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Beks H, Clayden S, Wong Shee A, Manias E, Versace VL, Beauchamp A, Mc Namara KP, Alston L. Low-value health care, de-implementation, and implications for nursing research: A discussion paper. Int J Nurs Stud 2024; 156:104780. [PMID: 38744150 DOI: 10.1016/j.ijnurstu.2024.104780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 03/13/2024] [Accepted: 04/19/2024] [Indexed: 05/16/2024]
Abstract
Globally, the nursing profession constitutes the largest proportion of the health workforce; however, it is challenged by widespread workforce shortages relative to need. Strategies to promote recruitment of the nursing workforce are well-established, with a lesser focus on strategies to alleviate the burden on the existing workforce. This burden may be exacerbated by the impact of low-value health care, characterised as health care that provides little or no benefit for patients, or has the potential to cause harm. Low-value health care is a global problem, a major contributor to the waste of healthcare resources, and a key focus of health system reform. Evidence of variation in low-value health care has been identified across countries and system levels. Research on low-value health care has largely focused on the medical profession, with a paucity of research examining either low-value health care or the de-implementation of low-value health care from a nursing perspective. The objective of this paper is to provide a scholarly discussion of the literature around low-value health care and de-implementation, with the purpose of identifying implications for nursing research. With increasing pressures on the global nursing workforce, research identifying low-value health care and developing approaches to de-implement this care, is crucial.
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Affiliation(s)
- H Beks
- Deakin Rural Health, Deakin University, Australia.
| | - S Clayden
- Deakin Rural Health, Deakin University, Australia; South West Healthcare, Australia
| | - A Wong Shee
- Deakin Rural Health, Deakin University, Australia; Grampians Health, Australia
| | - E Manias
- Deakin Rural Health, Deakin University, Australia; School of Nursing and Midwifery, Monash University, Australia
| | - V L Versace
- Deakin Rural Health, Deakin University, Australia
| | - A Beauchamp
- School of Rural Health, Monash University, Australia
| | | | - L Alston
- Deakin Rural Health, Deakin University, Australia; Colac Area Health, Australia
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Wu FM, Pralat R, Leong C, Carter V, Fritz Z, Martin G. Consensus-building to improve implementation of NICE guidance on planning for end-of-life treatment and care: a mixed-methods study. BMC Palliat Care 2024; 23:169. [PMID: 39003449 DOI: 10.1186/s12904-024-01495-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 06/26/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND Despite the availability of guidance for the provision of good end-of-life care, there are significant variations across the UK in its delivery. This study sought to identify the influences on end-of-life treatment and care planning across several areas where deficiencies in evidence-based practice have been identified, and to develop consensus among healthcare providers and users for recommendations on how to address these deficits. METHODS An online survey (106 responses), qualitative interviews (55 participants) and a consensus-building exercise (475 participants in the initial round) were undertaken. Participants included people approaching the end of life, people important to them, and health and care practitioners who help people plan for the end of life or provide end-of-life care. Recruitment was via online methods, including social media and online newsletters of relevant charities and professional organisations. Thematic analysis using the framework method was used to analyse qualitative data. Synthesis of qualitative and quantitative data led to the development of statements regarding recommendations for advancing implementation of good practice. A two-stage consensus-building exercise asked respondents first to rate these statements and then to rate and rank further sub-recommendations in three areas. RESULTS Results from the consensus building exercise confirmed that end-of-life care planning conversations are to be welcomed and encouraged, and that the priority should be to have the conversation (which could be initiated by a range of professionals, or people planning end-of-life care themselves), rather than to wait for an ideal time to have it. Further rounds identified specific components of a standardised record of end-of-life treatment and care preferences that should be prioritised, specific health and care staff that should be empowered through training in advanced communication, and aspects of communication most important to include in training for healthcare professionals. CONCLUSIONS Our study has identified opportunities for action to improve end-of-life treatment and care by combining multiple stakeholder perspectives and building consensus among them: the resulting recommendations have sufficient granularity to be implemented and evaluated. They are of relevance to policy makers, those who train healthcare professionals, and those looking after patients approaching the end of life.
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Affiliation(s)
- Frances M Wu
- RAND Europe, Eastbrook House, Shaftesbury Road, Cambridge, CB2 8BF, UK.
| | - Robert Pralat
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
| | - Clare Leong
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
| | - Victoria Carter
- The National Institute for Health and Care Excellence, London, UK
| | - Zoë Fritz
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
| | - Graham Martin
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
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Hensher M, McCartney G, Ochodo E. Health Economics in a World of Uneconomic Growth. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:427-433. [PMID: 38637451 PMCID: PMC11178562 DOI: 10.1007/s40258-024-00883-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/20/2024]
Abstract
Multiple, accelerating and interacting ecological crises are increasingly understood as constituting a major threat to human health and well-being. Unconstrained economic growth is strongly implicated in these growing crises, and it has been argued that this growth has now become "uneconomic growth", which is a situation where the size of the economy is still expanding, but this expansion is causing more harm than benefit. This article summarises the multiple pathways by which uneconomic growth can be expected to harm human health. It describes how health care systems-especially through overuse, low value and poor quality care-can themselves drive uneconomic growth. Health economists need to understand not only the consequences of environmental impacts on health care, but also the significance of uneconomic growth, and pay closer attention to the growing body of work by heterodox economists, especially in the fields of ecological and feminist economics. This will involve paying closer heed to the existence and consequences of diminishing marginal returns to health care consumption at high levels; the central importance of inequalities and injustice in health; and the need to remedy health economists' currently limited ability to deal effectively with low value care, overdiagnosis and overtreatment.
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Affiliation(s)
- Martin Hensher
- Henry Baldwin Professorial Research Fellow in Health System Sustainability, Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - Gerry McCartney
- School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Eleanor Ochodo
- Stellenbosch University, Stellenbosch, Western Cape, South Africa
- Kenya Medical Research Institute, Nairobi, Kenya
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Glarcher M, Rihari-Thomas J, Duffield C, Tuqiri K, Hackett K, Ferguson C. Advanced practice nurses' experiences of patient safety: a focus group study. Contemp Nurse 2024:1-15. [PMID: 38861587 DOI: 10.1080/10376178.2024.2363911] [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: 02/09/2024] [Accepted: 05/30/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Patient harm from unsafe care is an increasingly global phenomenon leading to death or disability. Drawing on their expertise, Advanced Practice Nurses provide the opportunity to improve care quality and safety. AIM To explore Nurse Practitioners and Clinical Nurse Consultants' experiences in patient safety. DESIGN A qualitative design was used involving six audio-visually recorded focus group interviews. Participants working in an acute or community adult nursing speciality were involved. METHODS Twenty-eight Advanced Practice Nurses (female 82.1%, mean age 47.5 ± 10 years) were recruited by convenience and snowball sampling. After transcription of interview data, qualitative content analysis was conducted. RESULTS Six categories were identified: patient safety as the highest priority (1), special contribution to patient safety (2), patients/relatives role in safety (3), multidisciplinary team approach (4), government regulation in safety (5), and further needs to improve safety (6). Advanced Practice Nurses saw themselves as role models and leaders for other healthcare staff through their expertise and professional experience and thus able to see the bigger picture in health. They identified as change agents at the system-level due to their decision-making ability and multi-professional team connectivity. CONCLUSIONS This study emphasises the key position of extended nursing roles and the need for future development of patient safety strategies in hospitals and community care. As influential leaders, Advanced Practice Nurses are best placed to identify improvements. They play a central role in guiding the multi-professional team, the patient and their family, educating nursing staff, and identifying and addressing system-wide safety gaps to improve patient safety.
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Affiliation(s)
- Manela Glarcher
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 11, 5020 Salzburg, Austria
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | | | | | | | - Kate Hackett
- South Eastern Sydney Local Health District, Sydney, Australia
| | - Caleb Ferguson
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
- Blacktown Hospital, Western Sydney Local Health District, Sydney, Australia
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Todd AL, Petrunoff N, Frommer M, Nutbeam D. The value of health service-based research to health service organisations: a qualitative study with senior health service executives. Health Res Policy Syst 2024; 22:65. [PMID: 38822374 PMCID: PMC11141057 DOI: 10.1186/s12961-024-01149-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/10/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Research evidence has demonstrably improved health care practices and patient outcomes. However, systemic translation of evidence into practice is far from optimal. The reasons are complex, but often because research is not well aligned with health service priorities. The aim of this study was to explore the experiences and perspectives of senior health service executives on two issues: (1) the alignment between local research activity and the needs and priorities of their health services, and (2) the extent to which research is or can be integrated as part of usual health care practice. METHODS In this qualitative study, semi-structured interviews were conducted with senior health leaders from four large health service organisations that are members of Sydney Health Partners (SHP), one of Australia's nationally accredited research translation centres committed to accelerating the translation of research findings into evidence-based health care. The interviews were conducted between November 2022 and January 2023, and were either audio-recorded and transcribed verbatim or recorded in the interviewer field notes. A thematic analysis of the interview data was conducted by two researchers, using the framework method to identify common themes. RESULTS Seventeen health executives were interviewed, including chief executives, directors of medical services, nursing, allied health, research, and others in executive leadership roles. Responses to issue (1) included themes on re-balancing curiosity- and priority-driven research; providing more support for research activity within health organisations; and helping health professionals and researchers discuss researchable priorities. Responses to issue (2) included identification of elements considered essential for embedding research in health care; and the need to break down silos between research and health care, as well as within health organisations. CONCLUSIONS Health service leaders value research but want more research that aligns with their needs and priorities. Discussions with researchers about those priorities may need some facilitation. Making research a more integrated part of health care will require strong and broad executive leadership, resources and infrastructure, and investing in capacity- and capability-building across health clinicians, managers and executive staff.
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Affiliation(s)
- Angela L Todd
- Sydney Health Partners, Level 2, Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Nicholas Petrunoff
- The Sax Institute, Level 3/30C Wentworth St, Glebe, NSW, 2037, Australia
| | - Michael Frommer
- The Sax Institute, Level 3/30C Wentworth St, Glebe, NSW, 2037, Australia
| | - Don Nutbeam
- Sydney Health Partners, Level 2, Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
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Glarcher M, Ferguson C, Patch M, Steven A, Vaismoradi M. Strategic de-implementation: strengthening patient safety by eliminating low value care practices. Contemp Nurse 2024:1-5. [PMID: 38767402 DOI: 10.1080/10376178.2024.2354319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Manela Glarcher
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Caleb Ferguson
- Centre for Chronic & Complex Care Research, Blacktown Hospital, Western Sydney Local Health District, Sydney, Australia
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Michelle Patch
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Alison Steven
- Department of Nursing Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle, UK
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Teede H, Cadilhac DA, Purvis T, Kilkenny MF, Campbell BCV, English C, Johnson A, Callander E, Grimley RS, Levi C, Middleton S, Hill K, Enticott J. Learning together for better health using an evidence-based Learning Health System framework: a case study in stroke. BMC Med 2024; 22:198. [PMID: 38750449 PMCID: PMC11094907 DOI: 10.1186/s12916-024-03416-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 04/30/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND In the context of expanding digital health tools, the health system is ready for Learning Health System (LHS) models. These models, with proper governance and stakeholder engagement, enable the integration of digital infrastructure to provide feedback to all relevant parties including clinicians and consumers on performance against best practice standards, as well as fostering innovation and aligning healthcare with patient needs. The LHS literature primarily includes opinion or consensus-based frameworks and lacks validation or evidence of benefit. Our aim was to outline a rigorously codesigned, evidence-based LHS framework and present a national case study of an LHS-aligned national stroke program that has delivered clinical benefit. MAIN TEXT Current core components of a LHS involve capturing evidence from communities and stakeholders (quadrant 1), integrating evidence from research findings (quadrant 2), leveraging evidence from data and practice (quadrant 3), and generating evidence from implementation (quadrant 4) for iterative system-level improvement. The Australian Stroke program was selected as the case study as it provides an exemplar of how an iterative LHS works in practice at a national level encompassing and integrating evidence from all four LHS quadrants. Using this case study, we demonstrate how to apply evidence-based processes to healthcare improvement and embed real-world research for optimising healthcare improvement. We emphasize the transition from research as an endpoint, to research as an enabler and a solution for impact in healthcare improvement. CONCLUSIONS The Australian Stroke program has nationally improved stroke care since 2007, showcasing the value of integrated LHS-aligned approaches for tangible impact on outcomes. This LHS case study is a practical example for other health conditions and settings to follow suit.
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Affiliation(s)
- Helena Teede
- Monash Centre for Health Research and Implementation, 43-51 Kanooka Grove, Clayton, VIC, Australia.
- Monash Partners Academic Health Science Centre, 43-51 Kanooka Grove, Clayton, VIC, Australia.
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 2 Monash University Research, Victorian Heart Hospital, 631 Blackburn Rd, Clayton, VIC, Australia.
