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McGuier EA, Kolko DJ, Aarons GA, Schachter A, Klem ML, Diabes MA, Weingart LR, Salas E, Wolk CB. Teamwork and implementation of innovations in healthcare and human service settings: a systematic review. Implement Sci 2024; 19:49. [PMID: 39010100 PMCID: PMC11247800 DOI: 10.1186/s13012-024-01381-9] [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: 01/18/2024] [Accepted: 07/07/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Implementation of new practices in team-based settings requires teams to work together to respond to new demands and changing expectations. However, team constructs and team-based implementation approaches have received little attention in the implementation science literature. This systematic review summarizes empirical research examining associations between teamwork and implementation outcomes when evidence-based practices and other innovations are implemented in healthcare and human service settings. METHODS We searched MEDLINE, CINAHL, APA PsycINFO and ERIC for peer-reviewed empirical articles published from January 2000 to March 2022. Additional articles were identified by searches of reference lists and a cited reference search for included articles (completed in February 2023). We selected studies using quantitative, qualitative, or mixed methods to examine associations between team constructs and implementation outcomes in healthcare and human service settings. We used the Mixed Methods Appraisal Tool to assess methodological quality/risk of bias and conducted a narrative synthesis of included studies. GRADE and GRADE-CERQual were used to assess the strength of the body of evidence. RESULTS Searches identified 10,489 results. After review, 58 articles representing 55 studies were included. Relevant studies increased over time; 71% of articles were published after 2016. We were unable to generate estimates of effects for any quantitative associations because of very limited overlap in the reported associations between team variables and implementation outcomes. Qualitative findings with high confidence were: 1) Staffing shortages and turnover hinder implementation; 2) Adaptive team functioning (i.e., positive affective states, effective behavior processes, shared cognitive states) facilitates implementation and is associated with better implementation outcomes; Problems in team functioning (i.e., negative affective states, problematic behavioral processes, lack of shared cognitive states) act as barriers to implementation and are associated with poor implementation outcomes; and 3) Open, ongoing, and effective communication within teams facilitates implementation of new practices; poor communication is a barrier. CONCLUSIONS Teamwork matters for implementation. However, both team constructs and implementation outcomes were often poorly specified, and there was little overlap of team constructs and implementation outcomes studied in quantitative studies. Greater specificity and rigor are needed to understand how teamwork influences implementation processes and outcomes. We provide recommendations for improving the conceptualization, description, assessment, analysis, and interpretation of research on teams implementing innovations. TRIAL REGISTRATION This systematic review was registered in PROSPERO, the international prospective register of systematic reviews. REGISTRATION NUMBER CRD42020220168.
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Affiliation(s)
- Elizabeth A McGuier
- Department of Psychiatry, School of Medicine, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA.
| | - David J Kolko
- Department of Psychiatry, School of Medicine, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- ACTRI Dissemination and Implementation Science Center, UC San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Allison Schachter
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Mary Lou Klem
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matthew A Diabes
- Tepper School of Business, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Laurie R Weingart
- Tepper School of Business, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Eduardo Salas
- Department of Psychological Sciences, Rice University, Houston, TX, USA
| | - Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Hunter B, Davidson S, Lumsden N, Chima S, Gutierrez JM, Emery J, Nelson C, Manski-Nankervis JA. Optimising a clinical decision support tool to improve chronic kidney disease management in general practice. BMC PRIMARY CARE 2024; 25:220. [PMID: 38898462 PMCID: PMC11186183 DOI: 10.1186/s12875-024-02470-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Early identification and treatment of chronic disease is associated with better clinical outcomes, lower costs, and reduced hospitalisation. Primary care is ideally placed to identify patients at risk of, or in the early stages of, chronic disease and to implement prevention and early intervention measures. This paper evaluates the implementation of a technological intervention called Future Health Today that integrates with general practice EMRs to (1) identify patients at-risk of, or with undiagnosed or untreated, chronic kidney disease (CKD), and (2) provide guideline concordant recommendations for patient care. The evaluation aimed to identify the barriers and facilitators to successful implementation. METHODS Future Health Today was implemented in 12 general practices in Victoria, Australia. Fifty-two interviews with 30 practice staff were undertaken between July 2020 and April 2021. Practice characteristics were collected directly from practices via survey. Data were analysed using inductive and deductive qualitative analysis strategies, using Clinical Performance - Feedback Intervention Theory (CP-FIT) for theoretical guidance. RESULTS Future Health Today was acceptable, user friendly and useful to general practice staff, and supported clinical performance improvement in the identification and management of chronic kidney disease. CP-FIT variables supporting use of FHT included the simplicity of design and delivery of actionable feedback via FHT, good fit within existing workflow, strong engagement with practices and positive attitudes toward FHT. Context variables provided the main barriers to use and were largely situated in the external context of practices (including pressures arising from the COVID-19 pandemic) and technical glitches impacting installation and early use. Participants primarily utilised the point of care prompt rather than the patient management dashboard due to its continued presence, and immediacy and relevance of the recommendations on the prompt, suggesting mechanisms of compatibility, complexity, actionability and credibility influenced use. Most practices continued using FHT after the evaluation phase was complete. CONCLUSIONS This study demonstrates that FHT is a useful and acceptable software platform that provides direct support to general practice in identifying and managing patients with CKD. Further research is underway to explore the effectiveness of FHT, and to expand the conditions on the platform.
