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Mumma JM, Weaver BW, Morgan JS, Ghassemian G, Gannon PR, Burke KB, Berryhill BA, MacKay RE, Lee L, Kraft CS. Connecting pathogen transmission and healthcare worker cognition: a cognitive task analysis of infection prevention and control practices during simulated patient care. BMJ Qual Saf 2024; 33:419-431. [PMID: 38050151 DOI: 10.1136/bmjqs-2023-016230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 10/25/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Relatively little is known about the cognitive processes of healthcare workers that mediate between performance-shaping factors (eg, workload, time pressure) and adherence to infection prevention and control (IPC) practices. We taxonomised the cognitive work involved in IPC practices and assessed its role in how pathogens spread. METHODS Forty-two registered nurses performed patient care tasks in a standardised high-fidelity simulation. Afterwards, participants watched a video of their simulation and described what they were thinking, which we analysed to obtain frequencies of macrocognitive functions (MCFs) in the context of different IPC practices. Performance in the simulation was the frequency at which participants spread harmless surrogates for pathogens (bacteriophages). Using a tertiary split, participants were categorised into a performance group: high, medium or low. To identify associations between the three variables-performance groups, MCFs and IPC practices-we used multiblock discriminant correspondence analysis (MUDICA). RESULTS MUDICA extracted two factors discriminating between performance groups. Factor 1 captured differences between high and medium performers. High performers monitored the situation for contamination events and mitigated risks by applying formal and informal rules or managing their uncertainty, particularly for sterile technique and cleaning. Medium performers engaged more in future-oriented cognition, anticipating contamination events and planning their workflow, across many IPC practices. Factor 2 distinguished the low performers from the medium and high performers who mitigated risks with informal rules and sacrificed IPC practices when managing tradeoffs, all in the context of minimising cross-contamination from physical touch. CONCLUSIONS To reduce pathogen transmission, new approaches to training IPC (eg, cognitive skills training) and system design are needed. Interventions should help nurses apply their knowledge of IPC fluidly during patient care, prioritising and monitoring situations for risks and deciding how to mitigate risks. Planning IPC into one's workflow is beneficial but may not account for the unpredictability of patient care.
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Affiliation(s)
- Joel M Mumma
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Bradley W Weaver
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
- Office of Quality, Emory Healthcare, Atlanta, Georgia, USA
| | - Jill S Morgan
- Clinical Research, Emory University Hospital, Atlanta, Georgia, USA
- Critical Care, Emory University Hospital, Atlanta, Georgia, USA
| | | | - Paige R Gannon
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Kylie B Burke
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Brandon A Berryhill
- Department of Biology, Emory University, Atlanta, Georgia, USA
- Program in Microbiology and Molecular Genetics, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, USA
| | - Rebecca E MacKay
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Lindsay Lee
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Colleen S Kraft
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
- Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Jagpal SK, Alismail A, Lin E, Blackwell L, Ahmed N, Lee MM, Chiarchiaro J. Beyond the Individual: A Multidisciplinary Model for Critical Thinking in the Intensive Care Unit. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:409-417. [PMID: 38764787 PMCID: PMC11102104 DOI: 10.2147/amep.s429982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/19/2024] [Indexed: 05/21/2024]
Abstract
Health profession educators readily identify with the goal of fostering healthcare providers who are critical thinkers focused on quality patient care. In the following paper, we aim to delve into critical thinking at the team level and help educators begin the process of creating a shared mental model focusing on cognition to identify gaps and opportunities for growth in their trainees. We will distinguish between microcognition (an individual's own critical thinking process in a controlled environment), macrocognition (critical thinking process in a real-world environment), and team cognition (the interaction and relationship among team members to augment macrocognition). A common case example will be used to guide the discussion as well as provide a model framework to be used for clinician educators in the future.
