strategies to reduce barriers to recruitment and intervention delivery. CONCLUSIONS This study demonstrates the feasibility of applying a behavioural approach to investigate ('diagnose') behavioural trial process problems and subsequently develop and implement targeted solutions ('treatment') in an active trauma trial. Understanding the factors that affected behaviour, attitudes and beliefs in this trauma trial allowed us to implement theoretically informed, evidence-based solutions designed to enhance trial practices. TRIAL REGISTRATION ISRCTN 16,184,981.
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Affiliation(s)
- Louisa Lawrie
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, Health Services Research Unit, 3Rd Floor Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Eilidh M Duncan
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, Health Services Research Unit, 3Rd Floor Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Jan O Jansen
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, Health Services Research Unit, 3Rd Floor Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Marion K Campbell
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, Health Services Research Unit, 3Rd Floor Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Dan Brunsdon
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, Health Services Research Unit, 3Rd Floor Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Zoë Skea
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, Health Services Research Unit, 3Rd Floor Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Taylor Coffey
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, Health Services Research Unit, 3Rd Floor Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Claire Cochran
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, Health Services Research Unit, 3Rd Floor Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Katie Gillies
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, Health Services Research Unit, 3Rd Floor Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
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Basinska K, Zúñiga F, Simon M, De Geest S, Guerbaai RA, Wellens NIH, Nicca D, Brunkert T. Implementation of a complex intervention to reduce hospitalizations from nursing homes: a mixed-method evaluation of implementation processes and outcomes. BMC Geriatr 2022; 22:196. [PMID: 35279088 PMCID: PMC8918313 DOI: 10.1186/s12877-022-02878-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background | objective
To evaluate the implementation of three intervention elements to reduce hospitalizations in nursing home residents.
Design
Convergent mixed-method design within a hybrid type-2 effectiveness-implementation study.
Setting
Eleven nursing homes in the German-speaking region of Switzerland.
Participants
Quantitative data were collected from 573 care workers; qualitative data were collected from 108 care workers and the leadership from 11 nursing homes.
Intervention
Three intervention elements targeting care workers were implemented to reduce unplanned hospitalizations: (1) the STOP&WATCH instrument for early recognition of changes in resident condition; (2) the ISBAR instrument for structured communication; and (3) specially-trained INTERCARE nurses providing on-site geriatric support. Multifaceted implementation strategies focusing both on the overall nursing home organization and on the care workers were used.
Methods
The quantitative part comprised surveys of care workers six- and twelve-months post-intervention. The intervention’s acceptability, feasibility and uptake were assessed using validated and self-developed scales.
Qualitative data were collected in 22 focus groups with care workers, then analyzed using thematic analysis methodology. Data on implementation processes were collected during implementation meetings with nursing home leadership and were analyzed via content analysis. Findings were integrated using a complementary approach.
Results
The ISBAR instrument and the INTERCARE nurse role were considered acceptable, feasible, and taken up by > 70% of care workers. The STOP&WATCH instrument showed the lowest acceptance (mean: 68%), ranging from 24 to 100% across eleven nursing homes. A combination of factors, including the amount of information received, the amount of support provided in daily practice, the users’ perceived ease of using the intervention and its adaptations, and the intervention’s usefulness, appeared to influence the implementation’s success. Two exemplary nursing homes illustrated context-specific implementation processes that serve as either barriers or facilitators to implementation.
Conclusions
Our findings suggest that, alongside the provision of information shortly before intervention start, constant daily support is crucial for implementation success. Ideally, this support is provided by designated and trained individuals who oversee implementation at the organizational and unit levels. Leaders who seek to implement interventions in nursing homes should consider their complexity and their consequences for workflow to optimize implementation processes accordingly.
Trial registration
This study was registered at clinicaltrials.gov (NCT03590470) on the 18/06/2018.
