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Simard P, Turcotte S, Vallée C, Lamontagne ME. Implementation of the strengths model of case management for people with a traumatic brain injury: a qualitative pre-implementation study. Brain Inj 2024; 38:734-741. [PMID: 38704843 DOI: 10.1080/02699052.2024.2347548] [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: 06/19/2023] [Accepted: 04/22/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION People who sustain a traumatic brain injury (TBI) may have to live with permanent sequelae such as mental health problems, cognitive impairments, and poor social participation. The strengths-based approach (SBA) of case management has a number of positive impacts such as greater community integration but it has never been implemented for persons with TBI. To support its successful implementation with this population, it is essential to gain understanding of how the key components of the intervention are perceived within the organization applying the approach. OBJECTIVES Documenting the barriers and facilitators in the implementation of the SBA as perceived by potential adopters. METHODS A qualitative pre-implementation study was conducted using semi-structured interviews with community workers and managers of the community organization where the SBA is to be implemented. Data were analyzed using a deductive approach based on the Consolidated Framework for Implementation Research (CFIR). RESULTS The major barriers are associated with the intervention (e.g. adaptability of the intervention) and the external context (e.g. the impact of the pandemic). Perceived facilitators are mainly associated with the internal context (e.g. compatibility with current values). CONCLUSION The barriers and facilitators identified will inform the research team's actions to maximize the likelihood of successful implementation.
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Affiliation(s)
- Pascale Simard
- School of Rehabilitation, Université Laval, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Canada
| | - Samuel Turcotte
- School of Rehabilitation, Université Laval, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Canada
| | - Catherine Vallée
- School of Rehabilitation, Université Laval, Quebec, Canada
- VITAM Center for Sustainable Health Research, Quebec, Canada
| | - Marie-Eve Lamontagne
- School of Rehabilitation, Université Laval, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Canada
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Lamb D, Milton A, Forsyth R, Lloyd-Evans B, Akther S, Fullarton K, O'Hanlon P, Johnson S, Morant N. Implementation of a crisis resolution team service improvement programme: a qualitative study of the critical ingredients for success. Int J Ment Health Syst 2024; 18:18. [PMID: 38704589 PMCID: PMC11069280 DOI: 10.1186/s13033-024-00638-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/25/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Crisis Resolution Teams (CRTs) offer home-based care for people in mental health crisis, as an alternative to hospital admission. The success of CRTs in England has been variable. In response to this, the CRT Optimization and RElapse prevention (CORE) study developed and trialled a 12-month Service Improvement Programme (SIP) based on a fidelity model. This paper describes a qualitative evaluation of the perspectives of CRT staff, managers, and programme facilitators. We identify barriers and facilitators to implementation, and mechanisms by which service improvements took place. METHODS Managers and staff from six purposively sampled CRTs were interviewed, as well as six facilitators who were employed to support the implementation of service improvement plans. Semi-structured focus groups and individual interviews were conducted and analysed using thematic analysis. FINDINGS A majority of participants viewed all components of the SIP as helpful in improving practice, although online resources were under-used. Perceived barriers to implementation centred principally around lack of staff time and ownership. Support from both senior staff and facilitators was essential in enabling teams to undertake the work associated with the SIP. All participating stakeholder groups reported that using the fidelity model to benchmark their CRT work to best practice and feel part of a 'bigger whole' was valuable. CONCLUSION CRT staff, managers and programme facilitators thought that a structured service improvement programme helped to increase fidelity to a best practice model. Flexibility (from all stakeholders) was key to enable service improvement actions to be manageable within time- and resource-poor teams.
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Affiliation(s)
- Danielle Lamb
- Department of Applied Health Research, UCL, Gower Street, London, WC1E 6BT, UK.
| | - Alyssa Milton
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Clair KS, Yano EM, Fickel JJ, Brunner J, Canelo I, Hamilton A. Enhancing Primary Care and Mental Health Integration for Women Veterans with Complex Healthcare Needs Using Evidence-Based Quality Improvement. J Gen Intern Med 2024:10.1007/s11606-024-08737-3. [PMID: 38689118 DOI: 10.1007/s11606-024-08737-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/18/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Women Veterans with co-morbid medical and mental health conditions face persistent barriers accessing high-quality health care. Evidence-based quality improvement (EBQI) offers a systematic approach to implementing new care models that can address care gaps for women Veterans. OBJECTIVE This study examines factors associated with the successful deployment of EBQI within integrated health systems to improve primary care for women Veterans with complex mental health needs. DESIGN Following a 12-site (8 EBQI, 4 control) cluster randomized study to evaluate EBQI effectiveness, we conducted an in-depth case study analysis of one women's health clinic that used EBQI to improve integrated primary care-mental health services for women Veterans. PARTICIPANTS Our study sample included providers, program managers, and clinic staff at a women Veteran's health clinic that, at the time of the study, had one Primary Care and Mental Health Integration team and one women's health primary care provider serving 800 women. We analyzed interviews conducted 12 months, 24 months, and 4 years post-implementation and call summaries between the clinic and support team. MAIN MEASURES We conducted qualitative thematic analysis of interview and call summary data to identify EBQI elements, clinic characteristics, and reported challenges and successes within project development and execution. KEY RESULTS The clinic harnessed core EBQI elements (multi-level stakeholder engagement, data-driven progress-monitoring, PDSA cycles, sharing results) to accomplish pre-defined project goals, strengthen inter-disciplinary partnerships, and bolster team confidence. Clinic characteristics that facilitated implementation success included prior QI experience and an organizational culture responsive to innovation, while lack of pre-existing guidelines and limited access to centralized databases posed implementation challenges. CONCLUSIONS Successful practice transformation emerges through the interaction of evidence-based methods and site-specific characteristics. Examining how clinic characteristics support or impede EBQI adaptation can facilitate efforts to improve care within integrated health systems.
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Affiliation(s)
- Kimberly S Clair
- HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Elizabeth M Yano
- HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health at University of California Los Angeles, Los Angeles, CA, USA
| | - Jacqueline J Fickel
- HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Julian Brunner
- HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Ismelda Canelo
- HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Alison Hamilton
- HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA.