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Affiliation(s)
- Barbara Hunter
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia.
| | - Sandra Davidson
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
| | - Natalie Lumsden
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
- Western Health Chronic Disease Alliance, Western Health Melbourne, Melbourne, Australia
| | - Sophie Chima
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
| | - Javiera Martinez Gutierrez
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Family Medicine Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jon Emery
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- The Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Craig Nelson
- Western Health Chronic Disease Alliance, Western Health Melbourne, Melbourne, Australia
- Department of Medicine - Western Health, University of Melbourne, Melbourne, Australia
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Koo YR, Kim EJ, Nam IC. Development of a communication platform for patients with head and neck cancer for effective information delivery and improvement of doctor-patient relationship: application of treatment journey-based service blueprint. BMC Med Inform Decis Mak 2024; 24:81. [PMID: 38509511 PMCID: PMC10956258 DOI: 10.1186/s12911-024-02477-4] [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: 06/05/2023] [Accepted: 03/07/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Effective communication and information delivery enhance doctor-patient relationships, improves adherence to treatment, reduces work burden, and supports decision-making. The study developed a head and neck cancer (HNC) communication platform to support effective delivery of information about HNC treatment and improve the doctor-patient relationship. METHODS This study was structured in three main phases: 1) The requirement elicitation phase sought an understanding of the HNC treatment journey and service failure points (FPs) obtained through patient/medical staff interviews and observations, along with a review of the electronic health record system; 2) The development phase involved core needs analysis, solutions development through a co-creation workshop, and validation of the solutions through focus groups; and 3) the proposed HNC communication platform was integrated with the current treatment system, and the flow and mechanism of the interacting services were structured using a service blueprint (SB). RESULTS Twenty-two service FPs identified through interviews and observations were consolidated into four core needs, and solutions were proposed to address each need: an HNC treatment journey map, cancer survivor stories, operation consent redesign with surgical illustrations, and a non-verbal communication toolkit. The communication platform was designed through the SB in terms of the stage at which the solution was applied and the actions and interactions of the service providers. CONCLUSIONS The developed platform has practical significance, reflecting a tangible service improvement for both patients and medical staff, making it applicable in hospital settings.
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Affiliation(s)
- Yoo-Ri Koo
- Department of Service Design, Graduate School of Industrial Arts, Hongik University, Seoul, 04066, Korea
| | - Eun-Jeong Kim
- Department of Industry-Academic Cooperation Foundation, The Catholic University of Korea, Seoul, 06591, Korea
| | - Inn-Chul Nam
- Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, 21431, Korea.