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Affiliation(s)
- Sugeet K Jagpal
- Division of Pulmonary, Critical Care and Sleep Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Abdullah Alismail
- Department of Cardiopulmonary Sciences, School of Allied Health Professions, Loma Linda University Health, Loma Linda, CA, USA
- Department of Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Erica Lin
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, La Jolla, CA, USA
| | - Lauren Blackwell
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Beth Israel Hospital, Icahn School of Medicine, New York, NY, USA
| | - Nayla Ahmed
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - May M Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, University of South California, Los Angeles, CA, USA
| | - Jared Chiarchiaro
- Division of Allergy, and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
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JaKa MM, Beran MS, Andersen JA, Whitebird RR, Bergdall AR, Kindt JM, Dehmer SP, Winger M, Solberg LI. The Role of Care Coordination: A Qualitative Study of Care Coordinator Perceptions. J Nurs Care Qual 2024; 39:44-50. [PMID: 37163721 DOI: 10.1097/ncq.0000000000000719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Care coordination is important for patients with complex needs; yet, little is known about the factors impacting implementation from the care coordinator perspective. PURPOSE To understand how care coordination implementation differs across clinics and what care coordinators perceive as barriers and facilitators of effective coordination. METHODS Nineteen care coordinators from primary care clinics in Minnesota participated in interviews about their perceptions of care coordination. A team of analysts coded interviews using inductive thematic analysis. RESULTS Four major themes emerged: variety in care coordination implementation; importance of social needs; necessity for leader buy-in; and importance of communication skills. CONCLUSIONS Described differences in care coordination implementation were often logistical, but the implications of these differences were foundational to care coordinator perceived effectiveness.
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Affiliation(s)
- Meghan M JaKa
- Center for Evaluation and Survey Research, HealthPartners Institute (Dr JaKa and Ms Andersen), HealthPartners Institute (Drs Beran, Dehmer, and Solberg and Mss Bergdall and Winger), Bloomington, Minnesota; Morrison Family College of Health, University of St Thomas, St Paul, Minnesota (Dr Whitebird); and Minnesota Department of Health, St Paul (Ms Kindt)
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Molayaghobi NS, Abazari P, Taleghani F, Iraj B. Lived Experiences of Diabetes Team and Patients about Diabetes Care System after Redesigning Delivery System and Supporting Self-Management in Iran: A Qualitative Research. Int J Prev Med 2022; 13:85. [PMID: 35958364 PMCID: PMC9362745 DOI: 10.4103/ijpvm.ijpvm_238_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/27/2020] [Indexed: 11/13/2022] Open
Abstract
Background Diabetes as a chronic disease requires a change in the paradigm of treatment and health care system based on acute illnesses to chronic conditions. Chronic Care Model has been designed to address this need. This study aimed to explore the lived experiences of the diabetes team and diabetic patients regarding the health care system after redesigning delivery system and supporting self-management based on the Chronic Care Model in Iran. Methods Research was conducted with a qualitative descriptive approach in one of the Isfahan city clinics in 2018. The participants were diabetes team (composed of diabetes physician, nurse, assistant nurse and dean of the clinic) and 17 type- 2 diabetic patients who were selected through purposive sampling. Data collection was performed through semi-structured interviews and then were analyzed using content analysis with an inductive approach. Results The findings of this study were composed of the following two main categories: (1) educational function change, including the sub-categories of evidence-based nurse education and patients' demand to ongoing participation in the training classes; and (2) treatment and care method upgrade, including the sub-categories of nurse's role change in a team approach, continuity in cares and upgrading patients' self-care behaviors. Conclusions Delivery system redesign and diabetes self-management support based on Chronic Care Model changed organizational structure and performance of the diabetes care system. It also reformed the structure of treatment providers from a vertical and hierarchical form to a team arrangement. Nurse's educational function became evidence-based and patients' self-care behaviors upgraded.