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Lewis JA, Samuels LR, Weems J, Park D, Winter R, Lindsell CJ, Callaway-Lane C, Audet C, Slatore CG, Wiener RS, Dittus RS, Kripalani S, Yankelevitz DF, Henschke CI, Moghanaki D, Matheny ME, Vogus TJ, Roumie CL, Spalluto LB. The Association of Organizational Readiness With Lung Cancer Screening Utilization. Am J Prev Med 2023; 65:844-853. [PMID: 37224985 PMCID: PMC10592591 DOI: 10.1016/j.amepre.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Lung cancer screening is widely underutilized. Organizational factors, such as readiness for change and belief in the value of change (change valence), may contribute to underutilization. The aim of this study was to evaluate the association between healthcare organizations' preparedness and lung cancer screening utilization. METHODS Investigators cross-sectionally surveyed clinicians, staff, and leaders at10 Veterans Affairs from November 2018 to February 2021 to assess organizational readiness to implement change. In 2022, investigators used simple and multivariable linear regression to evaluate the associations between facility-level organizational readiness to implement change and change valence with lung cancer screening utilization. Organizational readiness to implement change and change valence were calculated from individual surveys. The primary outcome was the proportion of eligible Veterans screened using low-dose computed tomography. Secondary analyses assessed scores by healthcare role. RESULTS The overall response rate was 27.4% (n=1,049), with 956 complete surveys analyzed: median age of 49 years, 70.3% female, 67.6% White, 34.6% clinicians, 61.1% staff, and 4.3% leaders. For each 1-point increase in median organizational readiness to implement change and change valence, there was an associated 8.4-percentage point (95% CI=0.2, 16.6) and a 6.3-percentage point increase in utilization (95% CI= -3.9, 16.5), respectively. Higher clinician and staff median scores were associated with increased utilization, whereas leader scores were associated with decreased utilization after adjusting for other roles. CONCLUSIONS Healthcare organizations with higher readiness and change valence utilized more lung cancer screening. These results are hypothesis generating. Future interventions to increase organizations' preparedness, especially among clinicians and staff, may increase lung cancer screening utilization.
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Affiliation(s)
- Jennifer A Lewis
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Medical Service, VA Tennessee Valley Healthcare System, Veterans Health Administration, Nashville, Tennessee; Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee.
| | - Lauren R Samuels
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jacy Weems
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel Park
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert Winter
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher J Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carol Callaway-Lane
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Medical Service, VA Tennessee Valley Healthcare System, Veterans Health Administration, Nashville, Tennessee; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carolyn Audet
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Health Policy, Vanderbilt University, Nashville, Tennessee
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care (CIVIC), Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, Oregon; Section of Pulmonary and Critical Care Medicine, Veterans Affairs Portland Health Care System, Portland, Oregon; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon; VA National Center for Lung Cancer Screening (NCLCS), Veterans Health Administration, Washington, District of Columbia
| | - Renda Soylemez Wiener
- VA National Center for Lung Cancer Screening (NCLCS), Veterans Health Administration, Washington, District of Columbia; Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts; The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
| | - Robert S Dittus
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sunil Kripalani
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David F Yankelevitz
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Claudia I Henschke
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York; VA Phoenix Health Care System, Phoenix, Arizona
| | - Drew Moghanaki
- Radiation Oncology Service, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California; Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Michael E Matheny
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Timothy J Vogus
- Owen Graduate School of Management, Vanderbilt University, Nashville, Tennessee
| | - Christianne L Roumie
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Health Policy, Vanderbilt University, Nashville, Tennessee
| | - Lucy B Spalluto
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
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Larkin C, Arensman E, Boudreaux ED. Preventing Suicide in Health Systems: How Can Implementation Science Help? Arch Suicide Res 2023; 27:1147-1162. [PMID: 36267036 DOI: 10.1080/13811118.2022.2131490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Suicide prevention is an emotive, complex goal for clinicians and health systems. Effective interventions for suicidality do exist; however, many patients do not receive them because implementation efforts tend to be time-limited and unsystematic. Implementation science is the study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice. This narrative review introduces implementation science to suicide researchers, with a special focus on healthcare settings. We outline prominent theories, methods, and measures, as well as examples of implementation research from suicidology. By embracing the principles of implementation science, suicidologists can help to close the gap between evidence-based practice and routine practice, thereby improving the delivery and uptake of suicide-related interventions and prevention programs.
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A systematic review of influences on implementation of supported self-management interventions for people with severe mental health problems in secondary mental health care settings. PLoS One 2023; 18:e0282157. [PMID: 36848334 PMCID: PMC9970054 DOI: 10.1371/journal.pone.0282157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 02/09/2023] [Indexed: 03/01/2023] Open
Abstract
PURPOSE There is robust evidence for offering supported self-management interventions for people with severe mental illness (SMI) throughout secondary mental health services, but their availability remains patchy. The aim of this systematic review is to synthesise the evidence on barriers and facilitators to implementing self-management interventions for people with SMI in secondary mental health care settings. METHODS The review protocol was registered with PROSPERO (CRD42021257078). Five databases were searched to identify relevant studies. We included full-text journal articles with primary qualitative or quantitative data on factors which affect the implementation of self-management interventions for people with SMI in secondary mental health services. The included studies were analysed using narrative synthesis, using the Consolidated Framework for Implementation Research and an established taxonomy of implementation outcomes. RESULTS Twenty-three studies from five countries met eligibility criteria. The barriers and facilitators identified in the review were mainly on the organisational level, but included some individual-level influences. Facilitators included high feasibility, high fidelity, a strong team structure, sufficient number of staff, support from colleagues, staff training, supervision, the presence of an implementation champion and adaptability of the intervention. Barriers to implementation include high staff turnover, staff shortage, lack of supervision, lack of support for staff delivering the programme, staff struggling with their increased workload, a lack of senior clinical leadership, and programme content perceived as irrelevant. CONCLUSION The findings from this research suggest promising strategies to improve implementation of self-management interventions. For services providing support for people with SMI, organisational culture should be considered, as well as the adaptability of interventions.
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Goodsmith N, Cohen AN, Pedersen ER, Evans E, Young AS, Hamilton AB. Predictors of Functioning and Recovery Among Men and Women Veterans with Schizophrenia. Community Ment Health J 2023; 59:110-121. [PMID: 35643881 DOI: 10.1007/s10597-022-00979-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/29/2022] [Indexed: 01/07/2023]
Abstract
Gender differences may play a role in functional outcomes for individuals with schizophrenia. To better understand differences, an exploratory secondary analysis was conducted using data from a large, multi-site study of individuals with schizophrenia in treatment at Veterans Affairs medical centers. Participants completed surveys at baseline (n = 801; 734 men, 67 women) to assess demographics, symptoms, social supports, and recovery; and one year (n = 662; 604 men, 58 women) to assess quality of life and functioning. Hierarchical linear regressions examined interactions of baseline factors with functioning and quality of life. Women and men did not differ significantly in baseline social support, psychiatric symptoms, or recovery. Female gender predicted higher occupational functioning, while social functioning in men was inversely related to baseline symptom severity. Being married predicted higher quality of life for women, but not men. These findings may inform gender tailoring of services for schizophrenia.
