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Vitous CA, Rivard SJ, Ervin JN, Duby A, Hendren S, Suwanabol PA. Reducing Ileostomy Readmissions: Using Implementation Science to Evaluate the Adoption of a Quality Improvement Initiative. Dis Colon Rectum 2023; 66:1587-1594. [PMID: 37018541 DOI: 10.1097/dcr.0000000000002684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND Translating empirical evidence into clinical practice remains challenging. Prevention of morbidity from new ileostomies may serve as an example. Despite evidence demonstrating improvements in electrolyte levels, kidney function markers, and hospital readmissions, widespread adoption of oral rehydration solutions among patients with new ileostomies has not occurred. The causes of low uptake are unknown and likely multifactorial. OBJECTIVE We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance implementation science framework to identify barriers and facilitators in the adoption of a quality improvement initiative aimed at decreasing emergency department visits and hospital readmissions because of dehydration among patients with new ileostomies using oral rehydration solutions. DESIGN Qualitative interviews were conducted with stakeholders based on the domains of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. SETTINGS Participating community and academic hospitals across Michigan (n = 12). PATIENTS Convenience sampling was used to recruit 25 key stakeholders, including wound, ostomy, and continence nurses; registered nurses; nurse practitioners; nurse managers; colorectal surgeons; surgery residents; physician assistants; and data abstractors (1-4 participants per site). MAIN OUTCOME MEASURES Through qualitative content analysis, we located, analyzed, and identified patterns using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. RESULTS We identified the following factors to increase the adoption of quality improvement initiatives at the provider level: 1) selection and coaching of champions, 2) broadening of multidisciplinary teams, 3) performing structured patient follow-up, and 4) addressing long-term sustainability concerns regarding cost and equity. LIMITATIONS Limited to high-volume ileostomy surgery hospitals, did not include in-person site visits to each hospital before and after implementation, and did not consider the hospital- and patient-level factors that impact the widespread adoption of quality improvement initiatives. CONCLUSIONS Integrating implementation science frameworks to rigorously study quality improvement initiatives may reveal the determinants of the widespread adoption of evidence-based practices. REDUCCIN DE REINGRESOS POR ILEOSTOMA USO DE LA CIENCIA DE LA IMPLEMENTACIN PARA EVALUAR LA ADOPCIN DE UNA INICIATIVA DE MEJORA DE LA CALIDAD ANTECEDENTES:Traducir la evidencia empírica a la práctica clínica sigue siendo un desafío. La prevención de la morbilidad por nuevas ileostomías puede servir como ejemplo. A pesar de la evidencia que demuestra mejoras en los niveles de electrolitos, marcadores de función renal y reingresos hospitalarios, no se ha producido una adopción generalizada de soluciones de rehidratación oral entre pacientes con nuevas ileostomías. Las causas de la baja captación son desconocidas y probablemente multifactoriales.OBJETIVO:Empleamos Alcance, Eficacia, Adopción, Implementación y Mantenimiento, un marco de las ciencias de implementación, para identificar barreras y facilitadores en la adopción de una iniciativa de mejora de la calidad destinada a disminuir las visitas al departamento de emergencias y los reingresos hospitalarios debido a la deshidratación entre los pacientes con nuevos ileostomías utilizando soluciones de rehidratación oral.DISEÑO:Se realizaron entrevistas cualitativas con las partes interesadas basadas en los dominios del marco de Alcance, Efectividad, Adopción, Implementación y Mantenimiento.CONFIGURACIÓN:Hospitales académicos y comunitarios participantes a través de Michigan (n = 12).PARTICIPANTES:Se utilizó un muestreo por conveniencia para reclutar a 25 partes interesadas clave, incluyendo enfermeras de heridas, ostomía y continencia; enfermeras registradas; enfermeras practicantes; gerentes de enfermera; cirujanos colorrectales; residentes de cirugía; asistentes médicos; y extractores de datos (1-4 participantes por sitio).PRINCIPALES MEDIDAS DE RESULTADO:A través del análisis de contenido cualitativo, localizamos, analizamos e identificamos patrones utilizando el marco de Alcance, Eficacia, Adopción, Implementación y Mantenimiento.RESULTADOS:Identificamos los siguientes factores para aumentar la adopción de iniciativas de mejora de la calidad a nivel de proveedores: 1) selección y entrenamiento de campeones, 2) ampliación de equipos multidisciplinarios, 3) seguimiento estructurado de pacientes y 4) abordaje a largo plazo. preocupaciones de sostenibilidad con respecto al costo y la equidad.LIMITACIONES:Limitado a hospitales de cirugía de ileostomía de alto volumen, incapaz de realizar visitas en persona a cada hospital antes y después de la implementación, no considera los factores a nivel del hospital y del paciente que afectan la adopción generalizada de iniciativas de mejora de la calidad.CONCLUSIONES:La integración de marcos científicos de implementación para estudiar rigurosamente las iniciativas de mejora de la calidad puede revelar los determinantes de la adopción generalizada de prácticas basadas en la evidencia. (Traducción-Dr. Aurian Garcia Gonzalez ).
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Affiliation(s)
- C Ann Vitous
- Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Samantha J Rivard
- Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Jennifer N Ervin
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ashley Duby
- Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Samantha Hendren
- Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Pasithorn A Suwanabol
- Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
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Hamm RF, Moniz MH, Wahid I, Breman RB, Callaghan-Koru JA. Implementation research priorities for addressing the maternal health crisis in the USA: results from a modified Delphi study among researchers. Implement Sci Commun 2023; 4:83. [PMID: 37480135 PMCID: PMC10360260 DOI: 10.1186/s43058-023-00461-z] [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: 02/02/2023] [Accepted: 06/21/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Maternal health outcomes in the USA are far worse than in peer nations. Increasing implementation research in maternity care is critical to addressing quality gaps and unwarranted variations in care. Implementation research priorities have not yet been defined or well represented in the plans for maternal health research investments in the USA. METHODS This descriptive study used a modified Delphi method to solicit and rank research priorities at the intersection of implementation science and maternal health through two sequential web-based surveys. A purposeful, yet broad sample of researchers with relevant subject matter knowledge was identified through searches of published articles and grant databases. The surveys addressed five implementation research areas in maternal health: (1) practices to prioritize for broader implementation, (2) practices to prioritize for de-implementation, (3) research questions about implementation determinants, (4) research questions about implementation strategies, and (5) research questions about methods/measures. RESULTS Of 160 eligible researchers, 82 (51.2%) agreed to participate. Participants were predominantly female (90%) and White (75%). Sixty completed at least one of two surveys. The practices that participants prioritized for broader implementation were improved postpartum care, perinatal and postpartum mood disorder screening and management, and standardized management of hypertensive disorders of pregnancy. For de-implementation, practices believed to be most impactful if removed from or reduced in maternity care were cesarean delivery for low-risk patients and routine discontinuation of all psychiatric medications during pregnancy. The top methodological priorities of participants were improving the extent to which implementation science frameworks and measures address equity and developing approaches for involving patients in implementation research. CONCLUSIONS Through a web-based Delphi exercise, we identified implementation research priorities that researchers consider to have the greatest potential to improve the quality of maternity care in the USA. This study also demonstrates the feasibility of using modified Delphi approaches to engage researchers in setting implementation research priorities within a clinical area.