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Bor P, van Delft L, Valkenet K, Veenhof C. Perceived Factors of Influence on the Implementation of a Multidimensional Project to Improve Patients' Movement Behavior During Hospitalization: A Qualitative Study. Phys Ther 2022; 102:6423599. [PMID: 34751782 DOI: 10.1093/ptj/pzab260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/29/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to explore perceived factors of influence on the implementation of Hospital in Motion, a multidimensional and multidisciplinary implementation project to improve inpatients' movement behavior. METHODS This qualitative study was conducted on 4 wards. Per ward, a tailored action plan was implemented consisting of multiple tools and interventions to stimulate the integration of inpatient physical activity in usual care processes. After implementation, semi-structured interviews were performed with health care professionals and patients to explore perceived factors of influence on the implementation of the Hospital in Motion project. A content analysis was performed using the framework of the Medical Research Council for complex interventions as guidance for the identification of categories and themes. RESULTS In total, 16 interviews were conducted with health care professionals and 12 with patients. The results were categorized into the 3 key components of the Medical Research Council framework: implementation, mechanisms of impact, and context. An important factor of influence within the theme "implementation" was the iterative and multidisciplinary approach. Within the theme "mechanisms of impact," continuous attention and the interaction of multiple interventions, tailored to the target group and targeting multiple dimensions (individual, inter-professional, community and society), were perceived as important. Within the theme "context," the intrinsic motivation and inter-professional, community and societal culture towards physical activity was perceived to be of influence. CONCLUSION Impact can be achieved and maintained by creating continuous attention to inpatient physical activity and by the interaction between different interventions and dimensions during implementation. To maintain enough focus, the amount of activities at one time should be limited. IMPACT To improve inpatients' movement behavior, implementation project teams should be multidisciplinary and should implement a small set of tailored interventions that target multiple dimensions. Intermediate evaluation of the implementation process, strategies, and interventions is recommended.
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Affiliation(s)
- Petra Bor
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Lotte van Delft
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Karin Valkenet
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Research Group Innovation of Human Movement Care, University of Applied Sciences Utrecht, Expertise Center Healthy Urban Living, Utrecht, the Netherlands
| | - Cindy Veenhof
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Research Group Innovation of Human Movement Care, University of Applied Sciences Utrecht, Expertise Center Healthy Urban Living, Utrecht, the Netherlands
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Dopp AR, Gilbert M, Silovsky J, Ringel JS, Schmidt S, Funderburk B, Jorgensen A, Powell BJ, Luke DA, Mandell D, Edwards D, Blythe M, Hagele D. Coordination of sustainable financing for evidence-based youth mental health treatments: protocol for development and evaluation of the fiscal mapping process. Implement Sci Commun 2022; 3:1. [PMID: 34983689 PMCID: PMC8724666 DOI: 10.1186/s43058-021-00234-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/01/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Sustained delivery of evidence-based treatments (EBTs) is essential to addressing the public health and economic impacts of youth mental health problems, but is complicated by the limited and fragmented funding available to youth mental health service agencies (hereafter, "service agencies"). Strategic planning tools are needed that can guide these service agencies in their coordination of sustainable funding for EBTs. This protocol describes a mixed-methods research project designed to (1) develop and (2) evaluate our novel fiscal mapping process that guides strategic planning efforts to finance the sustainment of EBTs in youth mental health services. METHOD Participants will be 48 expert stakeholder participants, including representatives from ten service agencies and their partners from funding agencies (various public and private sources) and intermediary organizations (which provide guidance and support on the delivery of specific EBTs). Aim 1 is to develop the fiscal mapping process: a multi-step, structured tool that guides service agencies in selecting the optimal combination of strategies for financing their EBT sustainment efforts. We will adapt the fiscal mapping process from an established intervention mapping process and will incorporate an existing compilation of 23 financing strategies. We will then engage participants in a modified Delphi exercise to achieve consensus on the fiscal mapping process steps and gather information that can inform the selection of strategies. Aim 2 is to evaluate preliminary impacts of the fiscal mapping process on service agencies' EBT sustainment capacities (i.e., structures and processes that support sustainment) and outcomes (e.g., intentions to sustain). The ten agencies will pilot test the fiscal mapping process. We will evaluate how the fiscal mapping process impacts EBT sustainment capacities and outcomes using a comparative case study approach, incorporating data from focus groups and document review. After pilot testing, the stakeholder participants will conceptualize the process and outcomes of fiscal mapping in a participatory modeling exercise to help inform future use and evaluation of the tool. DISCUSSION This project will generate the fiscal mapping process, which will facilitate the coordination of an array of financing strategies to sustain EBTs in community youth mental health services. This tool will promote the sustainment of youth-focused EBTs.