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Affiliation(s)
- Nichole Goodsmith
- VA Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd (206), Los Angeles, CA, 90073, USA.
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd (210A), Los Angeles, CA, 90073, USA.
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90095, USA.
| | - Amy N Cohen
- American Psychiatric Association, 800 Maine Avenue, S.W., Suite 900, Washington, DC, 20024, USA
| | - Eric R Pedersen
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 311 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003, USA
| | - Alexander S Young
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd (210A), Los Angeles, CA, 90073, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Alison B Hamilton
- VA Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd (206), Los Angeles, CA, 90073, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
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Vincent-Doe A, Sneed R, Jordan T, Key K, Bailey RS, Jefferson BB, Sanders RPE, Brewer A, Scott JB, Calvin K, Summers M, Farmer B, Johnson-Lawrence V. Exploring the Readiness of African-American Churches to Engage in a Community-Engaged Blood Pressure Reduction Research Study: Lessons Learned from the Church Challenge. JOURNAL OF COMMUNITY ENGAGEMENT AND SCHOLARSHIP 2022; 14:10. [PMID: 35734421 PMCID: PMC9207767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Introduction The Transtheoretical Model (TTM) has been used to assess individual readiness for health behavior change. We describe our use of the TTM to assess organizational readiness of African-American churches to participate in the Church Challenge (CC) in Flint, Michigan; the processes of change that moved churches toward readiness for change; and lessons learned. Methods The CC was a faith-based, multilevel intervention to reduce chronic disease risk. A community-based participatory approach was used to engage and recruit churches. We used the TTM to capture church readiness for change and track church progress through the five stages. Results We engaged with 70 churches: 35 remained in Stage 1 (precontemplation), 10 remained in Stage 2 (contemplation), 3 remained in Stage 3 (preparation), 5 made it to Stage 4 (action), and 17 finished within Stage 5 (maintenance). Churches engaged in several processes of change as they moved through the various stages of change. Lessons Learned Utilizing processes of change, establishing rapport, and having previous participants share success stories helped move churches from stage-to-stage. However, certain barriers prevented progression, such as burnout/trauma from the Flint Water Crisis and scheduling conflicts. Discussion Faith-based organizational readiness greatly impacted participation in the CC. Researchers should utilize established social capital, build rapport, and remain flexible when working with African-American churches. Conclusion Although traditionally used at the individual level, the TTM works well at the organizational level to assess and monitor church readiness to participate in community-engaged research and health programming to improve health in an African-American faith community.
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Affiliation(s)
| | - Rodlescia Sneed
- Division of Public Health, Michigan State University, Flint, MI
| | - Tamara Jordan
- Division of Public Health, Michigan State University, Flint, MI
| | - Kent Key
- Division of Public Health, Michigan State University, Flint, MI,Community Based Organization Partners, Flint, MI
| | - Rev. Sarah Bailey
- Bridges to the Future, Flint, MI,Community Based Organization Partners, Flint, MI
| | | | | | - Allysoon Brewer
- Division of Public Health, Michigan State University, Flint, MI
| | - Jamil B. Scott
- Division of Public Health, Michigan State University, Flint, MI,National Human Genome Research Institute, National Institute of Health
| | - Kahlil Calvin
- Division of Public Health, Michigan State University, Flint, MI
| | - Monicia Summers
- Division of Public Health, Michigan State University, Flint, MI
| | - Bridget Farmer
- Division of Public Health, Michigan State University, Flint, MI
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Hamilton AB, Brown A, Loeb T, Chin D, Grills C, Cooley-Strickland M, Liu HH, Wyatt GE. Enhancing patient and organizational readiness for cardiovascular risk reduction among Black and Latinx patients living with HIV: Study protocol. Prog Cardiovasc Dis 2020; 63:101-108. [PMID: 32109483 DOI: 10.1016/j.pcad.2020.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 02/23/2020] [Indexed: 01/14/2023]
Abstract
Cardiovascular disease (CVD) is an increasingly important cause of morbidity and mortality among people living with HIV (PLWH) now that HIV is a manageable chronic disease. Identification and treatment of comorbid medical conditions for PLWH, including CVD and its risk factors, typically lack a critical component of care: integrated care for histories of trauma. Experiences of trauma are associated with increased HIV infection, CVD risk, inconsistent treatment adherence, and poor CVD outcomes. To address this deficit among those at greatest risk and disproportionately affected by HIV and trauma-i.e., Black and Latinx individuals-a novel culturally-congruent, evidence-informed care model, "Healing our Hearts, Minds and Bodies" (HHMB), has been designed to address patients' trauma histories and barriers to care, and to prepare patients to engage in CVD risk reduction. Further, in recognition of the need to ensure that PLWH receive guideline-concordant cardiovascular care, implementation strategies have been identified that prepare providers and clinics to address CVD risk among their Black and Latinx PLWH. The focus of this paper is to describe the hybrid Type 2 effectiveness/implementation study design, the goal of which is to increase both patient and organizational readiness to address trauma and CVD risk among 260 Black and Latinx PLWH recruited from two HIV service organizations in Southern California. This study is expected to produce important information regarding the value of the HHMB intervention and implementation processes and strategies designed for use in implementing HHMB and other evidence-informed programs in diverse, resource-constrained treatment settings, including those that serve patients living in deep poverty. Clinical trials registry: NCT04025463.