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Affiliation(s)
- Rebecca F Hamm
- Maternal and Child Health Research Center, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Michelle H Moniz
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Inaya Wahid
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Rachel Blankstein Breman
- Department of Partnerships, Professional Education and Practice, School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Jennifer A Callaghan-Koru
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Springdale, AR, USA.
- Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
- Center for Implementation Research, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Callaghan-Koru J, Farzin A, Ridout E, Curran G. Integrating Implementation Science with Quality Improvement to Improve Perinatal Outcomes. Clin Perinatol 2023; 50:343-361. [PMID: 37201985 DOI: 10.1016/j.clp.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Implementation science is an interdisciplinary field that seeks to contribute generalizable knowledge that can improve the translation of clinical evidence in routine care. To promote the integration of implementation science approaches with health care quality improvement, the authors offer a framework that links the Model for Improvement with implementation strategies and methods. Perinatal quality improvement teams can leverage the robust frameworks of implementation science to diagnose implementation barriers, select implementation strategies, and assess the strategies' contribution to improving care. Partnerships between implementation scientists and quality improvement teams could accelerate efforts by both groups to achieve measurable improvements in care.
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Affiliation(s)
- Jennifer Callaghan-Koru
- Department of Internal Medicine, University of Arkansas for Medical Sciences, 1125 North College Avenue, Fayetteville, AR 72703, USA.
| | - Azadeh Farzin
- Pediatrix of Maryland/Adventist Healthcare, 9901 Medical Center Drive, Rockville, MD 20850, USA
| | - Erick Ridout
- American Academy of Pediatrics, 1380 East Medical Center Drive, St George, UT 84790, USA
| | - Geoffrey Curran
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA
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Roberts NA, Young AM, Duff J. Using Implementation Science in Nursing Research. Semin Oncol Nurs 2023; 39:151399. [PMID: 36894448 DOI: 10.1016/j.soncn.2023.151399] [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: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES Clinical research continues to build knowledge that can potentially improve clinical and health service outcomes; however, integrating evidence into routine care is challenging, resulting in a knowledge practice gap. The field of implementation science is a resource available for nurses to translate evidence into their practice. This article aims to provide nurses with an overview of implementation science, illustrate its value integrating evidence into practice, and show how it can be applied with high rigor in nursing research practice. DATA SOURCES A narrative synthesis of the implementation science literature was conducted. A series of case studies were purposively selected to demonstrate the application of commonly used implementation theories, models, and frameworks across health care settings relevant to nursing. These case studies demonstrate how the theoretical framework was applied and how the outcomes of the work reduced the knowledge practice gap. CONCLUSION Implementation science theoretical approaches have been used by nurses and multidisciplinary teams to better understand the gap between knowledge and practice for better informed implementation. These can be used to understand the processes involved, identify the determinants at play, and undertake an effective evaluation. IMPLICATIONS FOR NURSING PRACTICE By using implementation science research practice, nurses can also build a strong foundation of evidence about nursing clinical practice. As an approach, implementation science is practical and can optimize the valuable nursing resource.
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Affiliation(s)
- Natasha A Roberts
- University of Queensland, Metro North Health, Herston, QLD, Australia; University of Queensland, Brisbane, QLD, Australia; Queensland University of Technology, Brisbane, QLD, Australia.
| | - Adrienne M Young
- University of Queensland, Metro North Health, Herston, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Jed Duff
- University of Queensland, Metro North Health, Herston, QLD, Australia; Queensland University of Technology, Brisbane, QLD, Australia
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Abstract
Can we speed the testing, implementation and spread of management innovations in a systematic way to also contribute to scientific knowledge? Researchers and implementers have developed an approach to test and revise a local version of an innovation during its implementation. The chapter starts with a case example of an application of this combination of implementation and quality improvement sciences and practices (improve-mentation). It then summarizes four examples of this approach so as to help understand what improve-mentation is and how it is different from traditional quality improvement and traditional implementation of evidence-based practices. It considers gaps in knowledge that are hindering both more use of improve-mentation to generate scientific knowledge about spread and implementation, as well as more use of improve-mentation by health care service organizations and researchers. It closes by proposing fruitful research and development that can address these knowledge gaps to speed the implementation, sustainment and spread of care and management innovations.
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Chan SL, Lum E, Ong MEH, Graves N. Implementation science: A critical but undervalued part of the healthcare innovation ecosystem. HEALTH CARE SCIENCE 2022; 1:160-165. [PMID: 38938555 PMCID: PMC11080739 DOI: 10.1002/hcs2.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 06/29/2024]
Abstract
Healthcare systems face many competing demands and insufficient resources. Service innovations to improve efficiency are important to address this challenge. Innovations can range from new pharmaceuticals, alternate models of care, novel devices, and the use other technologies. Suboptimal implementation can mean lost benefits. This review article aims to highlight the role of implementation science, summarize how settings have leveraged this methodology to promote translation of innovation into practice, and describe our own experience of embedding implementation science into an academic medical center in Singapore. Implementation science offers a range of methods to promote systematic uptake of research findings about innovations and is gaining recognition worldwide as an important discipline for health services researchers. Health systems around the world have tried to promote implementation research in their settings by establishing (1) dedicated centers/programs, (2) offering funding, and (3) building knowledge and capacity among staff. Implementation science is a critical piece in the translational pathway of "evidence to innovation." The three efforts we describe should be strengthened to integrate implementation science into the innovation ecosystem around the world.
