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Hong C, Tai T, Zhou J, Gao C, Shi J, Huang J, Xu X, Du Y, Liu G, Guan B, Ning X, Liu X, Liu Z, Luo Y. Effect of home-based and remotely supervised combined exercise and cognitive intervention on older adults with mild cognitive impairment (COGITO): study protocol for a randomised controlled trial. BMJ Open 2024; 14:e081122. [PMID: 39107015 PMCID: PMC11308906 DOI: 10.1136/bmjopen-2023-081122] [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: 10/19/2023] [Accepted: 06/27/2024] [Indexed: 08/09/2024] Open
Abstract
INTRODUCTION Mild cognitive impairment (MCI) is an intermediate phase between normal cognitive ageing and dementia and poses a serious threat to public health worldwide; however, it might be reversible, representing the best opportunity for secondary prevention against serious cognitive impairment. As a non-pharmacological intervention for those patients, interventions that combine physical exercise and cognitive training, whether delivered simultaneously or sequentially, may have superior effects on various cognitive domains, including global cognition, memory, executive function and attention. The supportive evidence remains incomplete. This study aims to assess the effectiveness of a combined exercise and cognitive intervention in Chinese older adults with mild cognitive impairment (COGITO), empowered by digital therapy and guided by the Health Action Process Model and the Theory of Planned Behaviour (HAPA-TPB theory) in a home-based setting. METHODS AND ANALYSIS This study is a randomised controlled, assessor-blinded multi-centre study. Four parallel groups will include a total of 160 patients, receiving either a combined exercise and cognitive intervention, an isolated exercise intervention, an isolated cognitive intervention or only health education. These interventions will be conducted at least twice a week for 50 min each session, over 3 months. All interventions will be delivered at home and remotely monitored through RehabApp and Mini-programme, along with an arm-worn heart rate telemetry device. Specifically, supervisors will receive participants' real-time training diaries, heart rates or other online monitoring data and then provide weekly telephone calls and monthly home visits to encourage participants to complete their tasks and address any difficulties based on their training information. Eligible participants are community-dwelling patients with no regular exercise habit and diagnosed with MCI. The primary outcome is cognitive function assessed by the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) and Community Screening Instrument for Dementia (CSI-D), with baseline and three follow-up assessments. Secondary outcomes include quality of life, physical fitness, sleep quality, intrinsic capacity, frailty, social support, adherence, cost-effectiveness and cost-benefit. ETHICS AND DISSEMINATION The study was approved by the Institutional Review Board of Peking University. Research findings will be presented to stakeholders and published in peer-reviewed journals and at provincial, national and international conferences. TRIAL REGISTRATION NUMBER ChiCTR2300073900.
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Affiliation(s)
- Chenlu Hong
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - TakChing Tai
- Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Jianwei Zhou
- The Geriatrics Hospital of Yunnan Province, Yunnan, China
| | | | - Jianfei Shi
- Department of Psychiatry, Hangzhou Seventh People’s Hospital, Hangzhou, Zhejiang, China
| | - Jinsong Huang
- Dalian’s Seventh People's Hospital (Dalian Mental Health Center), Dalian, Liaoning, China
| | - Xuebing Xu
- Ning An Hospital of Ningxia, Yinchuan, Ningxia, China
| | - Yushan Du
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Guangwen Liu
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Boyuan Guan
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Department of International and Domestic Cooperation, Beijing Tiantan Hospital, Beijing, China
| | - Xin Ning
- Kunming Medical University, Kunming, Yunnan, China
| | - Xinran Liu
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Zhaorui Liu
- Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
- APEC Health Science Academy, Peking University, Beijing, China
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Choufani M, Kay J, Ermann J. Axial spondyloarthritis guidelines - aiming for maximum impact. Curr Opin Rheumatol 2024; 36:251-260. [PMID: 38661436 DOI: 10.1097/bor.0000000000001020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW This review discusses international clinical practice guidelines (CPGs) for axial spondyloarthritis (axSpA) focusing on methodology, guideline quality, and implementation. RECENT FINDINGS The Assessment of SpondyloArthritis International Society/European Alliance of Associations for Rheumatology (ASAS/EULAR) and Pan-American League of Associations for Rheumatology (PANLAR) recently published axSpA CPGs and updates of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network (ACR/SAA/SPARTAN) and Asia-Pacific League of Associations for Rheumatology (APLAR) CPGs are expected. GRADE has emerged as the dominant framework for CPG development and has been used by three of the four international axSpA guidelines. Notable differences exist among these guidelines in the way that the recommendations are presented. Two of the four acknowledge the need for implementation strategies, but little detail about this is provided. The few studies that have evaluated the implementation of axSpA CPGs have identified poor adherence to recommendations on physical therapy/exercise and disease activity monitoring. Implementation science has identified many barriers and facilitators affecting guideline uptake, including those related to healthcare professionals and to the guidelines themselves. Creation of a tailored implementation plan simultaneously with the CPG is recommended. SUMMARY While methodological rigor in the creation of evidence-based recommendations is the focus of CPG development, recommendations must be presented in a user-friendly format that makes them easy to apply. 'Living guidelines' could facilitate keeping content up to date. Implementation is critical for the success of a CPG and should be emphasized in future axSpA guideline updates. Further research is needed to better understand the factors impacting the successful implementation of axSpA CPGs.
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Affiliation(s)
| | - Jonathan Kay
- UMass Chan Medical School and UMass Memorial Medical Center, Worcester
| | - Joerg Ermann
- Brigham and Women's Hospital, Boston
- Harvard Medical School, Boston, Massachusetts, USA
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Gómez-Ríos MÁ, Sastre JA, Onrubia-Fuertes X, López T, Abad-Gurumeta A, Casans-Francés R, Gómez-Ríos D, Garzón JC, Martínez-Pons V, Casalderrey-Rivas M, Fernández-Vaquero MÁ, Martínez-Hurtado E, Martín-Larrauri R, Reviriego-Agudo L, Gutierrez-Couto U, García-Fernández J, Serrano-Moraza A, Rodríguez Martín LJ, Camacho Leis C, Espinosa Ramírez S, Fandiño Orgeira JM, Vázquez Lima MJ, Mayo-Yáñez M, Parente-Arias P, Sistiaga-Suárez JA, Bernal-Sprekelsen M, Charco-Mora P. Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part II. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:207-247. [PMID: 38340790 DOI: 10.1016/j.redare.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/28/2023] [Indexed: 02/12/2024]
Abstract
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
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Affiliation(s)
- M Á Gómez-Ríos
- Anesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - J A Sastre
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - X Onrubia-Fuertes
- Department of Anesthesiology, Hospital Universitary Dr Peset, Valencia, Spain
| | - T López
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - A Abad-Gurumeta
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - R Casans-Francés
- Department of Anesthesiology, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
| | | | - J C Garzón
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - V Martínez-Pons
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Casalderrey-Rivas
- Department of Anesthesiology. Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - M Á Fernández-Vaquero
- Department of Anesthesiology, Hospital Clínica Universitaria de Navarra, Madrid, Spain
| | - E Martínez-Hurtado
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - L Reviriego-Agudo
- Department of Anesthesiology, Hospital Clínico Universitario, Valencia, Spain
| | - U Gutierrez-Couto
- Biblioteca, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - J García-Fernández
- Department of Anesthesiology, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain; President of the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy (SEDAR), Spain
| | | | | | | | | | - J M Fandiño Orgeira
- Emergency Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M J Vázquez Lima
- Emergency Department, Hospital do Salnes, Vilagarcía de Arousa, Pontevedra, Spain; President of the Spanish Emergency Medicine Society (SEMES), Spain
| | - M Mayo-Yáñez
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - P Parente-Arias
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - J A Sistiaga-Suárez
- Department of Otorhinolaryngology, Hospital Universitario Donostia, Donostia, Gipuzkoa, Spain
| | - M Bernal-Sprekelsen
- Department of Otorhinolaryngology, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain; President of the Spanish Society for Otorhinolaryngology Head & Neck Surgery (SEORL-CCC), Spain
| | - P Charco-Mora
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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Berardi C, Antonini M, Jordan Z, Wechtler H, Paolucci F, Hinwood M. Barriers and facilitators to the implementation of digital technologies in mental health systems: a qualitative systematic review to inform a policy framework. BMC Health Serv Res 2024; 24:243. [PMID: 38408938 PMCID: PMC10898174 DOI: 10.1186/s12913-023-10536-1] [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: 02/04/2023] [Accepted: 12/28/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Despite the potential for improved population mental health and wellbeing, the integration of mental health digital interventions has been difficult to achieve. In this qualitative systematic review, we aimed to identify barriers and facilitators to the implementation of digital technologies in mental healthcare systems, and map these to an implementation framework to inform policy development. METHODS We searched Medline, Embase, Scopus, PsycInfo, Web of Science, and Google Scholar for primary research articles published between January 2010 and 2022. Studies were considered eligible if they reported barriers and/or facilitators to the integration of any digital mental healthcare technologies. Data were extracted using EPPI-Reviewer Web and analysed thematically via inductive and deductive cycles. RESULTS Of 12,525 references identified initially, 81 studies were included in the final analysis. Barriers and facilitators were grouped within an implementation (evidence-practice gap) framework across six domains, organised by four levels of mental healthcare systems. Broadly, implementation was hindered by the perception of digital technologies as impersonal tools that add additional burden of care onto both providers and patients, and change relational power asymmetries; an absence of resources; and regulatory complexities that impede access to universal coverage. Facilitators included person-cantered approaches that consider patients' intersectional features e.g., gender, class, disability, illness severity; evidence-based training for providers; collaboration among colleagues; appropriate investment in human and financial resources; and policy reforms that tackle universal access to digital health. CONCLUSION It is important to consider the complex and interrelated nature of barriers across different domains and levels of the mental health system. To facilitate the equitable, sustainable, and long-term digital transition of mental health systems, policymakers should consider a systemic approach to collaboration between public and private sectors to inform evidence-based planning and strengthen mental health systems. PROTOCOL REGISTRATION The protocol is registered on PROSPERO, CRD42021276838.
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Affiliation(s)
- Chiara Berardi
- Newcastle Business School, The University of Newcastle, Hunter St & Auckland St, 2300, Newcastle, NSW, Australia.
| | - Marcello Antonini
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- Department of Health Policy, London School of Economics and Political Science, London, WC2A 2AE, UK
| | - Zephanie Jordan
- Newcastle Business School, The University of Newcastle, Hunter St & Auckland St, 2300, Newcastle, NSW, Australia
| | - Heidi Wechtler
- Newcastle Business School, The University of Newcastle, Hunter St & Auckland St, 2300, Newcastle, NSW, Australia
| | - Francesco Paolucci
- Newcastle Business School, The University of Newcastle, Hunter St & Auckland St, 2300, Newcastle, NSW, Australia
| | - Madeleine Hinwood
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Seleznova Y, Bruder O, Loeser S, Artmann J, Shukri A, Naumann M, Stock S, Wein B, Müller D. Health economic consequences of optimal vs. observed guideline adherence of coronary angiography in patients with suspected obstructive stable coronary artery in Germany: a microsimulation model. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:45-54. [PMID: 36893809 PMCID: PMC10785585 DOI: 10.1093/ehjqcco/qcad015] [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: 01/14/2023] [Revised: 02/10/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023]
Abstract
AIMS While the number of patients with stable coronary artery disease (SCAD) is similar across European countries, Germany has the highest per capita volume of coronary angiographies (CA). This study evaluated the health economic consequences of guideline-non-adherent use of CA in patients with SCAD. METHODS AND RESULTS As part of the ENLIGHT-KHK trial, a prospective observational study, this microsimulation model compared the number of major adverse cardiac events (MACE) and the costs of real-world use of CA with those of (assumed) complete guideline-adherent use (according to the German National Disease Management Guideline 2019). The model considered non-invasive testing, CA, revascularization, MACE (30 days after CA), and medical costs. Model inputs were obtained from the ENLIGHT-KHK trial (i.e. patients' records, a patient questionnaire, and claims data). Incremental cost-effectiveness ratios were calculated by comparing the differences in costs and MACE avoided from the perspective of the Statutory Health Insurance (SHI). Independent on pre-test probability (PTP) of SCAD, complete guideline adherence for usage of CA would result in a slightly lower rate of MACE (-0.0017) and less cost (€-807) per person compared with real-world guideline adherence. While cost savings were shown for moderate and low PTP (€901 and €502, respectively), for a high PTP, a guideline-adherent process results in slightly higher costs (€78) compared with real-world guideline adherence. Sensitivity analyses confirmed the results. CONCLUSION Our analysis indicates that improving guideline adherence in clinical practice by reducing the amount of CAs in patients with SCAD would lead to cost savings for the German SHI.