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Affiliation(s)
- Alison B Hamilton
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, United States of America; Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America.
| | - Arleen Brown
- Division of General Internal Medicine and Health Services Research (GIM and HSR), University of California Los Angeles, United States of America; Division of GIM and HSR, Olive View-UCLA Medical Center, Sylmar, CA United States of America
| | - Tamra Loeb
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, United States of America
| | - Dorothy Chin
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, United States of America
| | - Cheryl Grills
- Department of Psychology, Loyola Marymount University, United States of America
| | - Michele Cooley-Strickland
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, United States of America
| | - Honghu H Liu
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, United States of America
| | - Gail E Wyatt
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, United States of America
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Young AS, Cohen AN, Hamilton AB, Hellemann G, Reist C, Whelan F. Implementing Patient-Reported Outcomes to Improve the Quality of Care for Weight of Patients with Schizophrenia. J Behav Health Serv Res 2018; 46:129-139. [PMID: 30465314 DOI: 10.1007/s11414-018-9641-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
"Enhancing QUality of Care In Psychosis" (EQUIP) was an eight-site clustered controlled trial of the implementation and effectiveness of patient-reported outcomes to support evidence-based practice and improve care for schizophrenia. Implementation sites chose to improve care for weight. Implementation included monitoring patient-reported outcomes using kiosks, patient and staff education, quality improvement teams, and phone care management. Qualitative and quantitative methods compared implementation and effectiveness between sites for 13 months. Eighty percent of 801 randomly selected patients were overweight. Two hundred one clinicians varied in competency. Baseline use of behavioral weight services was low. At implementation sites, patients became 2.3 times more likely to use weight services compared with control sites (95% CI, 1.5-3.6; χ2 = 14.4; p < 0.01). There was no effect on the weight gain liability of medications prescribed. Controlling for baseline, patients' final weight at control sites was 5.9 ± 2.7 kg heavier than at implementation sites (F = 4.8, p = 0.03). Patient-reported outcomes can inform implementation of evidence-based practice and improvement in outcomes.
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Affiliation(s)
- Alexander S Young
- Greater Los Angeles Veterans Healthcare Center, Los Angeles, CA, USA. .,University of California, Los Angeles, CA, USA. .,UCLA Center for Health Services, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA, 90024, USA. .,Veterans Health Administration, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA, 90073, USA.
| | - Amy N Cohen
- Greater Los Angeles Veterans Healthcare Center, Los Angeles, CA, USA.,University of California, Los Angeles, CA, USA.,Veterans Health Administration, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA, 90073, USA
| | - Alison B Hamilton
- Greater Los Angeles Veterans Healthcare Center, Los Angeles, CA, USA.,University of California, Los Angeles, CA, USA.,Veterans Health Administration, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA, 90073, USA
| | - Gerhard Hellemann
- University of California, Los Angeles, CA, USA.,Veterans Health Administration, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA, 90073, USA
| | - Christopher Reist
- Veterans Health Administration, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA, 90073, USA.,Long Beach Veterans Healthcare System, Long Beach, CA, USA.,University of California, Irvine, CA, USA
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Wray LO, Ritchie MJ, Oslin DW, Beehler GP. Enhancing implementation of measurement-based mental health care in primary care: a mixed-methods randomized effectiveness evaluation of implementation facilitation. BMC Health Serv Res 2018; 18:753. [PMID: 30285718 PMCID: PMC6171308 DOI: 10.1186/s12913-018-3493-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 08/23/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Mental health care lags behind other forms of medical care in its reliance on subjective clinician assessment. Although routine use of standardized patient-reported outcome measures, measurement-based care (MBC), can improve patient outcomes and engagement, clinician efficiency, and, collaboration across care team members, full implementation of this complex practice change can be challenging. This study seeks to understand whether and how an intensive facilitation strategy can be effective in supporting the implementation of MBC. Implementation researchers partnering with US Department of Veterans Affairs (VA) leaders are conducting the study within the context of a national initiative to support MBC implementation throughout VA mental health services. This study will focus specifically on VA Primary Care-Mental Health Integration (PCMHI) programs. METHODS A mixed-methods, multiple case study design will include 12 PCMHI sites recruited from the 23 PCMHI programs that volunteered to participate in the VA national initiative. Guided by a study partnership panel, sites are clustered into similar groups using administrative metrics. Site pairs are recruited from within these groups. Within pairs, sites are randomized to the implementation facilitation strategy (external facilitation plus QI team) or standard VA national support. The implementation strategy provides an external facilitator and MBC experts who work with intervention sites to form a QI team, develop an implementation plan, and, identify and overcome barriers to implementation. The RE-AIM framework guides the evaluation of the implementation facilitation strategy which will utilize data from administrative, medical record, and primary qualitative and quantitative sources. Guided by the iPARIHS framework and using a mixed methods approach, we will also examine factors associated with implementation success. Finally, we will explore whether implementation of MBC increases primary care team communication and function related to the care of mental health conditions. DISCUSSION MBC has significant potential to improve mental health care but it represents a major change in practice. Understanding factors that can support MBC implementation is essential to attaining its potential benefits and spreading these benefits across the health care system.
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Affiliation(s)
- Laura O. Wray
- Department of Veterans Affairs, VA Center for Integrated Healthcare, 3495 Bailey Avenue, Buffalo, NY 14215 USA
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 955 Main Street, Suite 6186, Buffalo, NY 14203 USA
| | - Mona J. Ritchie
- Department of Veterans Affairs, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, 2200 Ft Roots Dr, Bdg 58, North Little Rock, AR 72114 USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham St, #755, Little Rock, AR 72205 USA
| | - David W. Oslin
- VISN 4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104 USA
- Department of Psychiatry, Perlman School of Medicine, University of Pennsylvania, 3900 Chestnut St, Philadelphia, PA 19104 USA
| | - Gregory P. Beehler
- Department of Veterans Affairs, VA Center for Integrated Healthcare, 3495 Bailey Avenue, Buffalo, NY 14215 USA
- Schools of Public Health and Health Professions, University at Buffalo, 401 Kimball Tower, 955 Main Street, Buffalo, NY 14214 USA
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Community engagement to pilot electronic patient-reported outcomes (e-PROs) in early intervention: Lessons learned. J Clin Transl Sci 2018; 2:20-26. [PMID: 30333929 PMCID: PMC6188646 DOI: 10.1017/cts.2018.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Electronic data capture is essential to advancing family-centered coordinated care in early intervention (EI). The purpose of this paper is to report on EI service coordinator response to piloting an electronic parent-reported outcome (e-PRO) assessment as part of their routine workflow, including lessons learned that may inform future phases of e-PRO implementation. Methods This second pilot study involved families enrolled in a large EI program (n=1040 families) in concert with their implementation of a statewide quality improvement initiative for care plan development and outcomes reporting. A total of 22 EI service coordinators and supervisors were engaged in three phases: initial e-PRO intervention, peer mentor enhancement, and standard recruitment protocol. Results Implementation of the e-PRO intervention and peer mentoring enhancement yielded low enrollment rates over the first six months (n=17). A standard recruitment protocol has resulted in enrollment growth (n=83) towards the targeted enrollment rate (n=832). Conclusions This study reports on early insights for building and sustaining a productive academic-community partnership for e-PRO implementation to support family-centered coordinated care. Lessons learned from this academic-community partnership with respect to strategies for enhancing community significance, collaboration, return, and control are discussed as they inform further development of this intervention prior to scale-up.