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Affiliation(s)
- Sze Ling Chan
- Health Services Research Centre, SingHealthSingaporeSingapore
- Health Services and Systems ResearchDuke‐NUS Medical SchoolSingaporeSingapore
| | - Elaine Lum
- Health Services and Systems ResearchDuke‐NUS Medical SchoolSingaporeSingapore
| | - Marcus E. H. Ong
- Health Services Research Centre, SingHealthSingaporeSingapore
- Health Services and Systems ResearchDuke‐NUS Medical SchoolSingaporeSingapore
- Department of Emergency MedicineSingapore General HospitalSingaporeSingapore
| | - Nicholas Graves
- Health Services and Systems ResearchDuke‐NUS Medical SchoolSingaporeSingapore
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Bjørngaard H, Koksvik HS, Jakobsen B, Grønning K. Nurses experience increased clinical and organisational competence by working with a medical quality register, RevNatus - a qualitative study. BMC Health Serv Res 2022; 22:1291. [PMID: 36289511 PMCID: PMC9608925 DOI: 10.1186/s12913-022-08595-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background RevNatus is a consent-based, nationwide medical quality register that collects data on patients with inflammatory rheumatic diseases during pregnancy and one year postpartum. The entering of data takes place in outpatient clinics in rheumatology wards in hospitals. The aim of this study is to explore how rheumatology nurses experience organizing and working with the medical quality register RevNatus in addition to their normal clinical patient-care tasks. Methods Qualitative focus group interviews and individual in-depth interviews were conducted in 2018 to gain insights into how nurses organize performing quality register work and clinical work simultaneously. Data were analysed using systematic text condensation. Results The informants represented seven different rheumatology outpatient clinics in Norway. The analyses showed that working with RevNatus increased the nurses’ knowledge about pregnancy and rheumatic diseases, improved the content of their nurse consultations and found the ‘register form’ as a useful template to structure the nurse consultations. The nurses took the main responsibility for RevNatus, but lack of routines and uncoordinated collaboration with the rheumatologists and secretaries made the nurses spend too much time verifying the accuracy of data or post-registering missing data. Conclusion The nurses experienced work with RevNatus as time-consuming, but the register work increased both their clinical and organisational competences. Routines and collaboration within the registry team are important to ensure the data quality and reduce the workload. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08595-x.
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Affiliation(s)
- Hilde Bjørngaard
- grid.52522.320000 0004 0627 3560Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, St.Olavs Hospital, 7030 Trondheim, Norway
| | - Hege Svean Koksvik
- grid.52522.320000 0004 0627 3560Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, St.Olavs Hospital, 7030 Trondheim, Norway
| | - Bente Jakobsen
- grid.52522.320000 0004 0627 3560Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, St.Olavs Hospital, 7030 Trondheim, Norway
| | - Kjersti Grønning
- grid.5947.f0000 0001 1516 2393Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway ,Nord-Trøndelag Hospital Trust, 7601 Levanger, Norway
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Hartveit M, Hovlid E, Øvretveit J, Assmus J, Bond G, Joa I, Heiervang K, Stensrud B, Høifødt TS, Biringer E, Ruud T. Can systematic implementation support improve programme fidelity by improving care providers' perceptions of implementation factors? A cluster randomized trial. BMC Health Serv Res 2022; 22:808. [PMID: 35733211 PMCID: PMC9215018 DOI: 10.1186/s12913-022-08168-y] [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] [Received: 02/08/2022] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Investigations of implementation factors (e.g., collegial support and sense of coherence) are recommended to better understand and address inadequate implementation outcomes. Little is known about the relationship between implementation factors and outcomes, especially in later phases of an implementation effort. The aims of this study were to assess the association between implementation success (measured by programme fidelity) and care providers' perceptions of implementation factors during an implementation process and to investigate whether these perceptions are affected by systematic implementation support. METHODS Using a cluster-randomized design, mental health clinics were drawn to receive implementation support for one (intervention) and not for another (control) of four evidence-based practices. Programme fidelity and care providers' perceptions (Implementation Process Assessment Tool questionnaire) were scored for both intervention and control groups at baseline, 6-, 12- and 18-months. Associations and group differences were tested by means of descriptive statistics (mean, standard deviation and confidence interval) and linear mixed effect analysis. RESULTS Including 33 mental health centres or wards, we found care providers' perceptions of a set of implementation factors to be associated with fidelity but not at baseline. After 18 months of implementation effort, fidelity and care providers' perceptions were strongly correlated (B (95% CI) = .7 (.2, 1.1), p = .004). Care providers perceived implementation factors more positively when implementation support was provided than when it was not (t (140) = 2.22, p = .028). CONCLUSIONS Implementation support can facilitate positive perceptions among care providers, which is associated with higher programme fidelity. To improve implementation success, we should pay more attention to how care providers constantly perceive implementation factors during all phases of the implementation effort. Further research is needed to investigate the validity of our findings in other settings and to improve our understanding of ongoing decision-making among care providers, i.e., the mechanisms of sustaining the high fidelity of recommended practices. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03271242 (registration date: 05.09.2017).