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Affiliation(s)
| | - Parvaneh Abazari
- Department of Nursing, Najafabad Branch Islamic Azad University, Najafabad, Iran,Address for correspondence: Dr. Parvaneh Abazari, Department of Nursing, Najafabad Branch Islamic Azad University, Najafabad, Iran. E-mail:
| | - Fariba Taleghani
- RN, Professor, MSN, BSN, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bijan Iraj
- Associate Professor of Endocrinology, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Assadi A, Laussen PC, Freire G, Trbovich P. Understanding Clinician Macrocognition to Inform the Design of a Congenital Heart Disease Clinical Decision Support System. Front Cardiovasc Med 2022; 9:767378. [PMID: 35187118 PMCID: PMC8850471 DOI: 10.3389/fcvm.2022.767378] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Children with congenital heart disease (CHD) are at risk of deterioration in the face of common childhood illnesses, and their resuscitation and acute treatment requires guidance of CHD experts. Many children with CHD, however, present to their local emergency departments (ED) with gastrointestinal and respiratory symptoms that closely mimic symptoms of CHD related heart failure. This can lead to incorrect or delayed diagnosis and treatment where CHD expertise is limited. An understanding of the differences in cognitive decision-making processes between CHD experts and ED physicians can inform how best to support ED physicians when treating CHD patients. Methods Cardiac intensivists (CHD experts) and pediatric emergency department physicians (ED physicians) in a major academic cardiac center were interviewed using the critical decision method. Interview transcripts were coded deductively based on Schubert and Klein's macrocognitive frameworks and inductively to allow for new or modified characterization of dimensions. Results In total, 6 CHD experts and 7 ED physicians were interviewed for this study. Although both CHD experts and ED physicians spent a lot of time sensemaking, their approaches to sensemaking differed. CHD experts reported readily recognizing the physiology of complex congenital heart disease and focused primarily on ruling out cardiac causes for the presenting illness. ED physicians reported a delay in attributing the signs and symptoms of the presenting illness to congenital heart disease, because these clinical findings were often non-specific, and thus explored different diagnoses. CHD experts moved quickly to treatment and more time anticipating potential problems and making specific contingency plans, while ED physicians spent more time gathering a range of data prior to arriving at a diagnosis. These findings were then applied to develop a prototype web-based decision support application for patients with CHD. Conclusion There are differences in the cognitive processes used by CHD experts and ED physicians when managing CHD patients. An understanding of differences in the cognitive processes used by CHD experts and ED physicians can inform the development of potential interventions, such as clinical decision support systems and training pathways, to support decision making pertaining to the acute treatment of pediatric CHD patients.
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Affiliation(s)
- Azadeh Assadi
- Department of Critical Care Medicine, Labatt Family Heart Centre, Toronto, ON, Canada
- Department of Engineering and Applied Sciences, Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- *Correspondence: Azadeh Assadi
| | - Peter C. Laussen
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Executive Vice President for Health Affairs, Boston Children's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Gabrielle Freire
- Division of Emergency Medicine, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Patricia Trbovich
- Department of Engineering and Applied Sciences, Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Research and Innovation, North York General Hospital, Toronto, ON, Canada
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6
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Kandel ZK, Rittenhouse DR, Bibi S, Fraze TK, Shortell SM, Rodríguez HP. The CMS State Innovation Models Initiative and Improved Health Information Technology and Care Management Capabilities of Physician Practices. Med Care Res Rev 2020; 78:350-360. [PMID: 31967494 DOI: 10.1177/1077558719901217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Centers for Medicare and Medicaid Services' (CMS) State Innovation Models (SIMs) initiative funded 17 states to implement health care payment and delivery system reforms to improve health system performance. Whether SIM improved health information technology (HIT) and care management capabilities of physician practices, however, remains unclear. National surveys of physician practices (N = 2,722) from 2012 to 2013 and 2017 to 2018 were linked. Multivariable regression estimated differential adoption of 10 HIT functions and chronic care management processes (CMPs) based on SIM award status (SIM Round 1, SIM Round 2, or non-SIM). HIT and CMP capabilities improved equally for practices in SIM Round 1 (5.3 vs. 6.8 capabilities, p < .001), SIM Round 2 (4.7 vs. 7.0 capabilities, p < .001), and non-SIM (4.2 vs. 6.3 capabilities, p < .001) states. The CMS SIM Initiative did not accelerate the adoption of ten foundational physician practice capabilities beyond national trends.