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Brooke-Sumner C, Sorsdahl K, Lombard C, Petersen-Williams P, Myers B. Protocol for development and validation of a context-appropriate tool for assessing organisational readiness for change in primary health clinics in South Africa. BMJ Open 2018; 8:e020539. [PMID: 29632084 PMCID: PMC5892778 DOI: 10.1136/bmjopen-2017-020539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION A large treatment gap for common mental disorders (such as depression) exists in South Africa. Comorbidity with other chronic diseases, including HIV and diseases of lifestyle, is an increasing public health concern globally. Currently, primary health facilities as points of care for those with chronic disease provide limited services for common mental disorders. Assessing organisational readiness for change (ORC) towards adopting health innovations (such as mental health services) using contextually appropriate measures is needed to facilitate implementation of these services. This study aims to investigate the validity of the Texas Christian University Organisational Readiness for Change (TCU-ORC) scale in the South African context. Subsequently, we will develop a shortened version of this scale. This study is nested within Project MIND, a multiyear randomised controlled trial that is testing two different approaches for integrating counselling for common mental disorders into chronic disease care. Although the modified, contextually appropriate ORC measure resulting from the proposed study will be developed in the context of integrating mental health into primary healthcare services, the potential for the tool to be generalised to further understanding barriers to any change being implemented in primary care settings is high. METHODS AND ANALYSIS We will establish internal consistency (Cronbach's alpha coefficients), test-retest reliability (intraclass correlation coefficient) and construct validity of the long-form TCU-ORC questionnaire. Survey data will be collected from 288 clinical, management and operational staff from 24 primary health facilities where the Project MIND trial is implemented. A modified Delphi approach will assess the content validity of the TCU-ORC items and identify areas for potential adaptation and item reduction. ETHICS AND DISSEMINATION Ethical approval has been granted by the South African Medical Research Council (Protocol ID EC004-2-2015, amendment of 20 August 2017). Results will be submitted to peer-reviewed journals relevant to implementation and health systems strengthening.
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Affiliation(s)
- Carrie Brooke-Sumner
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Katherine Sorsdahl
- Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Petal Petersen-Williams
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Knowledge, Attitudes, Social Desirability, and Organizational Characteristics in Youth Mental Health Services. J Behav Health Serv Res 2018; 43:630-647. [PMID: 26645291 DOI: 10.1007/s11414-015-9491-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This project investigated the extent to which knowledge of evidence-based practices (EBPs) and organizational characteristics predicted attitudes toward EBPs, while controlling for social desirability and organization membership. Participants were 167 public sector youth practitioners. Hierarchical multiple regression analyses were conducted to determine which factors significantly predicted EBP attitudes. Findings suggested that social desirability, organization membership, and various organizational characteristics predicted EBP attitudes. Results are discussed as they relate to the importance of including social desirability in future research and identifying different factors that influence EBP attitudes across various organizations.
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Chinman M, Daniels K, Smith J, McCarthy S, Medoff D, Peeples A, Goldberg R. Provision of peer specialist services in VA patient aligned care teams: protocol for testing a cluster randomized implementation trial. Implement Sci 2017; 12:57. [PMID: 28464935 PMCID: PMC5414325 DOI: 10.1186/s13012-017-0587-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/22/2017] [Indexed: 11/10/2022] Open
Abstract
Background Over 1100 Veterans work in the Veterans Health Administration (VHA) as peer specialists (PSs). PSs are Veterans with formal training who provide support to other Veterans with similar diagnoses, primarily in mental health settings. A White House Executive Action mandated the pilot reassignment of VHA PSs from mental health to 25 primary care Patient Aligned Care Teams (PACT) in order to broaden the provision of wellness services that can address many chronic illnesses. An evaluation of this initiative was undertaken to assess the impact of outside assistance on the deployment of PS in PACT, as implementation support is often needed to prevent challenges commonly experienced when first deploying PSs in VHA settings. We present the protocol for this cluster-randomized hybrid type II trial to test the impact of standard implementation (receive minimal assistance) vs. facilitated implementation (receive outside assistance) on the deployment of VHA PSs in PACT. Methods A VHA Office of Mental Health Services work group is recruiting 25 Veterans Affairs Medical Centers to reassign a mental health PSs to provide wellness-oriented care in PACT. Sites in three successive cohorts (n = 8, 8, 9) beginning over 6-month blocks will be matched and randomized to either standard or facilitated implementation. In facilitated implementation, an outside expert works with site stakeholders through a site visit, regular calls, and performance data to guide the planning and address challenges. Standard implementation sites will receive a webinar and access the Office of Mental Health Services work group. The two conditions will be compared on PS workload data, fidelity to the PS model of service delivery, team functioning, and Veteran measures of activation, satisfaction, and functioning. Qualitative interviews will collect information on implementation barriers and facilitators. Discussion This evaluation will provide critical data to guide administrators and VHA policy makers on future deployment of PSs, as their role has been expanding beyond mental health. In addition, development of novel implementation strategies (facilitation tailored to PSs) and the use of new tools (peer fidelity) can be models for monitoring and supporting deployment of PSs throughout VHA. Trial registration ClinicalTrials.gov, NCT02732600 (URL:https://clinicaltrials.gov/ct2/show/NCT02732600)
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Affiliation(s)
- Matthew Chinman
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh, Pittsburgh, PA, USA. .,Center for Health Equity Research and Promotion, VA Pittsburgh, Pittsburgh, PA, USA. .,RAND Corporation, Pittsburgh, PA, USA. .,VA Pittsburgh Healthcare System, Research Office Building (151R), University Drive C, Pittsburgh, PA, 15240, USA.