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia.
| | - Tara Purvis
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 2 Monash University Research, Victorian Heart Hospital, 631 Blackburn Rd, Clayton, VIC, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 2 Monash University Research, Victorian Heart Hospital, 631 Blackburn Rd, Clayton, VIC, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Bruce C V Campbell
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
- Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Coralie English
- School of Health Sciences, Heart and Stroke Program, University of Newcastle, Hunter Medical Research Institute, University Drive, Callaghan, NSW, Australia
| | - Alison Johnson
- Monash Partners Academic Health Science Centre, 43-51 Kanooka Grove, Clayton, VIC, Australia
| | - Emily Callander
- Monash Centre for Health Research and Implementation, 43-51 Kanooka Grove, Clayton, VIC, Australia
| | - Rohan S Grimley
- School of Medicine and Dentistry, Griffith University, Birtinya, QLD, Australia
- Clinical Excellence Division, Queensland Health, Brisbane, Australia
| | - Christopher Levi
- John Hunter Hospital, Hunter New England Local Health District and University of Newcastle, Sydney, NSW, Australia
| | - Sandy Middleton
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW, Australia
- Nursing Research Institute, St Vincent's Health Network Sydney and and Australian Catholic University, Sydney, NSW, Australia
| | - Kelvin Hill
- Stroke Foundation, Level 7, 461 Bourke St, Melbourne, VIC, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, 43-51 Kanooka Grove, Clayton, VIC, Australia
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Padget M, Peters MA, Brunn M, Kringos D, Kruk ME. Health systems and environmental sustainability: updating frameworks for a new era. BMJ 2024; 385:e076957. [PMID: 38688557 DOI: 10.1136/bmj-2023-076957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Affiliation(s)
- Michael Padget
- Massachusetts General Hospital Center for the Environment and Health, Boston, MA, USA
| | | | - Matthias Brunn
- Laboratory for Interdisciplinary Evaluation of Public Policies (LIEPP), Sciences Po, Paris, France
| | - Dionne Kringos
- Department of Public and Occupational Health, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
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Hellstrand Tang U, Smith F, Karilampi UL, Gremyr A. Exploring the Role of Complexity in Health Care Technology Bottom-Up Innovations: Multiple-Case Study Using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability Complexity Assessment Tool. JMIR Hum Factors 2024; 11:e50889. [PMID: 38669076 PMCID: PMC11087855 DOI: 10.2196/50889] [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: 07/18/2023] [Revised: 02/24/2024] [Accepted: 03/02/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND New digital technology presents new challenges to health care on multiple levels. There are calls for further research that considers the complex factors related to digital innovations in complex health care settings to bridge the gap when moving from linear, logistic research to embracing and testing the concept of complexity. The nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to help study complexity in digital innovations. OBJECTIVE This study aims to investigate the role of complexity in the development and deployment of innovations by retrospectively assessing challenges to 4 digital health care innovations initiated from the bottom up. METHODS A multicase retrospective, deductive, and explorative analysis using the NASSS complexity assessment tool LONG was conducted. In total, 4 bottom-up innovations developed in Region Västra Götaland in Sweden were explored and compared to identify unique and shared complexity-related challenges. RESULTS The analysis resulted in joint insights and individual learning. Overall, the complexity was mostly found outside the actual innovation; more specifically, it related to the organization's readiness to integrate new innovations, how to manage and maintain innovations, and how to finance them. The NASSS framework sheds light on various perspectives that can either facilitate or hinder the adoption, scale-up, and spread of technological innovations. In the domain of condition or diagnosis, a well-informed understanding of the complexity related to the condition or illness (diabetes, cancer, bipolar disorders, and schizophrenia disorders) is of great importance for the innovation. The value proposition needs to be clearly described early to enable an understanding of costs and outcomes. The questions in the NASSS complexity assessment tool LONG were sometimes difficult to comprehend, not only from a language perspective but also due to a lack of understanding of the surrounding organization's system and its setting. CONCLUSIONS Even when bottom-up innovations arise within the same support organization, the complexity can vary based on the developmental phase and the unique characteristics of each project. Identifying, defining, and understanding complexity may not solve the issues but substantially improves the prospects for successful deployment. Successful innovation within complex organizations necessitates an adaptive leadership and structures to surmount cultural resistance and organizational impediments. A rigid, linear, and stepwise approach risks disregarding interconnected variables and dependencies, leading to suboptimal outcomes. Success lies in embracing the complexity with its uncertainty, nurturing creativity, and adopting a nonlinear methodology that accommodates the iterative nature of innovation processes within complex organizations.
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Affiliation(s)
- Ulla Hellstrand Tang
- Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Frida Smith
- Regional Cancer Centre West, Gothenburg, Sweden
- Department of Technology Management and Economics, Collaborative Plattform for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden
| | - Ulla Leyla Karilampi
- Department of Schizophrenia Spectrum Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Gremyr
- Department of Schizophrenia Spectrum Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Lyng HB, Ree E, Strømme T, Johannessen T, Aase I, Ullebust B, Thomsen LH, Holen-Rabbersvik E, Schibevaag L, Bates DW, Wiig S. Barriers and enablers for externally and internally driven implementation processes in healthcare: a qualitative cross-case study. BMC Health Serv Res 2024; 24:528. [PMID: 38664668 PMCID: PMC11046894 DOI: 10.1186/s12913-024-10985-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Quality in healthcare is a subject in need of continuous attention. Quality improvement (QI) programmes with the purpose of increasing service quality are therefore of priority for healthcare leaders and governments. This study explores the implementation process of two different QI programmes, one externally driven implementation and one internally driven, in Norwegian nursing homes and home care services. The aim for the study was to identify enablers and barriers for externally and internally driven implementation processes in nursing homes and homecare services, and furthermore to explore if identified enablers and barriers are different or similar across the different implementation processes. METHODS This study is based on an exploratory qualitative methodology. The empirical data was collected through the 'Improving Quality and Safety in Primary Care - Implementing a Leadership Intervention in Nursing Homes and Homecare' (SAFE-LEAD) project. The SAFE-LEAD project is a multiple case study of two different QI programmes in primary care in Norway. A large externally driven implementation process was supplemented with a tracer project involving an internally driven implementation process to identify differences and similarities. The empirical data was inductively analysed in accordance with grounded theory. RESULTS Enablers for both external and internal implementation processes were found to be technology and tools, dedication, and ownership. Other more implementation process specific enablers entailed continuous learning, simulation training, knowledge sharing, perceived relevance, dedication, ownership, technology and tools, a systematic approach and coordination. Only workload was identified as coincident barriers across both externally and internally implementation processes. Implementation process specific barriers included turnover, coping with given responsibilities, staff variety, challenges in coordination, technology and tools, standardizations not aligned with work, extensive documentation, lack of knowledge sharing. CONCLUSION This study provides understanding that some enablers and barriers are present in both externally and internally driven implementation processes, while other are more implementation process specific. Dedication, engagement, technology and tools are coinciding enablers which can be drawn upon in different implementation processes, while workload acted as the main barrier in both externally and internally driven implementation processes. This means that some enablers and barriers can be expected in implementation of QI programmes in nursing homes and home care services, while others require contextual understanding of their setting and work.
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Affiliation(s)
- Hilda Bø Lyng
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway.
| | - Eline Ree
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway
| | - Torunn Strømme
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway
| | - Terese Johannessen
- Department of Health and Nursing Sciences, Faculty of Health and Sports Science, University of Agder, Kristiansand, N-4604, Norway
| | - Ingunn Aase
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway
| | | | - Line Hurup Thomsen
- Helse Campus Stavanger, University of Stavanger, Stavanger, N-4036, Norway
| | - Elisabeth Holen-Rabbersvik
- Department of Health and Nursing Sciences, Faculty of Health and Sports Science, University of Agder, Kristiansand, N-4604, Norway
- Kristiansand municipality, Kristiansand, N-4604, Norway
| | - Lene Schibevaag
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway
| | - David W Bates
- Division of General Internal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Siri Wiig
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway
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Fjordkvist E, Eldh AC, Winberg M, Joelsson-Alm E, Hälleberg Nyman M. First-line managers' experience of guideline implementation during the COVID-19 pandemic. J Adv Nurs 2024. [PMID: 38644671 DOI: 10.1111/jan.16204] [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: 11/30/2023] [Revised: 03/23/2024] [Accepted: 04/06/2024] [Indexed: 04/23/2024]
Abstract
AIM(S) To explore first-line managers' experience of guideline implementation in orthopaedic care during the COVID-19 pandemic. DESIGN A descriptive, qualitative study. METHODS Semi-structured interviews with 30 first-line nursing and rehabilitation managers in orthopaedic healthcare at university, regional and local hospitals. The interviews were analysed by thematic analysis. RESULTS First-line managers described the implementation of guidelines related to the pandemic as different from everyday knowledge translation, with a swifter uptake and time freed from routine meetings in order to support staff in adoption and adherence. The urgent need to address the crisis facilitated guideline implementation, even though there were specific pandemic-related barriers such as staffing and communication issues. An overarching theme, Hanging on to guidelines for dear life, is substantiated by three themes: Adapting to facilitate change, Anchoring safety through guidelines and Embracing COVID guidelines. CONCLUSION A health crisis such as the COVID-19 pandemic can generate enabling elements for guideline implementation in healthcare, despite prevailing or new hindering components. The experience of guideline implementation during the COVID-19 pandemic can improve understanding of context aspects that can benefit organizations in everyday translation of evidence into practice. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Recognizing what enabled guideline implementation in a health crisis can help first-line managers to identify local enabling context elements and processes. This can facilitate future guideline implementation. IMPACT During the COVID-19 pandemic, the healthcare context and staff's motivation for guideline recognition and adoption changed. Resources and ways to bridge barriers in guideline implementation emerged, although specific challenges arose. Nursing managers can draw on experiences from the COVID-19 pandemic to support implementation of new evidence-based practices in the future. REPORTING METHOD This study adheres to the EQUATOR guidelines by using Standards for Reporting Qualitative Research (SRQR). No Patient or Public Contribution.
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Affiliation(s)
- Erika Fjordkvist
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
- Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ann Catrine Eldh
- Faculty of Medicine and Health Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Madeleine Winberg
- Faculty of Medicine and Health Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Maria Hälleberg Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
- University Health Care Research Center and Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Smith CL, Fisher G, Dharmayani PNA, Wijekulasuriya S, Ellis LA, Spanos S, Dammery G, Zurynski Y, Braithwaite J. Progress with the Learning Health System 2.0: a rapid review of Learning Health Systems' responses to pandemics and climate change. BMC Med 2024; 22:131. [PMID: 38519952 PMCID: PMC10960489 DOI: 10.1186/s12916-024-03345-8] [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: 09/06/2023] [Accepted: 01/23/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Pandemics and climate change each challenge health systems through increasing numbers and new types of patients. To adapt to these challenges, leading health systems have embraced a Learning Health System (LHS) approach, aiming to increase the efficiency with which data is translated into actionable knowledge. This rapid review sought to determine how these health systems have used LHS frameworks to both address the challenges posed by the COVID-19 pandemic and climate change, and to prepare for future disturbances, and thus transition towards the LHS2.0. METHODS Three databases (Embase, Scopus, and PubMed) were searched for peer-reviewed literature published in English in the five years to March 2023. Publications were included if they described a real-world LHS's response to one or more of the following: the COVID-19 pandemic, future pandemics, current climate events, future climate change events. Data were extracted and thematically analyzed using the five dimensions of the Institute of Medicine/Zurynski-Braithwaite's LHS framework: Science and Informatics, Patient-Clinician Partnerships, Continuous Learning Culture, Incentives, and Structure and Governance. RESULTS The search yielded 182 unique publications, four of which reported on LHSs and climate change. Backward citation tracking yielded 13 additional pandemic-related publications. None of the climate change-related papers met the inclusion criteria. Thirty-two publications were included after full-text review. Most were case studies (n = 12, 38%), narrative descriptions (n = 9, 28%) or empirical studies (n = 9, 28%). Science and Informatics (n = 31, 97%), Continuous Learning Culture (n = 26, 81%), Structure and Governance (n = 23, 72%) were the most frequently discussed LHS dimensions. Incentives (n = 21, 66%) and Patient-Clinician Partnerships (n = 18, 56%) received less attention. Twenty-nine papers (91%) discussed benefits or opportunities created by pandemics to furthering the development of an LHS, compared to 22 papers (69%) that discussed challenges. CONCLUSIONS An LHS 2.0 approach appears well-suited to responding to the rapidly changing and uncertain conditions of a pandemic, and, by extension, to preparing health systems for the effects of climate change. LHSs that embrace a continuous learning culture can inform patient care, public policy, and public messaging, and those that wisely use IT systems for decision-making can more readily enact surveillance systems for future pandemics and climate change-related events. TRIAL REGISTRATION PROSPERO pre-registration: CRD42023408896.
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Affiliation(s)
- Carolynn L Smith
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia.
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia.
| | - Georgia Fisher
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
| | - Putu Novi Arfirsta Dharmayani
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
| | - Shalini Wijekulasuriya
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
| | - Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
| | - Samantha Spanos
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
| | - Genevieve Dammery
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
| | - Yvonne Zurynski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
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Vullings N, Maas M, Adriaansen M, Vermeulen H, van der Wees P, Heinen M. Developing and testing a reflection method for implementation of the informal care guideline in community nursing: Design-based research. J Adv Nurs 2024. [PMID: 38515159 DOI: 10.1111/jan.16156] [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: 12/26/2023] [Revised: 02/20/2024] [Accepted: 03/02/2024] [Indexed: 03/23/2024]
Abstract
AIM To develop a reflection method for community nurses and certified nursing assistants to support the implementation of the Dutch Informal Care guideline in daily care. DESIGN Design-based research. METHODS A design group and four test groups of community nurses and nursing assistants were formed to develop a reflection method that aligns with the needs and preferences of its end-users. The design and test group meetings were video recorded. The video data were iteratively discussed and analysed thematically to adapt and refine the method and to identify its key features. RESULTS A final reflection method was developed. Five main themes were identified from the analysis: the group, reflective triggers, knowledge about the guidelines, the coach and preconditions. The themes are linked to nine key features representing the building blocks of the reflection method. The key features are group size, participants with different (educational) backgrounds, pairs of participants, expressing thoughts, video feedback, reflection game, making the connection with the guideline, coaching as a process facilitator and meeting organizational and contextual conditions for implementation. CONCLUSION An evidence- and practice-based reflection method for community nurses and certified nursing assistants is developed to support the implementation. By involving community nurses and certified nursing assistants, the method closely matches their needs and preferences. Critical elements of the reflection method are a game element, video feedback and working in pairs in a group of participants from different (educational) backgrounds. Guidance is needed to make the transfer from theory to practice. IMPACT A reflection method for community nurses and certified nursing assistants was developed to enhance care work according to guideline recommendations, aiming to improve the care provided by informal caregivers. REPORT METHOD The COREQ guideline was used. PATIENT OR PUBLIC CONTRIBUTION This reflection method was developed in close collaboration with all stakeholders during the entire study.