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Affiliation(s)
- Yana Seleznova
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935 Cologne, Germany
| | - Oliver Bruder
- Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth-Krankenhaus Essen, Klara-Kopp-Weg 1, 45138 Essen, Germany
- Faculty of Medicine, Ruhr University Bochum, 44801, Bochum, Germany
| | - Simon Loeser
- AOK Rheinland/Hamburg, Kasernenstraße 61, 40213 Düsseldorf, Germany
| | - Jörg Artmann
- AOK Rheinland/Hamburg, Kasernenstraße 61, 40213 Düsseldorf, Germany
| | - Arim Shukri
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935 Cologne, Germany
| | - Marie Naumann
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935 Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935 Cologne, Germany
| | - Bastian Wein
- Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth-Krankenhaus Essen, Klara-Kopp-Weg 1, 45138 Essen, Germany
- Department of Cardiology, Faculty of Medicine, University of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Dirk Müller
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935 Cologne, Germany
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Bierbaum M, Rapport F, Arnolda G, Tran Y, Nic Giolla Easpaig B, Ludlow K, Clay-Williams R, Austin E, Laginha B, Lo CY, Churruca K, van Baar L, Hutchinson K, Chittajallu R, Owais SS, Nullwala R, Hibbert P, Fajardo Pulido D, Braithwaite J. Rates of adherence to cancer treatment guidelines in Australia and the factors associated with adherence: A systematic review. Asia Pac J Clin Oncol 2023; 19:618-644. [PMID: 36881529 DOI: 10.1111/ajco.13948] [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: 12/01/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 03/08/2023]
Abstract
Adherence to cancer treatment clinical practice guidelines (CPGs) varies enormously across Australia, despite being associated with improved patient outcomes. This systematic review aims to characterize adherence rates to active-cancer treatment CPGs in Australia and related factors to inform future implementation strategies. Five databases were systematically searched, abstracts were screened for eligibility, a full-text review and critical appraisal of eligible studies performed, and data extracted. A narrative synthesis of factors associated with adherence was conducted, and the median adherence rates within cancer streams calculated. A total of 21,031 abstracts were identified. After duplicates were removed, abstracts screened, and full texts reviewed, 20 studies focused on adherence to active-cancer treatment CPGs were included. Overall adherence rates ranged from 29% to 100%. Receipt of guideline recommended treatments was higher for patients who were younger (diffuse large B-cell lymphoma [DLBCL], colorectal, lung, and breast cancer); female (breast and lung cancer), and male (DLBCL and colorectal cancer); never smokers (DLBCL and lung cancer); non-Indigenous Australians (cervical and lung cancer); with less advanced stage disease (colorectal, lung, and cervical cancer), without comorbidities (DLBCL, colorectal, and lung cancer); with good-excellent Eastern Cooperative Oncology Group performance status (lung cancer); living in moderately accessible places (colon cancer); and; treated in metropolitan facilities (DLBLC, breast and colon cancer). This review characterized active-cancer treatment CPG adherence rates and associated factors in Australia. Future targeted CPG implementation strategies should account for these factors, to redress unwarranted variation particularly in vulnerable populations, and improve patient outcomes (Prospero number: CRD42020222962).
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Affiliation(s)
- Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
| | - Brona Nic Giolla Easpaig
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
| | - Kristiana Ludlow
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Elizabeth Austin
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Bela Laginha
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Chi Yhun Lo
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Lieke van Baar
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Renuka Chittajallu
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Riverina Cancer Care Centre, Wagga Wagga, New South Wales, Australia
- GenesisCare, Kingswood, New South Wales, Australia
| | - Syeda Somyyah Owais
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Ruqaiya Nullwala
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- North Eastern Public Health Unit, Eastern Health, Melbourne, Victoria, Australia
| | - Peter Hibbert
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
- South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
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Wang Y, Wong ELY, Nilsen P, Chung VCH, Tian Y, Yeoh EK. A scoping review of implementation science theories, models, and frameworks - an appraisal of purpose, characteristics, usability, applicability, and testability. Implement Sci 2023; 18:43. [PMID: 37726779 PMCID: PMC10507824 DOI: 10.1186/s13012-023-01296-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 08/26/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND A proliferation of theories, models, and frameworks (TMFs) have been developed in the implementation science field to facilitate the implementation process. The basic features of these TMFs have been identified by several reviews. However, systematic appraisals on the quality of these TMFs are inadequate. To fill this gap, this study aimed to assess the usability, applicability, and testability of the current TMFs in a structured way. METHODS A scoping review method was employed. Electronic databases were searched to locate English and Chinese articles published between January 2000 and April 2022. Search terms were specific to implementation science. Additionally, hand searches were administered to identify articles from related reviews. Purpose and characteristics such as the type of TMF, analytical level, and observation unit were extracted. Structured appraisal criteria were adapted from Birken et al.'s Theory Comparison and Selection Tool (T-CaST) to conduct an in-depth analysis of the TMFs' usability, applicability, and testability. RESULTS A total of 143 TMFs were included in this analysis. Among them, the most common purpose was to identify barriers and facilitators. Most TMFs applied the descriptive method to summarize the included constructs or the prescriptive method to propose courses of implementation actions. TMFs were mainly mid-range theories built on existing conceptual frameworks or demonstrated grand theories. The usability of the TMFs needs to be improved in terms of the provision of conceptually matched strategies to barriers and facilitators and instructions on the TMFs usage. Regarding the applicability, little attention was paid to the constructs of macro-level context, stages of scale-up and sustainability, and implementation outcomes like feasibility, cost, and penetration. Also, fewer TMFs could propose recommended research and measurement methods to apply the TMFs. Lastly, explicit hypotheses or propositions were lacking in most of the TMFs, and empirical evidence was lacking to support the claimed mechanisms between framework elements in testability. CONCLUSIONS Common limitations were found in the usability, application, and testability of the current TMFs. The findings of this review could provide insights for developers of TMFs for future theoretical advancements.
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Affiliation(s)
- Yingxuan Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Eliza Lai-Yi Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Per Nilsen
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Vincent Chi-Ho Chung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Yue Tian
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Eng-Kiong Yeoh
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Naumann M, Scharfenberg SR, Seleznova Y, Wein B, Bruder O, Stock S, Simic D, Scheckel B, Müller D. Factors influencing adherence to clinical practice guidelines in patients with suspected chronic coronary syndrome: a qualitative interview study in the ambulatory care sector in Germany. BMC Health Serv Res 2023; 23:655. [PMID: 37340434 DOI: 10.1186/s12913-023-09587-1] [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: 03/14/2023] [Accepted: 05/21/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Chronic coronary syndrome (CCS) is a potentially progressive clinical presentation of coronary artery disease (CAD). Clinical practice guidelines (CPGs) are available for prevention, diagnosis, and treatment. Embedded in the "ENLIGHT-KHK" healthcare project, a qualitative study was conducted to identify factors that influence guideline adherence from the perspective of general practitioners (GPs) and cardiologists (CA) in the ambulatory care sector in Germany. METHODS GPs and CAs were surveyed via telephone using an interview guide. The respondents were first asked about their individual approach to caring for patients with suspected CCS. Subsequently, the accordance of their approach with guideline recommendations was addressed. Finally, potential measures for assisting with guideline adherence were discussed. The semi-structured interviews were transcribed verbatim and analysed using a qualitative content analysis in accordance with Kuckartz and Rädiker. Factors influencing adherence to CPGs were categorised by assessing whether they (i) inhibited or facilitated guideline adherence, (ii) played a role in patients at risk of CCS or with suspected or known CCS, (iii) were mentioned in implicit or explicit thematic reference to CPGs, and (iv) were declared a practical problem. RESULTS Based on interviews with ten GPs and five CAs, 35 potential influencing factors were identified. These emerged at four levels: patients, healthcare providers, CPGs, and the healthcare system. The most commonly cited barrier to guideline adherence among the respondents was structural aspects at the system level, including reachability of providers and services, waiting times, reimbursement through statutory health insurance (SHI) providers, and contract offers. There was a strong emphasis on interdependencies between factors acting at different levels. For instance, poor reachability of providers and services at the system level may result in inexpedience of guideline recommendations at the CPG level. Likewise, poor reachability of providers and services at the system level may be aggravated or alleviated by factors such as diagnostic preferences at the patient level or collaborations at the provider level. CONCLUSIONS To assist with adherence to CPGs regarding CCS, promoting measures may be needed that account for interdependencies between barriers and facilitators at various healthcare levels. Respective measures should consider medically justified deviations from guideline recommendations in individual cases. TRIAL REGISTRATION German Clinical Trials Register: DRKS00015638; Universal Trial Number (UTN): U1111-1227-8055.
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Affiliation(s)
- Marie Naumann
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany.
| | - Simon Robin Scharfenberg
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Yana Seleznova
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Bastian Wein
- Cardiology - Faculty of Medicine, University of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
- Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth-Hospital Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany
| | - Oliver Bruder
- Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth-Hospital Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany
- Ruhr University Bochum, Bochum, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Dusan Simic
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Benjamin Scheckel
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Dirk Müller
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany
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9
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Bierbaum M, Arnolda G, Braithwaite J, Rapport F. Clinician attitudes towards cancer treatment guidelines in Australia. BMC Res Notes 2023; 16:80. [PMID: 37194072 DOI: 10.1186/s13104-023-06356-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/09/2023] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVES Clinical Practice Guidelines (CPGs) are designed to guide treatment decisions, yet adherence rates vary widely. To characterise perceived barriers and facilitators to cancer treatment CPG adherence in Australia, and estimate the frequency of previous qualitative research findings, a survey was distributed to Australian oncologists. RESULTS The sample is described and validated guideline attitude scores reported for different groups. Differences in mean CPG attitude scores across clinician subgroups and associations between frequency of CPG use and clinician characteristics were calculated; with 48 respondents there was limited statistical power to find differences. Younger oncologists (< 50 years) and clinicians participating in three or more Multidisciplinary Team Meetings were more likely to routinely or occasionally use CPGs. Perceived barriers and facilitators were identified. Thematic analysis was conducted on open-text responses. Results were integrated with previous interview findings and presented in a thematic, conceptual matrix. Most barriers and facilitators identified earlier were corroborated by survey results, with minor discordance. Identified barriers and facilitators require further exploration within a larger sample to assess their perceived impact on cancer treatment CPG adherence in Australia, as well as to inform future CPG implementation strategies. This research was Human Research Ethics Committee approved (2019/ETH11722 and 52019568810127, ID:5688).
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Affiliation(s)
- Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2113, Australia.
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2113, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2113, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2113, Australia
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10
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Terbraak M, Verweij L, Jepma P, Buurman B, Jørstad H, Scholte Op Reimer W, van der Schaaf M. Feasibility of home-based cardiac rehabilitation in frail older patients: a clinical perspective. Physiother Theory Pract 2023; 39:560-575. [PMID: 35068322 DOI: 10.1080/09593985.2022.2025549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
(A) BACKGROUND Home-based cardiac rehabilitation (CR) is an attractive alternative for frail older patients who are unable to participate in hospital-based CR. Yet, the feasibility of home-based CR provided by primary care physiotherapists (PTs) to these patients remains uncertain. (B) OBJECTIVE To investigate physiotherapists' (PTs) clinical experience with a guideline-centered, home-based CR protocol for frail older patients. (C) METHODS A qualitative study examined the home-based CR protocol of a randomized controlled trial. Observations and interviews of the CR-trained primary care PTs providing home-based CR were conducted until data saturation. Two researchers separately coded the findings according to the theoretical framework of Gurses. (D) RESULTS The enrolled PTs (n = 8) had a median age of 45 years (IQR 27-57), and a median work experience of 20 years (IQR 5-33). Three principal themes were identified that influence protocol-adherence by PTs and the feasibility of protocol-implementation: 1) feasibility of exercise testing and the exercise program; 2) patients' motivation and PTs' motivational techniques; and 3) interdisciplinary collaboration with other healthcare providers in monitoring patients' risks. (E) CONCLUSION Home-based CR for frail patients seems feasible for PTs. Recommendations on the optimal intensity, use of home-based exercise tests and measurement tools, and interventions to optimize self-regulation are needed to facilitate home-based CR.
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Affiliation(s)
- Michel Terbraak
- Department of Physical Therapy, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Lotte Verweij
- Department of Physical Therapy, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Patricia Jepma
- Department of Physical Therapy, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Bianca Buurman
- Department of Physical Therapy, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Harald Jørstad
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Wilma Scholte Op Reimer
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands.,HU University of Applied Sciences Utrecht, Research Group Chronic Diseases, Utrecht, Netherlands
| | - Marike van der Schaaf
- Department of Physical Therapy, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, Netherlands
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11
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Bierbaum M, Rapport F, Arnolda G, Delaney GP, Liauw W, Olver I, Braithwaite J. Clinical practice guideline adherence in oncology: A qualitative study of insights from clinicians in Australia. PLoS One 2022; 17:e0279116. [PMID: 36525435 PMCID: PMC9757567 DOI: 10.1371/journal.pone.0279116] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The burden of cancer is large in Australia, and rates of cancer Clinical Practice Guideline (CPG) adherence is suboptimal across various cancers. METHODS The objective of this study is to characterise clinician-perceived barriers and facilitators to cancer CPG adherence in Australia. Semi-structured interviews were conducted to collect data from 33 oncology-focused clinicians (surgeons, radiation oncologists, medical oncologists and haematologists). Clinicians were recruited in 2019 and 2020 through purposive and snowball sampling from 7 hospitals across Sydney, Australia, and interviewed either face-to-face in hospitals or by phone. Audio recordings were transcribed verbatim, and qualitative thematic analysis of the interview data was undertaken. Human research ethics committee approval and governance approval was granted (2019/ETH11722, #52019568810127). RESULTS Five broad themes and subthemes of key barriers and facilitators to cancer treatment CPG adherence were identified: Theme 1: CPG content; Theme 2: Individual clinician and patient factors; Theme 3: Access to, awareness of and availability of CPGs; Theme 4: Organisational and cultural factors; and Theme 5: Development and implementation factors. The most frequently reported barriers to adherence were CPGs not catering for patient complexities, being slow to be updated, patient treatment preferences, geographical challenges for patients who travel large distances to access cancer services and limited funding of CPG recommended drugs. The most frequently reported facilitators to adherence were easy accessibility, peer review, multidisciplinary engagement or MDT attendance, and transparent CPG development by trusted, multidisciplinary experts. CPGs provide a reassuring framework for clinicians to check their treatment plans against. Clinicians want cancer CPGs to be frequently updated utilising a wiki-like process, and easily accessible online via a comprehensive database, coordinated by a well-trusted development body. CONCLUSION Future implementation strategies of cancer CPGs in Australia should be tailored to consider these context-specific barriers and facilitators, taking into account both the content of CPGs and the communication of that content. The establishment of a centralised, comprehensive, online database, with living wiki-style cancer CPGs, coordinated by a well-funded development body, along with incorporation of recommendations into point-of-care decision support would potentially address many of the issues identified.