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Affiliation(s)
- Miriam Hartveit
- Valen Hospital Helse Fonna HF, 5451, Valen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Box 7804, 5020, Bergen, Norway.
| | - Einar Hovlid
- Department of Social Science, Western Norway University of Applied Sciences, Røyrgata 6, 6856, Sogndal, Norway
| | - John Øvretveit
- Stockholm Health Care Services, Region Stockholm (SLSO) and LIME/MMC, Tomtebodavägen 18A, Karolinska Institutet, Stockholm, Sweden
| | - Jørg Assmus
- Centre for Clinical Research, Haukeland University Hospital, Box 1400, 5021, Bergen, Norway
| | - Gary Bond
- Westat, Rivermill Commercial Center, 85 Mechanic Street, Lebanon, NH, USA
| | - Inge Joa
- Network for Clinical Research in Psychosis, Stavanger University Hospital, Box 8100, 4068, Stavanger, Norway.,Network for Medical Sciences, Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Kristin Heiervang
- Division of Mental Health Services, Akershus University Hospital, Box 1000, 1478, Lørenskog, Norway
| | - Bjørn Stensrud
- Division of Mental Health, Innlandet Hospital Trust, Box 104, 2381, Brumunddal, Norway
| | | | - Eva Biringer
- Valen Hospital Helse Fonna HF, 5451, Valen, Norway.,Department of Research and Innovation, Helse Fonna HF, 5416, Stord, Norway
| | - Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, Box 1000, 1478, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Box 1171 Blindern, 0318, Oslo, Norway
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Nilsen P, Thor J, Bender M, Leeman J, Andersson-Gäre B, Sevdalis N. Bridging the Silos: A Comparative Analysis of Implementation Science and Improvement Science. FRONTIERS IN HEALTH SERVICES 2022; 1:817750. [PMID: 36926490 PMCID: PMC10012801 DOI: 10.3389/frhs.2021.817750] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022]
Abstract
Background Implementation science and improvement science have similar goals of improving health care services for better patient and population outcomes, yet historically there has been limited exchange between the two fields. Implementation science was born out of the recognition that research findings and effective practices should be more systematically disseminated and applied in various settings to achieve improved health and welfare of populations. Improvement science has grown out of the wider quality improvement movement, but a fundamental difference between quality improvement and improvement science is that the former generates knowledge for local improvement, whereas the latter is aimed at producing generalizable scientific knowledge. Objectives The first objective of this paper is to characterise and contrast implementation science and improvement science. The second objective, building on the first, is to highlight aspects of improvement science that potentially could inform implementation science and vice versa. Methods We used a critical literature review approach. Search methods included systematic literature searches in PubMed, CINAHL, and PsycINFO until October 2021; reviewing references in identified articles and books; and the authors' own cross-disciplinary knowledge of key literature. Findings The comparative analysis of the fields of implementation science and improvement science centred on six categories: (1) influences; (2) ontology, epistemology and methodology; (3) identified problem; (4) potential solutions; (5) analytical tools; and (6) knowledge production and use. The two fields have different origins and draw mostly on different sources of knowledge, but they have a shared goal of using scientific methods to understand and explain how health care services can be improved for their users. Both describe problems in terms of a gap or chasm between current and optimal care delivery and consider similar strategies to address the problems. Both apply a range of analytical tools to analyse problems and facilitate appropriate solutions. Conclusions Implementation science and improvement science have similar endpoints but different starting points and academic perspectives. To bridge the silos between the fields, increased collaboration between implementation and improvement scholars will help to clarify the differences and connections between the science and practice of improvement, to expand scientific application of quality improvement tools, to further address contextual influences on implementation and improvement efforts, and to share and use theory to support strategy development, delivery and evaluation.
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Affiliation(s)
- Per Nilsen
- Division of Society and Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Johan Thor
- Jönköping University, Jönköping Academy for Improvement of Health and Welfare, Jönköping, Sweden
| | - Miriam Bender
- Sue and Bill Gross School of Nursing, University of California, Irvine, Irvine, CA, United States
| | - Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Boel Andersson-Gäre
- Jönköping University, Jönköping Academy for Improvement of Health and Welfare, Jönköping, Sweden
| | - Nick Sevdalis
- Health Service & Population Research Department, Centre for Implementation Science, King's College London, London, United Kingdom
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Ovretveit J, Mittman BS, Rubenstein LV, Ganz DA. Combining Improvement and Implementation Sciences and Practices for the Post COVID-19 Era. J Gen Intern Med 2021; 36:3503-3510. [PMID: 34494208 PMCID: PMC8423072 DOI: 10.1007/s11606-020-06373-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/30/2020] [Indexed: 11/26/2022]
Abstract
Health services made many changes quickly in response to the SARS-CoV-2 pandemic. Many more are being made. Some changes were already evaluated, and there are rigorous research methods and frameworks for evaluating their local implementation and effectiveness. But how useful are these methods for evaluating changes where evidence of effectiveness is uncertain, or which need adaptation in a rapidly changing situation? Has implementation science provided implementers with tools for effective implementation of changes that need to be made quickly in response to the demands of the pandemic? This perspectives article describes how parts of the research and practitioner communities can use and develop a combination of implementation and improvement to enable faster and more effective change in the future, especially where evidence of local effectiveness is limited. We draw on previous reviews about the advantages and disadvantages of combining these two domains of knowledge and practice. We describe a generic digitally assisted rapid cycle testing (DA-RCT) approach that combines elements of each in order to better describe a change, monitor outcomes, and make adjustments to the change when implemented in a dynamic environment.
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Affiliation(s)
| | - Brian S Mittman
- Kaiser Permanente Southern California Department of Research and Evaluation, Oakland, CA, USA
| | - Lisa V Rubenstein
- David Geffen School of Medicine and Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
- RAND Corporation, Santa Monica, CA, USA
| | - David A Ganz
- VA Center for the Study of Healthcare Innovation, Implementation and Policy, and Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Linke SE, Kallenberg GR, Kronick R, Tai-Seale M, De-Guzman K, Rabin B. Integrating "Exercise Is Medicine" into primary care workflow: a study protocol. Transl Behav Med 2021; 11:921-929. [PMID: 32945881 DOI: 10.1093/tbm/ibaa088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
As a major contributor to the burden of most chronic diseases, insufficient physical activity (PA) creates a significant financial burden on the health care system. Numerous interventions effectively increase PA, but few are integrated into primary care clinic workflows. Exercise Is Medicine (EIM) is a global health initiative committed to the belief that PA is integral to the prevention and treatment of diseases and should be routinely assessed as a vital sign and treated in the health care setting. This paper describes an in-progress embedded quality improvement (QI) project that integrates EIM into routine clinical practice. A combination of implementation science (IS) and QI models are used to adapt, implement, and evaluate the integration of EIM into six primary care clinics. The Practical, Robust Implementation and Sustainability Model (PRISM) guided preimplementation evaluation and adaptation of EIM protocol, materials, and delivery strategies. The learning evaluation QI model is used to design, test, refine, and implement EIM using rapid, 3 month Plan-Do-Study-Act microcycles. Learning meetings are used to obtain feedback and optimize workflow. The Stirman Framework is used to document adaptations to the program throughout implementation. Reach, adoption, implementation, effectiveness, and maintenance outcomes embedded within PRISM will guide the program evaluation to determine sustainability and scalability. Using an innovative approach of combining IS and QI methods to improve the identification of primary care patients with insufficient PA to increase their activity levels has great population health potential. Our work will inform the best approaches for EIM integration in primary care.