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Affiliation(s)
| | - Diane R Rittenhouse
- University of California, Berkeley, CA, USA.,University of California, San Francisco, CA, USA
| | - Salma Bibi
- University of California, Berkeley, CA, USA
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Peixoto MVDS, Chaves SCL. Analysis of the national hearing health care policy implementation in a Brazilian State. Codas 2019; 31:e20180092. [PMID: 31271577 DOI: 10.1590/2317-1782/20182018092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/30/2018] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The present study aimed to analyze the degree of implementation of the national health care policy at the state level. METHODS This qualitative evaluation study was carried out in two stages. Firstly, the policy was modelled by means of document analysis and the application of the Delphi technique for consensus among experts. In the second stage, a qualitative, exploratory evaluative research was conducted, designed as a single case study in a Brazilian state through semi-structured interviews with health managers. RESULTS The experts reached a consensus for a logical model and an evaluation matrix of the policy implementation. The results at the state level evinced an incipient degree of implementation, as the level of government characteristics achieved 45% of the maximum score; management, 41%; and system organization, 33%. CONCLUSION The degree of implementation in the state evaluated was classified as incipient. Barriers were identified in the management and organization levels of the system, as well as in the political context.
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Lin YL, Tomasi J, Guerguerian AM, Trbovich P. Technology-mediated macrocognition: Investigating how physicians, nurses, and respiratory therapists make critical decisions. J Crit Care 2019; 53:132-141. [PMID: 31228764 DOI: 10.1016/j.jcrc.2019.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/09/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Although intensive care clinicians are expected to make data-driven critical decisions using the technologies available to them, the effect of those technologies on decision-making are not well understood. Using the macrocognitive framework, we studied critical decision-making and technology use to understand how different specialists within teams make decisions and guide the development of decision-making support technologies. MATERIALS AND METHODS The Critical Decision Method was used to understand the macrocognitive processes used during critical decision-making of twelve critical care clinicians. Deductive (based on the macrocognition framework) and inductive coding were used to analyze the macrocognitive processes, their interrelationships, and their relation to technologies. RESULTS Over 60% of critical decision-making macrocognition was devoted to Sensemaking, Anticipation, and Communication. The most technology-mediated process was Sensemaking. Of particular note, physicians and respiratory therapists extracted information for their own use, while nurses extracted information to communicate to others. Physicians switched between ten macrocognitive processes, whereas nurses and respiratory therapists switched between five processes. CONCLUSIONS This exploratory study provides much needed details about the different ways in which specialists use technologies to support decision-making tasks, particularly those involving sensemaking, which are essential to the design and development of decision-support technologies.
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Affiliation(s)
- Ying Ling Lin
- Institute of Biomaterials and Biomedical Engineering, Faculty of Engineering, University of Toronto, Toronto, Canada; Interdepartmental Division of Critical Care Medicine, Hospital for Sick Children, Toronto, Canada
| | - Jessica Tomasi
- Institute of Biomaterials and Biomedical Engineering, Faculty of Engineering, University of Toronto, Toronto, Canada
| | - Anne-Marie Guerguerian
- Institute of Biomaterials and Biomedical Engineering, Faculty of Engineering, University of Toronto, Toronto, Canada; Interdepartmental Division of Critical Care Medicine, Hospital for Sick Children, Toronto, Canada; Faculty of Medicine, University of Toronto, Toronto, Canada; Neuroscience and Mental Health Research, Hospital for Sick Children, Toronto, Canada
| | - Patricia Trbovich
- Institute of Biomaterials and Biomedical Engineering, Faculty of Engineering, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Research and Innovation, North York General Hospital, Toronto, Canada.
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Reimer T, Lee SJC, Garcia S, Gill M, Duncan T, Williams EL, Gerber DE. Cancer Center Clinic and Research Team Perceptions of Identity and Interactions. J Oncol Pract 2017; 13:e1021-e1029. [PMID: 29028418 PMCID: PMC5728363 DOI: 10.1200/jop.2017.024349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Conduct of cancer clinical trials requires coordination and cooperation among research and clinic teams. Diffusion of and confusion about responsibility may occur if team members' perceptions of roles and objectives do not align. These factors are critical to the success of cancer centers but are poorly studied. METHODS We developed a survey adapting components of the Adapted Team Climate Inventory, Measure of Team Identification, and Measure of In-Group Bias. Surveys were administered to research and clinic staff at a National Cancer Institute-designated comprehensive cancer center. Data were analyzed using descriptive statistics, t tests, and analyses of variance. RESULTS Responses were received from 105 staff (clinic, n = 55; research, n = 50; 61% response rate). Compared with clinic staff, research staff identified more strongly with their own group ( P < .01) but less strongly with the overall cancer center ( P = .02). Both clinic staff and research staff viewed their own group's goals as clearer than those of the other group ( P < .01) and felt that members of their groups interacted and shared information within ( P < .01) and across ( P < .01) groups more than the other group did. Research staff perceived daily outcomes as more important than did clinic staff ( P = .05), specifically research-related outcomes ( P = .07). CONCLUSION Although there are many similarities between clinic and research teams, we also identified key differences, including perceptions of goal clarity and sharing, understanding and alignment with cancer center goals, and importance of outcomes. Future studies should examine how variation in perceptions and group dynamics between clinic and research teams may impact function and processes of cancer care.