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Affiliation(s)
- Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- * E-mail:
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
| | - Geoff P. Delaney
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
- SWSLHD Cancer Services, Liverpool, Australia
| | - Winston Liauw
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
- SESLHD Cancer Service, Kogarah, Australia
| | - Ian Olver
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
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12
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Dickerson F, Goldsholl S, Yuan CT, Dalcin A, Eidman B, Minahan E, Gennusa III JV, Mace E, Cullen B, Evins AE, Cather C, Wang NY, McGinty EM, Daumit GL. Promoting Evidence-Based Tobacco Cessation Treatment in Community Mental Health Clinics: Protocol for a Pilot Study (Preprint). JMIR Res Protoc 2022; 12:e44787. [PMID: 37171851 DOI: 10.2196/44787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Tobacco smoking is highly prevalent among persons with serious mental illness (SMI) and is the largest contributor to premature mortality in this population. Evidence-based smoking cessation therapy with medications and behavioral counseling is effective for persons with SMI, but few receive this treatment. Mental health providers have extensive experience working with clients with SMI and frequent treatment contacts, making them well positioned to deliver smoking cessation treatment. However, few mental health providers feel adequately trained to deliver this treatment, and many providers believe that smokers with SMI are not interested in quitting or have concerns about the safety of smoking cessation pharmacotherapy, despite substantial evidence to the contrary. OBJECTIVE We present the protocol for the pilot "IMPACT" (Implementing Action for Tobacco Smoking Cessation Treatment) study, which aims to pilot test a multicomponent implementation intervention to increase the delivery of evidence-based tobacco smoking cessation treatment in community mental health clinics. METHODS We are using a prepost observational design to examine the effects of an implementation intervention designed to improve mental health providers' delivery of the following four evidence-based practices related to smoking cessation treatment: (1) assessment of smoking status, (2) assessment of willingness to quit, (3) behavioral counseling, and (4) pharmacotherapy prescribing. To overcome key barriers related to providers' knowledge and self-efficacy of smoking cessation treatment, the study will leverage implementation strategies including (1) real-time and web-based training for mental health providers about evidence-based smoking cessation treatment and motivational interviewing, including an avatar practice module; (2) a tobacco smoking treatment protocol; (3) expert consultation; (4) coaching; and (5) organizational strategy meetings. We will use surveys and in-depth interviews to assess the implementation intervention's effects on providers' knowledge and self-efficacy, the mechanisms of change targeted by the intervention, as well as providers' perceptions of the acceptability, appropriateness, and feasibility of both the evidence-based practices and implementation strategies. We will use data on care delivery to assess providers' implementation of evidence-based smoking cessation practices. RESULTS The IMPACT study is being conducted at 5 clinic sites. More than 50 providers have been enrolled, exceeding our recruitment target. The study is ongoing. CONCLUSIONS In order for persons with SMI to realize the benefits of smoking cessation treatment, it is important for clinicians to implement evidence-based practices successfully. This pilot study will result in a set of training modules, implementation tools, and resources for clinicians working in community mental health clinics to address tobacco smoking with their clients. Trial Registration: ClinicalTrials.gov NCT04796961; https://clinicaltrials.gov/ct2/show/NCT04796961. TRIAL REGISTRATION ClinicalTrials.gov NCT04796961; https://clinicaltrials.gov/ct2/show/NCT04796961. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44787.
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13
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Frantsve-Hawley J, Abt E, Carrasco-Labra A, Dawson T, Michaels M, Pahlke S, Rindal DB, Spallek H, Weyant RJ. Strategies for developing evidence-based clinical practice guidelines to foster implementation into dental practice. J Am Dent Assoc 2022; 153:1041-1052. [PMID: 36127176 DOI: 10.1016/j.adaj.2022.07.012] [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: 06/02/2022] [Revised: 07/09/2022] [Accepted: 07/13/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Professional and other organizations, including oral health care organizations, have been developing evidence-based clinical practice guidelines (CPGs) to help providers incorporate the best available evidence into their clinical decision making. Although the rigor of guideline development has increased over time, ongoing challenges prevent the full adoption of CPGs into clinical practices that experience variability in provider expertise and opinion, patient flow pace, and use of electronic dental records. These challenges include lack of relevant evidence, failure to keep guidelines up to date, and failure to adopt strategies aimed at overcoming the barriers preventing implementation into clinical practice. RESULTS This article provides a brief overview of strategies that can be used to overcome common challenges to guideline adoption. Such strategies include creating evidence-based CPGs that use additional sources of evidence and methods to inform guideline development and accelerate the guideline updating and dissemination process (that is, evidence directly from clinical practice, big data, patients' values and preferences, and living guidelines) and applying implementation strategies that have been documented as improving translation of CPGs into routine clinical practice (that is, guideline implementability, implementation science, and computable guidelines). PRACTICAL IMPLICATIONS Adopting newer strategies for developing and translating evidence into practice could lead to improvements in patient care and population health.
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14
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Yuan CT, McGinty EE, Dalcin A, Goldsholl S, Dickerson F, Gudzune KA, Jerome GJ, Thompson DA, Murphy KA, Minahan E, Daumit GL. Scaling Evidence-Based Interventions to Improve the Cardiovascular Health of People With Serious Mental Illness. Front Psychiatry 2022; 13:793146. [PMID: 35185650 PMCID: PMC8855048 DOI: 10.3389/fpsyt.2022.793146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
People with serious mental illnesses (SMIs) experience excess mortality, driven in large part by high rates of cardiovascular disease (CVD), with all cardiovascular disease risk factors elevated. Interventions designed to improve the cardiovascular health of people with SMI have been shown to lead to clinically significant improvements in clinical trials; however, the uptake of these interventions into real-life clinical settings remains limited. Implementation strategies, which constitute the "how to" component of changing healthcare practice, are critical to supporting the scale-up of evidence-based interventions that can improve the cardiovascular health of people with SMI. And yet, implementation strategies are often poorly described and rarely justified theoretically in the literature, limiting the ability of researchers and practitioners to tease apart why, what, how, and when implementation strategies lead to improvement. In this Perspective, we describe the implementation strategies that the Johns Hopkins ALACRITY Center for Health and Longevity in Mental Illness is using to scale-up three evidenced-based interventions related to: (1) weight loss; (2) tobacco smoking cessation treatment; and (3) hypertension, dyslipidemia, and diabetes care for people with SMI. Building on concepts from the literature on complex health interventions, we focus on considerations related to the core function of an intervention (i.e., or basic purposes of the change process that the health intervention seeks to facilitate) vs. the form (i.e., implementation strategies or specific activities taken to carry out core functions that are customized to local contexts). By clearly delineating how implementation strategies are operationalized to support the interventions' core functions across these three studies, we aim to build and improve the future evidence base of how to adapt, implement, and evaluate interventions to improve the cardiovascular health of people with SMI.
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Affiliation(s)
- Christina T. Yuan
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Emma E. McGinty
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Arlene Dalcin
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Stacy Goldsholl
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | | | - Kimberly A. Gudzune
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Gerald J. Jerome
- Department of Kinesiology, Towson University, Towson, MD, United States
| | - David A. Thompson
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Karly A. Murphy
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Eva Minahan
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Gail L. Daumit
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
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Huybrechts I, Declercq A, Verté E, Raeymaeckers P, Anthierens S. The Building Blocks of Implementation Frameworks and Models in Primary Care: A Narrative Review. Front Public Health 2021; 9:675171. [PMID: 34414155 PMCID: PMC8369196 DOI: 10.3389/fpubh.2021.675171] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/08/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Our aim is to identify the core building blocks of existing implementation frameworks and models, which can be used as a basis to further develop a framework for the implementation of complex interventions within primary care practices. Within the field of implementation science, various frameworks, and models exist to support the uptake of research findings and evidence-based practices. However, these frameworks and models often are not sufficiently actionable or targeted for use by intervention designers. The objective of this research is to map the similarities and differences of various frameworks and models, in order to find key constructs that form the foundation of an implementation framework or model that is to be developed. Methods: A narrative review was conducted, searching for papers that describe a framework or model for implementation by means of various search terms, and a snowball approach. The core phases, components, or other elements of each framework or model are extracted and listed. We analyze the similarities and differences between the frameworks and models and elaborate on their core building blocks. These core building blocks form the basis of an overarching model that we will develop based upon this review and put into practice. Results: A total of 28 implementation frameworks and models are included in our analysis. Throughout 15 process models, a total of 67 phases, steps or requirements are extracted and throughout 17 determinant frameworks a total of 90 components, constructs, or elements are extracted and listed into an Excel file. They are bundled and categorized using NVivo 12© and synthesized into three core phases and three core components of an implementation process as common elements of most implementation frameworks or models. The core phases are a development phase, a translation phase, and a sustainment phase. The core components are the intended change, the context, and implementation strategies. Discussion: We have identified the core building blocks of an implementation framework or model, which can be synthesized in three core phases and three core components. These will be the foundation for further research that aims to develop a new model that will guide and support intervention designers to develop and implement complex interventions, while taking account contextual factors.
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Affiliation(s)
- Ine Huybrechts
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.,Department of Family Medicine and Chronic Care, Free University of Brussels, Brussels, Belgium
| | - Anja Declercq
- LUCAS - Centre for Care Research and Consultancy & CESO - Centre for Sociological Research, Catholic University of Leuven, Leuven, Belgium
| | - Emily Verté
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.,Department of Family Medicine and Chronic Care, Free University of Brussels, Brussels, Belgium
| | - Peter Raeymaeckers
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Sibyl Anthierens
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
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Adherence to Car Seat Tolerance Screening Differs by Indication and Patient Characteristics. Matern Child Health J 2021; 25:1707-1716. [PMID: 34403071 PMCID: PMC8369874 DOI: 10.1007/s10995-021-03220-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/04/2022]
Abstract
Objectives To assess whether adherence to institutional car seat tolerance screening (CSTS) guidelines differed for infants born preterm (PTM), term low birth weight (T-LBW), or both preterm and low birth weight (P-LBW), and to examine the association between CSTS adherence and patient characteristics. Study Design Within two large academic and community hospitals, we retrospectively reviewed all infants meeting institutional criteria (< 37 weeks’ gestation and/or < 2.27 kg) for CSTS from 2014 to 2018. Multivariable logistic regression evaluated the association of patient characteristics with institutional CSTS guideline adherence. Results 4374 eligible infants were born PTM (50.9%), T-LBW (6.5%), or P-LBW (42.6%). Adherence rates were 92.7% in the neonatal intensive care unit (NICU) and 95.2% in the well-baby nursery with initial CSTS failure rates of 6.1% and 9.9%, respectively. Adherence was lowest among T-LBW (80.7%) compared to PTM (95.1%) or P-LBW (92.2%) infants in the NICU (p < 0.001) and well-baby nursery (81.6%, 96.7% and 97.1%, respectively, p < 0.001). In bivariate analyses, gestational age, birth weight, insurance, race, hospital type, discharge year, and preferred language were associated with adherence. In fully-adjusted models, adherence was positively associated with lower gestational age, higher birth weight, non-Medicaid insurance, and later discharge year (NICU) and lower gestational age and later discharge year (well-baby nursery). Conclusions Adherence was lower for T-LBW than PTM or P-LBW infants, despite similar CSTS failure rates. Disparities in adherence among Medicaid-insured patients in the NICU warrant further study. Future studies are needed to clarify the benefit of CSTS and increase adherence in high-risk populations. Supplementary Information The online version contains supplementary material available at 10.1007/s10995-021-03220-5.
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Loch AP, Rocha SQ, Fonsi M, de Magalhães Caraciolo JM, Kalichman AO, de Alencar Souza R, Gianna MC, Gonçalves A, Short D, Pimenta SL, Bagnola L, Wonhnrath Menuzzo C, da Rocha Meireles Z, Natividade Diz E, Zajdenverg R, Prudente I, Battistella Nemes MI. Improving the continuum of care monitoring in Brazilian HIV healthcare services: An implementation science approach. PLoS One 2021; 16:e0250060. [PMID: 33970914 PMCID: PMC8109816 DOI: 10.1371/journal.pone.0250060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 03/30/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the impact of an intervention improving the continuum of care monitoring (CCM) within HIV public healthcare services in São Paulo, Brazil, and implementing a clinical monitoring system. This system identified three patient groups prioritized for additional care engagement: (1) individuals diagnosed with HIV, but not receiving treatment (the treatment gap group); (2) individuals receiving treatment for >6 months with a detectable viral load (the virologic failure group); and (3) patients lost to follow-up (LTFU). METHODS The implementation strategies included three training sessions, covering system logistics, case discussions, and development of maintenance goals. These strategies were conducted within 30 HIV public healthcare services (May 2019 to April 2020). After each training session, professionals shared their experiences with CCM at regional meetings. Before and after the intervention, providers were invited to answer 23 items from the normalization process theory questionnaire (online) to understand contextual factors. The mean item scores were compared using the Mann-Whitney U test. The RE-AIM implementation science framework (evaluating reach, effectiveness, adoption, implementation, and maintenance) was used to evaluate the integration of the CCM. RESULTS In the study, 47 (19.3%) of 243 patients with a treatment gap initiated treatment, 456 (49.1%) of 928 patients with virologic failure achieved suppression, and 700 of 1552 (45.1%) LTFU patients restarted treatment. Strategies for the search and reengagement of patients were developed and shared. Providers recognized the positive effects of CCM on their work and how it modified existing activities (3.7 vs. 4.4, p<0.0001, and 3.9 vs. 4.1, p<0.05); 27 (90%) centers developed plans to sustain routine CCM. CONCLUSION Implementing CCM helped identify patients requiring more intensive attention. This intervention led to changes in providers' perceptions of CCM and care and management processes, which increased the number of patients engaged across the care continuum and improved outcomes.