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Affiliation(s)
- Alex R Dopp
- Department of Behavioral and Policy Sciences, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Marylou Gilbert
- Department of Behavioral and Policy Sciences, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Jane Silovsky
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Oklahoma Health Sciences Center, 940 NE 13th Street Suite 4900, Oklahoma City, OK, 73104, USA
| | - Jeanne S Ringel
- Department of Economics, Sociology, and Statistics, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Susan Schmidt
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Oklahoma Health Sciences Center, 940 NE 13th Street Suite 4900, Oklahoma City, OK, 73104, USA
| | - Beverly Funderburk
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Oklahoma Health Sciences Center, 940 NE 13th Street Suite 4900, Oklahoma City, OK, 73104, USA
| | - Ashley Jorgensen
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Oklahoma Health Sciences Center, 940 NE 13th Street Suite 4900, Oklahoma City, OK, 73104, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School and School of Medicine, Washington University, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Douglas A Luke
- Brown School, Washington University, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - David Mandell
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Fl., Philadelphia, PA, 19104, USA
| | - Daniel Edwards
- Evidence-Based Associates, 1311 Delaware Ave, Suite 637, Washington, DC, 20024, USA
| | - Mellicent Blythe
- NC Child Treatment Program c/o Center for Child and Family Health, 1121 W, Chapel Hill St. Ste. 100, Durham, NC, 27701, USA
| | - Dana Hagele
- NC Child Treatment Program c/o Center for Child and Family Health, 1121 W, Chapel Hill St. Ste. 100, Durham, NC, 27701, USA
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Ament SMC, van den Broek LM, van den Beuken-van Everdingen MHJ, Boyne JJJ, Maessen JMC, Bekkers SCAM, Bellersen L, Rocca HPBL, Engels Y, Janssen DJA. What to consider when implementing a tool for timely recognition of palliative care needs in heart failure: a context-based qualitative study. Palliat Care 2022; 21:1. [PMID: 34980105 PMCID: PMC8723899 DOI: 10.1186/s12904-021-00896-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 12/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Needs assessment tools can facilitate healthcare professionals in timely recognition of palliative care needs. Despite the increased attention for implementation of such tools, most studies provide little or no attention to the context of implementation. The aim of this study was to explore factors that contribute positively and negatively to timely screening of palliative care needs in advanced chronic heart failure. METHODS Qualitative study using individual interviews and focus groups with healthcare professionals. The data were analysed using a deductive approach. The Consolidated Framework for Implementation Research was used to conceptualise the contextual factors. RESULTS Twenty nine healthcare professionals with different backgrounds and working in heart failure care in the Southern and Eastern parts of the Netherlands participated. Several factors were perceived to play a role, such as perception and knowledge about palliative care, awareness of palliative care needs in advanced chronic heart failure, perceived difficulty when and how to start palliative care, limited acceptance to treatment boundaries in cardiology, limited communication and collaboration between healthcare professionals, and need for education and increased attention for palliative care in advanced chronic heart failure guidelines. CONCLUSIONS This study clarified critical factors targeting patients, healthcare professionals, organisations to implement a needs assessment tool for timely recognition of palliative care needs in the context of advanced chronic heart failure. A multifaceted implementation strategy is needed which has attention for education, patient empowerment, interdisciplinary collaboration, identification of local champions, chronic heart failure specific guidelines and culture.
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Affiliation(s)
- Stephanie M C Ament
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | | | | | - Josiane J J Boyne
- Department of Patient and Care, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - José M C Maessen
- Department of Patient and Care, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Sebastiaan C A M Bekkers
- Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Louise Bellersen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Daisy J A Janssen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. .,Department of Research and Development, Ciro Horn, P.O. Box 4009, Haelen, 6080 AA, the Netherlands.