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Affiliation(s)
- Torsten Reimer
- Purdue University, West Lafayette, IN; and University of Texas Southwestern Medical Center, Dallas, TX,Corresponding author: Torsten Reimer, PhD, Departments of Communication and Psychology, Purdue University, 100 North University St, West Lafayette, IN 47907-2098; e-mail:
| | - Simon J. Craddock Lee
- Purdue University, West Lafayette, IN; and University of Texas Southwestern Medical Center, Dallas, TX
| | - Sandra Garcia
- Purdue University, West Lafayette, IN; and University of Texas Southwestern Medical Center, Dallas, TX
| | - Mary Gill
- Purdue University, West Lafayette, IN; and University of Texas Southwestern Medical Center, Dallas, TX
| | - Tobi Duncan
- Purdue University, West Lafayette, IN; and University of Texas Southwestern Medical Center, Dallas, TX
| | - Erin L. Williams
- Purdue University, West Lafayette, IN; and University of Texas Southwestern Medical Center, Dallas, TX
| | - David E. Gerber
- Purdue University, West Lafayette, IN; and University of Texas Southwestern Medical Center, Dallas, TX
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Walton H, Spector A, Tombor I, Michie S. Measures of fidelity of delivery of, and engagement with, complex, face-to-face health behaviour change interventions: A systematic review of measure quality. Br J Health Psychol 2017; 22:872-903. [PMID: 28762607 PMCID: PMC5655766 DOI: 10.1111/bjhp.12260] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 06/21/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Understanding the effectiveness of complex, face-to-face health behaviour change interventions requires high-quality measures to assess fidelity of delivery and engagement. This systematic review aimed to (1) identify the types of measures used to monitor fidelity of delivery of, and engagement with, complex, face-to-face health behaviour change interventions and (2) describe the reporting of psychometric and implementation qualities. METHODS Electronic databases were searched, systematic reviews and reference lists were hand-searched, and 21 experts were contacted to identify articles. Studies that quantitatively measured fidelity of delivery of, and/or engagement with, a complex, face-to-face health behaviour change intervention for adults were included. Data on interventions, measures, and psychometric and implementation qualities were extracted and synthesized using narrative analysis. RESULTS Sixty-six studies were included: 24 measured both fidelity of delivery and engagement, 20 measured fidelity of delivery, and 22 measured engagement. Measures of fidelity of delivery included observation (n = 17; 38.6%), self-report (n = 15; 34%), quantitatively rated qualitative interviews (n = 1; 2.3%), or multiple measures (n = 11; 25%). Measures of engagement included self-report (n = 18; 39.1%), intervention records (n = 11; 24%), or multiple measures (n = 17; 37%). Fifty-one studies (77%) reported at least one psychometric or implementation quality; 49 studies (74.2%) reported at least one psychometric quality, and 17 studies (25.8%) reported at least one implementation quality. CONCLUSION Fewer than half of the reviewed studies measured both fidelity of delivery of, and engagement with complex, face-to-face health behaviour change interventions. More studies reported psychometric qualities than implementation qualities. Interpretation of intervention outcomes from fidelity of delivery and engagement measurements may be limited due to a lack of reporting of psychometric and implementation qualities. Statement of contribution What is already known on this subject? Evidence of fidelity and engagement is needed to understand effectiveness of complex interventions Evidence of fidelity and engagement are rarely reported High-quality measures are needed to measure fidelity and engagement What does this study add? Evidence that indicators of quality of measures are reported in some studies Evidence that psychometric qualities are reported more frequently than implementation qualities A recommendation for intervention evaluations to report indicators of quality of fidelity and engagement measures.