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Affiliation(s)
- Nicole Vullings
- Institute of Nursing Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Marjo Maas
- IQ Health Science Department, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marian Adriaansen
- Institute of Nursing Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Hester Vermeulen
- IQ Health Science Department, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Philip van der Wees
- IQ Health Science Department, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maud Heinen
- IQ Health Science Department, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
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Best S, Thursky K, Buzza M, Klaic M, Peters S, Guccione L, Trainer A, Francis J. Aligning organisational priorities and implementation science for cancer research. BMC Health Serv Res 2024; 24:338. [PMID: 38486219 PMCID: PMC10938739 DOI: 10.1186/s12913-024-10801-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/28/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The challenge of implementing evidence into routine clinical practice is well recognised and implementation science offers theories, models and frameworks to promote investigation into delivery of evidence-based care. Embedding implementation researchers into health systems is a novel approach to ensuring research is situated in day-to-day practice dilemmas. To optimise the value of embedded implementation researchers and resources, the aim of this study was to investigate stakeholders' views on opportunities for implementation science research in a cancer setting that holds potential to impact on care. The research objectives were to: 1) Establish stakeholder and theory informed organisation-level implementation science priorities and 2) Identify and prioritise a test case pilot implementation research project. METHODS We undertook a qualitative study using semi-structured interviews. Participants held either a formal leadership role, were research active or a consumer advocate and affiliated with either a specialist cancer hospital or a cancer alliance of ten hospitals. Interview data were summarised and shared with participants prior to undertaking both thematic analysis, to identify priority areas for implementation research, and content analysis, to identify potential pilot implementation research projects. The selected pilot Implementation research project was prioritised using a synthesis of an organisational and implementation prioritisation framework - the organisational priority setting framework and APEASE framework. RESULTS Thirty-one people participated between August 2022 and February 2023. Four themes were identified: 1) Integration of services to address organisational priorities e.g., tackling fragmented services; 2) Application of digital health interventions e.g., identifying the potential benefits of digital health interventions; 3) Identification of potential for implementation research, including deimplementation i.e., discontinuing ineffective or low value care and; 4) Focusing on direct patient engagement e.g., wider consumer awareness of the challenges in delivering cancer care. Six potential pilot implementation research projects were identified and the EMBED project, to support clinicians to refer appropriate patients with cancer for genetic testing, was selected using the synthesised prioritisation framework. CONCLUSIONS Using a theory informed and structured approach the alignment between strategic organisational priorities and implementation research priorities can be identified. As a result, the implementation research focus can be placed on activities with the highest potential impact.
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Affiliation(s)
- Stephanie Best
- University of Melbourne; Peter MacCallum Cancer Centre; Australian Genomics, Melbourne, Australia.
| | - Karin Thursky
- Peter MacCallum Cancer Centre; Royal Melbourne Hospital; University of Melbourne, Melbourne, Australia
| | | | | | | | - Lisa Guccione
- Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia
| | - Alison Trainer
- Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia
| | - Jillian Francis
- University of Melbourne; Peter MacCallum Cancer Centre, Melbourne, Australia
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Brandenburg C, Ward EC, Schwarz M, Palmer M, Hartley C, Byrnes J, Coccetti A, Phillips R, Wishart LR. 'The big value of it is getting the patient seen by the right person at the right time': clinician perceptions of the value of allied health primary contact models of care. Int J Qual Health Care 2024; 36:mzae021. [PMID: 38442741 DOI: 10.1093/intqhc/mzae021] [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: 09/21/2023] [Revised: 01/18/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
Allied health primary contact clinic models of care have increasingly been used as a strategy to increase public health service capacity. A recent systematic review found little consistency or agreement on how primary contact clinics are evaluated. The concept of value of primary contact clinics, which has important implications for evaluation, has not yet been explored in-depth. To explore allied health clinicians' perceptions of the value of allied health primary contact clinics, with the goal of informing an evaluation framework, a descriptive qualitative approach utilizing semi-structured interviews was employed. Participants included allied health staff embedded in clinical lead roles within primary contact clinics across four acute care hospitals in a metropolitan health service located in South-East Queensland, Australia. Lead staff from 30 identified primary contact clinic models in the health service were approached to take part via email. All eligible participants who provided consent were included. An inductive thematic analysis approach was used. A total of 23 clinicians (n = 23) representing 22 diverse models of primary contact clinics participated. Most participants were physiotherapists, dietitians, or occupational therapists, although speech pathology, audiology, and podiatry were also represented. Participant perceptions of the 'value' of PCCs were a highly complex phenomenon, comprising five intersecting domains: (i) patient satisfaction; (ii) clinical outcomes; (iii) care pathway and resource use; (iv) health service performance; and (v) staff satisfaction and professional standing. These five core value domains were positively or negatively influenced by 12 perceived benefits and 8 perceived drawbacks, respectively. Value domains were also highly interrelated and impacted upon each other. The concept of 'value' relating to primary contact clinics involves multiple intersecting domains encompassing different perspectives. This study highlighted potential benefits and drawbacks of primary contact clinics that have not yet been measured or explored in the literature, and as such may be useful for healthcare administrators to consider. The findings of this study will inform an evaluation framework including health economics calculator for primary contact clinics.
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Affiliation(s)
- Caitlin Brandenburg
- Centre for Functioning and Health Research, Metro South Health, 199 Ipswich Road, Brisbane, Queensland 4102, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Health, 199 Ipswich Road, Brisbane, Queensland 4102, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Fred Schonell Drive, Brisbane, Queensland 4072 Australia
| | - Maria Schwarz
- Allied Health, Metro South Health, Cnr Armstrong and Loganlea Roads Brisbane, Queensland 4131 Australia
| | - Michelle Palmer
- Nutrition and Dietetics, Logan Hospital, Metro South Health, Cnr Armstrong and Loganlea Roads, Brisbane, Queensland 4131, Australia
| | - Carina Hartley
- Occupational Therapy, Logan Hospital, Metro South Health, Cnr Armstrong and Loganlea Roads, Brisbane, Queensland 4131, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, 1 Parklands Dr, Gold Coast, Queensland 4215, Australia
| | - Anne Coccetti
- Metro South Health, QEII Jubilee Hospital, Cnr Kessels and Troughton Roads, Brisbane, Queensland 4108, Australia
| | - Rachel Phillips
- Metro South Health, Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Queensland 4102, Australia
| | - Laurelie R Wishart
- Centre for Functioning and Health Research, Metro South Health, 199 Ipswich Road, Brisbane, Queensland 4102, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Fred Schonell Drive, Brisbane, Queensland 4072 Australia
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Testa L, Richardson L, Cheek C, Hensel T, Austin E, Safi M, Ransolin N, Carrigan A, Long J, Hutchinson K, Goirand M, Bierbaum M, Bleckly F, Hibbert P, Churruca K, Clay-Williams R. Strategies to improve care for older adults who present to the emergency department: a systematic review. BMC Health Serv Res 2024; 24:178. [PMID: 38331778 PMCID: PMC10851482 DOI: 10.1186/s12913-024-10576-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND The aim of this systematic review was to examine the relationship between strategies to improve care delivery for older adults in ED and evaluation measures of patient outcomes, patient experience, staff experience, and system performance. METHODS A systematic review of English language studies published since inception to December 2022, available from CINAHL, Embase, Medline, and Scopus was conducted. Studies were reviewed by pairs of independent reviewers and included if they met the following criteria: participant mean age of ≥ 65 years; ED setting or directly influenced provision of care in the ED; reported on improvement interventions and strategies; reported patient outcomes, patient experience, staff experience, or system performance. The methodological quality of the studies was assessed by pairs of independent reviewers using The Joanna Briggs Institute critical appraisal tools. Data were synthesised using a hermeneutic approach. RESULTS Seventy-six studies were included in the review, incorporating strategies for comprehensive assessment and multi-faceted care (n = 32), targeted care such as management of falls risk, functional decline, or pain management (n = 27), medication safety (n = 5), and trauma care (n = 12). We found a misalignment between comprehensive care delivered in ED for older adults and ED performance measures oriented to rapid assessment and referral. Eight (10.4%) studies reported patient experience and five (6.5%) reported staff experience. CONCLUSION It is crucial that future strategies to improve care delivery in ED align the needs of older adults with the purpose of the ED system to ensure sustainable improvement effort and critical functioning of the ED as an interdependent component of the health system. Staff and patient input at the design stage may advance prioritisation of higher-impact interventions aligned with the pace of change and illuminate experience measures. More consistent reporting of interventions would inform important contextual factors and allow for replication.
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Affiliation(s)
- Luke Testa
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Lieke Richardson
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Colleen Cheek
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia.
| | - Theresa Hensel
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Elizabeth Austin
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Mariam Safi
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Internal Medicine Research Unit, University Hospital of Southern Denmark, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Natália Ransolin
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brasil
| | - Ann Carrigan
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Janet Long
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Magali Goirand
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Allied Health and Human Performance, IIMPACT in Health, University of South Australia, Adelaide, 5001, Australia
| | - Felicity Bleckly
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Peter Hibbert
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Allied Health and Human Performance, IIMPACT in Health, University of South Australia, Adelaide, 5001, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
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Geleta D, Abebe G, Workneh N, Ararso M, Tilahun T, Beyene G. Hierarchical Predictors of Mortality in Neonatal Sepsis at Jimma Medical Center, Ethiopia: A Case-Control Study. J Multidiscip Healthc 2024; 17:541-555. [PMID: 38348209 PMCID: PMC10860391 DOI: 10.2147/jmdh.s446303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/26/2024] [Indexed: 02/15/2024] Open
Abstract
Background Neonatal sepsis made the neonatal period the most perilous time for child survival, and it continued to cause preventable mortalities worldwide. These mortalities stem from the interaction of several factors that have not been sufficiently studied and, in some cases, remain overlooked. Thus, the study aims to investigate the predictors of mortality that arise from the interaction of these factors and quantitatively determine their etiologic fraction. Methods A case-control study with hierarchical data input was conducted at Jimma Medical Center (JMC) in Oromia, Ethiopia, spanning from May 2022 to July 2023. It employed logistic regression to calculate adjusted odds ratios (AORs) and their corresponding 95% confidence intervals (CI) at a significance level of p ≤ 0.05. The model adjusted odds ratios (ORs) for variables within each level and farther levels and presented an etiologic fraction (EF), indicating the proportion of neonatal mortality attributable to specific factors. Results The analysis of 67 cases and 268 controls unveiled significant predictors of mortality in sepsis that emerged from distal, intermediate, and proximal levels. In the final model, thus, rural residence [AOR 3.1; 95% CI (1.5, 6.3), p ≤ 0.01], prolonged labor [AOR 4.5; 95% CI (2.2, 9.3), p ≤ 0.01], prematurity [AOR 3.9; 95% CI (1.9, 7.9), P ≤ 0.0], gram-negative bacteremia [AOR 3.8; 95% CI (1.9, 7.6); P ≤ 0.01], convulsion [AOR 3.2; 95% CI (1.6, 6.4); P ≤ 0.03], low birth weight [AOR 2.7; 95% CI (1.3, 5.4); P≤0.01], and delayed breastfeeding [AOR 2.5; 95% CI (1.2, 4.9); P ≤ 0.01] attributed a variable percentage of mortality. Conclusion Factors emerging and interacting at distal (residence), intermediate (prolonged labor), and proximal (prematurity, birth weight, convulsion, bacterial etiology, and feeding) levels influence neonatal mortality in sepsis at JMC. Therefore, concurrently improving rural family characteristics, managing labor duration, strengthening diagnostic stewardship, and promoting essential newborn care can actively prevent and reduce these mortalities.