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Affiliation(s)
- Sarah E Linke
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA
| | | | - Rick Kronick
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA
| | - Ming Tai-Seale
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA
| | - Kimberly De-Guzman
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA
| | - Borsika Rabin
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA
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Morrow A, Chan P, Tiernan G, Steinberg J, Debono D, Wolfenden L, Tucker KM, Hogden E, Taylor N. Building capacity from within: qualitative evaluation of a training program aimed at upskilling healthcare workers in delivering an evidence-based implementation approach. Transl Behav Med 2021; 12:6320108. [PMID: 34255088 PMCID: PMC8765000 DOI: 10.1093/tbm/ibab094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Translating evidence into complex health systems is an ongoing challenge. Building the capacity of healthcare workers in behavioral and implementation science methods may facilitate the use of evidence-based implementation approaches, leading to sustainable and effective translation. The aim was to describe the development, contents and evaluation of a training workshop aimed at upskilling hospital-embedded staff to deliver an evidence-based implementation approach. The Hide and Seek Project (HaSP) is a cluster randomized controlled trial testing two implementation approaches for improving hereditary cancer referral at eight Australian hospitals. Healthcare workers were recruited as “Implementation Leads” and trained via a one-day workshop—TRAining in evideNce-baSed ImpLementATion for hEalth (TRANSLATE). The purpose of TRANSLATE was to upskill Implementation Leads in the delivery of HaSP, as well as implementation science methods more broadly. Implementation Leads participated in semi-structured evaluation interviews, which were analyzed using inductive thematic analysis. Nine Implementation Leads from various professional backgrounds completed the training. Four key themes were identified: (i) training day reactions, (ii) learning, (iii) implementation barriers and facilitators, and (iv) building health system capacity for implementation. Participants reported high levels of satisfaction, and anticipated that the knowledge and skills may be useful in the future. We describe a novel training program focused on the delivery of evidence-based implementation within health systems. Guided by insights from this study, methods to deliver the training on a larger scale and across different contexts are being explored. The prolonged impact of TRANSLATE will be further evaluated at trial completion. Trial registration: ANZCTR, ACTRN12618001072202. Registered on June 27, 2018
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Affiliation(s)
- April Morrow
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Camperdown New South Wales, Australia
| | - Priscilla Chan
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
| | - Gabriella Tiernan
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
| | - Julia Steinberg
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Camperdown New South Wales, Australia
| | - Deborah Debono
- Centre for Health Services Management, School of Public Health, University of Technology Sydney, New South Wales, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Katherine M Tucker
- Hereditary Cancer Centre, Prince of Wales Hospital, New South Wales, Australia.,Prince of Wales Clinical School, UNSW Sydney, New South Wales, Australia
| | - Emily Hogden
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
| | - Natalie Taylor
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Camperdown New South Wales, Australia
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Hamm RF, Iriye BK, Srinivas SK. Implementation Science is Imperative to the Optimization of Obstetric Care. Am J Perinatol 2021; 38:643-648. [PMID: 33321535 PMCID: PMC9268067 DOI: 10.1055/s-0040-1721728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In an effort aimed at improving outcomes, obstetric teams have enacted comprehensive care bundles and other clinical tools. Yet, these practices have had limited degrees of success on a national scale. Implementation science aims to bridge the divide between the development of evidence-based interventions and their real-world utilization. This emerging field takes into account key stakeholders at the clinician, institution, and health policy levels. Implementation science evaluates how well an intervention is or can be delivered, to whom, in which context, and how it may be up-scaled and sustained. Other medical disciplines have embraced these concepts with success. The frameworks and theories of implementation science can and should be incorporated into both obstetric research and practice. By doing so, we can increase widespread and timely adoption of evidence and further our common goal of decreasing maternal morbidity and mortality. KEY POINTS: · Evidence-based practices have been implemented in obstetrics with variable success.. · Implementation science aims to bridge the divide between the development of evidence-based interventions and their real-world utilization.. · The methodologies of implementation science may be helpful to obstetric research and practice..
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Affiliation(s)
- Rebecca F. Hamm
- Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Sindhu K. Srinivas
- Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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14
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Sierras-Davó MC, Lillo-Crespo M, Verdú Rodríguez P. Qualitative evaluation of an educational intervention about healthcare improvement for nursing students. AQUICHAN 2021. [DOI: 10.5294/aqui.2021.21.1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To explore the meaning of the experience and knowledge acquired by nursing students trained in healthcare improvement.
Material and methods: A phenomenological approach based on the Giorgi method was made through a group discussion of 21 European students from four countries in July 2019. The data was triangulated with the testimonies of key informants and with the use of an evaluation tool specific to this topic. The analysis was also triangulated with three experienced researchers who reduced the data by consensus to eight units of meaning.
Results: Nursing empowerment and horizontal health organizations were two of the most recurrent units of meaning along with professional values such as teamwork and humanization of care.
Conclusions: The knowledge, attitudes and values acquired are evidence of the shortcomings in the training of future nursing professionals in Europe. The theoretical and practical approach of the sessions, as well as the mixture of cultures, were strengths for the students. It is necessary to follow up on more cases that show the return on the training investment in substantial improvements in real contexts and its impact on the quality of care.