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Affiliation(s)
- Holly Walton
- Department of Clinical, Educational and Health PsychologyUniversity College LondonUK
| | - Aimee Spector
- Department of Clinical, Educational and Health PsychologyUniversity College LondonUK
| | - Ildiko Tombor
- Department of Epidemiology and Public HealthUniversity College LondonUK
| | - Susan Michie
- Department of Clinical, Educational and Health PsychologyUniversity College LondonUK
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Holtrop JS, Luo Z, Piatt G, Green LA, Chen Q, Piette J. Diabetic and Obese Patient Clinical Outcomes Improve During a Care Management Implementation in Primary Care. J Prim Care Community Health 2017. [PMID: 28645227 PMCID: PMC5932733 DOI: 10.1177/2150131917715536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: To address the increasing burden of chronic disease, many primary care practices are turning to care management and the hiring of care managers to help patients coordinate their care and self-manage their conditions. Care management is often, but not always, proving effective at improving patient outcomes, but more evidence is needed. Methods: In this pair-matched cluster randomized trial, 5 practices implemented care management and were compared with 5 comparison practices within the same practice organization. Targeted patients included diabetic patients with a hemoglobin A1c >9% and nondiabetic obese patients. Clinical values tracked were A1c, blood pressure, low-density lipoprotein, microalbumin, and weight. Results: Clinically important improvements were demonstrated in the intervention versus comparison practices, with diabetic patients improving A1c control and obese patients experiencing weight loss. There was a 12% relative increase in the proportion of patients meeting the clinical target of A1c <7% (95% CI, 3%-20%), and 26% of obese nondiabetic patients in chronic care management practices lost 5% or more of their body weight as compared with 10% of comparison patients (adjusted relative improvement, 15%; CI, 2%-28%). Conclusions: These findings add to the growing evidence-base for the effectiveness of care management as an effective clinical practice with regard to improving diabetes- and obesity-related outcomes.
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Affiliation(s)
| | - Zhehui Luo
- 2 Michigan State University College of Human Medicine, East Lansing, MI, USA
| | | | - Lee A Green
- 4 University of Alberta School of Medicine, Edmonton, Alberta, Canada
| | - Qiaoling Chen
- 2 Michigan State University College of Human Medicine, East Lansing, MI, USA.,5 Kaiser Permanente Southern California, Pasadena, CA, USA
| | - John Piette
- 3 University of Michigan, Ann Arbor, MI, USA.,6 Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
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Understanding the experience of care managers and relationship with patient outcomes: the COMPASS initiative. Gen Hosp Psychiatry 2017; 44:86-90. [PMID: 27558105 DOI: 10.1016/j.genhosppsych.2016.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 03/28/2016] [Accepted: 03/31/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To understand how care managers implemented COMPASS and if this was related to patient health outcomes. METHODS A total of 96 COMPASS care managers were approached to participate in the online survey and 93 (97%) provided responses. Correlations were generated between key survey responses and the average number of care management contacts, patient depression, blood pressure and glycosylated hemoglobin outcomes. RESULTS Patients of care managers who reported spending more time on COMPASS-related tasks had higher rates of depression improvement (r=0.34; P=.002) and remission (r=0.27; P=.02) as well as higher rates of blood pressure control (r=0.29; P=.03). CONCLUSIONS To improve the effectiveness of care management in collaborative care models, particularly for patients with comorbid conditions and complex nonmedical needs, care managers need the support of social work and administrative support staff. Care managers for this patient population would also benefit from more intensive training in nonpharmacological depression treatment, such as motivational interviewing and behavioral activation. Additionally, systems support is needed such as education for primary care teams and psychiatry on the value of collaborative care models and integration of population management tools into electronic medical records.