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Affiliation(s)
- Daniel Geleta
- School of Medical Laboratory Sciences, Faculty of Health Sciences, Jimma University, Jimma, Oromia, Ethiopia
| | - Gemeda Abebe
- School of Medical Laboratory Sciences, Faculty of Health Sciences, Jimma University, Jimma, Oromia, Ethiopia
- Mycobacteriology Research Center, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Netsanet Workneh
- Department of Pediatrics and Child Health, Faculty of Medicine, Jimma University, Jimma, Oromia, Ethiopia
| | - Mekdes Ararso
- Department of Pediatrics and Child Health, Faculty of Medicine, Jimma University, Jimma, Oromia, Ethiopia
| | - Tsion Tilahun
- Department of Pediatrics and Child Health, Faculty of Medicine, Jimma University, Jimma, Oromia, Ethiopia
| | - Getenet Beyene
- School of Medical Laboratory Sciences, Faculty of Health Sciences, Jimma University, Jimma, Oromia, Ethiopia
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McDonald PL, Foley TJ, Verheij R, Braithwaite J, Rubin J, Harwood K, Phillips J, Gilman S, van der Wees PJ. Data to knowledge to improvement: creating the learning health system. BMJ 2024; 384:e076175. [PMID: 38272498 PMCID: PMC10809034 DOI: 10.1136/bmj-2023-076175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Affiliation(s)
| | - Tom J Foley
- Newcastle University, Newcastle upon Tyne, UK
- University College Dublin, Dublin, Ireland
- Health Service Executive, Donegal, Ireland
| | - Robert Verheij
- Netherlands Institute of Health Services Research (NIVEL), Utrecht, Netherlands
- Tranzo, Department of Social and Behavioural Sciences, Tilburg University, Tilburg, Netherlands
- Dutch National Healthcare Institute, Diemen, Netherlands
| | | | | | | | - Jessica Phillips
- Translational Health Sciences, Department of Clinical Research and Leadership, George Washington University, Washington, DC, USA
| | - Sarah Gilman
- Translational Health Sciences, Department of Clinical Research and Leadership, George Washington University, Washington, DC, USA
| | - Philip J van der Wees
- George Washington University, Washington, DC, USA
- Radboud University Medical Center, Nijmegen, Netherlands
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Pham TD, Holmes SB, Coulthard P. A review on artificial intelligence for the diagnosis of fractures in facial trauma imaging. Front Artif Intell 2024; 6:1278529. [PMID: 38249794 PMCID: PMC10797131 DOI: 10.3389/frai.2023.1278529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
Patients with facial trauma may suffer from injuries such as broken bones, bleeding, swelling, bruising, lacerations, burns, and deformity in the face. Common causes of facial-bone fractures are the results of road accidents, violence, and sports injuries. Surgery is needed if the trauma patient would be deprived of normal functioning or subject to facial deformity based on findings from radiology. Although the image reading by radiologists is useful for evaluating suspected facial fractures, there are certain challenges in human-based diagnostics. Artificial intelligence (AI) is making a quantum leap in radiology, producing significant improvements of reports and workflows. Here, an updated literature review is presented on the impact of AI in facial trauma with a special reference to fracture detection in radiology. The purpose is to gain insights into the current development and demand for future research in facial trauma. This review also discusses limitations to be overcome and current important issues for investigation in order to make AI applications to the trauma more effective and realistic in practical settings. The publications selected for review were based on their clinical significance, journal metrics, and journal indexing.
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Affiliation(s)
- Tuan D. Pham
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Haylor H, Sparkes T, Armitage G, Dawson-Jones M, Double K, Edwards L. The process and perspective of serious incident investigations in adult community mental health services: integrative review and synthesis. BJPsych Bull 2024:1-13. [PMID: 38174424 DOI: 10.1192/bjb.2023.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
AIMS AND METHOD Serious incident management and organisational learning are international patient safety priorities. Little is known about the quality of suicide investigations and, in turn, the potential for organisational learning. Suicide risk assessment is acknowledged as a complex phenomenon, particularly in the context of adult community mental health services. Root cause analysis (RCA) is the dominant investigative approach, although the evidence base underpinning RCA is contested, with little attention paid to the patient in context and their cumulative risk over time. RESULTS Recent literature proposes a safety-II approach in response to the limitations of RCA. The importance of applying these approaches within a mental healthcare system that advocates a zero suicide framework, grounded in a restorative just culture, is highlighted. CLINICAL IMPLICATIONS Although integrative reviews and syntheses have clear methodological limitations, this approach facilitates the management of a disparate body of work to advance a critical understanding of patient safety in adult community mental healthcare.
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Affiliation(s)
- Helen Haylor
- First Response Crisis Service, Bradford District Care NHS Foundation Trust, UK
| | - Tony Sparkes
- Faculty of Management, Law and Social Sciences, University of Bradford, UK
| | - Gerry Armitage
- Research and Development Department, Bradford District Care NHS Foundation Trust, UK
- Faculty of Health Studies, University of Bradford, UK
| | - Melanie Dawson-Jones
- Library and Health Promotion Resources Centre, Bradford District Care NHS Foundation Trust, UK
| | - Keith Double
- Patient and Carer Experience and Involvement Team, Bradford District Care NHS Foundation Trust, UK
| | - Lisa Edwards
- Faculty of Health Studies, University of Bradford, UK
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Majcherek D, Hegerty SW, Kowalski AM, Lewandowska MS, Dikova D. Opportunities for healthcare digitalization in Europe: Comparative analysis of inequalities in access to medical services. Health Policy 2024; 139:104950. [PMID: 38061175 DOI: 10.1016/j.healthpol.2023.104950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/18/2023] [Accepted: 11/27/2023] [Indexed: 12/31/2023]
Abstract
Digitalization of healthcare systems is a great opportunity to address inequalities in access to healthcare in the European Union. There is an urgent need to build on what we learned from the COVID-19 pandemic, where digital health technologies were integrated swiftly to limit challenges in healthcare delivery. We created a database for the 27 European Union countries from the European Health Interview Survey (EHIS), the Digital Economy and Society Index (DESI), and other Eurostat databases. We performed k-means cluster analysis to group EU countries along two dimensions: inequalities in access to medical services and level of digitalization. We identified five distinct clusters: two clusters with high, two clusters with moderate, and one cluster with low unmet need for healthcare. Regarding digitalization, only one cluster comprising the Nordic countries, Spain and Cyprus exhibit high digital readiness. A cluster comprising the most developed countries in Western Europe represents moderate levels of both unmet need for healthcare and digitalization. For most EU countries, there is still a need to build digital infrastructure for the healthcare industry, which in the long term may increase the number of digital solutions used by both patients and healthcare professionals. Policy makers across the EU need to consider investing in initiatives that would support digital health solutions as an effective means of healthcare provision and healthcare management.
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Carrandi A, Nguyen C, Tse WC, Taylor C, McGain F, Thompson K, Hensher M, McAlister S, Higgins AM. How environmental impact is considered in economic evaluations of critical care: a scoping review. Intensive Care Med 2024; 50:36-45. [PMID: 38191675 PMCID: PMC10810918 DOI: 10.1007/s00134-023-07274-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/11/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Health care is a major contributor to climate change, and critical care is one of the sector's highest carbon emitters. Health economic evaluations form an important component of critical care and may be useful in identifying economically efficient and environmentally sustainable strategies. The purpose of this scoping review was to synthesise available literature on whether and how environmental impact is considered in health economic evaluations of critical care. METHODS A robust scoping review methodology was used to identify studies reporting on environmental impact in health economic evaluations of critical care. We searched six academic databases to locate health economic evaluations, costing studies and life cycle assessments of critical care from 1993 to present. RESULTS Four studies met the review's inclusion criteria. Of the 278 health economic evaluations of critical care identified, none incorporated environmental impact into their assessments. Most included studies (n = 3/4) were life cycle assessments, and the remaining study was a prospective observational study. Life cycle assessments used a combination of process-based data collection and modelling to incorporate environmental impact into their economic assessments. CONCLUSIONS Health economic evaluations of critical care have not yet incorporated environmental impact into their assessments, and few life cycle assessments exist that are specific to critical care therapies and treatments. Guidelines and standardisation regarding environmental data collection and reporting in health care are needed to support further research in the field. In the meantime, those planning health economic evaluations should include a process-based life cycle assessment to establish key environmental impacts specific to critical care.
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Affiliation(s)
- Alayna Carrandi
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Level 3, Melbourne, VIC, 3004, Australia
| | - Christina Nguyen
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Level 3, Melbourne, VIC, 3004, Australia
- School of Medicine, Monash University, Melbourne, VIC, Australia
| | - Wai Chung Tse
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Level 3, Melbourne, VIC, 3004, Australia
- School of Medicine, Monash University, Melbourne, VIC, Australia
| | - Colman Taylor
- Faculty of Medicine, Critical Care Division, The George Institute for Global Health, University of New South Wales Sydney, Sydney, Australia
| | - Forbes McGain
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
- Department of Anaesthesia, Western Health, Footscray, VIC, Australia
- Department of Intensive Care, Western Health, Footscray, VIC, Australia
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Kelly Thompson
- Faculty of Medicine, Critical Care Division, The George Institute for Global Health, University of New South Wales Sydney, Sydney, Australia
- Nepean Blue Mountains Local Health District, Penrith, NSW, Australia
| | - Martin Hensher
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Scott McAlister
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, Dentistry and Health Sciences, Centre for Health Policy, The University of Melbourne, Melbourne, VIC, Australia
| | - Alisa M Higgins
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Level 3, Melbourne, VIC, 3004, Australia.
- Faculty of Medicine, Critical Care Division, The George Institute for Global Health, University of New South Wales Sydney, Sydney, Australia.
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Eekholm S, Samuelson K, Ahlström G, Lindhardt T. Development of an Implementation Strategy Tailored to Deliver Evidence-Based and Person-Centred Nursing Care for Patients with Community-Acquired Pneumonia: An Intervention Mapping Approach. Healthcare (Basel) 2023; 12:32. [PMID: 38200938 PMCID: PMC10779328 DOI: 10.3390/healthcare12010032] [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: 11/10/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Community-acquired pneumonia is a serious public health problem, and more so in older patients, leading to high morbidity and mortality. However, this problem can be reduced by optimising in-hospital nursing care. Accordingly, this study describes a systematic process of designing and developing a tailored theory- and research-based implementation strategy that supports registered nurses (RNs) in delivering evidence-based and person-centred care for this patient population in a hospital setting. The implementation strategy was developed by completing the six steps of the Intervention Mapping framework: (1) developing a logic model of the problem and (2) a logic model of change by defining performance and change objectives, (3) designing implementation strategy interventions by selecting theory-based change methods, (4) planning the interventions and producing materials through a co-design approach, (5) developing a structured plan for adoption, maintenance and implementation and (6) developing an evaluation plan. This method can serve as a guide to (1) target behavioural and environmental barriers hindering the delivery of nursing care in local clinical practice, (2) support evidence uptake, (3) support RNs in the delivery of nursing care according to individual patient needs and thereby (4) optimise health-related patient outcomes.
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Affiliation(s)
- Signe Eekholm
- Department of Health Sciences, Faculty of Medicine, Lund University, Sölvegatan 19, P.O. Box 117, SE-221 00 Lund, Sweden; (K.S.); (G.A.)
- Department of Internal Medicine, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 4, 2nd. Floor, DK-2900 Hellerup, Denmark;
| | - Karin Samuelson
- Department of Health Sciences, Faculty of Medicine, Lund University, Sölvegatan 19, P.O. Box 117, SE-221 00 Lund, Sweden; (K.S.); (G.A.)
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Sölvegatan 19, P.O. Box 117, SE-221 00 Lund, Sweden; (K.S.); (G.A.)
| | - Tove Lindhardt
- Department of Internal Medicine, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 4, 2nd. Floor, DK-2900 Hellerup, Denmark;
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Callander EJ, Enticott JC, Eklom B, Gamble J, Teede HJ. The value of maternity care in Queensland, 2012-18, based on an analysis of administrative data: a retrospective observational study. Med J Aust 2023; 219:535-541. [PMID: 37940105 PMCID: PMC10952409 DOI: 10.5694/mja2.52156] [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: 07/26/2022] [Accepted: 08/18/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE To quantify the value of maternity health care - the relationship of outcomes to costs - in Queensland during 2012-18. STUDY DESIGN Retrospective observational study; analysis of Queensland Perinatal Data Collection data linked with the Queensland Health Admitted Patient, Non-Admitted Patient, and Emergency Data Collections, and with the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) databases. SETTING, PARTICIPANTS All births in Queensland during 1 July 2012 - 30 June 2018. MAIN OUTCOME MEASURES Maternity care costs per birth (reported in 2021-22 Australian dollars), both overall and by funder type (public hospital funders, MBS, PBS, private health insurers, out-of-pocket costs); value of care, defined as total cost per positive birth outcome (composite measure). RESULTS The mean cost per birth (all funders) increased from $20 471 (standard deviation [SD], $17 513) during the second half of 2012 to $30 000 (SD, $22 323) during the first half of 2018; the annual total costs for all births increased from $1.31 billion to $1.84 billion, despite a slight decline in the total number of births. In a mixed effects linear analysis adjusted for demographic, clinical, and birth characteristics, the mean total cost per birth in the second half of 2018 was $9493 higher (99.9% confidence interval, $8930-10 056) than during the first half of 2012. The proportion of births that did not satisfy our criteria for a positive birth outcome increased from 27.1% (8404 births) during the second half of 2012 to 30.5% (9041 births) during the first half of 2018. CONCLUSION The costs of maternity care have increased in Queensland, and many adverse birth outcomes have become more frequent. Broad clinical collaboration, effective prevention and treatment strategies, as well as maternal health services focused on all dimensions of value, are needed to ensure the quality and viability of maternity care in Australia.
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Affiliation(s)
| | - Joanne C Enticott
- Monash Centre for Health Research and ImplementationMonash UniversityMelbourneVIC
| | | | | | - Helena J Teede
- Monash Centre for Health Research and ImplementationMonash UniversityMelbourneVIC
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Sarkies M, Francis-Auton E, Long J, Roberts N, Westbrook J, Levesque JF, Watson DE, Hardwick R, Sutherland K, Disher G, Hibbert P, Braithwaite J. Audit and feedback to reduce unwarranted clinical variation at scale: a realist study of implementation strategy mechanisms. Implement Sci 2023; 18:71. [PMID: 38082301 PMCID: PMC10714549 DOI: 10.1186/s13012-023-01324-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Unwarranted clinical variation in hospital care includes the underuse, overuse, or misuse of services. Audit and feedback is a common strategy to reduce unwarranted variation, but its effectiveness varies widely across contexts. We aimed to identify implementation strategies, mechanisms, and contextual circumstances contributing to the impact of audit and feedback on unwarranted clinical variation. METHODS Realist study examining a state-wide value-based healthcare program implemented between 2017 and 2021 in New South Wales, Australia. Three initiatives within the program included audit and feedback to reduce unwarranted variation in inpatient care for different conditions. Multiple data sources were used to formulate the initial audit and feedback program theory: a systematic review, realist review, program document review, and informal discussions with key program stakeholders. Semi-structured interviews were then conducted with 56 participants to refute, refine, or confirm the initial program theories. Data were analysed retroductively using a context-mechanism-outcome framework for 11 transcripts which were coded into the audit and feedback program theory. The program theory was validated with three expert panels: senior health leaders (n = 19), Agency for Clinical Innovation (n = 11), and Ministry of Health (n = 21) staff. RESULTS The program's audit and feedback implementation strategy operated through eight mechanistic processes. The strategy worked well when clinicians (1) felt ownership and buy-in, (2) could make sense of the information provided, (3) were motivated by social influence, and (4) accepted responsibility and accountability for proposed changes. The success of the strategy was constrained when the audit process led to (5) rationalising current practice instead of creating a learning opportunity, (6) perceptions of unfairness and concerns about data integrity, 7) development of improvement plans that were not followed, and (8) perceived intrusions on professional autonomy. CONCLUSIONS Audit and feedback strategies may help reduce unwarranted clinical variation in care where there is engagement between auditors and local clinicians, meaningful audit indicators, clear improvement plans, and respect for clinical expertise. We contribute theoretical development for audit and feedback by proposing a Model for Audit and Feedback Implementation at Scale. Recommendations include limiting the number of audit indicators, involving clinical staff and local leaders in feedback, and providing opportunities for reflection.