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Affiliation(s)
- Ana Paula Loch
- Centro de Referência e Treinamento DST/AIDS do Estado de São Paulo, São Paulo, Brazil
- * E-mail:
| | - Simone Queiroz Rocha
- Centro de Referência e Treinamento DST/AIDS do Estado de São Paulo, São Paulo, Brazil
| | - Mylva Fonsi
- Centro de Referência e Treinamento DST/AIDS do Estado de São Paulo, São Paulo, Brazil
| | | | | | - Rosa de Alencar Souza
- Centro de Referência e Treinamento DST/AIDS do Estado de São Paulo, São Paulo, Brazil
| | - Maria Clara Gianna
- Centro de Referência e Treinamento DST/AIDS do Estado de São Paulo, São Paulo, Brazil
| | - Alexandre Gonçalves
- Centro de Referência e Treinamento DST/AIDS do Estado de São Paulo, São Paulo, Brazil
| | - Duncan Short
- ViiV Healthcare–Innovation and Implementation Science, London, England
| | - Shenia Liane Pimenta
- Grupo de Vigilância Epidemiológica de Campinas—GVE XVII—Secretaria Estadual de Saúde de São Paulo, Campinas, São Paulo, Brazil
| | - Lea Bagnola
- Programa Municipal de IST/Aids de Votuporanga, Votuporanga, São Paulo, Brazil
| | | | | | | | - Roberto Zajdenverg
- ViiV Healthcare–Scientific Affairs & Public Health, Rio de Janeiro, Brazil
| | | | - Maria Ines Battistella Nemes
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, estado de São Paulo, Brazil
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18
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Khalil H, Kynoch K. Implementation of sustainable complex interventions in health care services: the triple C model. BMC Health Serv Res 2021; 21:143. [PMID: 33588823 PMCID: PMC7885422 DOI: 10.1186/s12913-021-06115-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The changing and evolving healthcare environment means organisations are under increasing pressure to deliver value-based, high quality care to patients through enabling access, reducing costs and improving outcomes. These factors result in an increased pressure to deliver efficient and beneficial interventions to improve patient care and support sustainability beyond the scope of the implementation of such interventions. Additionally, the literature highlights the importance of coordination, cooperation and working together across areas is critical to achieving implementation success. This paper discusses the development of a triple C model for implementation that supports sustainability of complex interventions in health care services. METHODS In order to develop the proposed implementation model, we adapted the formal tradition of theory building that is described in sociology. Firstly, we conducted a review of the literature on complex interventions and the available implementation models used to embed these interventions to identify the key aspects relating to successful implementation. Secondly, we devised a framework that encompassed these findings into a simple and workable model that can be easily embedded into everyday practice. This proposed model uses clear, systemic explanation, adds to the current knowledge in this area and is fit for purpose, providing healthcare workers with a simple easy-to-follow framework to embed practice change. RESULTS A three-stage implementation model was devised based on the findings of the literature and named the Triple C model (Consultation, Collaboration and Consolidation). The three stages are interconnected and overlap to support sustainability is considered at all levels of the project ensuring its greater success. This model considers the sustainability within any implementation project. Sustainability of interventions are a key consideration for continuous and successful change in any health care organisation. A set of criteria were developed for each of the three stages to support adaptability and sustainment of interventions are maintained throughout the life of the intervention. CONCLUSION Ensuring sustainability of interventions requires continuing effort and embedding the need for sustainability throughout all stages of an implementation project. The Triple C model offers a new approach for healthcare clinicians to support sustainability of organizational change.
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Affiliation(s)
- Hanan Khalil
- School of Psychology and Public Health, La Trobe University, Level 3, 360 Collins Street, 3000, Melbourne, Vic, Australia.
| | - Kathryn Kynoch
- Evidence in Practice Unit and The Queensland Centre for Evidence Based Nursing and Midwifery, A JBI Centre of Excellence, Mater Health, Brisbane, Australia.,The Queensland Centre for Evidence Based Nursing and Midwifery, A JBI Centre of Excellence, Adelaide, Australia
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Hassan S, Chan V, Stevens J, Stupans I. Factors that influence adherence to surgical antimicrobial prophylaxis (SAP) guidelines: a systematic review. Syst Rev 2021; 10:29. [PMID: 33453730 PMCID: PMC7811740 DOI: 10.1186/s13643-021-01577-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 01/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite the extensive research that has been conducted to date, practice often differs from established guidelines and will vary between individuals and organisations. It has been noted that the global uptake of local and international surgical antimicrobial prophylaxis (SAP) guidelines is poor with limited research investigating factors that affect guideline adherence. The purpose of this systematic review was to determine the reported barriers and enablers to the adherence of SAP guidelines. METHODS A search of the literature was performed using four electronic databases (CINAHL, EMBASE, PubMed and SCOPUS) for articles published in the English language from January 1998 to December 2018. Articles were included if they were solely related to SAP and discussed the barriers or enablers to SAP guideline adherence. Articles that assessed the adherence to a range of infection control measures or discussed adherence to antibiotic treatment guidelines rather than SAP guidelines were excluded from this review. Barriers and enablers were mapped to the Theoretical Domains Framework (TDF). The Mixed Methods Appraisal Tool was used to assess the quality of included studies. RESULTS A total of 1489 papers were originally retrieved, with 48 papers meeting the eligibility criteria. Barriers and enablers were mapped to 11 out of 14 TDF domains: knowledge, skills, social/professional role and identity, beliefs about capabilities, beliefs about consequences, reinforcement, memory, attention and decision processes, environmental context and resources, social influences, emotion and behavioural regulation. Barriers were further categorised into personal or organisational barriers, while enablers were arranged under commonly trialled interventions. CONCLUSIONS There are numerous factors that can determine the uptake of SAP guidelines. An identification and understanding of these factors at a local level is required to develop tailored interventions to enhance guideline adherence. Interventions, when used in combination, can be considered as a means of improving guideline use.
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Affiliation(s)
- Sarah Hassan
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.
| | - Vincent Chan
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Julie Stevens
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.,School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Ieva Stupans
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
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20
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Sarkies M, Long JC, Pomare C, Wu W, Clay-Williams R, Nguyen HM, Francis-Auton E, Westbrook J, Levesque JF, Watson DE, Braithwaite J. Avoiding unnecessary hospitalisation for patients with chronic conditions: a systematic review of implementation determinants for hospital avoidance programmes. Implement Sci 2020; 15:91. [PMID: 33087147 PMCID: PMC7579904 DOI: 10.1186/s13012-020-01049-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/01/2020] [Indexed: 12/31/2022] Open
Abstract
Background Studies of clinical effectiveness have demonstrated the many benefits of programmes that avoid unnecessary hospitalisations. Therefore, it is imperative to examine the factors influencing implementation of these programmes to ensure these benefits are realised across different healthcare contexts and settings. Numerous factors may act as determinants of implementation success or failure (facilitators and barriers), by either obstructing or enabling changes in healthcare delivery. Understanding the relationships between these determinants is needed to design and tailor strategies that integrate effective programmes into routine practice. Our aims were to describe the implementation determinants for hospital avoidance programmes for people with chronic conditions and the relationships between these determinants. Methods An electronic search of four databases was conducted from inception to October 2019, supplemented by snowballing for additional articles. Data were extracted using a structured data extraction tool and risk of bias assessed using the Hawker Tool. Thematic synthesis was undertaken to identify determinants of implementation success or failure for hospital avoidance programmes for people with chronic conditions, which were categorised according to the Consolidated Framework for Implementation Research (CFIR). The relationships between these determinants were also mapped. Results The initial search returned 3537 articles after duplicates were removed. After title and abstract screening, 123 articles underwent full-text review. Thirteen articles (14 studies) met the inclusion criteria. Thematic synthesis yielded 23 determinants of implementation across the five CFIR domains. ‘Availability of resources’, ‘compatibility and fit’, and ‘engagement of interprofessional team’ emerged as the most prominent determinants across the included studies. The most interconnected implementation determinants were the ‘compatibility and fit’ of interventions and ‘leadership influence’ factors. Conclusions Evidence is emerging for how chronic condition hospital avoidance programmes can be successfully implemented and scaled across different settings and contexts. This review provides a summary of key implementation determinants and their relationships. We propose a hypothesised causal loop diagram to represent the relationship between determinants within a complex adaptive system. Trial registration PROSPERO 162812
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Affiliation(s)
- Mitchell Sarkies
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia.
| | - Janet C Long
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Chiara Pomare
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Wendy Wu
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Robyn Clay-Williams
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Hoa Mi Nguyen
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Emilie Francis-Auton
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Jean-Frédéric Levesque
- Agency for Clinical Innovation, New South Wales, Australia.,Centre for Primary Health Care and Equity, University of New South Wales, New South Wales, Australia
| | - Diane E Watson
- Bureau of Health Information, New South Wales, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
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21
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Baloh J, Reisinger HS, Dukes K, da Silva JP, Salehi HP, Ward M, Chasco EE, Pennathur PR, Herwaldt L. Healthcare Workers' Strategies for Doffing Personal Protective Equipment. Clin Infect Dis 2020; 69:S192-S198. [PMID: 31517970 PMCID: PMC6743502 DOI: 10.1093/cid/ciz613] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Personal protective equipment (PPE) helps protect healthcare workers (HCWs) from pathogens and prevents cross-contamination. PPE effectiveness is often undermined by inappropriate doffing methods. Our knowledge of how HCWs approach doffing PPE in practice is limited. In this qualitative study, we examine HCWs’ perspectives about doffing PPE. Methods Thirty participants at a Midwestern academic hospital were recruited and assigned to 1 of 3 doffing simulation scenarios: 3 mask designs (n = 10), 2 gown designs (n = 10), or 2 glove designs (n = 10). Participants were instructed to doff PPE as they would in routine practice. Their performances were video-recorded and reviewed with participants. Semistructured interviews about their doffing approaches were conducted and audio-recorded, then transcribed and thematically analyzed. Results Three overarching themes were identified in interviews: doffing strategies, cognitive processes, and barriers and facilitators. Doffing strategies included doffing safely (minimizing self-contamination) and doffing expediently (eg, ripping PPE off). Cognitive processes during doffing largely pertained to tracking contaminated PPE surfaces, examining PPE design cues (eg, straps), or improvising based on prior experience from training or similar PPE designs. Doffing barriers and facilitators typically related to PPE design, such as PPE fit (or lack of it) and fastener type. Some participants also described personal barriers (eg, glasses, long hair); however, some PPE designs helped mitigate these barriers. Conclusions Efforts to improve HCWs’ doffing performance need to address HCWs’ preferences for both safety and expediency when using PPE, which has implications for PPE design, training approaches, and hospital policies and procedures.
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Affiliation(s)
- Jure Baloh
- Department of Internal Medicine, University of Iowa, Iowa City.,Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock
| | - Heather Schacht Reisinger
- Department of Internal Medicine, University of Iowa, Iowa City.,Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City
| | - Kimberly Dukes
- Institute for Clinical and Translational Science, University of Iowa, Iowa City
| | | | - Hugh P Salehi
- Department of Industrial and Systems Engineering, University of Iowa, Iowa City.,Department of Engineering Management, Systems and Technology, University of Dayton, Ohio
| | - Melissa Ward
- Department of Internal Medicine, University of Iowa, Iowa City
| | - Emily E Chasco
- Department of Internal Medicine, University of Iowa, Iowa City.,Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City
| | - Priyadarshini R Pennathur
- Department of Internal Medicine, University of Iowa, Iowa City.,Department of Industrial and Systems Engineering, University of Iowa, Iowa City
| | - Loreen Herwaldt
- Department of Internal Medicine, University of Iowa, Iowa City.,Department of Epidemiology, University of Iowa, Iowa City
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22
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Gonthier D, Basselin P, Boivin JM, Kivits J, Pulcini C. Postponing vaccination in children with an infection: a qualitative study among general practitioners and pediatricians. Fam Pract 2020; 37:541-546. [PMID: 31995189 DOI: 10.1093/fampra/cmaa007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Vaccination postponement is an important contributing factor to low vaccination coverage. The causes of vaccine postponement are numerous, but the presence of viral infection, whether febrile or not, is the most frequent cause. OBJECTIVE The objective was to explore the factors motivating the practice of vaccination postponement in a child with an infection by general practitioners (GPs) and paediatricians. METHODS An exploratory qualitative study using semi-directive individual interviews was carried out among GPs and paediatricians in a French region between November 2015 and January 2018. After the interviews were fully transcribed, an analysis of the data was performed using an inductive method derived from the grounded theory. RESULTS Fourteen GPs and four paediatricians participated in the study. Vaccination postponement during infection in children is rooted in doctors' practices; it is considered a low-risk habit that is shared with parents, and vaccine hesitancy reinforces this practice. In children presenting with an infection, the presence of uncertainty about vaccine safety and effectiveness seems to justify postponing vaccination. The organization of a consultation dedicated to vaccination catch-up was cited as the best tool to limit the effects of vaccination delay on vaccination coverage. DISCUSSION In children presenting with an infection, vaccination postponement is widely used by GPs and paediatricians. Simplification of the vaccination catch-up process and clear and consistent recommendations on the indications and modalities for vaccination postponement would be useful.