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Alyousef B, Carayon P, Hoonakker P, Hundt AS, Salek D, Tomcavage J. Obstacles Experienced by Care Managers in Managing Information for the Care of Chronically Ill Patients. INTERNATIONAL JOURNAL OF HUMAN-COMPUTER INTERACTION 2017; 33:313-321. [PMID: 31186604 PMCID: PMC6557451 DOI: 10.1080/10447318.2016.1270017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Care managers play a key role in coordinating care, especially for patients with chronic conditions. They use multiple health information technology application in order to access, process and communicate patient-related information. Using the work system model and its extension, the SEIPS model (Carayon et al., 2006a; Smith and Carayon-Sainfort, 1989), we describe obstacles experienced by care manager in managing patient-related information. A web-based questionnaire was used to collect data from 80 care managers (61% response rate) located in clinics, hospitals and a call center. Care managers were more likely to consider 'inefficiencies in access to patient-related information' and 'having to use multiple information systems' as major obstacles than 'lack of computer training and support' and 'inefficient use of case management software.' Care managers who reported inefficient use of software as an obstacle were more likely to report high workload. Future research should explore strategies used by care managers' to address obstacles, and efforts should be targeted at improving the health information technologies used by care managers.
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Affiliation(s)
| | - Pascale Carayon
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Peter Hoonakker
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison
| | - Ann Schoofs Hundt
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison
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14
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Luo Z, Chen Q, Annis AM, Piatt G, Green LA, Tao M, Holtrop JS. A Comparison of Health Plan- and Provider-Delivered Chronic Care Management Models on Patient Clinical Outcomes. J Gen Intern Med 2016; 31:762-70. [PMID: 26951287 PMCID: PMC4907946 DOI: 10.1007/s11606-016-3617-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 08/31/2015] [Accepted: 02/01/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The real world implementation of chronic care management model varies greatly. One aspect of this variation is the delivery mode. Two contrasting strategies include provider-delivered care management (PDCM) and health plan-delivered care management (HPDCM). OBJECTIVE We aimed to compare the effectiveness of PDCM vs. HPDCM on improving clinical outcomes for patients with chronic diseases. DESIGN We used a quasi-experimental two-group pre-post design using the difference-in-differences method. PATIENTS Commercially insured patients, with any of the five chronic diseases-congestive heart failure, chronic obstructive pulmonary disease, coronary heart disease, diabetes, or asthma, who were outreached to and engaged in either PDCM or HPDCM were included in the study. MAIN MEASURES Outreached patients were those who received an attempted or actual contact for enrollment in care management; and engaged patients were those who had one or more care management sessions/encounters with a care manager. Effectiveness measures included blood pressure, low density lipoprotein (LDL), weight loss, and hemoglobin A1c (for diabetic patients only). Primary endpoints were evaluated in the first year of follow-up. KEY RESULTS A total of 4,000 patients were clustered in 165 practices (31 in PDCM and 134 in HPDCM). The PDCM approach demonstrated a statistically significant improvement in the proportion of outreached patients whose LDL was under control: the proportion of patients with LDL < 100 mg/dL increased by 3 % for the PDCM group (95 % CI: 1 % to 6 %) and 1 % for the HPDCM group (95 % CI: -2 % to 5 %). However, the 2 % difference in these improvements was not statistically significant (95 % CI: -2 % to 6 %). The HPDCM approach showed 3 % [95 % CI: 2 % to 6 %] improvement in overall diabetes care among outreached patients and significant reduction in obesity rates compared to PDCM (4 %, 95 % CI: 0.3 % to 8 %). CONCLUSIONS Both care management delivery modes may be viable options for improving care for patients with chronic diseases. In this commercially insured population, neither PDCM nor HPDCM resulted in substantial improvement in patients' clinical indicators in the first year. Different care management strategies within the provider-delivered programs need further investigation.
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Affiliation(s)
- Zhehui Luo
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
| | - Qiaoling Chen
- Department of Research and Evaluation, Kaiser Permanente Sourthen California, Pasadena, CA, USA
| | - Ann M Annis
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Gretchen Piatt
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Lee A Green
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Min Tao
- Clinical Epidemiology and Biostatistics, Blue Cross Blue Shield of Michigan, Detroit, MI, USA
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15
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Abstract
We trace several trajectories-the evolution of field-based decision making models in the mid-1980s to the formation of the Naturalistic Decision Making movement in 1989, then the further broadening of NDM into Macrocognition in 2003, and finally the transition from macrocognitive models into a set of methods and tools to boost cognitive performance.
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