| | - Karin Daniels
- Center for Health Equity Research and Promotion, VA Pittsburgh, Pittsburgh, PA, USA
| | - Jeff Smith
- Central Arkansas Veterans Healthcare System, HSR&D and Mental Health Quality Enhancement Research Initiative (QUERI), Little Rock, AR, USA
| | - Sharon McCarthy
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh, Pittsburgh, PA, USA.,Center for Health Equity Research and Promotion, VA Pittsburgh, Pittsburgh, PA, USA
| | - Deborah Medoff
- VISN 5 Mental Illness Research, Education and Clinical Center (MIRECC), Baltimore, MD, USA.,Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Amanda Peeples
- VISN 5 Mental Illness Research, Education and Clinical Center (MIRECC), Baltimore, MD, USA.,Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Richard Goldberg
- VISN 5 Mental Illness Research, Education and Clinical Center (MIRECC), Baltimore, MD, USA.,Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland, School of Medicine, Baltimore, MD, USA
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Abrahamsen C, Nørgaard B, Draborg E. Health care professionals' readiness for an interprofessional orthogeriatric unit: A cross-sectional survey. Int J Orthop Trauma Nurs 2016; 26:18-23. [PMID: 28259736 DOI: 10.1016/j.ijotn.2016.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 07/04/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
Abstract
An assessment of readiness for change can set the stage for the implementation by providing information regarding staff members' beliefs and attitudes prior to an organizational change. We conducted a cross-sectional survey to assess readiness for change (N = 113 employees) in a hospital on the verge of implementing an interprofessional, co-managed orthogeriatric unit. Staff members from three departments with roles related to orthogeriatric patients were invited to answer a web-based questionnaire. Our survey demonstrates that health care professionals are confident that interprofessional collaboration will be promoted by the implementation of orthogeriatric care. We found they were knowledgeable about the proposed orthogeriatric collaboration model and ready to engage in its implementation. Their concerns pertained to various practical aspects; those voiced by the nursing staff related to work strain and the work-related interests of their professional group whereas the physicians' reservations concentrated on the planning of the change. The exploration of readiness for organizational change among health care professionals offers managers an understanding of their motivations and concerns and provides a useful tool for the planning and implementation of a new interprofessional collaboration model.
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Affiliation(s)
- Charlotte Abrahamsen
- Department of Orthopaedic Surgery, Kolding Hospital, Skovvangen 2-8, 6000 Kolding, Denmark; Department of Public Health, University of Southern Denmark, J.B Winsløws Vej 9B, 5000 Odense, Denmark.
| | - Birgitte Nørgaard
- Department of Public Health, University of Southern Denmark, J.B Winsløws Vej 9B, 5000 Odense, Denmark.
| | - Eva Draborg
- Department of Public Health, University of Southern Denmark, J.B Winsløws Vej 9B, 5000 Odense, Denmark.
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Advancing Evidence-Based Assessment in School Mental Health: Key Priorities for an Applied Research Agenda. Clin Child Fam Psychol Rev 2016; 19:271-284. [PMID: 27730441 DOI: 10.1007/s10567-016-0217-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Harris M, Jones P, Heartfield M, Allstrom M, Hancock J, Lawn S, Battersby M. Changing practice to support self-management and recovery in mental illness: application of an implementation model. Aust J Prim Health 2016; 21:279-85. [PMID: 24685120 DOI: 10.1071/py13103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 03/10/2014] [Indexed: 12/22/2022]
Abstract
Health services introducing practice changes need effective implementation methods. Within the setting of a community mental health service offering recovery-oriented psychosocial support for people with mental illness, we aimed to: (i) identify a well-founded implementation model; and (ii) assess its practical usefulness in introducing a new programme for recovery-oriented self-management support. We reviewed the literature to identify implementation models applicable to community mental health organisations, and that also had corresponding measurement tools. We used one of these models to inform organisational change strategies. The literature review showed few models with corresponding tools. The Promoting Action on Research Implementation in Health Services (PARIHS) model and the related Organisational Readiness to Change Assessment (ORCA) tool were used. The PARIHS proposes prerequisites for health service change and the ORCA measures the extent to which these prerequisites are present. Application of the ORCA at two time points during implementation of the new programme showed strategy-related gains for some prerequisites but not for others, reflecting observed implementation progress. Additional strategies to address target prerequisites could be drawn from the PARIHS model. The PARIHS model and ORCA tool have potential in designing and monitoring practice change strategies in community mental health organisations. Further practical use and testing of implementation models appears justified in overcoming barriers to change.
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Cohen AN, Hamilton AB, Ritchie M, Mittman BS, Kirchner JE, Wyatt GE, Fortney JC, Hellemann G, Liu H, Curran GM, Whelan F, Eccles AM, Parker LE, McNagny K, Hutchinson CS, Teague AB, Reist C, Young AS. Improving care quality through hybrid implementation/effectiveness studies: Best practices in design, methods, and measures. Implement Sci 2015. [PMCID: PMC4551814 DOI: 10.1186/1748-5908-10-s1-a29] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Gagnon MP, Attieh R, Ghandour EK, Légaré F, Ouimet M, Estabrooks CA, Grimshaw J. A systematic review of instruments to assess organizational readiness for knowledge translation in health care. PLoS One 2014; 9:e114338. [PMID: 25474622 PMCID: PMC4256226 DOI: 10.1371/journal.pone.0114338] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 11/09/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The translation of research into practices has been incomplete. Organizational readiness for change (ORC) is a potential facilitator of effective knowledge translation (KT). However we know little about the best way to assess ORC. Therefore, we sought to systematically review ORC measurement instruments. METHODS We searched for published studies in bibliographic databases (Pubmed, Embase, CINAHL, PsychINFO, Web of Science, etc.) up to November 1st, 2012. We included publications that developed ORC measures and/or empirically assessed ORC using an instrument at the organizational level in the health care context. We excluded articles if they did not refer specifically to ORC, did not concern the health care domain or were limited to individual-level change readiness. We focused on identifying the psychometric properties of instruments that were developed to assess readiness in an organization prior to implementing KT interventions in health care. We used the Standards for Educational and Psychological Testing to assess the psychometric properties of identified ORC measurement instruments. FINDINGS We found 26 eligible instruments described in 39 publications. According to the Standards for Educational and Psychological Testing, 18 (69%) of a total of 26 measurement instruments presented both validity and reliability criteria. The Texas Christian University -ORC (TCU-ORC) scale reported the highest instrument validity with a score of 4 out of 4. Only one instrument, namely the Modified Texas Christian University - Director version (TCU-ORC-D), reported a reliability score of 2 out of 3. No information was provided regarding the reliability and validity of five (19%) instruments. CONCLUSION Our findings indicate that there are few valid and reliable ORC measurement instruments that could be applied to KT in the health care sector. The TCU-ORC instrument presents the best evidence in terms of validity testing. Future studies using this instrument could provide more knowledge on its relevance to diverse clinical contexts.