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Affiliation(s)
- Mitchell Sarkies
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
- School of Health Sciences, University of Sydney, Sydney, Australia.
| | - Emilie Francis-Auton
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Janet Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Natalie Roberts
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jean-Frederic Levesque
- Centre for Primary Health Care and Equity, University of New South Wales, Kensington, NSW, Australia
- NSW Agency for Clinical Innovation, Sydney, Australia
| | - Diane E Watson
- Bureau of Health Information, St Leonards, NSW, Australia
| | - Rebecca Hardwick
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
| | | | | | - Peter Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Allied Health and Human Performance, IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Flynn R, Cassidy C, Dobson L, Al-Rassi J, Langley J, Swindle J, Graham ID, Scott SD. Knowledge translation strategies to support the sustainability of evidence-based interventions in healthcare: a scoping review. Implement Sci 2023; 18:69. [PMID: 38049900 PMCID: PMC10694920 DOI: 10.1186/s13012-023-01320-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 11/13/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Knowledge translation (KT) strategies are widely used to facilitate the implementation of EBIs into healthcare practices. However, it is unknown what and how KT strategies are used to facilitate the sustainability of EBIs in institutional healthcare settings. OBJECTIVES This scoping review aimed to consolidate the current evidence on (i) what and how KT strategies are being used for the sustainability of EBIs in institutional healthcare settings; (ii) the reported KT strategy outcomes (e.g., acceptability) for EBI sustainability, and (iii) the reported EBI sustainability outcomes (e.g., EBI activities or component of the intervention continue). METHODS We conducted a scoping review of five electronic databases. We included studies describing the use of specific KT strategies to facilitate the sustainability of EBIs (more than 1-year post-implementation). We coded KT strategies using the clustered ERIC taxonomy and AIMD framework, we coded KT strategy outcomes using Tierney et al.'s measures, and EBI sustainability outcomes using Scheirer and Dearing's and Lennox's taxonomy. We conducted descriptive numerical summaries and a narrative synthesis to analyze the results. RESULTS The search identified 3776 studies for review. Following the screening, 25 studies (reported in 27 papers due to two companion reports) met the final inclusion criteria. Most studies used multi-component KT strategies for EBI sustainability (n = 24). The most common ERIC KT strategy clusters were to train and educate stakeholders (n = 38) and develop stakeholder interrelationships (n = 34). Education was the most widely used KT strategy (n = 17). Many studies (n = 11) did not clearly report whether they used different or the same KT strategies between EBI implementation and sustainability. Seven studies adapted KT strategies from implementation to sustainability efforts. Only two studies reported using a new KT strategy for EBI sustainability. The most reported KT strategy outcomes were acceptability (n = 10), sustainability (n = 5); and adoption (n = 4). The most commonly measured EBI sustainability outcome was the continuation of EBI activities or components (n = 23), followed by continued benefits for patients, staff, and stakeholders (n = 22). CONCLUSIONS Our review provides insight into a conceptual problem where initial EBI implementation and sustainability are considered as two discrete time periods. Our findings show we need to consider EBI implementation and sustainability as a continuum and design and select KT strategies with this in mind. Our review has emphasized areas that require further research (e.g., KT strategy adaptation for EBI sustainability). To advance understanding of how to employ KT strategies for EBI sustainability, we recommend clearly reporting the dose, frequency, adaptations, fidelity, and cost of KT strategies. Advancing our understanding in this area would facilitate better design, selection, tailored, and adapted use of KT strategies for EBI sustainability, thereby contributing to improved patient, provider, and health system outcomes.
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Affiliation(s)
- Rachel Flynn
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College of Cork, College Road Cork, Cork, T12 AK54, Ireland.
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
| | - Christine Cassidy
- School of Nursing, Faculty of Health, Dalhousie University, Room N21, Forrest Bldg., PO Box 15000 5869 University Avenue Halifax, Nova Scotia, B3H 4R2, Canada.
| | - Lauren Dobson
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Joyce Al-Rassi
- School of Nursing, Faculty of Health, Dalhousie University, Room N21, Forrest Bldg., PO Box 15000 5869 University Avenue Halifax, Nova Scotia, B3H 4R2, Canada
| | - Jodi Langley
- School of Nursing, Faculty of Health, Dalhousie University, Room N21, Forrest Bldg., PO Box 15000 5869 University Avenue Halifax, Nova Scotia, B3H 4R2, Canada
| | - Jennifer Swindle
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
- The Centre for Implementation Research, Ottawa Hospital Research Institute, 501 Smyth Road, Box 241, Ottawa, Ontario, K1H 8L6, Canada
| | - Shannon D Scott
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
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Cullen J, Childerhouse P, Jayamaha N, McBain L. Developing a model for primary care quality improvement success: a comparative case study in rural, urban and Kaupapa Māori organisations. J Prim Health Care 2023; 15:333-342. [PMID: 38112700 DOI: 10.1071/hc23046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/10/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction Primary care is under pressure to achieve accessible, equitable, quality health care, while being increasingly under resourced. There is a need to understand factors that influence quality improvement (QI) to support a high-performing primary care system. Literature highlights the impact of context on QI but there is little primary care research on this topic. Aim This qualitative case study research seeks to discover the contextual factors influencing QI in primary care, and how the relationships between contextual factors, the QI initiative, and the implementation process influence outcomes. Methods The Consolidated Framework for Implementation Research was used to frame this qualitative study exploring primary care experiences in depth. Six sites were selected to provide a sample of rural, urban and Kaupapa Māori settings. Qualitative data was collected via semi-structured interviews and compared and contrasted with the organisational documents and data provided by participants. Results Cases reported success in achieving improved outcomes for patients, practices, and staff. Strong internal cultures of 'Clan' and 'Adhocracy' typologies supported teamwork, distributed leadership, and a learning climate to facilitate iterative sensemaking activities. To varying degrees, external network relationships provided resources, knowledge, and support. Discussion Organisations were motivated by a combination of patient/community need and organisational culture. Network relationships assisted to varying degrees depending on need. Engaged and distributed leadership based on teamwork was observed, where leadership was shared and emerged at different levels and times as the need arose. A learning climate was supported to enable iterative sensemaking activities to achieve success.
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Affiliation(s)
- Jane Cullen
- Massey University, Palmerston North, New Zealand
| | | | | | - Lynn McBain
- Department of Primary Care, University of Otago, Wellington, New Zealand
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Kelly Y, O'Rourke N, Flynn R, O'Connor L, Hegarty J. Factors that influence the implementation of (inter)nationally endorsed health and social care standards: a systematic review and meta-summary. BMJ Qual Saf 2023; 32:750-762. [PMID: 37290917 PMCID: PMC10803983 DOI: 10.1136/bmjqs-2022-015287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 04/15/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Health and social care standards have been widely adopted as a quality improvement intervention. Standards are typically made up of evidence-based statements that describe safe, high-quality, person-centred care as an outcome or process of care delivery. They involve stakeholders at multiple levels and multiple activities across diverse services. As such, challenges exist with their implementation. Existing literature relating to standards has focused on accreditation and regulation programmes and there is limited evidence to inform implementation strategies specifically tailored to support the implementation of standards. This systematic review aimed to identify and describe the most frequently reported enablers and barriers to implementing (inter)nationally endorsed standards, in order to inform the selection of strategies that can optimise their implementation. METHODS Database searches were conducted in Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), SocINDEX, Google Scholar, OpenGrey and GreyNet International, complemented by manual searches of standard-setting bodies' websites and hand searching references of included studies. Primary qualitative, quantitative descriptive and mixed methods studies that reported enablers and barriers to implementing nationally or internationally endorsed standards were included. Two researchers independently screened search outcomes and conducted data extraction, methodological appraisal and CERQual (Confidence in Evidence from Reviews of Qualitative research) assessments. An inductive analysis was conducted using Sandelowski's meta-summary and measured frequency effect sizes (FES) for enablers and barriers. RESULTS 4072 papers were retrieved initially with 35 studies ultimately included. Twenty-two thematic statements describing enablers were created from 322 descriptive findings and grouped under six themes. Twenty-four thematic statements describing barriers were created from 376 descriptive findings and grouped under six themes. The most prevalent enablers with CERQual assessments graded as high included: available support tools at local level (FES 55%); training courses to increase awareness and knowledge of the standards (FES 52%) and knowledge sharing and interprofessional collaborations (FES 45%). The most prevalent barriers with CERQual assessments graded as high included: a lack of knowledge of what standards are (FES 63%), staffing constraints (FES 46%), insufficient funds (FES 43%). CONCLUSIONS The most frequently reported enablers related to available support tools, education and shared learning. The most frequently reported barriers related to a lack of knowledge of standards, staffing issues and insufficient funds. Incorporating these findings into the selection of implementation strategies will enhance the likelihood of effective implementation of standards and subsequently, improve safe, quality care for people using health and social care services.
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Affiliation(s)
- Yvonne Kelly
- Health Information and Standards Directorate, Health Information and Quality Authority (HIQA), Cork, Ireland
- Catherine McAuley School of Nursing and Midwifery and School of Public Health (SPHeRE programme), University College Cork, Cork, Ireland
| | - Niamh O'Rourke
- Health Information and Standards Directorate, Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Rachel Flynn
- Health Information and Standards Directorate, Health Information and Quality Authority (HIQA), Cork, Ireland
| | - Laura O'Connor
- Health Information and Standards Directorate, Health Information and Quality Authority (HIQA), Cork, Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Bonaldi A, Vernero S. Choosing Wisely Italy, and the role of doctors in containing the climate emergency. Dermatol Reports 2023; 15:9881. [PMID: 38196896 PMCID: PMC10774844 DOI: 10.4081/dr.2023.9881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 01/11/2024] Open
Abstract
The philosopher of science, Telmo Pievani, in his beautiful and passionate presentation on 30 September 2023, at the conclusion of the 60th National Congress of the Italian Association of Hospital Dermatologists (ADOI) held in Vicenza, reminded us with simple words and concrete examples of the devastating impact of human behavior on the environment and biodiversity, highlighting the growing deterioration of the delicate natural balances that preserve terrestrial ecosystems and with them life on our planet [...]
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Gill S, Page RS. Doing our bit to save the planet: Identifying and abandoning low value surgery. ANZ J Surg 2023; 93:2565-2566. [PMID: 37326246 DOI: 10.1111/ans.18569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Stephen Gill
- Barwon Centre for Orthopaedic Research and Education (B-CORE), St John of God Hospital Geelong, Barwon Health and Deakin University, Geelong, Victoria, Australia
| | - Richard S Page
- Barwon Centre for Orthopaedic Research and Education (B-CORE), St John of God Hospital Geelong, Barwon Health and Deakin University, Geelong, Victoria, Australia
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Snow H, Hodgson R, Hii MW, Reeves F, Proud D, Lam T, Gyomber D, Dunne B. Environmentally sustainable surgery: A plea to act. ANZ J Surg 2023; 93:2562-2564. [PMID: 37458184 DOI: 10.1111/ans.18609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/15/2023] [Accepted: 07/06/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Hayden Snow
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Surgery, Western Health, Sunshine, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Russell Hodgson
- Division of Surgery, Northern Health, Melbourne, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Michael W Hii
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- Department of HPB and Upper GI Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Fairleigh Reeves
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- Department of Urology, Royal Melbourne Hospital, Melbourne, Australia
| | - David Proud
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- Department of General Surgery, Austin Health, Melbourne, Australia
| | - Tracey Lam
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- Epworth General Surgery Clinical Institute, Epworth HealthCare, Melbourne, Australia
- Department of Surgery, Western Health, Footscray, Australia
| | - Dennis Gyomber
- Division of Surgery, Northern Health, Melbourne, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Benjamin Dunne
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia
- Royal Australasian College of Surgeons, Environmental Sustainability in Surgical Practice Working Party, Australia
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Greenwood J. Overcoming challenges with getting current evidence into practice. JBI Evid Synth 2023; 21:2152-2153. [PMID: 37935420 DOI: 10.11124/jbies-23-00473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Affiliation(s)
- Jennifer Greenwood
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA RFUMS Center for Interprofessional Evidence Based Practice, a JBI Centre of Excellence, North Chicago, IL, USA
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Braithwaite J, Pichumani A, Crowley P. Tackling climate change: the pivotal role of clinicians. BMJ 2023; 382:e076963. [PMID: 37770093 DOI: 10.1136/bmj-2023-076963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
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Aloisio LD, Graham N, Grinspun D, Naik S, Coughlin M, Medeiros C, McConnell H, Sales A, McNeill S, Santos WJ, Squires JE. Indicators to measure implementation and sustainability of nursing best practice guidelines: A mixed methods analysis. Heliyon 2023; 9:e19983. [PMID: 37809679 PMCID: PMC10559663 DOI: 10.1016/j.heliyon.2023.e19983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Background The use of best practice guidelines (BPGs) has the potential to decrease the gap between best evidence and nursing and healthcare practices. We conducted an exploratory mixed method study to identify strategies, processes, and indicators relevant to the implementation and sustainability of two Registered Nurses' Association of Ontario (RNAO) BPGs at Best Practice Spotlight Organizations® (BPSOs). Methods Our study had four phases. In Phase 1, we triangulated two qualitative studies: a) secondary analysis of 126 narrative reports detailing implementation progress from 21 BPSOs spanning four sectors to identify strategies and processes used to support the implementation and sustainability of BPGs and b) interviews with 25 guideline implementers to identify additional strategies and processes. In Phase 2, we evaluated correlations between strategies and processes identified from the narrative reports and one process and one outcome indicator for each of the guideline. In Phase 3, the results from Phases 1 and 2 informed indicator development, led by an expert panel. In Phase 4, the indicators were assessed internally by RNAO staff and externally by Ontario Health Teams. A survey was used to validate proposed indicators to determine relevance, feasibility, readability, and usability with knowledge users and BPSO leaders. Results Triangulation of the two qualitative studies revealed 46 codes of implementation and sustainability of BPGs, classified into eight overarching themes: Stakeholder Engagement, Practice Interventions, Capacity Building, Evidence-Based Culture, Leadership, Evaluation & Monitoring, Communication, and Governance. A total of 28 structure, process, or outcome indicators were developed. End users and BPSO leaders were agreeable with the indicators according to the validation survey. Conclusions Many processes and strategies can influence the implementation and sustainability of BPGs at BPSOs. We have developed indicators that can help BPSOs promote evidence-informed practice implementation of BPGs.