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Affiliation(s)
| | | | - Jean-Marc Boivin
- APEMAC, Université de Lorraine, France
- CIC Plurithématique, CHRU de Nancy, INSERM, Université de Lorraine, France
| | | | - Céline Pulcini
- APEMAC, Université de Lorraine, France
- Infectious Diseases Department, CHRU de Nancy, Université de Lorraine, France
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23
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Odberg KR, Hansen BS, Aase K, Wangensteen S. A work system analysis of the medication administration process in a Norwegian nursing home ward. APPLIED ERGONOMICS 2020; 86:103100. [PMID: 32342890 DOI: 10.1016/j.apergo.2020.103100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/20/2020] [Accepted: 03/19/2020] [Indexed: 06/11/2023]
Abstract
Nursing home patients often have multiple diagnoses and a high prevalence of polypharmacy and are at risk of experiencing adverse drug events. The study aims to explore the dynamic interactions of stakeholders and work system elements in the medication administration process in a nursing home ward. Data were collected using observations and interviews. A deductive content analysis led to a SEIPS-based process map and an accompanying work system analysis. The study increases knowledge of the complexity of the medication administration process by portraying the dynamic interactions between the major stakeholders in the work system, and the temporal flow of the activities involved. Secondly, it identifies facilitators and barriers in the work system linked to the medication administration process. Most barriers and facilitators are associated with the work system elements - tools & technology, organisation and tasks - and occur early in the medication administration process.
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Affiliation(s)
- Kristian Ringsby Odberg
- Norwegian University of Science and Technology (NTNU), Department of Health Sciences in Gjøvik, Norway.
| | | | - Karina Aase
- University of Stavanger, Department of Health Studies, Centre Director, SHARE - Centre for Resilience in Healthcare, Norway
| | - Sigrid Wangensteen
- Norwegian University of Science and Technology (NTNU), Department of Health Sciences in Gjøvik, Norway.
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24
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Niño de Guzmán E, Song Y, Alonso-Coello P, Canelo-Aybar C, Neamtiu L, Parmelli E, Pérez-Bracchiglione J, Rabassa M, Rigau D, Parkinson ZS, Solà I, Vásquez-Mejía A, Ricci-Cabello I. Healthcare providers' adherence to breast cancer guidelines in Europe: a systematic literature review. Breast Cancer Res Treat 2020; 181:499-518. [PMID: 32378052 PMCID: PMC7220981 DOI: 10.1007/s10549-020-05657-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/27/2020] [Indexed: 12/19/2022]
Abstract
Purpose Clinical guidelines’ (CGs) adherence supports high-quality care. However, healthcare providers do not always comply with CGs recommendations. This systematic literature review aims to assess the extent of healthcare providers’ adherence to breast cancer CGs in Europe and to identify the factors that impact on healthcare providers’ adherence. Methods We searched for systematic reviews and quantitative or qualitative primary studies in MEDLINE and Embase up to May 2019. The eligibility assessment, data extraction, and risk of bias assessment were conducted by one author and cross-checked by a second author. We conducted a narrative synthesis attending to the modality of the healthcare process, methods to measure adherence, the scope of the CGs, and population characteristics. Results Out of 8137 references, we included 41 primary studies conducted in eight European countries. Most followed a retrospective cohort design (19/41; 46%) and were at low or moderate risk of bias. Adherence for overall breast cancer care process (from diagnosis to follow-up) ranged from 54 to 69%; for overall treatment process [including surgery, chemotherapy (CT), endocrine therapy (ET), and radiotherapy (RT)] the median adherence was 57.5% (interquartile range (IQR) 38.8–67.3%), while for systemic therapy (CT and ET) it was 76% (IQR 68–77%). The median adherence for the processes assessed individually was higher, ranging from 74% (IQR 10–80%), for the follow-up, to 90% (IQR 87–92.5%) for ET. Internal factors that potentially impact on healthcare providers’ adherence were their perceptions, preferences, lack of knowledge, or intentional decisions. Conclusions A substantial proportion of breast cancer patients are not receiving CGs-recommended care. Healthcare providers’ adherence to breast cancer CGs in Europe has room for improvement in almost all care processes. CGs development and implementation processes should address the main factors that influence healthcare providers' adherence, especially patient-related ones. Registration: PROSPERO (CRD42018092884). Electronic supplementary material The online version of this article (10.1007/s10549-020-05657-8) contains supplementary material, which is available to authorised users.
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Affiliation(s)
- Ena Niño de Guzmán
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain.
| | - Yang Song
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Luciana Neamtiu
- European Commission, Joint Research Centre (JRC), Via E. Fermi 2749, 21027, Ispra, VA, Italy.
| | - Elena Parmelli
- European Commission, Joint Research Centre (JRC), Via E. Fermi 2749, 21027, Ispra, VA, Italy
| | | | - Montserrat Rabassa
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain
| | - David Rigau
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain
| | - Zuleika Saz Parkinson
- European Commission, Joint Research Centre (JRC), Via E. Fermi 2749, 21027, Ispra, VA, Italy
| | - Iván Solà
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain
| | - Adrián Vásquez-Mejía
- Facultad de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Ignacio Ricci-Cabello
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Balearic Islands Health Research Institute (IdISBa), Palma, Spain.,Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Palma, Spain
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25
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Implementing Clinical Practice Guidelines for Replacing Peripheral Intravenous Catheters. J Nurs Care Qual 2020; 35:108-114. [DOI: 10.1097/ncq.0000000000000429] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Renolen Å, Hjälmhult E, Høye S, Danbolt LJ, Kirkevold M. Creating room for evidence‐based practice: Leader behavior in hospital wards. Res Nurs Health 2019; 43:90-102. [DOI: 10.1002/nur.21981] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 09/02/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Åste Renolen
- Faculty of Medicine, Institute of Health and SocietyUniversity of OsloOslo Norway
- Department of MedicineInnlandet Hospital TrustLillehammer Norway
| | - Esther Hjälmhult
- Faculty of Health and Social Sciences, Centre for Evidence‐Based PracticeWestern Norway University of Applied SciencesBergen Norway
| | - Sevald Høye
- Department of Health and Nursing SciencesInland Norway University of Applied SciencesElverum Norway
| | - Lars Johan Danbolt
- Division of Mental Health Care, Center for Psychology of ReligionInnlandet Hospital TrustOttestad Norway
- Department of Theology and Ministry, Norwegian School of TheologyReligion and SocietyOslo Norway
| | - Marit Kirkevold
- Faculty of Medicine, Institute of Health and SocietyUniversity of OsloOslo Norway
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27
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Denger B, Kinnett K, Martin A, Grant S, Armstrong C, Khodyakov D. Patient and caregiver perspectives on guideline adherence: the case of endocrine and bone health recommendations for Duchenne muscular dystrophy. Orphanet J Rare Dis 2019; 14:205. [PMID: 31429780 PMCID: PMC6702715 DOI: 10.1186/s13023-019-1173-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/13/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Clinical care guidelines are typically developed by clinicians and researchers. Including patient and caregiver voices in guideline development may help create guidelines that are more useful for patients and consequently improve their guideline adherence. Although there is substantial research on the factors the affect providers' adherence to guidelines, there is less research on the factors that affect patients' compliance with guideline recommendations, especially among those with rare disorders. The purpose of this study is to explore factors that are likely to affect patient/caregiver adherence to endocrine and bone health recommendations for Duchenne Muscular Dystrophy (DMD). To do so, we used qualitative data collected as part of the study designed to develop, implement, and evaluate a new online, modified-Delphi approach to engaging patients with rare diseases and their caregivers in guideline development, using care guidelines for DMD as a case study. METHODS We thematically analyzed qualitative data collected from 95 adults with DMD and their caregivers who participated in at least one round of our online Modified-Delphi panel process. Participants rated and commented on the patient-centeredness of 19 recommendations about vertical growth, weight management, bone health, and delayed puberty included in the 2018 DMD care considerations. Patient-centeredness was operationalized as the importance and acceptability of care recommendations. RESULTS Thematic analyses revealed six factors that affect guideline adherence from the patient/caregiver perspective: content and format of recommendations, patient and provider characteristics, and social and financial factors. CONCLUSIONS This study used a novel approach to exploring patient and caregiver perspectives on factors that may affect guideline adherence. The six factors identified by DMD patients and caregivers are similar to the factors affecting provider adherence and are not limited to DMD. Understanding consistency between provider- and patient/caregiver-identified barriers to following guideline recommendations can lead to developing more successful interventions for increasing guideline adherence.
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Affiliation(s)
- Brian Denger
- Parent Project Muscular Dystrophy, 401 Hackensack Avenue, 9th Floor, Hackensack, NJ, 07601, USA
| | - Kathi Kinnett
- Parent Project Muscular Dystrophy, 401 Hackensack Avenue, 9th Floor, Hackensack, NJ, 07601, USA
| | - Ann Martin
- Parent Project Muscular Dystrophy, 401 Hackensack Avenue, 9th Floor, Hackensack, NJ, 07601, USA
| | - Sean Grant
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA.,Department of Social & Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, RG 6046, Indianapolis, 46202, IN, USA
| | - Courtney Armstrong
- RAND Corporation, 1885 Mission Street, Suite 300, San Francisco, CA, 94103, USA
| | - Dmitry Khodyakov
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA.
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28
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Naguib M, Brull SJ, Kopman AF, Hunter JM, Fülesdi B, Arkes HR, Elstein A, Todd MM, Johnson KB. Consensus Statement on Perioperative Use of Neuromuscular Monitoring. Anesth Analg 2019; 127:71-80. [PMID: 29200077 DOI: 10.1213/ane.0000000000002670] [Citation(s) in RCA: 176] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
A panel of clinician scientists with expertise in neuromuscular blockade (NMB) monitoring was convened with a charge to prepare a consensus statement on indications for and proper use of such monitors. The aims of this article are to: (a) provide the rationale and scientific basis for the use of quantitative NMB monitoring; (b) offer a set of recommendations for quantitative NMB monitoring standards; (c) specify educational goals; and (d) propose training recommendations to ensure proper neuromuscular monitoring and management. The panel believes that whenever a neuromuscular blocker is administered, neuromuscular function must be monitored by observing the evoked muscular response to peripheral nerve stimulation. Ideally, this should be done at the hand muscles (not the facial muscles) with a quantitative (objective) monitor. Objective monitoring (documentation of train-of-four ratio ≥0.90) is the only method of assuring that satisfactory recovery of neuromuscular function has taken place. The panel also recommends that subjective evaluation of the responses to train-of-four stimulation (when using a peripheral nerve stimulator) or clinical tests of recovery from NMB (such as the 5-second head lift) should be abandoned in favor of objective monitoring. During an interim period for establishing these recommendations, if only a peripheral nerve stimulator is available, its use should be mandatory in any patient receiving a neuromuscular blocking drug. The panel acknowledges that publishing this statement per se will not result in its spontaneous acceptance, adherence to its recommendations, or change in routine practice. Implementation of objective monitoring will likely require professional societies and anesthesia department leadership to champion its use to change anesthesia practitioner behavior.