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15
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De Leo A, Bayes S, Butt J, Bloxsome D, Geraghty S. Midwifery leaders' views on the factors considered crucial to implementing evidence-based practice in clinical areas. Women Birth 2020; 34:22-29. [PMID: 33129744 DOI: 10.1016/j.wombi.2020.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 12/13/2022]
Abstract
PROBLEM The evidence-to-practice gap continues to persist in healthcare and midwives report limited knowledge and use of effective intervention strategies to support the implementation of new evidence-based practices in clinical settings. BACKGROUND Despite ongoing development and dissemination of high quality research findings, the translation of latest research evidence by midwives into new evidence-based practices remains sub-optimal. This inefficiency places consumers at risk of obsolete or potentially dangerous healthcare interventions. AIM To explore midwifery leaders' views on what information and support midwives require to lead practice change initiatives in clinical areas. METHODS The study formed part of a broader Participatory Action Research (PAR) project designed to improve the processes by which midwives implement evidence-based practice change in clinical settings. The study employed a qualitative design and was guided by the methodological underpinnings of Action Research (AR). FINDINGS One core finding emerged to fulfil the aim and objectives of the study. To lead implementation of evidence-based practices, midwives need practical solutions and a map of the process, packaged into a centralised web-based resource. DISCUSSION The findings reported in this study provide valuable insight into the specific needs of midwives wanting to improve the uptake and longevity of new evidence based practices in clinical areas. This includes information specific to evidence implementation, support networks and knowledge of Implementation Science. CONCLUSION To lead practice change initiatives, midwives require a web-based resource that standardises the process of evidence implementation, while providing midwives with clear direction and the support needed to confidently champion for evidence base change in clinical areas.
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Affiliation(s)
- Annemarie De Leo
- Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, Australia.
| | - Sara Bayes
- Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, Australia
| | - Janice Butt
- Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, Australia; King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Dianne Bloxsome
- Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, Australia
| | - Sadie Geraghty
- Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, Australia
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16
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McDermott CL, Engelberg RA, Curtis JR. Authors' Response to: Novel Data Linkage for Quality Improvement in Palliative and End-of-Life Care. J Pain Symptom Manage 2020; 59:e4. [PMID: 31887401 PMCID: PMC8359791 DOI: 10.1016/j.jpainsymman.2019.12.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 11/23/2022]
Affiliation(s)
- Cara L McDermott
- Department of Medicine, Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Fred Hutchinson Cancer Research Center, Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington, USA.
| | - Ruth A Engelberg
- Department of Medicine, Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
| | - J Randall Curtis
- Department of Medicine, Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
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17
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Leeman J, Toles M. What does it take to scale-up a complex intervention? Lessons learned from the Connect-Home transitional care intervention. J Adv Nurs 2019; 76:387-397. [PMID: 31642091 DOI: 10.1111/jan.14239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/16/2019] [Accepted: 10/14/2019] [Indexed: 11/28/2022]
Abstract
AIMS To discuss the multiple phases of research done to plan for wide-scale implementation (i.e. scale-up) of Connect-Home, a complex nurse-develop intervention. Barker et al.'s (Implementation Science, 2016, 11, 12) framework for intervention scale-up is applied to address the methods used to answer the following four questions: 'Who' needs to be involved in scale-up? 'What' intervention and implementation strategies need to be taken to scale? 'How' will scale-up be achieved? And what contextual factors influence 'when' scale-up is or is not successful? DESIGN Discussion paper. DATA SOURCES Data sources include the experience of our research team, supported by literature and theory. The Connect-Home team conducted multiple research studies to plan for Connect-Home scale-up. Early studies (2008-2015) focused on formative work to design the Connect-Home intervention. Recent studies have involved successive pilot tests of Connect-Home's effectiveness, implementation, and scale-up (2015-2019). IMPLICATIONS FOR NURSING This article describes a systematic approach that nurse researchers can apply to plan for taking their interventions to scale. CONCLUSIONS Planning for scale-up early in the process of intervention development is essential to speeding the translation of effective interventions into wide-scale practice. IMPACT This article details the methods that nursing researchers applied to develop and test the strategies needed to plan for taking a complex intervention to scale across multiple settings. The methods described are applicable to nursing and other health researchers' development and scale-up of any complex intervention.
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Affiliation(s)
- Jennifer Leeman
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - Mark Toles
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA
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18
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Lillo-Crespo M, Sierras-Davó MC, Taylor A, Ritters K, Karapostoli A. Mapping the Status of Healthcare Improvement Science through a Narrative Review in Six European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4480. [PMID: 31739419 PMCID: PMC6887973 DOI: 10.3390/ijerph16224480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/03/2019] [Accepted: 11/11/2019] [Indexed: 01/09/2023]
Abstract
With the aim to explore how improvement science is understood, taught, practiced, and its impact on quality healthcare across Europe, the Improvement Science Training for European Healthcare Workers (ISTEW) project "Improvement Science Training for European Healthcare Workers" was funded by the European Commission and integrated by 7 teams from different European countries. As part of the project, a narrative literature review was conducted between 2008 and 2019, including documents in all partners' languages from 26 databases. Data collection and analysis involved a common database. Validation took place through partners' discussions. Referring to healthcare improvement science (HIS), a variety of terms, tools, and techniques were reported with no baseline definition or specific framework. All partner teams were informed about the non-existence of a specific term equivalent to HIS in their mother languages, except for the English-speaking countries. A lack of consensus, regarding the understanding and implementation of HIS into the healthcare and educational contexts was found. Our findings have brought to light the gap existing in HIS within Europe, far from other nations, such as the US, where there is a clearer HIS picture. As a consequence, the authors suggest further developing the standardization of HIS understanding and education in Europe.