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Affiliation(s)
- Laura D. Aloisio
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Nicole Graham
- University of Ottawa, Faculty of Health Sciences, School of Nursing, Ottawa, ON, Canada
| | - Doris Grinspun
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Shanoja Naik
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Mary Coughlin
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Christina Medeiros
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | | | - Anne Sales
- Sinclair School of Nursing and Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Susan McNeill
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Wilmer J. Santos
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Janet E. Squires
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- University of Ottawa, Faculty of Health Sciences, School of Nursing, Ottawa, ON, Canada
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Kühlein T, Macdonald H, Kramer B, Johansson M, Woloshin S, McCaffery K, Brodersen JB, Copp T, Jørgensen KJ, Møller A, Scherer M. Overdiagnosis and too much medicine in a world of crises. BMJ 2023; 382:1865. [PMID: 37573032 DOI: 10.1136/bmj.p1865] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Affiliation(s)
- Thomas Kühlein
- Institute of General Practice, Universitätsklinikum Erlangen, Germany
| | | | - Barnett Kramer
- The Lisa Schwartz Foundation for Truth in Medicine Norwich, VT/USA
| | - Minna Johansson
- Global Center for Sustainable Healthcare, Gothenburg, Sweden
| | - Steven Woloshin
- Global Center for Sustainable Healthcare, Gothenburg, Sweden
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH/USA
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, Wiser Healthcare, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - John B Brodersen
- Centre of Research & Education in General Practice, Department of Public Health, Faculty of Health Sciences, University of Copenhagen; Primary Health Care Research Unit, Region Zealand and Research Unit for General Practice, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø Odense University Hospital Odense, Denmark and Cochrane Collaboration, Oxford, United Kingdom
| | - Tessa Copp
- Wiser Healthcare, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Karsten Juhl Jørgensen
- Herrestads Healthcare Centre, Närhälsan, Denmark; Global Center for Sustainable Healthcare, Gothenburg Denmark; University, FoUUI Fyrbodal, Cochrane Sweden
| | - Anne Møller
- Centre of Research & Education in General Practice, Department of Public Health, Faculty of Health Sciences, University of Copenhagen; Primary Health Care Research Unit, Region Zealand, Denmark
| | - Martin Scherer
- Institut and Polyclinic of General Practice, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany
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Pagano L, Hemmert C, Hirschhorn A, Francis-Auton E, Arnolda G, Long JC, Braithwaite J, Gumley G, Hibbert PD, Churruca K, Hutchinson K, Partington A, Hughes C, Gillatt D, Ellis LA, Testa L, Patel R, Sarkies MN. Implementation of consensus-based perioperative care pathways to reduce clinical variation for elective surgery in an Australian private hospital: a mixed-methods pre-post study protocol. BMJ Open 2023; 13:e075008. [PMID: 37495386 PMCID: PMC10373689 DOI: 10.1136/bmjopen-2023-075008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
INTRODUCTION Addressing clinical variation in elective surgery is challenging. A key issue is how to gain consensus between largely autonomous clinicians. Understanding how the consensus process works to develop and implement perioperative pathways and the impact of these pathways on reducing clinical variation can provide important insights into the effectiveness of the consensus process. The primary objective of this study is to understand the implementation of an organisationally supported, consensus approach to implement perioperative care pathways in a private healthcare facility and to determine its impact. METHODS A mixed-methods Effectiveness-Implementation Hybrid (type III) pre-post study will be conducted in one Australian private hospital. Five new consensus-based perioperative care pathways will be developed and implemented for specific patient cohorts: spinal surgery, radical prostatectomy, cardiac surgery, bariatric surgery and total hip and knee replacement. The individual components of these pathways will be confirmed as part of a consensus-building approach and will follow a four-stage implementation process using the Exploration, Preparation, Implementation and Sustainment framework. The process of implementation, as well as barriers and facilitators, will be evaluated through semistructured interviews and focus groups with key clinical and non-clinical staff, and participant observation. We anticipate completing 30 interviews and 15-20 meeting observations. Administrative and clinical end-points for at least 152 participants will be analysed to assess the effectiveness of the pathways. ETHICS AND DISSEMINATION This study received ethical approval from Macquarie University Human Research Ethics Medical Sciences Committee (Reference No: 520221219542374). The findings of this study will be disseminated through peer-reviewed publications, conference presentations and reports for key stakeholders.
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Affiliation(s)
- Lisa Pagano
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Cameron Hemmert
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Hirschhorn
- MQ Health, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Emilie Francis-Auton
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Graham Gumley
- MQ Health, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Andrew Partington
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Cliff Hughes
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- MQ Health, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - David Gillatt
- MQ Health, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Luke Testa
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Romika Patel
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Mitchell N Sarkies
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Czosnek L, Rankin NM, Cormie P, Murnane A, Turner J, Richards J, Rosenbaum S, Zopf EM. "Now is the time for institutions to be investing in growing exercise programs as part of standard of care": a multiple case study examining the implementation of exercise oncology interventions. Support Care Cancer 2023; 31:422. [PMID: 37358744 DOI: 10.1007/s00520-023-07844-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/24/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Implementation science seeks to systematically identify determinants, strategies, and outcomes within a causal pathway to help explain successful implementation. This process is applied to evidence-based interventions (EBIs) to improve their adoption, implementation, and sustainment. However, this method has not been applied to exercise oncology services, meaning we lack knowledge about implementing exercise EBIs in routine practice. This study aimed to develop causal pathways from the determinants, strategies (including mechanism of change), and implementation outcomes to explain exercise EBIs implementation in routine cancer care. METHODS A multiple-case study was conducted across three healthcare sites in Australia. Sites selected had implemented exercise within routine care for people diagnosed with cancer and sustained the delivery of services for at least 12 months. Four data sources informed the study: semi-structured interviews with staff, document reviews, observations, and the Program Sustainability Assessment Tool (survey). Framework analysis was applied to understand the findings. The Implementation Research Logic Model was used to identify commonalities in implementation across sites and develop causal pathways. RESULTS Two hundred and eighteen data points informed our findings. Across sites, 18 determinants and 22 implementation strategies were consistent. Sixteen determinants and 24 implementation strategies differed across sites and results of implementation outcomes varied. We identified 11 common pathways that when combined, help explain implementation processes. The mechanisms of implementation strategies operating within the pathways included (1) knowledge, (2) skills, (3) secure resources, (4) optimism, and (5) simplified decision-making processes associated with exercise; (6) relationships (social and professional) and support for the workforce; (7) reinforcing positive outcomes; (8) capability to action plan through evaluations and (9) interactive learning; (10) aligned goals between the organisation and the EBI; and (11) consumer-responsiveness. CONCLUSION This study developed causal pathways that explain the how and why of successful implementation of exercise EBIs in cancer care. These findings can support future planning and optimisation activities by creating more opportunities for people with cancer to access evidence-based exercise oncology services. IMPLICATIONS FOR CANCER SURVIVORS Understanding how to implement exercise within routine cancer care successfully is important so cancer survivors can experience the benefits of exercise.
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Affiliation(s)
- Louise Czosnek
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
| | - Nicole M Rankin
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Prue Cormie
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Murnane
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jane Turner
- Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Justin Richards
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Simon Rosenbaum
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Eva M Zopf
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
- Cabrini Cancer Institute, Department of Medical Oncology, Cabrini Health, Melbourne, Victoria, Australia
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Tieu M, Lawless M, Hunter SC, Pinero de Plaza MA, Darko F, Mudd A, Yadav L, Kitson A. Wicked problems in a post-truth political economy: a dilemma for knowledge translation. HUMANITIES & SOCIAL SCIENCES COMMUNICATIONS 2023; 10:280. [PMID: 37305353 PMCID: PMC10238234 DOI: 10.1057/s41599-023-01789-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/23/2023] [Indexed: 06/13/2023]
Abstract
The discipline of knowledge translation (KT) emerged as a way of systematically understanding and addressing the challenges of applying health and medical research in practice. In light of ongoing and emerging critique of KT from the medical humanities and social sciences disciplines, KT researchers have become increasingly aware of the complexity of the translational process, particularly the significance of culture, tradition and values in how scientific evidence is understood and received, and thus increasingly receptive to pluralistic notions of knowledge. Hence, there is now an emerging view of KT as a highly complex, dynamic, and integrated sociological phenomenon, which neither assumes nor creates knowledge hierarchies and neither prescribes nor privileges scientific evidence. Such a view, however, does not guarantee that scientific evidence will be applied in practice and thus poses a significant dilemma for KT regarding its status as a scientific and practice-oriented discipline, particularly within the current sociopolitical climate. Therefore, in response to the ongoing and emerging critique of KT, we argue that KT must provide scope for relevant scientific evidence to occupy an appropriate position of epistemic primacy in public discourse. Such a view is not intended to uphold the privileged status of science nor affirm the "scientific logos" per se. It is proffered as a counterbalance to powerful social, cultural, political and market forces that are able to challenge scientific evidence and promote disinformation to the detriment of democratic outcomes and the public good.
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Affiliation(s)
- Matthew Tieu
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA Australia
- Caring Futures Institute, Flinders University, Bedford Park, SA Australia
- College of Humanities, Arts and Social Sciences, Flinders University, Bedford Park, SA Australia
| | - Michael Lawless
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA Australia
- Caring Futures Institute, Flinders University, Bedford Park, SA Australia
| | - Sarah C. Hunter
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA Australia
- Caring Futures Institute, Flinders University, Bedford Park, SA Australia
| | - Maria Alejandra Pinero de Plaza
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA Australia
- Caring Futures Institute, Flinders University, Bedford Park, SA Australia
| | - Francis Darko
- College of Humanities, Arts and Social Sciences, Flinders University, Bedford Park, SA Australia
| | - Alexandra Mudd
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA Australia
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Lalit Yadav
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA Australia
- Caring Futures Institute, Flinders University, Bedford Park, SA Australia
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA Australia
- Caring Futures Institute, Flinders University, Bedford Park, SA Australia
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Roberts G, Cahill A, Lawthom C, Price M, Blyth C, Jones C, Mc Laughlin L, Noyes J. Protocol for a realist and social return on investment evaluation of the use of patient-reported outcomes in four value-based healthcare programmes. BMJ Open 2023; 13:e072234. [PMID: 37105686 PMCID: PMC10151973 DOI: 10.1136/bmjopen-2023-072234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION There is growing recognition that in order to remain sustainable, the UK's National Health Service must deliver the best patient outcomes within available resources. This focus on outcomes relative to cost is the basis of value-based healthcare (VBHC) and has led to interest in the recording of patient-reported outcome measures (PROMs) to measure patient perspectives on the impact of a health condition on their lives. Every health board in Wales is now required to collect PROMS as part of routine care. We will evaluate the VBHC programme implemented in a lead health board. The study aim is to understand what works about PROMs collection, for whom, in what contexts and why in a VBHC context. In addition, we will assess the social value of integrating PROMs collection into routine care. METHODS AND ANALYSIS A three-stage mixed-methods study comprising a realist evaluation integrated with social return on investment (SROI) analysis across four conditions; Parkinson's disease, epilepsy, heart failure and cataract surgery. Workstream 1: Development of logic models, informed by a scoping review, documentary analysis, patient and public involvement (PPI), staff and key stakeholder engagement. Workstream 2: Realist evaluation building on multiple data sources from stages 1 to 3 to test and refine the programme theories that arise from the logic model development. Workstream 3: SROI analysis using interview data with patients, staff and carers, stakeholder and PPI engagement, anonymised routinely collected data, and questionnaires to populate a model that will explore the social value generated by the implementation of PROMs. Findings across stages will be validated with key stakeholders. ETHICS AND DISSEMINATION The study is approved by Wales Research Ethics Committee #5 (22/WA/0044). Outcomes will be shared with key stakeholders, published in peer-reviewed journals and presented at national and international conferences.This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) licence, which permits others to distribute, remix, adapt, build on this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial.