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Affiliation(s)
- Mohamed Naguib
- From the Department of General Anesthesia, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio
| | - Sorin J Brull
- Department of Anesthesiology, Mayo Clinic College of Medicine, Jacksonville, Florida
| | - Aaron F Kopman
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York
| | - Jennifer M Hunter
- Department of Musculoskeletal Biology, University of Liverpool, Liverpool, United Kingdom
| | - Béla Fülesdi
- Faculty of Medicine, Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary
| | - Hal R Arkes
- Department of Psychology, The Ohio State University, Columbus, Ohio
| | - Arthur Elstein
- Department of Medical Education, University of Illinois, College of Medicine at Chicago, Chicago, Illinois
| | - Michael M Todd
- Department of Anesthesiology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Ken B Johnson
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah
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Faiola A, Papautsky EL, Isola M. Empowering the Aging with Mobile Health: A mHealth Framework for Supporting Sustainable Healthy Lifestyle Behavior. Curr Probl Cardiol 2019; 44:232-266. [DOI: 10.1016/j.cpcardiol.2018.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 11/25/2022]
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Brantnell A, Baraldi E, van Achterberg T. An inductive exploration of the implementation knowledge of research funders. Health Res Policy Syst 2019; 17:67. [PMID: 31319867 PMCID: PMC6637601 DOI: 10.1186/s12961-019-0472-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 06/28/2019] [Indexed: 11/19/2022] Open
Abstract
Background Healthcare research funders may undertake various roles to facilitate implementation of research findings. Their ability to enact such roles depends on several factors, knowledge of implementation being one essential requirement. However, previous studies do not assess the type or level of knowledge about implementation that research funders possess. This paper therefore presents findings from a qualitative, inductive study of the implementation knowledge of research funders. Three aspects of this knowledge are explored, namely how research funders define implementation, their level of self-assessed implementation knowledge and the factors influencing their self-assessment of implementation knowledge. Methods Research funders (n = 18) were purposefully selected from a sample of research funding organisations in Sweden (n = 10). In-depth semi-structured interviews were conducted, recorded and transcribed verbatim. An inductive method using a systematic coding procedure was employed to derive the findings. Results The research funders defined implementation as either an outcome or a process, with the majority believing that implementation of healthcare research results demands a process, although its complexity varied in the research funders’ view. They perceived their own level of implementation knowledge as either limited or substantial, with a majority regarding it as limited. Clinical research experience, clinical experience and task relevance were singled out as the clearest factors affecting the self-assessment of their own implementation knowledge. Conclusions This study, the first to focus on implementation knowledge of research funders, demonstrates that they are a category of policy-makers who may possess knowledge, based on their previous professional experience, that is comparable to some important findings from implementation research. Consequently, the findings not only pinpoint the relevance of professional experience, but also reveal a lack of awareness and knowledge of the results of implementation research among research funders in charge of healthcare research. Electronic supplementary material The online version of this article (10.1186/s12961-019-0472-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anders Brantnell
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Enrico Baraldi
- Department of Industrial Engineering and Management, Uppsala University, Uppsala, Sweden
| | - Theo van Achterberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,KU Leuven Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.,Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
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Nilsen P, Schildmeijer K, Ericsson C, Seing I, Birken S. Implementation of change in health care in Sweden: a qualitative study of professionals' change responses. Implement Sci 2019; 14:51. [PMID: 31088483 PMCID: PMC6518624 DOI: 10.1186/s13012-019-0902-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/02/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Implementation of evidence-based practices in health care implies change. Understanding health care professionals' change responses may be critical for facilitating implementation to achieve an evidence-based practice in the rapidly changing health care environment. The aim of this study was to investigate health care professionals' responses to organizational and workplace changes that have affected their work. METHODS We conducted interviews with 30 health care professionals (physicians, registered nurses and assistant nurses) employed in the Swedish health care system. An inductive approach was applied, using a semi-structured interview guide developed by the authors. We used an analytical framework first published in 1999 to analyze the informants' change responses in which change responses are perceived as a continuum ranging from a strong acceptance of change to strong resistance to change, describing seven forms of change responses along this continuum. Change response is conceptualized as a tridimensional attitude composed of three components: cognitive, affective and intentional/behavioral. RESULTS Analysis of the data yielded 10 types of change responses, which could be mapped onto 5 of the 7 change response categories in the framework. Participants did not report change responses that corresponded with the two most extreme forms of responses in the framework, i.e., commitment and aggressive resistance. Most of the change responses were classified as either indifference or passive resistance to changes. Involvement in or support for changes occurred when the health care professionals initiated the changes themselves or when the changes featured their active input and when changes were seen as well founded and well communicated. We did not identify any change responses that could not be fitted into the framework. CONCLUSIONS We found the framework to be useful for a nuanced understanding of how people respond to changes. This knowledge of change responses is useful for the management of changes and for efforts to achieve more successful implementation of evidence-based practices in health care.
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Affiliation(s)
- Per Nilsen
- Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, SE-581 83, Linköping, Sweden.
| | - Kristina Schildmeijer
- Department of Health and Care Sciences, Linnaeus University, SE-392 81, Kalmar, Sweden
| | - Carin Ericsson
- Cardiology and Speciality Medicine Centre, County Council of Östergötland, SE-581 85, Linköping, Sweden
| | - Ida Seing
- Department of Behavioural Sciences and Learning, Linköping University, SE-581 83, Linköping, Sweden
| | - Sarah Birken
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1106F McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA
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Nilsen P, Bernhardsson S. Context matters in implementation science: a scoping review of determinant frameworks that describe contextual determinants for implementation outcomes. BMC Health Serv Res 2019; 19:189. [PMID: 30909897 PMCID: PMC6432749 DOI: 10.1186/s12913-019-4015-3] [Citation(s) in RCA: 378] [Impact Index Per Article: 75.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 03/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relevance of context in implementation science is reflected in the numerous theories, frameworks, models and taxonomies that have been proposed to analyse determinants of implementation (in this paper referred to as determinant frameworks). This scoping review aimed to investigate and map how determinant frameworks used in implementation science were developed, what terms are used for contextual determinants for implementation, how the context is conceptualized, and which context dimensions that can be discerned. METHODS A scoping review was conducted. MEDLINE and EMBASE were searched from inception to October 2017, and supplemented with implementation science text books and known published overviews. Publications in English that described a determinant framework (theory, model, taxonomy or checklist), of which context was one determinant, were eligible. Screening and inclusion were done in duplicate. Extracted data were analysed to address the study aims. A qualitative content analysis with an inductive approach was carried out concerning the development and core context dimensions of the frameworks. The review is reported according to the PRISMA guidelines. RESULTS The database searches yielded a total of 1113 publications, of which 67 were considered potentially relevant based on the predetermined eligibility criteria, and retrieved in full text. Seventeen unique determinant frameworks were identified and included. Most were developed based on the literature and/or the developers' implementation experiences. Six of the frameworks explicitly referred to "context", but only four frameworks provided a specific definition of the concept. Instead, context was defined indirectly by description of various categories and sub-categories that together made up the context. Twelve context dimensions were identified, pertaining to different aggregation levels. The most widely addressed context dimensions were organizational support, financial resources, social relations and support, and leadership. CONCLUSIONS The findings suggest variation with regard to how the frameworks were developed and considerable inconsistency in terms used for contextual determinants, how context is conceptualized, and which contextual determinants are accounted for in frameworks used in implementation science. Common context dimensions were identified, which can facilitate research that incorporates a theory of context, i.e. assumptions about how different dimensions may influence each other and affect implementation outcomes. A thoughtful application of the concept and a more consistent terminology would enhance transparency, simplify communication among researchers, and facilitate comparison across studies.
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Affiliation(s)
- Per Nilsen
- Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, SE-581 83, Linköping, Sweden
| | - Susanne Bernhardsson
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Unit of Physiotherapy, University of Gothenburg, The Sahlgrenska Academy, Gothenburg, Sweden.
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Wikström E, Dellenborg L, Wallin L, Gillespie BM, Erichsen Andersson A. The Safe Hands Study: Implementing aseptic techniques in the operating room: Facilitating mechanisms for contextual negotiation and collective action. Am J Infect Control 2019; 47:251-257. [PMID: 30449454 DOI: 10.1016/j.ajic.2018.08.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/16/2018] [Accepted: 08/17/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Even though hand hygiene and aseptic techniques are essential to provide safe care in the operating room, several studies have found a lack of successful implementation. The aim of this study was to describe facilitative mechanisms supporting the implementation of hand hygiene and aseptic techniques. METHODS This study was set in a large operating room suite in a Swedish university hospital. The theory-driven implementation process was informed by the literature on organizational change and dialogue. Data were collected using interviews and participant observations and analyzed using a thematic approach. The normalization process theory served as a frame of interpretation during the analysis. RESULTS Three facilitating mechanisms were identified: (1) commitment through a sense of urgency, requiring extensive communication between the managers, operating room professionals, and facilitators in building commitment to change and putting the issues on the agenda; (2) dialogue for co-creation, increasing and sustaining commitment and resource mobilization; and (3) tailored management support, including helping managers to develop their leadership role, progressively involving staff, and retaining focus during the implementation process. CONCLUSIONS The facilitating mechanisms can be used in organizing implementation processes. Putting the emphasis on help and support to managers seems to be a crucial condition in complex implementation processes, from preparation of the change process to stabilization of the new practice.
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Affiliation(s)
- Ewa Wikström
- Department of Business Administration, School of Business, Economics, and Law, University of Gothenburg, Gothenburg, Sweden
| | - Lisen Dellenborg
- Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Wallin
- Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden; Department of Neurobiology, Care Sciences, and Society, Division of Nursing, Karolinska Institutet, Sweden
| | - Brigid M Gillespie
- School of Nursing & Midwifery, Griffith University, Gold Coast, Queensland, Australia; Gold Coast Hospital and Health Service, Queensland, Australia
| | - Annette Erichsen Andersson
- Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital Mölndal, Gothenburg, Sweden.
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Yapa HM, Bärnighausen T. Implementation science in resource-poor countries and communities. Implement Sci 2018; 13:154. [PMID: 30587195 PMCID: PMC6307212 DOI: 10.1186/s13012-018-0847-1] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 12/18/2022] Open
Abstract
Background Implementation science in resource-poor countries and communities is arguably more important than implementation science in resource-rich settings, because resource poverty requires novel solutions to ensure that research results are translated into routine practice and benefit the largest possible number of people. Methods We reviewed the role of resources in the extant implementation science frameworks and literature. We analyzed opportunities for implementation science in resource-poor countries and communities, as well as threats to the realization of these opportunities. Results Many of the frameworks that provide theoretical guidance for implementation science view resources as contextual factors that are important to (i) predict the feasibility of implementation of research results in routine practice, (ii) explain implementation success and failure, (iii) adapt novel evidence-based practices to local constraints, and (iv) design the implementation process to account for local constraints. Implementation science for resource-poor settings shifts this view from “resources as context” to “resources as primary research object.” We find a growing body of implementation research aiming to discover and test novel approaches to generate resources for the delivery of evidence-based practice in routine care, including approaches to create higher-skilled health workers—through tele-education and telemedicine, freeing up higher-skilled health workers—through task-shifting and new technologies and models of care, and increasing laboratory capacity through new technologies and the availability of medicines through supply chain innovations. In contrast, only few studies have investigated approaches to change the behavior and utilization of healthcare resources in resource-poor settings. We identify three specific opportunities for implementation science in resource-poor settings. First, intervention and methods innovations thrive under constraints. Second, reverse innovation transferring novel approaches from resource-poor to research-rich settings will gain in importance. Third, policy makers in resource-poor countries tend to be open for close collaboration with scientists in implementation research projects aimed at informing national and local policy. Conclusions Implementation science in resource-poor countries and communities offers important opportunities for future discoveries and reverse innovation. To harness this potential, funders need to strongly support research projects in resource-poor settings, as well as the training of the next generation of implementation scientists working on new ways to create healthcare resources where they lack most and to ensure that those resources are utilized to deliver care that is based on the latest research results.
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Affiliation(s)
- H Manisha Yapa
- The Kirby Institute, University of New South Wales, Sydney, Australia.,Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
| | - Till Bärnighausen
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa. .,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA. .,Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, INF 130.3, 69120, Heidelberg, Germany.
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Human factors-based risk analysis to improve the safety of doffing enhanced personal protective equipment. Infect Control Hosp Epidemiol 2018; 40:178-186. [PMID: 30520708 DOI: 10.1017/ice.2018.292] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To systematically assess enhanced personal protective equipment (PPE) doffing safety risks. DESIGN We employed a 3-part approach to this study: (1) hierarchical task analysis (HTA) of the PPE doffing process; (2) human factors-informed failure modes and effects analysis (FMEA); and (3) focus group sessions with a convenience sample of infection prevention (IP) subject matter experts. SETTING A large academic US hospital with a regional Special Pathogens Treatment Center and enhanced PPE doffing protocol experience.ParticipantsEight IP experts. METHODS The HTA was conducted jointly by 2 human-factors experts based on the Centers for Disease Control and Prevention PPE guidelines. The findings were used as a guide in 7 focus group sessions with IP experts to assess PPE doffing safety risks. For each HTA task step, IP experts identified failure mode(s), assigned priority risk scores, identified contributing factors and potential consequences, and identified potential risk mitigation strategies. Data were recorded in a tabular format during the sessions. RESULTS Of 103 identified failure modes, the highest priority scores were associated with team members moving between clean and contaminated areas, glove removal, apron removal, and self-inspection while preparing to doff. Contributing factors related to the individual (eg, technical/ teamwork competency), task (eg, undetected PPE contamination), tools/technology (eg, PPE design characteristics), environment (eg, inadequate space), and organizational aspects (eg, training) were identified. Participants identified 86 types of risk mitigation strategies targeting the failure modes. CONCLUSIONS Despite detailed guidelines, our study revealed 103 enhanced PPE doffing failure modes. Analysis of the failure modes suggests potential mitigation strategies to decrease self-contamination risk during enhanced PPE doffing.
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Carlsson N, Kullberg A, Johansson IK, Bergman P, Skagerström J, Andersson A. Exploring experiences among adopters during the diffusion of a novel dance intervention in Sweden. Int J Qual Stud Health Well-being 2018; 13:1438697. [PMID: 29464990 PMCID: PMC5827768 DOI: 10.1080/17482631.2018.1438697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 11/03/2022] Open
Abstract
There is a demand for interventions aimed at adolescent girls with psychosomatic problems. In 2013, positive results were reported from a dance intervention programme addressing girls with internalizing problems. The research team behind the intervention immediately received requests from municipalities and county councils interested in using the intervention. From an implementation point of view it is unclear what made the intervention spread without an active plan. The aim of this study was to explore adopters' experiences about the diffusion and initiation of a public health intervention targeting adolescent girls with internalizing problems. Interviews were conducted with 12 people who were engaged in initiating the intervention in different settings. Data were analysed using conventional content analysis, yielding three categories: perceived appeal and trustworthiness, convenient information, and contextual factors. The results reflected that the participants found that there was a need for an intervention and found the dance intervention to be evidence based and not too complex to perform. Further, there was available information on the project which could easily be distributed to decision makers and others. When initiating the intervention, factors related to economy, possibility for collaboration and recruitment were of importance.