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Shrubsole K, Rogers K, Power E. Sustaining acute speech-language therapists' implementation of recommended aphasia practices: A mixed methods follow-up evaluation of a cluster RCT. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:152-171. [PMID: 34882907 DOI: 10.1111/1460-6984.12684] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND While implementation studies in aphasia management have shown promising improvements to clinical practice, it is currently unknown if aphasia implementation outcomes are sustained and what factors may influence clinical sustainability. AIMS To evaluate the sustainment (i.e., sustained improvement of aphasia management practices and domains influencing clinicians' practice) and sustainability (i.e., factors influencing sustainability) outcomes of the Acute Aphasia IMplementation Study (AAIMS). METHODS & PROCEDURES A convergent interactive mixed-methods sustainability evaluation was conducted on two previously delivered implementation interventions (AAIMS). The AAIMS interventions were targeted at improving either written aphasia-friendly information provision (Intervention A) or collaborative goal-setting (Intervention B). Outcomes were collected 2 and 3 years post-implementation, addressing the research questions of sustainment (e.g., medical record audits and behavioural constructs questionnaires) and sustainability (e.g., post-study focus groups and organizational readiness surveys). Quantitative sustainability data were compared with post-implementation data, allowing for sustainment to be determined. Clinicians' perspectives on sustainability outcomes and challenges were analysed using framework analysis and integrated with the quantitative findings. OUTCOMES & RESULTS A total of 35 speech-language therapists (SLTs) from four hospitals participated. The medical records of 79 patients were audited in the sustainability period compared with the 107 medical records audited during AAIMS. Overall, there was variable sustainment of the target behaviours; implementation for Intervention A was not sustained at either sustainability time point (2018 = 47.8% decrease; 2019 = 22.78% decrease), but implementation for Intervention B was sustained at both time points (2018 = 7.78% increase; 2019 = 18.1% increase). There was a pattern of sustained change in the behaviour change domains targeted by the implementation interventions, where scores of the targeted domains increased over time (0.13, 95% confidence interval (CI) = -0.05 to 0.30) and scores of the non-targeted domains declined (-0.03, 95% CI = -0.11 to 0.04). Factors influencing sustainability were mainly related to 'processes', 'the inner context' and 'SLT characteristics', and these interacted dynamically to account for variation between teams. CONCLUSIONS & IMPLICATIONS Implementation outcomes (i.e., practice changes) were not sustained to the same level for three of the four participating SLT teams, with variable or partial sustainment most common. While the factors influencing sustainability differed depending on the context and individuals involved, the most important factor influencing outcomes seemed to be the level to which behaviour-change processes and strategies were embedded within the SLT department. Future implementation studies should incorporate sustainability measures from the onset and include follow-ups and monitoring systems to help support sustained change in the long term. WHAT THIS PAPER ADDS What is already known on the subject In post-stroke aphasia management, there are few examples of long-term sustainability of implementation outcomes. It is therefore unknown what factors are potentially important to sustain implementation of best-practice recommendations in aphasia services. What this paper adds to existing knowledge There is potential for implementation outcomes to be sustained long term, but sustainment is impacted by a range of factors. Ongoing facilitation or follow-up after initial implementation may to useful to promote sustainment, but is not essential if processes are sufficiently embedded. Gradual implementation into practice may lead to better sustainment than rapid change that is quickly forgotten. What are the potential or actual clinical implications of this work? Future implementation efforts should incorporate sustainability measures from the onset. Applying a sustainability framework was useful to guide evaluations and explore factors influencing the sustainment outcomes and is recommended for those interested in sustainability. Results from our evaluation can be used to guide refinement and support future development of sustainable implementation interventions.
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Affiliation(s)
- Kirstine Shrubsole
- Faculty of Health, Southern Cross University, Gold Coast, QLD, Australia
- The Queensland Aphasia Research Centre, The University of Queensland, Herston Health Precinct, Brisbane, QLD, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Bundura, Australia
| | - Kris Rogers
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Emma Power
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Bundura, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
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Nadalin Penno L, Graham ID, Backman C, Fuentes-Plough J, Davies B, Squires J. Sustaining a nursing best practice guideline in an acute care setting over 10 years: A mixed methods case study. FRONTIERS IN HEALTH SERVICES 2022; 2:940936. [PMID: 36925887 PMCID: PMC10012662 DOI: 10.3389/frhs.2022.940936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022]
Abstract
Background To improve patient outcomes many healthcare organizations have undertaken a number of steps to enhance the quality of care, including the use of evidence-based practices (EBPs) such as clinical practice guidelines. However, there is little empirical understanding of the longer-term use of guideline-based practices and how to ensure their ongoing use. The aim of this study was to identify the determinants and knowledge translation interventions (KTIs) influencing ongoing use of selected recommendations of an institutional pain policy and protocol over time from an organizational perspective and 10 years post implementation on two units within an acute care setting. Methods We conducted a mixed methods case study guided by the Dynamic Sustainability Framework of an EBP 10 years post implementation. We examined protocol sustainability at the nursing department and unit levels of a multi-site tertiary center in Canada. Data sources included document review (n = 29), chart audits (n = 200), and semi-structured interviews with nurses at the department (n = 3) and unit (n = 16) level. Results We identified 32 sustainability determinants and 29 KTIs influencing ongoing use of an EBP in acute care. Three determinants and eight KTIs had a continuous influence in all three time periods: implementation phase (0-2 yrs), sustained phase (>2-10 yrs.), and at the 10-year mark. Implementation of KTIs evolved with the level of application (e.g., department vs. unit) to fit the EBP within the context highlighting the need to focus on determinants influencing ongoing use. Sustainability was associated with continual efforts of monitoring and providing timely feedback regarding adherence to recommendations. KTIs used to embed recommendations into routine practices/processes positively influenced high adherence rates. Use of a participatory approach for implementation and sustainment and linking KTIs designed to incrementally address low adherence rates facilitated sustainment. Conclusion This research provides insight into the relationship between implementation and sustainability determinants and related KTIs during implementation and sustained use phases. Unique determinants identified by department and unit nurses reflect their different perspectives toward the innovation based on their respective roles and responsibilities. KTIs fostered changed behaviors and facilitated EBP sustainment in acute care. Findings confirm the concept of sustainability is a dynamic "ongoing process."