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Affiliation(s)
- Marie-Pierre Gagnon
- Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada
- Faculty of Nursing, Université Laval, Québec, Canada
| | - Randa Attieh
- Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada
| | - El Kebir Ghandour
- Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada
| | - France Légaré
- Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada
- Department of Family Medicine, Université Laval, Québec, Canada
| | - Mathieu Ouimet
- Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada
- Department of Political Science, Université Laval, Québec, Canada
| | | | - Jeremy Grimshaw
- Ottawa Hospital Research Institute, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Williams TM, Smith GP, Lumbus AM. Evaluating the introduction of joint crisis plans into routine clinical practice in four community mental health services. Australas Psychiatry 2014; 22:476-80. [PMID: 25147314 DOI: 10.1177/1039856214546172] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Our aim was to evaluate the implementation of joint crisis planning into routine clinical practice in community mental health services in Western Australia. METHOD Four community mental health services, two metropolitan and two country based, were invited to participate in a 1-year pilot program to field test a crisis planning tool and the implementation process with a view to then rolling it out across Western Australia. Training and extensive support was offered to staff at the four sites. RESULTS Consumers experienced the process as both empowering and therapeutic. Despite acknowledgement of the value of interagency collaboration in the planning process, almost all plans were completed by consumers with their case managers. The most conspicuous finding was the marked difference in the number of completed plans at each site. CONCLUSIONS This study supports previous research findings that joint crisis planning enhances the therapeutic relationship and empowers consumers. Organisational readiness was a major factor in the differential uptake of crisis plans between sites. Our study highlights the critical importance of addressing the context and culture of each individual service in which a new intervention is being introduced as part of the implementation process.
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Affiliation(s)
- Theresa M Williams
- Director, Western Australian Centre for Mental Health Policy Research, Graylands Hospital, Mount Claremont, WA, and; Adjunct Associate Professor, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia
| | - Geoffrey P Smith
- Medical Director, Western Australian Centre for Mental Health Policy Research, Graylands Hospital, Mount Claremont, WA, and; Clinical Associate Professor, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia
| | - Anita M Lumbus
- Former Research Officer, Western Australian Centre for Mental Health Policy Research, Graylands Hospital, Mount Claremont, WA, Australia
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Hamilton AB, Mittman BS, Williams JK, Liu HH, Eccles AM, Hutchinson CS, Wyatt GE. Community-based implementation and effectiveness in a randomized trial of a risk reduction intervention for HIV-serodiscordant couples: study protocol. Implement Sci 2014; 9:79. [PMID: 24950708 PMCID: PMC4085467 DOI: 10.1186/1748-5908-9-79] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/11/2014] [Indexed: 04/21/2024] Open
Abstract
Background The HIV/AIDS epidemic continues to disproportionately affect African American communities in the US, particularly those located in urban areas. Despite the fact that HIV is often transmitted from one sexual partner to another, most HIV prevention interventions have focused only on individuals, rather than couples. This five-year study investigates community-based implementation, effectiveness, and sustainability of ‘Eban II,’ an evidence-based risk reduction intervention for African-American heterosexual, serodiscordant couples. Methods/design This hybrid implementation/effectiveness implementation study is guided by organizational change theory as conceptualized in the Texas Christian University Program Change Model (PCM), a model of phased organizational change from exposure to adoption, implementation, and sustainability. The primary implementation aims are to assist 10 community-based organizations (CBOs) to implement and sustain Eban II; specifically, to partner with CBOs to expose providers to the intervention; facilitate its adoption, implementation and sustainment; and to evaluate processes and determinants of implementation, effectiveness, fidelity, and sustainment. The primary effectiveness aim is to evaluate the effect of Eban II on participant (n = 200 couples) outcomes, specifically incidents of protected sex and proportion of condom use. We will also determine the cost-effectiveness of implementation, as measured by implementation costs and potential cost savings. A mixed methods evaluation will examine implementation at the agency level; staff members from the CBOs will complete baseline measures of organizational context and climate, while key stakeholders will be interviewed periodically throughout implementation. Effectiveness of Eban II will be assessed using a randomized delayed enrollment (waitlist) control design to evaluate the impact of treatment on outcomes at posttest and three-month follow-up. Multi-level hierarchical modeling with a multi-level nested structure will be used to evaluate the effects of agency- and couples-level characteristics on couples-level outcomes (e.g., condom use). Discussion This study will produce important information regarding the value of the Eban II program and a theory-guided implementation process and tools designed for use in implementing Eban II and other evidence-based programs in demographically diverse, resource-constrained treatment settings. Trial registration NCT00644163
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Affiliation(s)
- Alison B Hamilton
- UCLA Department of Psychiatry and Biobehavioral Sciences, 760 Westwood Plaza, 38-240 NPI, Box 175919, 90024-1759 Los Angeles, CA, USA.
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Reddy A, Shea JA, Canamucio A, Werner RM. The effect of organizational climate on patient-centered medical home implementation. Am J Med Qual 2014; 30:309-16. [PMID: 24788252 DOI: 10.1177/1062860614532516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Organizational climate is a key determinant of successful adoption of innovations; however, its relation to medical home implementation is unknown. This study examined the association between primary care providers' (PCPs') perception of organization climate and medical home implementation in the Veterans Health Administration. Multivariate regression was used to test the hypothesis that organizational climate predicts medical home implementation. This analysis of 191 PCPs found that higher scores in 2 domains of organizational climate (communication and cooperation, and orientation to quality improvement) were associated with a statistically significantly higher percentage (from 7 to 10 percentage points) of PCPs implementing structural changes to support the medical home model. In addition, some aspects of a better organizational climate were associated with improved organizational processes of care, including a higher percentage of patients contacted within 2 days of hospital discharge (by 2 to 3 percentage points) and appointments made within 3 days of a patient request (by 2 percentage points).