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Affiliation(s)
- Manuel Lillo-Crespo
- Nursing Department and International Mobility Coordinator, Faculty of Health Sciences, University of Alicante, Carretera de San Vicente del Raspeig s/n, 03690 San Vicente del Raspeig, Alicante, Spain
| | - Maria Cristina Sierras-Davó
- Nursing Department, Faculty of Health Sciences, University of Alicante, Carretera de San Vicente del Raspeig s/n, 03690 San Vicente del Raspeig, Alicante, Spain
| | - Alan Taylor
- Department of Social, Therapeutic and Community Studies, Coventry University, Gosford St, Coventry CV1 5DL, UK
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19
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Westerlund A, Nilsen P, Sundberg L. Implementation of Implementation Science Knowledge: The Research-Practice Gap Paradox. Worldviews Evid Based Nurs 2019; 16:332-334. [PMID: 31603625 PMCID: PMC6899530 DOI: 10.1111/wvn.12403] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Anna Westerlund
- Department of Epidemiology and Global HealthUmeå UniversityUmeåSweden
| | - Per Nilsen
- Department of Medical and Health SciencesDivision of Community MedicineLinköping UniversityLinköpingSweden
| | - Linda Sundberg
- Department of Epidemiology and Global HealthUmeå UniversityUmeåSweden
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20
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Tavender E, Babl FE, Middleton S. Review article: A primer for clinical researchers in the emergency department: Part VIII. Implementation science: An introduction. Emerg Med Australas 2019; 31:332-338. [DOI: 10.1111/1742-6723.13296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Emma Tavender
- Emergency Research, Murdoch Children's Research Institute Melbourne Victoria Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT) Melbourne, Victoria Australia
- Department of PaediatricsThe University of Melbourne Melbourne Victoria Australia
| | - Franz E Babl
- Emergency Research, Murdoch Children's Research Institute Melbourne Victoria Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT) Melbourne, Victoria Australia
- Department of PaediatricsThe University of Melbourne Melbourne Victoria Australia
- Emergency DepartmentThe Royal Children's Hospital Melbourne Victoria Australia
| | - Sandy Middleton
- Nursing Research InstituteSt Vincent's Health Australia and Australian Catholic University Sydney New South Wales Australia
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21
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Dearani JA, Rosengart TK, Marshall MB, Mack MJ, Jones DR, Prager RL, Cerfolio RJ. Incorporating Innovation and New Technology Into Cardiothoracic Surgery. Ann Thorac Surg 2019; 107:1267-1274. [DOI: 10.1016/j.athoracsur.2018.10.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/07/2018] [Indexed: 11/26/2022]
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22
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Wright N, Abantanga F, Amoah M, Appeadu-Mensah W, Bokhary Z, Bvulani B, Davies J, Miti S, Nandi B, Nimako B, Poenaru D, Tabiri S, Yifieyeh A, Ade-Ajayi N, Sevdalis N, Leather A. Developing and implementing an interventional bundle to reduce mortality from gastroschisis in low-resource settings. Wellcome Open Res 2019; 4:46. [PMID: 30984879 PMCID: PMC6456836 DOI: 10.12688/wellcomeopenres.15113.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Gastroschisis is associated with less than 4% mortality in high-income countries and over 90% mortality in many tertiary paediatric surgery centres across sub-Saharan Africa (SSA). The aim of this trial is to develop, implement and prospectively evaluate an interventional bundle to reduce mortality from gastroschisis in seven tertiary paediatric surgery centres across SSA. Methods: A hybrid type-2 effectiveness-implementation, pre-post study design will be utilised. Using current literature an evidence-based, low-technology interventional bundle has been developed. A systematic review, qualitative study and Delphi process will provide further evidence to optimise the interventional bundle and implementation strategy. The interventional bundle has core components, which will remain consistent across all sites, and adaptable components, which will be determined through in-country co-development meetings. Pre- and post-intervention data will be collected on clinical, service delivery and implementation outcomes for 2-years at each site. The primary clinical outcome will be all-cause, in-hospital mortality. Secondary outcomes include the occurrence of a major complication, length of hospital stay and time to full enteral feeds. Service delivery outcomes include time to hospital and primary intervention, and adherence to the pre-hospital and in-hospital protocols. Implementation outcomes are acceptability, adoption, appropriateness, feasibility, fidelity, coverage, cost and sustainability. Pre- and post-intervention clinical outcomes will be compared using Chi-squared analysis, unpaired t-test and/or Mann-Whitney U test. Time-series analysis will be undertaken using Statistical Process Control to identify significant trends and shifts in outcome overtime. Multivariate logistic regression analysis will be used to identify clinical and implementation factors affecting outcome with adjustment for confounders. Outcome: This will be the first multi-centre interventional study to our knowledge aimed at reducing mortality from gastroschisis in low-resource settings. If successful, detailed evaluation of both the clinical and implementation components of the study will allow sustainability in the study sites and further scale-up. Registration: ClinicalTrials.gov Identifier NCT03724214.
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Affiliation(s)
- Naomi Wright
- King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, SE5 9RJ, UK
| | - Francis Abantanga
- Department of Surgery, Tamale Teaching Hospital, Tamale, P.O. Box TL 16, Ghana
| | - Michael Amoah
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, P.O.Box 1934, Ghana
| | | | - Zaitun Bokhary
- Department of Paediatric Surgery, Muhimbili National Hospital, Dar es Salaam, P.O Box 65000, Tanzania
| | - Bruce Bvulani
- Department of Paediatric Surgery, University Teaching Hospital of Lusaka, Lusaka, 10101, Zambia
| | - Justine Davies
- Global Health and Education Department, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sam Miti
- Department of Paediatrics, Arthur Davison Children's Hospital, Ndola, Zambia
| | - Bip Nandi
- Department of Paediatric Surgery, Kamuzu Central Hospital, Lilongwe, P.O. Box 149, Malawi
| | - Boateng Nimako
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, P.O.Box 1934, Ghana
| | - Dan Poenaru
- McGill University, Montreal, Quebec, H3A 0G4, Canada
| | - Stephen Tabiri
- Department of Surgery, Tamale Teaching Hospital, Tamale, P.O. Box TL 16, Ghana
| | - Abiboye Yifieyeh
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, P.O.Box 1934, Ghana
| | - Niyi Ade-Ajayi
- Department of Paediatric Surgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Nick Sevdalis
- Centre for Implementation Science, King's College London, London, SE5 8AF, UK
| | - Andy Leather
- King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, SE5 9RJ, UK
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Panella M, Seys D, Sermeus W, Bruyneel L, Lodewijckx C, Deneckere S, Sermon A, Nijs S, Boto P, Vanhaecht K. Minimal impact of a care pathway for geriatric hip fracture patients. Injury 2018; 49:1581-1586. [PMID: 29884319 DOI: 10.1016/j.injury.2018.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/23/2018] [Accepted: 06/02/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Adherence to guidelines for patients with proximal femur fracture is suboptimal. OBJECTIVE To evaluate the effect of a care pathway for the in-hospital management of older geriatric hip fracture patients on adherence to guidelines and patient outcomes. DESIGN The European Quality of Care Pathways study is a cluster randomized controlled trial. SETTING 26 hospitals in Belgium, Italy and Portugal. SUBJECTS Older adults with a proximal femur fracture (n = 514 patients) were included. METHODS Hospitals treating older adults (>65) with a proximal femur fracture were randomly assigned to an intervention group, i.e. implementation of a care pathway, or control group, i.e. usual care. Thirteen patient outcomes and 24 process indicators regarding in-hospital management, as well as three not-recommended care activities were measured. Adjusted and unadjusted regression analyses were conducted using intention-to-treat procedures. RESULTS In the intervention group 301 patients in 15 hospitals were included, and in the control group 213 patients in 11 hospitals. Sixty-five percent of the patients were older than 80 years. The implementation of this care pathway had no significant impact on the thirteen patient outcomes. The preoperative management improved significantly. Eighteen of 24 process indicators improved, but only two improved significantly. Only for a few teams a geriatrician was an integral member of the treatment team. DISCUSSION Implementation of a care pathway improved compliance to evidence, but no significant effect on patient outcomes was found. The impact of the collaboration between surgeons and geriatricians on adherence to guidelines and patient outcomes should be studied. TRIAL REGISTRATION ClinicalTrials.gov: NCT00962910.