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Affiliation(s)
- Noomi Carlsson
- Public Health & Healthcare, Regional Executive Office, Jönköping, Sweden
| | - Agneta Kullberg
- Division of Community Medicine, Social Medicine and Public Health Science, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | | - Paula Bergman
- Public Health & Healthcare, Regional Executive Office, Jönköping, Sweden
| | - Janna Skagerström
- Research & Development Unit in Local Health Care, and Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Agneta Andersson
- Research & Development Unit in Local Health Care, and Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
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Infection prevention in long-term care: re-evaluating the system using a human factors engineering approach. Infect Control Hosp Epidemiol 2018; 40:95-99. [PMID: 30460887 DOI: 10.1017/ice.2018.308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The emergence and spread of extensively multidrug-resistant organisms is a public health crisis, and long-term care settings have been identified as a reservoir for the cultivation of these organisms. Long-term care settings are now taking on increasingly ill residents with complicated medical problems, indwelling devices, and significant healthcare exposure, all of which are considered risk factors selecting for resistant organisms. Despite this, guidelines addressing infection prevention procedures in long-term care remain vague, and implementation of these guidelines is challenging, largely due to staff turnover, limited resources, knowledge gaps, and lack of organizational support. Human factors engineering approaches have emerged as an important innovation to address patient safety issues and develop interventions in the healthcare work system (ie, tools and technologies, tasks, organization, physical environment) that support human performance, which, in turn, lead to improvements in processes (eg, compliance with infection prevention guidelines) and outcomes (eg, reduced infection rates). We propose the concept of using the methods and approaches from the scientific field of human factors engineering to address the unique challenges of implementing infection prevention in the long-term care setting.
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Smith MW, Brown C, Virani SS, Weir CR, Petersen LA, Kelly N, Akeroyd J, Garvin JH. Incorporating Guideline Adherence and Practice Implementation Issues into the Design of Decision Support for Beta-Blocker Titration for Heart Failure. Appl Clin Inform 2018; 9:478-489. [PMID: 29949816 DOI: 10.1055/s-0038-1660849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The recognition of and response to undertreatment of heart failure (HF) patients can be complicated. A clinical reminder can facilitate use of guideline-concordant β-blocker titration for HF patients with depressed ejection fraction. However, the design must consider the cognitive demands on the providers and the context of the work. OBJECTIVE This study's purpose is to develop requirements for a clinical decision support tool (a clinical reminder) by analyzing the cognitive demands of the task along with the factors in the Cabana framework of physician adherence to guidelines, the health information technology (HIT) sociotechnical framework, and the Promoting Action on Research Implementation in Health Services (PARIHS) framework of health services implementation. It utilizes a tool that extracts information from medical records (including ejection fraction in free text reports) to identify qualifying patients at risk of undertreatment. METHODS We conducted interviews with 17 primary care providers, 5 PharmDs, and 5 Registered Nurses across three Veterans Health Administration outpatient clinics. The interviews were based on cognitive task analysis (CTA) methods and enhanced through the inclusion of the Cabana, HIT sociotechnical, and PARIHS frameworks. The analysis of the interview data led to the development of requirements and a prototype design for a clinical reminder. We conducted a small pilot usability assessment of the clinical reminder using realistic clinical scenarios. RESULTS We identified organizational challenges (such as time pressures and underuse of pharmacists), knowledge issues regarding the guideline, and information needs regarding patient history and treatment status. We based the design of the clinical reminder on how to best address these challenges. The usability assessment indicated the tool could help the decision and titration processes. CONCLUSION Through the use of CTA methods enhanced with adherence, sociotechnical, and implementation frameworks, we designed a decision support tool that considers important challenges in the decision and execution of β-blocker titration for qualifying HF patients at risk of undertreatment.
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Affiliation(s)
- Michael W Smith
- Department of Industrial & Mechanical Engineering, Universidad de las Americas Puebla, Cholula, PUE, Mexico
| | - Charnetta Brown
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, United States
| | - Salim S Virani
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, United States.,Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Charlene R Weir
- Salt Lake City VA Health Care System HSR&D Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, United States.,Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, United States
| | - Laura A Petersen
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, United States.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Natalie Kelly
- Salt Lake City VA Health Care System HSR&D Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, United States
| | - Julia Akeroyd
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, United States
| | - Jennifer H Garvin
- Salt Lake City VA Health Care System HSR&D Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, United States.,Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, United States.,Division of Health Information Management and Systems, The Ohio State University, Columbus, Ohio, United States.,Indianapolis VA Medical Center HSR&D Center for Health Information and Communication, Indianapolis, Indiana, United States
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Abstract
After more than two decades of research focused on care transition improvement and intervention development, unfavorable outcome measures associated with care transitions across healthcare settings persist. Readmissions rates remain an important outcome to target for intervention, adverse events associated with care transitions continue to be an issue, and patients are often dissatisfied with the quality of their care. Currently, interventions to improve care transitions are disease specific, require substantial financial investments in training allied healthcare professionals, or focus primarily on hospital-based discharge planning with mixed results. This complex situation requires a method of evaluation that can provide a comprehensive, in-depth, and context-driven investigation of potential risks to safe care transitions across healthcare settings, which can lead to the creation of effective, usable, and sustainable interventions. A systems' approach known as Human Factors and Ergonomics (HFE) evaluates the factors in a system that affect human performance. This article describes how HFE can complement and further strengthen efforts to improve care transitions.
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40
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Renolen Å, Høye S, Hjälmhult E, Danbolt LJ, Kirkevold M. “Keeping on track”—Hospital nurses’ struggles with maintaining workflow while seeking to integrate evidence-based practice into their daily work: A grounded theory study. Int J Nurs Stud 2018; 77:179-188. [DOI: 10.1016/j.ijnurstu.2017.09.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 09/05/2017] [Accepted: 09/11/2017] [Indexed: 11/16/2022]
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King AA, Baumann AA. Sickle cell disease and implementation science: A partnership to accelerate advances. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26649. [PMID: 28556441 PMCID: PMC6026013 DOI: 10.1002/pbc.26649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/05/2017] [Accepted: 04/24/2017] [Indexed: 12/11/2022]
Abstract
Sickle cell disease (SCD) results in end organ damage and a shortened lifespan. Both the pathophysiology of the disease and the social determinants of health affect patient outcomes. Randomized controlled trials have been completed among this population and resulted in medical advances; however, the gestation of these advances and the lack of penetrance into clinical practice have limited advancements in clinical improvements for many people with SCD. We discuss the role of implementation science in SCD and highlight the need for this science to shorten the length of time to implement evidence-based care for more people with SCD.
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Affiliation(s)
- Allison A. King
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
- Division of Hematology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Ana A. Baumann
- Brown School, Washington University, St. Louis, Missouri
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Gold R, Cottrell E, Bunce A, Middendorf M, Hollombe C, Cowburn S, Mahr P, Melgar G. Developing Electronic Health Record (EHR) Strategies Related to Health Center Patients' Social Determinants of Health. J Am Board Fam Med 2017; 30:428-447. [PMID: 28720625 PMCID: PMC5618800 DOI: 10.3122/jabfm.2017.04.170046] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 02/14/2017] [Accepted: 02/18/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND "Social determinants of heath" (SDHs) are nonclinical factors that profoundly affect health. Helping community health centers (CHCs) document patients' SDH data in electronic health records (EHRs) could yield substantial health benefits, but little has been reported about CHCs' development of EHR-based tools for SDH data collection and presentation. METHODS We worked with 27 diverse CHC stakeholders to develop strategies for optimizing SDH data collection and presentation in their EHR, and approaches for integrating SDH data collection and the use of those data (eg, through referrals to community resources) into CHC workflows. RESULTS We iteratively developed a set of EHR-based SDH data collection, summary, and referral tools for CHCs. We describe considerations that arose while developing the tools and present some preliminary lessons learned. CONCLUSION Standardizing SDH data collection and presentation in EHRs could lead to improved patient and population health outcomes in CHCs and other care settings. We know of no previous reports of processes used to develop similar tools. This article provides an example of 1 such process. Lessons from our process may be useful to health care organizations interested in using EHRs to collect and act on SDH data. Research is needed to empirically test the generalizability of these lessons.
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Affiliation(s)
- Rachel Gold
- From the Center for Health Research, Kaiser Permanente Northwest, Portland, OR (RG, AB, CH); OCHIN, Inc., Portland (RG, EC, MM, SC); the Multnomah County Health Department, Portland (PM); and the Cowlitz Family Health Center, Longview, WA (GM).
| | - Erika Cottrell
- From the Center for Health Research, Kaiser Permanente Northwest, Portland, OR (RG, AB, CH); OCHIN, Inc., Portland (RG, EC, MM, SC); the Multnomah County Health Department, Portland (PM); and the Cowlitz Family Health Center, Longview, WA (GM)
| | - Arwen Bunce
- From the Center for Health Research, Kaiser Permanente Northwest, Portland, OR (RG, AB, CH); OCHIN, Inc., Portland (RG, EC, MM, SC); the Multnomah County Health Department, Portland (PM); and the Cowlitz Family Health Center, Longview, WA (GM)
| | - Mary Middendorf
- From the Center for Health Research, Kaiser Permanente Northwest, Portland, OR (RG, AB, CH); OCHIN, Inc., Portland (RG, EC, MM, SC); the Multnomah County Health Department, Portland (PM); and the Cowlitz Family Health Center, Longview, WA (GM)
| | - Celine Hollombe
- From the Center for Health Research, Kaiser Permanente Northwest, Portland, OR (RG, AB, CH); OCHIN, Inc., Portland (RG, EC, MM, SC); the Multnomah County Health Department, Portland (PM); and the Cowlitz Family Health Center, Longview, WA (GM)
| | - Stuart Cowburn
- From the Center for Health Research, Kaiser Permanente Northwest, Portland, OR (RG, AB, CH); OCHIN, Inc., Portland (RG, EC, MM, SC); the Multnomah County Health Department, Portland (PM); and the Cowlitz Family Health Center, Longview, WA (GM)
| | - Peter Mahr
- From the Center for Health Research, Kaiser Permanente Northwest, Portland, OR (RG, AB, CH); OCHIN, Inc., Portland (RG, EC, MM, SC); the Multnomah County Health Department, Portland (PM); and the Cowlitz Family Health Center, Longview, WA (GM)
| | - Gerardo Melgar
- From the Center for Health Research, Kaiser Permanente Northwest, Portland, OR (RG, AB, CH); OCHIN, Inc., Portland (RG, EC, MM, SC); the Multnomah County Health Department, Portland (PM); and the Cowlitz Family Health Center, Longview, WA (GM)
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Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:231-244. [DOI: 10.1007/s00103-016-2486-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Clinical practice audit concerning antimicrobial prophylaxis in paediatric neurosurgery: results from a German paediatric oncology unit. Childs Nerv Syst 2017; 33:159-169. [PMID: 27822762 DOI: 10.1007/s00381-016-3279-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 10/14/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Perioperative antimicrobial prophylaxis (PAP) has been identified as an important target for internal audits, concerning the judicious use of antibiotics. Paediatric oncology patients with brain tumours face an increased risk of surgical site infection (SSI) after neurosurgery and receive routine PAP in this setting. PATIENTS AND METHODS All patients younger than 18 years admitted to the paediatric oncology centre (POC) with a neurosurgical intervention. Systematic audit of routine clinical data is divided in two groups: retrospective (Jan 01, 2012-March 31, 2014) and prospective (April 01, 2014-March 31, 2015) referring to an internal PAP guideline, invented in Jan. 2014). Surveillance of SSI up to 30 days after the operation with standard criteria (Centres for Disease Control and Prevention, USA). RESULTS In total, 53 neurosurgical operations were analysed in 33 paediatric oncology patients. Twelve patients received more than one operation. The detailed analysis of PAP revealed prophylactic cefuroxim doses about 30 mg/kg instead of 50 mg/kg and no repeated dosing in operations lasting longer than 4 h. In addition, Cefotaxim, which is not indicated as PAP in neurosurgery, was used instead of Cefuroxim (or Ampicillin-Sulbactam) in 23 % of all cases in the retrospective and 18 % of all cases in the prospective audit. PAP for more than 3 doses (>24 h) was administered in 66 % in the retrospective group and in 60 % in the prospective group (p = n.s.). In both groups, no SSI was detected. DISCUSSION This first comprehensive audit of PAP in paediatric oncology patients undergoing neurosurgery outlines significant opportunities to improve clinical practice in terms of correct dosing, the correct choice of the antibiotic, a correct timing schedule and a shorter duration of PAP. In addition, our results illustrate in detail the challenges in clinical practice when an evidence-based approach to improve a standard workflow has to be implemented.
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Holden RJ, Valdez RS, Schubert CC, Thompson MJ, Hundt AS. Macroergonomic factors in the patient work system: examining the context of patients with chronic illness. ERGONOMICS 2017; 60:26-43. [PMID: 27164171 PMCID: PMC5639913 DOI: 10.1080/00140139.2016.1168529] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Human factors/ergonomics recognises work as embedded in and shaped by levels of social, physical and organisational context. This study investigates the contextual or macroergonomic factors present in the health-related work performed by patients. We performed a secondary content analysis of findings from three studies of the work of chronically ill patients and their informal caregivers. Our resulting consolidated macroergonomic patient work system model identified 17 factors across physical, social and organisational domains and household and community levels. These factors are illustrated with examples from the three studies and discussed as having positive, negative or varying effects on health and health behaviour. We present three brief case studies to illustrate how macroergonomic factors combine across domains and levels to shape performance in expected and unexpected ways. Findings demonstrate not only the importance of context for patients' health-related activities but also specific factors to consider in future research, design and policy efforts. Practitioner Summary: Health-related activities of patients are embedded in and shaped by levels of social, physical and organisational context. This paper combined findings from three studies to specify 17 contextual or macroergonomic factors in home- and community-based work systems of chronically ill patients. These factors have research, design and policy implications.