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Antonacci G, Williams A, Smith J, Green L. Study of Whole blood in Frontline Trauma (SWiFT): implementation study protocol. BMJ Open 2024; 14:e078953. [PMID: 38316586 PMCID: PMC11145983 DOI: 10.1136/bmjopen-2023-078953] [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: 08/16/2023] [Accepted: 01/04/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Uncontrolled bleeding is a major cause of death for patients with major trauma. Current transfusion practices vary, and there is uncertainty about the optimal strategy. Whole blood (WB) transfusion, which contains all components in one bag, is considered potentially advantageous, particularly for resuscitating patients with major bleeding in the prehospital setting. It could potentially improve survival, reduce donor risk and simplify the processes of delivering blood transfusions outside hospitals. However, the evidence supporting the effectiveness and safety of WB compared with the standard separate blood component therapy is limited. A multicentre randomised controlled trial will be conducted, alongside an implementation study, to assess the efficacy, cost-effectiveness and implementation of prehospital WB transfusion in the prehospital environment. The implementation study will focus on evaluating the acceptability and integration of the intervention into clinical settings and on addressing broader contextual factors that may influence its success or failure. METHODS AND ANALYSIS A type 1 effectiveness-implementation hybrid design will be employed. The implementation study will use qualitative methods, encompassing comprehensive interviews and focus groups with operational staff, patients and blood donor representatives. Staff will be purposefully selected to ensure a wide range of perspectives based on their professional background and involvement in the WB pathway. The study design includes: (1) initial assessment of current practice and processes in the WB pathway; (2) qualitative interviews with up to 40 operational staff and (3) five focus groups with staff and donor representatives. Data analysis will be guided by the theoretical lenses of the Normalisation Process Theory and the Theoretical Framework of Acceptability. ETHICS AND DISSEMINATION The study was prospectively registered and approved by the South Central-Oxford C Research Ethics Committee and the Health Research Authority and Health and Care Research Wales. The results will be published in peer-reviewed journals and provided to all relevant stakeholders. TRIAL REGISTRATION NUMBER ISRCTN23657907; EudraCT: 2021-006876-18; IRAS Number: 300414; REC: 22/SC/0072.
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Affiliation(s)
- Grazia Antonacci
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Allison Williams
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Jason Smith
- Department of Emergency, University Hospitals Plymouth NHS Trust, Plymouth, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - Laura Green
- NHS Blood & Transplant and Barts Health NHS Trust, London, UK
- Queen Mary University of London Blizard Institute, London, UK
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Chae A, Yao MS, Sagreiya H, Goldberg AD, Chatterjee N, MacLean MT, Duda J, Elahi A, Borthakur A, Ritchie MD, Rader D, Kahn CE, Witschey WR, Gee JC. Strategies for Implementing Machine Learning Algorithms in the Clinical Practice of Radiology. Radiology 2024; 310:e223170. [PMID: 38259208 PMCID: PMC10831483 DOI: 10.1148/radiol.223170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 01/24/2024]
Abstract
Despite recent advancements in machine learning (ML) applications in health care, there have been few benefits and improvements to clinical medicine in the hospital setting. To facilitate clinical adaptation of methods in ML, this review proposes a standardized framework for the step-by-step implementation of artificial intelligence into the clinical practice of radiology that focuses on three key components: problem identification, stakeholder alignment, and pipeline integration. A review of the recent literature and empirical evidence in radiologic imaging applications justifies this approach and offers a discussion on structuring implementation efforts to help other hospital practices leverage ML to improve patient care. Clinical trial registration no. 04242667 © RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
| | | | - Hersh Sagreiya
- From the Departments of Bioengineering (M.S.Y.), Radiology (H.S.,
N.C., M.T.M., J.D., A.B., C.E.K., W.R.W., J.C.G.), Genetics (M.D.R.), and
Medicine (D.R.), Perelman School of Medicine (A.C., M.S.Y., H.S., A.B., C.E.K.,
W.R.W., J.C.G.), University of Pennsylvania, 3400 Civic Center Blvd,
Philadelphia, PA 19104; Department of Radiology, Loyola University Medical
Center, Maywood, Ill (A.D.G.); Department of Information Services, University of
Pennsylvania, Philadelphia, Pa (A.E.); and Leonard Davis Institute of Health
Economics, University of Pennsylvania, Philadelphia, Pa (A.B.)
| | - Ari D. Goldberg
- From the Departments of Bioengineering (M.S.Y.), Radiology (H.S.,
N.C., M.T.M., J.D., A.B., C.E.K., W.R.W., J.C.G.), Genetics (M.D.R.), and
Medicine (D.R.), Perelman School of Medicine (A.C., M.S.Y., H.S., A.B., C.E.K.,
W.R.W., J.C.G.), University of Pennsylvania, 3400 Civic Center Blvd,
Philadelphia, PA 19104; Department of Radiology, Loyola University Medical
Center, Maywood, Ill (A.D.G.); Department of Information Services, University of
Pennsylvania, Philadelphia, Pa (A.E.); and Leonard Davis Institute of Health
Economics, University of Pennsylvania, Philadelphia, Pa (A.B.)