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Affiliation(s)
- Ashok Reddy
- VISN 4 Center for Evaluation of PACT, Philadelphia VA Medical Center, Philadelphia, PA Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA Robert Wood Johnson Clinical Scholar Program, University of Pennsylvania, Philadelphia, PA
| | - Judy A Shea
- VISN 4 Center for Evaluation of PACT, Philadelphia VA Medical Center, Philadelphia, PA Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Anne Canamucio
- VISN 4 Center for Evaluation of PACT, Philadelphia VA Medical Center, Philadelphia, PA
| | - Rachel M Werner
- VISN 4 Center for Evaluation of PACT, Philadelphia VA Medical Center, Philadelphia, PA Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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Hamilton AB, Cohen AN, Glover DL, Whelan F, Chemerinski E, McNagny KP, Mullins D, Reist C, Schubert M, Young AS. Implementation of evidence-based employment services in specialty mental health. Health Serv Res 2013; 48:2224-44. [PMID: 24138608 DOI: 10.1111/1475-6773.12115] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Study a quality improvement approach for implementing evidence-based employment services at specialty mental health clinics. DATA SOURCES/STUDY SETTING Semistructured interviews with clinicians and administrators before, during, and after implementation. Qualitative field notes, structured baseline and follow-up interviews with patients, semistructured interviews with patients after implementation, and administrative data. STUDY DESIGN Site-level controlled trial at four implementation and four control sites. Hybrid implementation-effectiveness study with mixed methods intervention evaluation design. DATA COLLECTION/EXTRACTION METHODS Site visits, in-person and telephone interviews, patient surveys, patient self-assessment. A total of 801 patients completed baseline surveys and 53 clinicians and other clinical key stakeholders completed longitudinal qualitative interviews. PRINCIPAL FINDINGS At baseline, sites varied in the availability, utilization, and quality of supported employment. Each site needed quality improvement for this service, though for differing reasons, with some needing development of the service itself and others needing increased service capacity. Improvements in knowledge, attitudes, beliefs, and referral behaviors were evident in mid- and postimplementation interviews, though some barriers persisted. Half of patients expressed an interest in working at baseline. Patients at implementation sites were 2.3 times more likely to receive employment services during the study year. Those who had a service visit were more likely to be employed at follow-up than those who did not. CONCLUSIONS Studies of implementation and effectiveness require mixed methods to both enhance implementation in real time and provide context for interpretation of complex results. In this study, a quality improvement approach resulted in superior patient-level outcomes and improved clinician knowledge, attitudes, and behaviors, in the context of substantial variation among sites.
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Affiliation(s)
- Alison B Hamilton
- Greater Los Angeles VA Healthcare Center, Los Angeles, CA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
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Chang ET, Rose DE, Yano EM, Wells KB, Metzger ME, Post EP, Lee ML, Rubenstein LV. Determinants of readiness for primary care-mental health integration (PC-MHI) in the VA Health Care System. J Gen Intern Med 2013; 28:353-62. [PMID: 23054917 PMCID: PMC3579970 DOI: 10.1007/s11606-012-2217-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 07/26/2012] [Accepted: 08/13/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Depression management can be challenging for primary care (PC) settings. While several evidence-based models exist for depression care, little is known about the relationships between PC practice characteristics, model characteristics, and the practice's choices regarding model adoption. OBJECTIVE We examined three Veterans Affairs (VA)-endorsed depression care models and tested the relationships between theoretically-anchored measures of organizational readiness and implementation of the models in VA PC clinics. DESIGN 1) Qualitative assessment of the three VA-endorsed depression care models, 2) Cross-sectional survey of leaders from 225 VA medium-to-large PC practices, both in 2007. MAIN MEASURES We assessed PC readiness factors related to resource adequacy, motivation for change, staff attributes, and organizational climate. As outcomes, we measured implementation of one of the VA-endorsed models: collocation, Translating Initiatives in Depression into Effective Solutions (TIDES), and Behavioral Health Lab (BHL). We performed bivariate and, when possible, multivariate analyses of readiness factors for each model. KEY RESULTS Collocation is a relatively simple arrangement with a mental health specialist physically located in PC. TIDES and BHL are more complex; they use standardized assessments and care management based on evidence-based collaborative care principles, but with different organizational requirements. By 2007, 107 (47.5 %) clinics had implemented collocation, 39 (17.3 %) TIDES, and 17 (7.6 %) BHL. Having established quality improvement processes (OR 2.30, [1.36, 3.87], p = 0.002) or a depression clinician champion (OR 2.36, [1.14, 4.88], p = 0.02) was associated with collocation. Being located in a VA regional network that endorsed TIDES (OR 8.42, [3.69, 19.26], p < 0.001) was associated with TIDES implementation. The presence of psychologists or psychiatrists on PC staff, greater financial sufficiency, or greater spatial sufficiency was associated with BHL implementation. CONCLUSIONS Both readiness factors and characteristics of depression care models influence model adoption. Greater model simplicity may make collocation attractive within local quality improvement efforts. Dissemination through regional networks may be effective for more complex models such as TIDES.
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Affiliation(s)
- Evelyn T Chang
- VA Greater Los Angeles, General Internal Medicine, Los Angeles, CA, USA.
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Abstract
The present paper addresses basic evaluation and procedural concepts that are involved in the process of implementing sustainable oral health behavioral and social interventions. It is part of a series of thematic articles describing cutting-edge methods for conducting oral health interventions research. Core components for effective intervention implementation are presented as part of a comprehensive model composed of four stages (training, adoption, implementation, and practice), along with sustaining influences involving preparation and maintenance. This model systematically addresses common barriers that can reduce innovation success and permanence. Special attention is given to the measurement and impact of organizational and related contextual influences across stages of the implementation process. Assessment tools and research strategies are recommended and illustrated based on evaluations of interventions implemented in addiction and mental health treatment systems. These tools and research strategies also hold promise for use within the National Institute of Dental and Craniofacial Research Practice-Based Research Networks, as well as other systems of oral health care delivery.
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Affiliation(s)
- D Dwayne Simpson
- S. B. Sells Distinguished Professor of Psychology and Emeritus Director of Institute of Behavioral Research (IBR), Texas Christian University, TCU Box 298740, Fort Worth Texas, USA
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Atkins D. Connecting research and patient care: lessons from the VA's Quality Enhancement Research Initiative. J Gen Intern Med 2010; 25 Suppl 1:1-2. [PMID: 20077144 PMCID: PMC2806965 DOI: 10.1007/s11606-009-1149-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- David Atkins
- Department of Veterans Affairs, Health Services Research and Development Service, 810 Vermont Avenue NW, Washington, DC 20420, USA.
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