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Affiliation(s)
- Letitia Nadalin Penno
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Ian D Graham
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Chantal Backman
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Jessica Fuentes-Plough
- Business School and Leadership School, Anahuac-Mayab University, Mérida, Yucatan, Mexico
| | - Barbara Davies
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Janet Squires
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Gallione C, Barisone M, Molon A, Pavani M, Torgano C, Bassi E, Dal Molin A. Extrinsic and intrinsic factors acting as barriers or facilitators in nurses' implementation of clinical practice guidelines: a mixed-method systematic review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022252. [PMID: 35775756 PMCID: PMC9335442 DOI: 10.23750/abm.v93i3.12942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Greater evaluations are needed to identify barriers or facilitators in nurses' guidelines adherence. The current review aims to explore extrinsic and intrinsic factors impacting nurses' compliance. METHODS Mixed-method systematic review with a convergent approach, following the PRISMA checklist and the JBI Mixed Methods Review Methodological Guidance was conducted. MEDLINE, Embase, CINAHL were systematically searched, to find studies published between 2010 and 2021, including qualitative, quantitative or mixed-methods articles. RESULTS Sixty studies were included, and the major findings were analysed by aggregating them in two main themes: intrinsic and extrinsic factors. The intrinsic factors were: a) knowledge and skills; b) attitudes of health personnel; c) sense of belonging towards guidelines. The extrinsic factors were: a) organizational and environmental factors; b) workload; c) guidelines structure; d) patients and caregivers' attitude. CONCLUSIONS The included studies report lack of resources, among environmental factors, as the main barrier perceived. Nurses, who are at the forefront in addressing the direct application of knowledge and skills to ensure patient safety, have a higher perception of this kind of barriers than other healthcare personnel. Potential facilitators emerged in the review are positive feedback and reinforcements at the workplace, either from the members of the team or from the leaders. Moreover, the level of active participation of the patient and caregiver could have a positive impact on nurses' guidelines adherence. Guidelines implementation remains a complex process, resulting in a strong recommendation to support health policymakers and nursing leaders in implementing continuing education programs.
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Affiliation(s)
- Chiara Gallione
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy, Maggiore della Carità University Hospital, Novara, Italy
| | - Michela Barisone
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | | | - Moreno Pavani
- Maggiore della Carità University Hospital, Novara, Italy
| | | | - Erika Bassi
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy, Maggiore della Carità University Hospital, Novara, Italy
| | - Alberto Dal Molin
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy, Maggiore della Carità University Hospital, Novara, Italy
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Effect of after action review on safety culture and second victim experience and its implementation in an Irish hospital: A mixed methods study protocol. PLoS One 2021; 16:e0259887. [PMID: 34793495 PMCID: PMC8601442 DOI: 10.1371/journal.pone.0259887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/28/2021] [Indexed: 12/02/2022] Open
Abstract
Background After Action Review is a form of facilitated team learning and review of events. The methodology originated in the United States Army and forms part of the Incident Management Framework in the Irish Health Services. After Action Review has been hypothesized to improve safety culture and the effect of patient safety events on staff (second victim experience) in health care settings. Yet little direct evidence exists to support this and its implementation has not been studied. Aim To investigate the effect of After Action Review on safety culture and second victim experience and to examine After Action Review implementation in a hospital setting. Methods A mixed methods study will be conducted at an Irish hospital. To assess the effect on safety culture and second victim experience, hospital staff will complete surveys before and twelve months after the introduction of After Action Review to the hospital (Hospital Survey on Safety Culture 2.0 and Second Victim Experience and Support Tool). Approximately one in twelve staff will be trained as After Action Review Facilitators using a simulation based training programme. Six months after the After Action Review training, focus groups will be conducted with a stratified random sample of the trained facilitators. These will explore enablers and barriers to implementation using the Theoretical Domains Framework. At twelve months, information will be collected from the trained facilitators and the hospital to establish the quality and resource implications of implementing After Action Review. Discussion The results of the study will directly inform local hospital decision-making and national and international approaches to incorporating After Action Review in hospitals and other healthcare settings.
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