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Affiliation(s)
- Richard J. Holden
- Indiana University School of Informatics and Computing, Indianapolis, Indiana, USA
- Corresponding author: Richard J. Holden, Walker Plaza – WK 319, 719 Indiana Avenue, Indianapolis, IN, USA 46202. . 1-317-278-5323
| | | | | | | | - Ann S. Hundt
- University of Wisconsin-Madison, Madison, Wisconsin, USA
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Abstract
OBJECTIVE To describe the current practice of pediatric organ donor management in the United States for donors declared dead based upon neurologic criteria. The study directs particular attention to how pediatric donors are defined, the use of donor management guidelines, the use of donor management goals, and the involvement of pediatric critical care or transplantation expertise. DESIGN Cross-sectional observational study using a web-based survey and follow-up telephone interview with respondents from U.S. organ procurement organizations. The study also incorporated organ procurement organization-specific data on organ yield for the 4-year period (2010-2013) preceding the study. SETTING The 58 U.S. organ procurement organizations. SUBJECTS Respondents chosen by each organ procurement organization. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS All 58 U.S. organ procurement organizations participated in the study. Fifty-two respondents (90%) indicated that their organ procurement organization distinguished pediatric from adult donors resulting in 28 unique pediatric definitions. Thirty-nine organ procurement organizations utilized some form of written pediatric management guidelines, and 27 (47%) maintained pediatric donor management goals; compliance was infrequently monitored for both guidelines (28%) and goals (33%). A pediatric intensivist was always or usually involved in pediatric donor management at 47 organ procurement organizations (81%); transplant/organ recovery surgeons were always or usually involved at 12 organ procurement organizations (21%). There was an increase in the number of organs transplanted per donor among donors 11-17 years old for organ procurement organizations that used donor management goals for the duration of the period studied (p < 0.01). There was also an increase in the ratio of observed/expected organs transplanted among donors of 0-10 years old for organ procurement organizations that always or usually consulted a transplant/organ recovery surgeon (p = 0.02) although this did not reach our threshold for statistical significance.. CONCLUSIONS There is little consensus among organ procurement organizations regarding the definition of "pediatric" during organ donor management. Most organ procurement organizations employ written pediatric guidelines and use pediatric intensive care physicians for assistance in managing these donors. There is a positive association between the use of donor management goals and organ yield among pediatric donors in the 11- to 17-year age group.
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Arts DL, Voncken AG, Medlock S, Abu-Hanna A, van Weert HC. Reasons for intentional guideline non-adherence: A systematic review. Int J Med Inform 2016; 89:55-62. [DOI: 10.1016/j.ijmedinf.2016.02.009] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 02/18/2016] [Accepted: 02/20/2016] [Indexed: 01/22/2023]
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Gupta S, Rai N, Bhattacharrya O, Cheng AYY, Connelly KA, Boulet LP, Kaplan A, Brouwers MC, Kastner M. Optimizing the language and format of guidelines to improve guideline uptake. CMAJ 2016; 188:E362-E368. [PMID: 27091799 DOI: 10.1503/cmaj.151102] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Samir Gupta
- Departments of Medicine (Gupta, Cheng, Connelly) and of Family and Community Medicine (Bhattacharrya), University of Toronto, Toronto, Ont.; Divisions of Respirology (Gupta) and Cardiology (Connelly), St. Michael's Hospital; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gupta, Rai, Connelly, Kastner), Toronto, Ont.; Department of Family and Community Medicine (Bhattacharrya), Women's College Hospital, Toronto, Ont.; Division of Endocrinology (Cheng), Trillium Health Partners and St. Michael's Hospital; Institut universitaire de cardiologie et de pneumologie de Québec (Boulet), Université Laval, Québec, Que.; Family Physician Airways Group of Canada (Kaplan), Richmond Hill, Ont.; Escarpment Cancer Research Institute (Brouwers), McMaster University, Hamilton, Ont.; Division of Epidemiology (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.
| | - Navjot Rai
- Departments of Medicine (Gupta, Cheng, Connelly) and of Family and Community Medicine (Bhattacharrya), University of Toronto, Toronto, Ont.; Divisions of Respirology (Gupta) and Cardiology (Connelly), St. Michael's Hospital; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gupta, Rai, Connelly, Kastner), Toronto, Ont.; Department of Family and Community Medicine (Bhattacharrya), Women's College Hospital, Toronto, Ont.; Division of Endocrinology (Cheng), Trillium Health Partners and St. Michael's Hospital; Institut universitaire de cardiologie et de pneumologie de Québec (Boulet), Université Laval, Québec, Que.; Family Physician Airways Group of Canada (Kaplan), Richmond Hill, Ont.; Escarpment Cancer Research Institute (Brouwers), McMaster University, Hamilton, Ont.; Division of Epidemiology (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Onil Bhattacharrya
- Departments of Medicine (Gupta, Cheng, Connelly) and of Family and Community Medicine (Bhattacharrya), University of Toronto, Toronto, Ont.; Divisions of Respirology (Gupta) and Cardiology (Connelly), St. Michael's Hospital; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gupta, Rai, Connelly, Kastner), Toronto, Ont.; Department of Family and Community Medicine (Bhattacharrya), Women's College Hospital, Toronto, Ont.; Division of Endocrinology (Cheng), Trillium Health Partners and St. Michael's Hospital; Institut universitaire de cardiologie et de pneumologie de Québec (Boulet), Université Laval, Québec, Que.; Family Physician Airways Group of Canada (Kaplan), Richmond Hill, Ont.; Escarpment Cancer Research Institute (Brouwers), McMaster University, Hamilton, Ont.; Division of Epidemiology (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Alice Y Y Cheng
- Departments of Medicine (Gupta, Cheng, Connelly) and of Family and Community Medicine (Bhattacharrya), University of Toronto, Toronto, Ont.; Divisions of Respirology (Gupta) and Cardiology (Connelly), St. Michael's Hospital; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gupta, Rai, Connelly, Kastner), Toronto, Ont.; Department of Family and Community Medicine (Bhattacharrya), Women's College Hospital, Toronto, Ont.; Division of Endocrinology (Cheng), Trillium Health Partners and St. Michael's Hospital; Institut universitaire de cardiologie et de pneumologie de Québec (Boulet), Université Laval, Québec, Que.; Family Physician Airways Group of Canada (Kaplan), Richmond Hill, Ont.; Escarpment Cancer Research Institute (Brouwers), McMaster University, Hamilton, Ont.; Division of Epidemiology (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Kim A Connelly
- Departments of Medicine (Gupta, Cheng, Connelly) and of Family and Community Medicine (Bhattacharrya), University of Toronto, Toronto, Ont.; Divisions of Respirology (Gupta) and Cardiology (Connelly), St. Michael's Hospital; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gupta, Rai, Connelly, Kastner), Toronto, Ont.; Department of Family and Community Medicine (Bhattacharrya), Women's College Hospital, Toronto, Ont.; Division of Endocrinology (Cheng), Trillium Health Partners and St. Michael's Hospital; Institut universitaire de cardiologie et de pneumologie de Québec (Boulet), Université Laval, Québec, Que.; Family Physician Airways Group of Canada (Kaplan), Richmond Hill, Ont.; Escarpment Cancer Research Institute (Brouwers), McMaster University, Hamilton, Ont.; Division of Epidemiology (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Louis-Philippe Boulet
- Departments of Medicine (Gupta, Cheng, Connelly) and of Family and Community Medicine (Bhattacharrya), University of Toronto, Toronto, Ont.; Divisions of Respirology (Gupta) and Cardiology (Connelly), St. Michael's Hospital; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gupta, Rai, Connelly, Kastner), Toronto, Ont.; Department of Family and Community Medicine (Bhattacharrya), Women's College Hospital, Toronto, Ont.; Division of Endocrinology (Cheng), Trillium Health Partners and St. Michael's Hospital; Institut universitaire de cardiologie et de pneumologie de Québec (Boulet), Université Laval, Québec, Que.; Family Physician Airways Group of Canada (Kaplan), Richmond Hill, Ont.; Escarpment Cancer Research Institute (Brouwers), McMaster University, Hamilton, Ont.; Division of Epidemiology (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Alan Kaplan
- Departments of Medicine (Gupta, Cheng, Connelly) and of Family and Community Medicine (Bhattacharrya), University of Toronto, Toronto, Ont.; Divisions of Respirology (Gupta) and Cardiology (Connelly), St. Michael's Hospital; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gupta, Rai, Connelly, Kastner), Toronto, Ont.; Department of Family and Community Medicine (Bhattacharrya), Women's College Hospital, Toronto, Ont.; Division of Endocrinology (Cheng), Trillium Health Partners and St. Michael's Hospital; Institut universitaire de cardiologie et de pneumologie de Québec (Boulet), Université Laval, Québec, Que.; Family Physician Airways Group of Canada (Kaplan), Richmond Hill, Ont.; Escarpment Cancer Research Institute (Brouwers), McMaster University, Hamilton, Ont.; Division of Epidemiology (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Melissa C Brouwers
- Departments of Medicine (Gupta, Cheng, Connelly) and of Family and Community Medicine (Bhattacharrya), University of Toronto, Toronto, Ont.; Divisions of Respirology (Gupta) and Cardiology (Connelly), St. Michael's Hospital; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gupta, Rai, Connelly, Kastner), Toronto, Ont.; Department of Family and Community Medicine (Bhattacharrya), Women's College Hospital, Toronto, Ont.; Division of Endocrinology (Cheng), Trillium Health Partners and St. Michael's Hospital; Institut universitaire de cardiologie et de pneumologie de Québec (Boulet), Université Laval, Québec, Que.; Family Physician Airways Group of Canada (Kaplan), Richmond Hill, Ont.; Escarpment Cancer Research Institute (Brouwers), McMaster University, Hamilton, Ont.; Division of Epidemiology (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Monika Kastner
- Departments of Medicine (Gupta, Cheng, Connelly) and of Family and Community Medicine (Bhattacharrya), University of Toronto, Toronto, Ont.; Divisions of Respirology (Gupta) and Cardiology (Connelly), St. Michael's Hospital; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gupta, Rai, Connelly, Kastner), Toronto, Ont.; Department of Family and Community Medicine (Bhattacharrya), Women's College Hospital, Toronto, Ont.; Division of Endocrinology (Cheng), Trillium Health Partners and St. Michael's Hospital; Institut universitaire de cardiologie et de pneumologie de Québec (Boulet), Université Laval, Québec, Que.; Family Physician Airways Group of Canada (Kaplan), Richmond Hill, Ont.; Escarpment Cancer Research Institute (Brouwers), McMaster University, Hamilton, Ont.; Division of Epidemiology (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
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Suria S, Harkouk H, Eghiaian A, Weil G. How to rationalize preoperative tests? A method to implement local guidelines successfully. Anaesth Crit Care Pain Med 2015; 35:103-7. [PMID: 26711017 DOI: 10.1016/j.accpm.2015.10.004] [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: 01/05/2015] [Revised: 06/19/2015] [Accepted: 10/06/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Preoperative screening includes clinical examination and tests. Systematic prescription leads to excessive tests. We conducted an observational retrospective study to assess the success of implementing a protocol-guided prescription procedure for preoperative tests (PTs). We compared the number of PTs prescribed for scheduled surgery before and after the implementation of local guidelines with a specific method. METHODS Local guidelines for prescribing PTs based on the French Society of Anaesthesia's recommendations were developed, validated by the anaesthesia team and actively implemented. The implementation procedure was complex and based on the application of sociologic concepts to facilitate PT prescriptions in accordance with the protocol. All PTs (except for children and emergency surgeries) prescribed over a one-week observation period were analysed before and after protocol implementation, respectively in 2011 and 2013. RESULTS Two hundred and ninety-two patient files were analysed: 157 in 2011 and 135 in 2013. Ninety-one percent of the prescriptions were in accordance with the recommendations in 2013. Excessive prescribing decreased significantly after the implementation of recommendations (7.1% versus 20.7%, P<0.0001), enabling us to reduce excess costs. CONCLUSION We observed excellent adherence to the prescription protocol for PTs. The method used to implement the protocol was successful. A future evaluation should be undertaken to confirm these results over the long-term.
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Affiliation(s)
- Stéphanie Suria
- Service d'anesthésie, Gustave-Roussy Cancer Campus, 94805 Villejuif, France.
| | - Hakim Harkouk
- Service d'anesthésie, Gustave-Roussy Cancer Campus, 94805 Villejuif, France.
| | - Alexandre Eghiaian
- Service d'anesthésie, Gustave-Roussy Cancer Campus, 94805 Villejuif, France.
| | - Grégoire Weil
- Service d'anesthésie, Gustave-Roussy Cancer Campus, 94805 Villejuif, France.
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Parker SH. Human Factors Science: Brief History and Applications to Healthcare. Curr Probl Pediatr Adolesc Health Care 2015; 45:390-4. [PMID: 26573244 DOI: 10.1016/j.cppeds.2015.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
Abstract
This section will define the science of human factors, its origins, its impact on safety in other domains, and its impact and potential for impact on patient safety.
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Affiliation(s)
- Sarah Henrickson Parker
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, DC
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