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Affiliation(s)
- Gareth Roberts
- Aneurin Bevan University Health Board, Newport, Gwent, UK
| | - Adele Cahill
- Aneurin Bevan University Health Board, Newport, Gwent, UK
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Ahumada-Canale A, Jeet V, Bilgrami A, Seil E, Gu Y, Cutler H. Barriers and facilitators to implementing priority setting and resource allocation tools in hospital decisions: A systematic review. Soc Sci Med 2023; 322:115790. [PMID: 36913838 DOI: 10.1016/j.socscimed.2023.115790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/24/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
Health care budgets in high-income countries are having issues coping with unsustainable growth in demand, particularly in the hospital setting. Despite this, implementing tools systematising priority setting and resource allocation decisions has been challenging. This study answers two questions: (1) what are the barriers and facilitators to implementing priority setting tools in the hospital setting of high-income countries? and (2) what is their fidelity? A systematic review using the Cochrane methods was conducted including studies of hospital-related priority setting tools reporting barriers or facilitators for implementation, published after the year 2000. Barriers and facilitators were classified using the Consolidated Framework for Implementation Research (CFIR). Fidelity was assessed using priority setting tool's standards. Out of thirty studies, ten reported program budgeting and marginal analysis (PBMA), twelve multi-criteria decision analysis (MCDA), six health technology assessment (HTA) related frameworks, and two, an ad hoc tool. Barriers and facilitators were outlined across all CFIR domains. Implementation factors not frequently observed, such as 'evidence of previous successful tool application', 'knowledge and beliefs about the intervention' or 'external policy and incentives' were reported. Conversely, some constructs did not yield any barrier or facilitator including 'intervention source' or 'peer pressure'. PBMA studies satisfied the fidelity criteria between 86% and 100%, for MCDA it varied between 36% and 100%, and for HTA it was between 27% and 80%. However, fidelity was not related to implementation. This study is the first to use an implementation science approach. Results represent the starting point for organisations wishing to use priority setting tools in the hospital setting by providing an overview of barriers and facilitators. These factors can be used to assess readiness for implementation or to serve as the foundation for process evaluations. Through our findings, we aim to improve the uptake of priority setting tools and support their sustainable use.
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Affiliation(s)
- Antonio Ahumada-Canale
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
| | - Varinder Jeet
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
| | - Anam Bilgrami
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
| | - Elizabeth Seil
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
| | - Henry Cutler
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
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Jordan Z, Pilla B, Porritt K, Munn Z, Aromataris E, Lockwood C. Turning the flywheel: mobilizing the JBI model of evidence-based healthcare. JBI Evid Implement 2023; 21:96-100. [PMID: 36378852 DOI: 10.1097/xeb.0000000000000342] [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: 11/26/2022]
Abstract
ABSTRACT Since its emergence in the 1990s, evidence-based healthcare (EBHC) has made great strides in locating, synthesizing, summarizing, and disseminating evidence, but sustainable mechanisms for getting trustworthy evidence into policy and practice continues to be less well understood. We propose that there is an EBHC 'Flywheel' that begins and ends with culture and the development of adaptive but disciplined approaches that generate new 'norms' in relation to EBHC. In mechanics, a flywheel is a device that uses momentum to create rotational energy. The concept of a 'flywheel effect' has been adopted in management fields to demonstrate how change in organizations or practices rarely happen in one fell swoop; rather, sustainable change requires energy and persistent effort.This energy might be exemplified by leadership to get the wheel moving, but it needs to be guided, channelled, harnessed and supported throughout the rest of the organization. To achieve sustainable momentum, it is necessary to communicate with transparency the EBHC principles, practices, and perspectives that are considered of broad organizational value to generate cohesion and understanding about practice expectations. With a common vision, cooperation and collective identity in place, true multidisciplinary collaboration underpinned by EBHC is possible. The final component in the EBHC flywheel, capacity, is self-generating (i.e. you do not need 'more time' or 'more resource' for EBHC as EBHC is embedded in the fabric and fibre of the organization). This shifts the notion of EBHC initiatives from being 'in addition to' or being singular one-off initiatives or projects to being part of the lifeblood of how the organization functions. EBHC is, ultimately, a human-to-human endeavour. It relates to individuals connecting and committing to a common purpose. The 'four C's' that underpin the JBI Model (culture, communication, collaboration, and capacity) are the organizational navigational instruments and roadmaps required to provide the human focus/lens that is needed.
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Affiliation(s)
- Zoe Jordan
- Faculty of Health and Medical Sciences, JBI, University of Adelaide, Adelaide, Australia
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Gallagher A, Smyth B, Jha V. Climate Change, Heat-Related Acute Kidney Disease, and the Need for Action. Am J Kidney Dis 2023; 81:501-503. [PMID: 36759239 DOI: 10.1053/j.ajkd.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 11/13/2022] [Indexed: 02/10/2023]
Affiliation(s)
- Alex Gallagher
- Department of Renal Medicine, St George Hospital, Kogarah, Australia; NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Brendan Smyth
- Department of Renal Medicine, St George Hospital, Kogarah, Australia; NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia.
| | - Vivekanand Jha
- The George Institute for Global Health, New Delhi, India; School of Public Health, Imperial College London, London, United Kingdom; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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Gaspar T, Salado V, do Céu Machado M, Guedes FB, Faia-Correia M, Coelho A. Impact of COVID-19 on Management, Quality and Satisfaction of Health Organizations: A Case Study in a Portuguese Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH 2023; 17:21. [PMID: 36741968 PMCID: PMC9882738 DOI: 10.1007/s41742-022-00505-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/21/2022] [Accepted: 12/29/2022] [Indexed: 06/18/2023]
Abstract
The hospital health care professionals are the front-line fighting COVID-19 considering they are responsible for all the care provided to patients. The purpose of this study was to determine the impact of COVID-19 at the hospital management level and, also, to understand how psychosocial environment, and satisfaction of Health Professionals were affected. A case study was performed in a Portuguese Hospital. Data were collected at one hospital under study at two different occasions: the first before the pandemic (November 2019) and the second almost two years after the pandemic started (November 2021). Regarding data collection, 37.0% of participants responded in the occasion 1 (n = 296) and 63.0% responded in the occasion 2 (n = 503). The instrument for the Assessment of Global Management of Health Organizations (AGMHO) consists of 39 items organized into six dimensions (Gaspar et al. in J Occup Environ Med 63: 581-587, 2021). Comparing timings pre and during pandemic COVID-19, it was found that the participants in the pre-COVID-19 era showed stronger organizational culture, higher quality of life, better psychosocial environment regarding content/leadership and higher job satisfaction when compared to the participants during pandemic COVID-19. On the other hand, participants in the second occasion were found to have higher psychosocial risks related to mental health when compared to participants in the pre-COVID-19 phase. We conclude that the professionals' perception of the different dimensions of the health organization worsened after 2 years of the pandemic. With special focus on psychosocial risks at work and relationship with leadership.
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Affiliation(s)
- Tânia Gaspar
- Universidade Lusófona das Humanidades e Tecnologias/HEI-LAB, Campo Grande 376, 1749-024 Lisbon, Portugal
- Portuguese Lab for Healthy Workplaces, Lisbon, Portugal
- ISAMB/Lisbon University, Lisbon, Portugal
| | | | - Maria do Céu Machado
- Portuguese Lab for Healthy Workplaces, Lisbon, Portugal
- ISAMB/Lisbon University, Lisbon, Portugal
| | - Fábio Botelho Guedes
- Portuguese Lab for Healthy Workplaces, Lisbon, Portugal
- ISAMB/Lisbon University, Lisbon, Portugal
| | - Manuela Faia-Correia
- Universidade Lusófona das Humanidades e Tecnologias/HEI-LAB, Campo Grande 376, 1749-024 Lisbon, Portugal
- Portuguese Lab for Healthy Workplaces, Lisbon, Portugal
- COMEGI-Centro de Investigação em Organizações, Mercados e Gestão Industrial, Lisbon, Portugal
| | - Anabela Coelho
- Universidade de Évora, Évora, Portugal
- Comprehensive Health Research Centre (CHRC)/Évora University, Évora, Portugal
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Swaithes L, Paskins Z, Quicke JG, Stevenson K, Fell K, Dziedzic K. Optimising the process of knowledge mobilisation in Communities of Practice: recommendations from a (multi-method) qualitative study. Implement Sci Commun 2023; 4:11. [PMID: 36703232 PMCID: PMC9879236 DOI: 10.1186/s43058-022-00384-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 12/04/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Communities of Practice (CoPs) offer a strategy for mobilising knowledge and integrating evidence-based interventions into musculoskeletal practice, yet little is known about their practical application in this context. This study aimed to (i) explore the process of knowledge mobilisation in the context of a CoP to implement evidence-based interventions in musculoskeletal care and (ii) co-develop recommendations to optimise the process of knowledge mobilisation in CoPs. METHODS A qualitative study comprising observation of a CoP and related planning meetings (n = 5), and interviews with CoP stakeholders (including clinicians, lay members, managers, commissioners, academics) (n = 15) was undertaken. Data were analysed using thematic analysis and interpreted considering the Integrated Promoting Action on Research Implementation in Health Services theory. Public contributors were collaboratively involved at key stages of the study. RESULTS Four themes were identified: identifying and interpreting knowledge, practical implementation of a CoP, culture and relationship building, and responding to the external context. Resource and infrastructure enabled the set-up, delivery and running of the CoP. Support for lay members is recommended to ensure effective participation and equity of power. CoP aims and purpose can develop iteratively, and this may enhance the ability to respond to contextual changes. Several recommendations for the practical application of CoPs are suggested to create the best environment for knowledge exchange and creation, support an equitable platform for participation, and help members to navigate and make sense of the CoP in a flexible way. CONCLUSION This study identified how a CoP with diverse membership can promote partnership working at the intersection between knowledge and practice. Several important considerations for preparing for and operationalising the approach in implementation have been identified. Evaluation of the costs, effectiveness and impact of CoPs is needed to better understand the value added by the approach. More broadly, research is needed to explore the practical application of online CoPs and the role of international CoPs in optimising the uptake of innovations and best practice.
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Affiliation(s)
- Laura Swaithes
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK.
| | - Zoe Paskins
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK.,Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Staffordshire, UK
| | - Jonathan G Quicke
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK.,Haywood Hospital, Midlands Partnership NHS Foundation Trust, Staffordshire, UK
| | - Kay Stevenson
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK.,Haywood Hospital, Midlands Partnership NHS Foundation Trust, Staffordshire, UK
| | - Kathy Fell
- Research User Group, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Krysia Dziedzic
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
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The journey to a learning health system in primary care: a qualitative case study utilising an embedded research approach. BMC PRIMARY CARE 2023; 24:22. [PMID: 36653772 PMCID: PMC9849102 DOI: 10.1186/s12875-022-01955-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/23/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Healthcare systems may be resilient and adaptive, but they are not fit for purpose in their current state. Increasing threats to health system sustainability have underscored the need to move towards a learning health system in which research and data are used routinely in clinical practice to facilitate system improvement. This study aimed to establish which elements of the learning health system were being realised within a university-based general practice and determine acceptability from staff to embrace further the transition towards a learning health system. METHODS Semi-structured interviews were conducted with practice staff, including clinical and administrative staff, to determine the current state of the learning health system in the practice. An embedded researcher was placed within the general practice on a part-time basis to investigate the learning health system model. Interviews were transcribed and thematically analysed based on the National Academy of Medicine's framework of learning health systems. RESULTS In total, 32 (91%) practice staff were interviewed, comprising general practitioners (n = 15), nurses (n = 3), administrative staff (n = 13), and a psychologist (n = 1). Participants indicated that the practice was operating with several characteristics of a learning health system (e.g., emphasising science and informatics; focusing on patient-clinician partnerships; applying incentives; supporting a continuous learning culture; and establishing structures and governance for learning). These measures were supported by the university-based setting, and resultant culture of learning. Nevertheless, there were areas of the practice where the learning health system could be strengthened, specifically relating to the use of patient data and informatics. Staff generally expressed willingness to engage with the process of strengthening the learning health system within their practice. CONCLUSION Although the idea of a learning health system has been gaining traction in recent years, there are comparatively few empirical studies presented in the literature. This research presents a case study of a general practice that is operating as a learning health system and highlights the utility of using the learning health system framework.
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Raban MZ, Gonzalez G, Nguyen AD, Newell BR, Li L, Seaman KL, Westbrook JI. Nudge interventions to reduce unnecessary antibiotic prescribing in primary care: a systematic review. BMJ Open 2023; 13:e062688. [PMID: 36657758 PMCID: PMC9853249 DOI: 10.1136/bmjopen-2022-062688] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Antibiotic prescribing in primary care contributes significantly to antibiotic overuse. Nudge interventions alter the decision-making environment to achieve behaviour change without restricting options. Our objectives were to conduct a systematic review to describe the types of nudge interventions used to reduce unnecessary antibiotic prescribing in primary care, their key features, and their effects on antibiotic prescribing overall. METHODS Medline, Embase and grey literature were searched for randomised trials or regression discontinuity studies in April 2021. Risk of bias was assessed independently by two researchers using the Cochrane Effective Practice and Organisation of Care group's tool. Results were synthesised to report the percentage of studies demonstrating a reduction in overall antibiotic prescribing for different types of nudges. Effects of social norm nudges were examined for features that may enhance effectiveness. RESULTS Nineteen studies were included, testing 23 nudge interventions. Four studies were rated as having a high risk of bias, nine as moderate risk of bias and six as at low risk. Overall, 78.3% (n=18, 95% CI 58.1 to 90.3) of the nudges evaluated resulted in a reduction in overall antibiotic prescribing. Social norm feedback was the most frequently applied nudge (n=17), with 76.5% (n=13; 95% CI 52.7 to 90.4) of these studies reporting a reduction. Other nudges applied were changing option consequences (n=3; with 2 reporting a reduction), providing reminders (n=2; 2 reporting a reduction) and facilitating commitment (n=1; reporting a reduction). Successful social norm nudges typically either included an injunctive norm, compared prescribing to physicians with the lowest prescribers or targeted high prescribers. CONCLUSIONS Nudge interventions are effective for improving antibiotic prescribing in primary care. Expanding the use of nudge interventions beyond social norm nudges could reap further improvements in antibiotic prescribing practices. Policy-makers and managers need to be mindful of how social norm nudges are implemented to enhance intervention effects.