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Affiliation(s)
- Massimiliano Panella
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium; Department of Translational Medicine, University of Eastern Piedmont "A. Avogadro", Italy
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Belgium
| | - Cathy Lodewijckx
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium
| | - Svin Deneckere
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium; Medical Department, Delta Hospitals Roeselare, Belgium
| | - An Sermon
- Department of Development and Regeneration, KU Leuven - University of Leuven, Belgium; Department of Traumatology, University Hospitals Leuven, Belgium
| | - Stefaan Nijs
- Department of Development and Regeneration, KU Leuven - University of Leuven, Belgium; Department of Traumatology, University Hospitals Leuven, Belgium
| | - Paulo Boto
- Department of Health Services Policy and Management, Centro de Investigação em Saúde Pública (CISP), Escola Nacional de Saúde Pública (ENSP), Universidade Nova de Lisboa (UNL), Portugal
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Belgium.
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24
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Rabin BA, McCreight M, Battaglia C, Ayele R, Burke RE, Hess PL, Frank JW, Glasgow RE. Systematic, Multimethod Assessment of Adaptations Across Four Diverse Health Systems Interventions. Front Public Health 2018; 6:102. [PMID: 29686983 PMCID: PMC5900443 DOI: 10.3389/fpubh.2018.00102] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/23/2018] [Indexed: 11/25/2022] Open
Abstract
Background Many health outcomes and implementation science studies have demonstrated the importance of tailoring evidence-based care interventions to local context to improve fit. By adapting to local culture, history, resources, characteristics, and priorities, interventions are more likely to lead to improved outcomes. However, it is unclear how best to adapt evidence-based programs and promising innovations. There are few guides or examples of how to best categorize or assess health-care adaptations, and even fewer that are brief and practical for use by non-researchers. Materials and methods This study describes the importance and potential of assessing adaptations before, during, and after the implementation of health systems interventions. We present a promising multilevel and multimethod approach developed and being applied across four different health systems interventions. Finally, we discuss implications and opportunities for future research. Results The four case studies are diverse in the conditions addressed, interventions, and implementation strategies. They include two nurse coordinator-based transition of care interventions, a data and training-driven multimodal pain management project, and a cardiovascular patient-reported outcomes project, all of which are using audit and feedback. We used the same modified adaptation framework to document changes made to the interventions and implementation strategies. To create the modified framework, we started with the adaptation and modification model developed by Stirman and colleagues and expanded it by adding concepts from the RE-AIM framework. Our assessments address the intuitive domains of Who, How, When, What, and Why to classify and organize adaptations. For each case study, we discuss how the modified framework was operationalized, the multiple methods used to collect data, results to date and approaches utilized for data analysis. These methods include a real-time tracking system and structured interviews at key times during the intervention. We provide descriptive data on the types and categories of adaptations made and discuss lessons learned. Conclusion The multimethod approaches demonstrate utility across diverse health systems interventions. The modified adaptations model adequately captures adaptations across the various projects and content areas. We recommend systematic documentation of adaptations in future clinical and public health research and have made our assessment materials publicly available.
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Affiliation(s)
- Borsika A Rabin
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (COIN), Denver VHA Medical Center, Denver, CO, United States.,Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, CA, United States.,Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado, Aurora, CO, United States.,Department of Family Medicine, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Marina McCreight
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (COIN), Denver VHA Medical Center, Denver, CO, United States
| | - Catherine Battaglia
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (COIN), Denver VHA Medical Center, Denver, CO, United States.,Department of Health System Management and Policy, Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | - Roman Ayele
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (COIN), Denver VHA Medical Center, Denver, CO, United States.,Department of Health System Management and Policy, Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | - Robert E Burke
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (COIN), Denver VHA Medical Center, Denver, CO, United States.,Department of Medicine, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Paul L Hess
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (COIN), Denver VHA Medical Center, Denver, CO, United States.,Department of Medicine, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Joseph W Frank
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (COIN), Denver VHA Medical Center, Denver, CO, United States.,Department of Medicine, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Russell E Glasgow
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (COIN), Denver VHA Medical Center, Denver, CO, United States.,Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado, Aurora, CO, United States.,Department of Family Medicine, School of Medicine, University of Colorado, Aurora, CO, United States
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25
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Quality Improvement in Health Care: The Role of Psychologists and Psychology. J Clin Psychol Med Settings 2018; 25:278-294. [PMID: 29468570 DOI: 10.1007/s10880-018-9542-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Quality Improvement (QI) is a health care interprofessional team activity wherein psychology as a field and individual psychologists in health care settings can and should adopt a more robust presence. The current article makes the argument for why psychology's participation in QI is good for health care, is good for our profession, and is the right thing to do for the patients and families we serve. It reviews the varied ways individual psychologists and our profession can integrate quality processes and improve health care through: (1) our approach to our daily work; (2) our roles on health care teams and involvement in organizational initiatives; (3) opportunities for teaching and scholarship; and (4) system redesign and advocacy within our health care organizations and health care environment.
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