| | - Neil Chatterjee
- From the Departments of Bioengineering (M.S.Y.), Radiology (H.S.,
N.C., M.T.M., J.D., A.B., C.E.K., W.R.W., J.C.G.), Genetics (M.D.R.), and
Medicine (D.R.), Perelman School of Medicine (A.C., M.S.Y., H.S., A.B., C.E.K.,
W.R.W., J.C.G.), University of Pennsylvania, 3400 Civic Center Blvd,
Philadelphia, PA 19104; Department of Radiology, Loyola University Medical
Center, Maywood, Ill (A.D.G.); Department of Information Services, University of
Pennsylvania, Philadelphia, Pa (A.E.); and Leonard Davis Institute of Health
Economics, University of Pennsylvania, Philadelphia, Pa (A.B.)
| | - Matthew T. MacLean
- From the Departments of Bioengineering (M.S.Y.), Radiology (H.S.,
N.C., M.T.M., J.D., A.B., C.E.K., W.R.W., J.C.G.), Genetics (M.D.R.), and
Medicine (D.R.), Perelman School of Medicine (A.C., M.S.Y., H.S., A.B., C.E.K.,
W.R.W., J.C.G.), University of Pennsylvania, 3400 Civic Center Blvd,
Philadelphia, PA 19104; Department of Radiology, Loyola University Medical
Center, Maywood, Ill (A.D.G.); Department of Information Services, University of
Pennsylvania, Philadelphia, Pa (A.E.); and Leonard Davis Institute of Health
Economics, University of Pennsylvania, Philadelphia, Pa (A.B.)
| | - Jeffrey Duda
- From the Departments of Bioengineering (M.S.Y.), Radiology (H.S.,
N.C., M.T.M., J.D., A.B., C.E.K., W.R.W., J.C.G.), Genetics (M.D.R.), and
Medicine (D.R.), Perelman School of Medicine (A.C., M.S.Y., H.S., A.B., C.E.K.,
W.R.W., J.C.G.), University of Pennsylvania, 3400 Civic Center Blvd,
Philadelphia, PA 19104; Department of Radiology, Loyola University Medical
Center, Maywood, Ill (A.D.G.); Department of Information Services, University of
Pennsylvania, Philadelphia, Pa (A.E.); and Leonard Davis Institute of Health
Economics, University of Pennsylvania, Philadelphia, Pa (A.B.)
| | - Ameena Elahi
- From the Departments of Bioengineering (M.S.Y.), Radiology (H.S.,
N.C., M.T.M., J.D., A.B., C.E.K., W.R.W., J.C.G.), Genetics (M.D.R.), and
Medicine (D.R.), Perelman School of Medicine (A.C., M.S.Y., H.S., A.B., C.E.K.,
W.R.W., J.C.G.), University of Pennsylvania, 3400 Civic Center Blvd,
Philadelphia, PA 19104; Department of Radiology, Loyola University Medical
Center, Maywood, Ill (A.D.G.); Department of Information Services, University of
Pennsylvania, Philadelphia, Pa (A.E.); and Leonard Davis Institute of Health
Economics, University of Pennsylvania, Philadelphia, Pa (A.B.)
| | - Arijitt Borthakur
- From the Departments of Bioengineering (M.S.Y.), Radiology (H.S.,
N.C., M.T.M., J.D., A.B., C.E.K., W.R.W., J.C.G.), Genetics (M.D.R.), and
Medicine (D.R.), Perelman School of Medicine (A.C., M.S.Y., H.S., A.B., C.E.K.,
W.R.W., J.C.G.), University of Pennsylvania, 3400 Civic Center Blvd,
Philadelphia, PA 19104; Department of Radiology, Loyola University Medical
Center, Maywood, Ill (A.D.G.); Department of Information Services, University of
Pennsylvania, Philadelphia, Pa (A.E.); and Leonard Davis Institute of Health
Economics, University of Pennsylvania, Philadelphia, Pa (A.B.)