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Affiliation(s)
- Magdalena Z Raban
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gabriela Gonzalez
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Amy D Nguyen
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Ben R Newell
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Ling Li
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Karla L Seaman
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Johanna I Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Wilson MG, Palmer E, Asselbergs FW, Harris SK. Integrated rapid-cycle comparative effectiveness trials using flexible point of care randomisation in electronic health record systems. J Biomed Inform 2023; 137:104273. [PMID: 36535604 DOI: 10.1016/j.jbi.2022.104273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/13/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Whilst the Randomised Controlled Trial remains the gold standard for deriving robust causal estimates of treatment efficacy, too often a traditional design proves prohibitively expensive or cumbersome when it comes to assessing questions regarding the comparative effectiveness of routinely used treatments. As a result, patients experience variation in practice as clinicians lack the evidence needed to personalise treatments effectively. This variation may be classified as unwarranted, where existing evidence is ignored, or legitimate where in the absence of evidence, clinicians rely on experience, expert opinion, and inferred principles from basic science to make decisions. We argue that within the right ethical and technological framework, legitimate variation can be transformed into a mechanism for evidence generation and learning. Learning Health Systems which harness existing variation in practice, represent a novel approach for generating evidence from everyday clinical practice. The development of these systems has gained traction due to the increased availability of modern Electronic Health Record Systems. However, despite their promise, overcoming hurdles to successfully integrating clinical trials within Learning Health Systems has proven challenging. This article describes the origins of integrated clinical trials and explores two main barriers to their further implementation - how best to obtain informed consent from patients to participate in routine comparative effectiveness research, and how to automate and integrate randomisation into a clinical workflow. Having described these barriers, we present a potential solution in the form of a research pipeline using a novel form of flexible point-of-care randomisation to allow clinicians and patients to participate in studies where there is clinical equipoise.
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Affiliation(s)
- Matthew G Wilson
- Institute of Health Informatics, Faculty of Population Health Sciences, University College London, UK.
| | - Edward Palmer
- Bloomsbury Institute of Intensive Care Medicine, University College London, UK; Whittington Hospital NHS Trust, UK
| | - Folkert W Asselbergs
- Institute of Cardiovascular Science and Institute of Health Informatics, Faculty of Population Health Sciences, University College London, UK; Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Steve K Harris
- Institute of Health Informatics, Faculty of Population Health Sciences, University College London, UK; Critical Care Department, University College London Hospital, UK
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Morris AH, Horvat C, Stagg B, Grainger DW, Lanspa M, Orme J, Clemmer TP, Weaver LK, Thomas FO, Grissom CK, Hirshberg E, East TD, Wallace CJ, Young MP, Sittig DF, Suchyta M, Pearl JE, Pesenti A, Bombino M, Beck E, Sward KA, Weir C, Phansalkar S, Bernard GR, Thompson BT, Brower R, Truwit J, Steingrub J, Hiten RD, Willson DF, Zimmerman JJ, Nadkarni V, Randolph AG, Curley MAQ, Newth CJL, Lacroix J, Agus MSD, Lee KH, deBoisblanc BP, Moore FA, Evans RS, Sorenson DK, Wong A, Boland MV, Dere WH, Crandall A, Facelli J, Huff SM, Haug PJ, Pielmeier U, Rees SE, Karbing DS, Andreassen S, Fan E, Goldring RM, Berger KI, Oppenheimer BW, Ely EW, Pickering BW, Schoenfeld DA, Tocino I, Gonnering RS, Pronovost PJ, Savitz LA, Dreyfuss D, Slutsky AS, Crapo JD, Pinsky MR, James B, Berwick DM. Computer clinical decision support that automates personalized clinical care: a challenging but needed healthcare delivery strategy. J Am Med Inform Assoc 2022; 30:178-194. [PMID: 36125018 PMCID: PMC9748596 DOI: 10.1093/jamia/ocac143] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/27/2022] [Accepted: 08/22/2022] [Indexed: 12/15/2022] Open
Abstract
How to deliver best care in various clinical settings remains a vexing problem. All pertinent healthcare-related questions have not, cannot, and will not be addressable with costly time- and resource-consuming controlled clinical trials. At present, evidence-based guidelines can address only a small fraction of the types of care that clinicians deliver. Furthermore, underserved areas rarely can access state-of-the-art evidence-based guidelines in real-time, and often lack the wherewithal to implement advanced guidelines. Care providers in such settings frequently do not have sufficient training to undertake advanced guideline implementation. Nevertheless, in advanced modern healthcare delivery environments, use of eActions (validated clinical decision support systems) could help overcome the cognitive limitations of overburdened clinicians. Widespread use of eActions will require surmounting current healthcare technical and cultural barriers and installing clinical evidence/data curation systems. The authors expect that increased numbers of evidence-based guidelines will result from future comparative effectiveness clinical research carried out during routine healthcare delivery within learning healthcare systems.
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Affiliation(s)
- Alan H Morris
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Christopher Horvat
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brian Stagg
- Department of Ophthalmology and Visual Sciences, Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - David W Grainger
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Michael Lanspa
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - James Orme
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Terry P Clemmer
- Department of Internal Medicine (Critical Care), Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Lindell K Weaver
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Frank O Thomas
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Colin K Grissom
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Ellie Hirshberg
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Thomas D East
- SYNCRONYS - Chief Executive Officer, Albuquerque, New Mexico, USA
| | - Carrie Jane Wallace
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Michael P Young
- Department of Critical Care, Renown Regional Medical Center, Reno, Nevada, USA
| | - Dean F Sittig
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas, USA
| | - Mary Suchyta
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - James E Pearl
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Antinio Pesenti
- Faculty of Medicine and Surgery—Anesthesiology, University of Milan, Milano, Lombardia, Italy
| | - Michela Bombino
- Department of Emergency and Intensive Care, San Gerardo Hospital, Monza (MB), Italy
| | - Eduardo Beck
- Faculty of Medicine and Surgery - Anesthesiology, University of Milan, Ospedale di Desio, Desio, Lombardia, Italy
| | - Katherine A Sward
- Department of Biomedical Informatics, College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Shobha Phansalkar
- Wolters Kluwer Health—Clinical Solutions—Medical Informatics, Wolters Kluwer Health, Newton, Massachusetts, USA
| | - Gordon R Bernard
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - B Taylor Thompson
- Pulmonary and Critical Care Division, Department of Internal Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Roy Brower
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jonathon Truwit
- Department of Internal Medicine, Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jay Steingrub
- Department of Internal Medicine, Pulmonary and Critical Care, University of Massachusetts Medical School, Baystate Campus, Springfield, Massachusetts, USA
| | - R Duncan Hiten
- Department of Internal Medicine, Pulmonary and Critical Care, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Douglas F Willson
- Pediatric Critical Care, Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jerry J Zimmerman
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Vinay Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adrienne G Randolph
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Martha A Q Curley
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Christopher J L Newth
- Childrens Hospital Los Angeles, Department of Anesthesiology and Critical Care, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jacques Lacroix
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Université de Montréal Faculté de Médecine, Montreal, Quebec, Canada
| | - Michael S D Agus
- Division of Medical Pediatric Critical Care, Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kang Hoe Lee
- Department of Intensive Care Medicine, Ng Teng Fong Hospital and National University Centre of Transplantation, National University Singapore Yong Loo Lin School of Medicine, Singapore
| | - Bennett P deBoisblanc
- Department of Internal Medicine, Pulmonary and Critical Care, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Frederick Alan Moore
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - R Scott Evans
- Department of Medical Informatics, Intermountain Healthcare, and Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Dean K Sorenson
- Department of Medical Informatics, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Anthony Wong
- Department of Data Science Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michael V Boland
- Department of Ophthalmology, Massachusetts Ear and Eye Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Willard H Dere
- Endocrinology and Metabolism Division, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Alan Crandall
- Department of Ophthalmology and Visual Sciences, Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
- Posthumous
| | - Julio Facelli
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Stanley M Huff
- Department of Medical Informatics, Intermountain Healthcare, Department of Biomedical Informatics, University of Utah, and Graphite Health, Salt Lake City, Utah, USA
| | - Peter J Haug
- Department of Medical Informatics, Intermountain Healthcare, and Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Ulrike Pielmeier
- Aalborg University Faculty of Engineering and Science - Department of Health Science and Technology, Respiratory and Critical Care Group, Aalborg, Nordjylland, Denmark
| | - Stephen E Rees
- Aalborg University Faculty of Engineering and Science - Department of Health Science and Technology, Respiratory and Critical Care Group, Aalborg, Nordjylland, Denmark
| | - Dan S Karbing
- Aalborg University Faculty of Engineering and Science - Department of Health Science and Technology, Respiratory and Critical Care Group, Aalborg, Nordjylland, Denmark
| | - Steen Andreassen
- Aalborg University Faculty of Engineering and Science - Department of Health Science and Technology, Respiratory and Critical Care Group, Aalborg, Nordjylland, Denmark
| | - Eddy Fan
- Internal Medicine, Pulmonary and Critical Care Division, Institute of Health Policy, Management and Evaluation, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Roberta M Goldring
- Department of Internal Medicine, Pulmonary and Critical Care, New York University School of Medicine, New York, New York, USA
| | - Kenneth I Berger
- Department of Internal Medicine, Pulmonary and Critical Care, New York University School of Medicine, New York, New York, USA
| | - Beno W Oppenheimer
- Department of Internal Medicine, Pulmonary and Critical Care, New York University School of Medicine, New York, New York, USA
| | - E Wesley Ely
- Internal Medicine, Pulmonary and Critical Care, Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Tennessee Valley Veteran’s Affairs Geriatric Research Education Clinical Center (GRECC), Nashville, Tennessee, USA
| | - Brian W Pickering
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - David A Schoenfeld
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Irena Tocino
- Department of Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Russell S Gonnering
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Peter J Pronovost
- Department of Anesthesiology and Critical Care Medicine, University Hospitals, Highland Hills, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Lucy A Savitz
- Northwest Center for Health Research, Kaiser Permanente, Oakland, California, USA
| | - Didier Dreyfuss
- Assistance Publique—Hôpitaux de Paris, Université de Paris, Sorbonne Université - INSERM unit UMR S_1155 (Common and Rare Kidney Diseases), Paris, France
| | - Arthur S Slutsky
- Interdepartmental Division of Critical Care Medicine, Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - James D Crapo
- Department of Internal Medicine, National Jewish Health, Denver, Colorado, USA
| | - Michael R Pinsky
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Brent James
- Department of Internal Medicine, Clinical Excellence Research Center (CERC), Stanford University School of Medicine, Stanford, California, USA
| | - Donald M Berwick
- Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
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Coiera E, Liu S. Evidence synthesis, digital scribes, and translational challenges for artificial intelligence in healthcare. Cell Rep Med 2022; 3:100860. [PMID: 36513071 PMCID: PMC9798027 DOI: 10.1016/j.xcrm.2022.100860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/15/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022]
Abstract
Healthcare has well-known challenges with safety, quality, and effectiveness, and many see artificial intelligence (AI) as essential to any solution. Emerging applications include the automated synthesis of best-practice research evidence including systematic reviews, which would ultimately see all clinical trial data published in a computational form for immediate synthesis. Digital scribes embed themselves in the process of care to detect, record, and summarize events and conversations for the electronic record. However, three persistent translational challenges must be addressed before AI is widely deployed. First, little effort is spent replicating AI trials, exposing patients to risks of methodological error and biases. Next, there is little reporting of patient harms from trials. Finally, AI built using machine learning may perform less effectively in different clinical settings.
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Affiliation(s)
- Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, Sydney, NSW 2109, Australia.
| | - Sidong Liu
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, Sydney, NSW 2109, Australia
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50
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Callander EJ, Teede H, Enticott J. Value in maternal care: Using the Learning Health System to facilitate action. Birth 2022; 49:589-594. [PMID: 36265164 PMCID: PMC9828125 DOI: 10.1111/birt.12684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/20/2022] [Accepted: 10/06/2022] [Indexed: 01/12/2023]
Abstract
There is an increasing need to deliver high-value health care. Here, we discuss how value should be measured and implemented in maternity care through a Learning Health System. High-value maternity care will produce the highest level of benefit for women at a given cost. As pregnancy is not an illness state, and there is no cure or remission to be achieved, we believe that patient-reported outcomes should be an integral component of benefit quantification when measuring value. Furthermore, as care impacts more than just health outcomes-particularly in maternity care-there is also a need to consider patient-reported experiences as a part of defining the level of benefit. However, to move beyond traditional narrow and passive measurement of value, we need to partner with stakeholders to identify priorities for change, identify evidence for how to achieve this change, integrate measurement activities, and promote effective implementation, in a continuous, learning cycle-a Learning Health System. A robust Framework for implementing a Learning Health System has been developed, which could be applied in maternity care.
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Affiliation(s)
- Emily J. Callander
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia,Monash Centre for Health Research and ImplementationMonash UniversityMelbourneVictoriaAustralia
| | - Helena Teede
- Monash Centre for Health Research and ImplementationMonash UniversityMelbourneVictoriaAustralia
| | - Joanne Enticott
- Monash Centre for Health Research and ImplementationMonash UniversityMelbourneVictoriaAustralia
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