| | - Marylyn D. Ritchie
- From the Departments of Bioengineering (M.S.Y.), Radiology (H.S.,
N.C., M.T.M., J.D., A.B., C.E.K., W.R.W., J.C.G.), Genetics (M.D.R.), and
Medicine (D.R.), Perelman School of Medicine (A.C., M.S.Y., H.S., A.B., C.E.K.,
W.R.W., J.C.G.), University of Pennsylvania, 3400 Civic Center Blvd,
Philadelphia, PA 19104; Department of Radiology, Loyola University Medical
Center, Maywood, Ill (A.D.G.); Department of Information Services, University of
Pennsylvania, Philadelphia, Pa (A.E.); and Leonard Davis Institute of Health
Economics, University of Pennsylvania, Philadelphia, Pa (A.B.)
| | - Daniel Rader
- From the Departments of Bioengineering (M.S.Y.), Radiology (H.S.,
N.C., M.T.M., J.D., A.B., C.E.K., W.R.W., J.C.G.), Genetics (M.D.R.), and
Medicine (D.R.), Perelman School of Medicine (A.C., M.S.Y., H.S., A.B., C.E.K.,
W.R.W., J.C.G.), University of Pennsylvania, 3400 Civic Center Blvd,
Philadelphia, PA 19104; Department of Radiology, Loyola University Medical
Center, Maywood, Ill (A.D.G.); Department of Information Services, University of
Pennsylvania, Philadelphia, Pa (A.E.); and Leonard Davis Institute of Health
Economics, University of Pennsylvania, Philadelphia, Pa (A.B.)
| | - Charles E. Kahn
- From the Departments of Bioengineering (M.S.Y.), Radiology (H.S.,
N.C., M.T.M., J.D., A.B., C.E.K., W.R.W., J.C.G.), Genetics (M.D.R.), and
Medicine (D.R.), Perelman School of Medicine (A.C., M.S.Y., H.S., A.B., C.E.K.,
W.R.W., J.C.G.), University of Pennsylvania, 3400 Civic Center Blvd,
Philadelphia, PA 19104; Department of Radiology, Loyola University Medical
Center, Maywood, Ill (A.D.G.); Department of Information Services, University of
Pennsylvania, Philadelphia, Pa (A.E.); and Leonard Davis Institute of Health
Economics, University of Pennsylvania, Philadelphia, Pa (A.B.)
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Williams A, Lennox L, Harris M, Antonacci G. Supporting translation of research evidence into practice-the use of Normalisation Process Theory to assess and inform implementation within randomised controlled trials: a systematic review. Implement Sci 2023; 18:55. [PMID: 37891671 PMCID: PMC10612208 DOI: 10.1186/s13012-023-01311-1] [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: 06/08/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The status of randomised controlled trials (RCTs) as the 'gold standard' for evaluating efficacy in healthcare interventions is increasingly debated among the research community, due to often insufficient consideration for implementation. Normalisation Process Theory (NPT), which focuses on the work required to embed processes into practice, offers a potentially useful framework for addressing these concerns. While the theory has been deployed in numerous RCTs to date, more work is needed to consolidate understanding of if, and how, NPT may aid implementation planning and processes within RCTs. Therefore, this review seeks to understand how NPT contributes to understanding the dynamics of implementation processes within RCTs. Specifically, this review will identify and characterise NPT operationalisation, benefits and reported challenges and limitations in RCTs. METHODS A qualitative systematic review with narrative synthesis of peer-reviewed journal articles from eight databases was conducted. Studies were eligible for inclusion if they reported sufficient detail on the use of NPT within RCTs in a healthcare domain. A pre-specified data extraction template was developed based on the research questions of this review. A narrative synthesis was performed to identify recurrent findings. RESULTS Searches identified 48 articles reporting 42 studies eligible for inclusion. Findings suggest that NPT is primarily operationalised prospectively during the data collection stage, with limited sub-construct utilisation overall. NPT is beneficial in understanding implementation processes by aiding the identification and analysis of key factors, such as understanding intervention fidelity in real-world settings. Nearly three-quarters of studies failed to report the challenges and limitations of utilising NPT, though coding difficulties and data falling outside the NPT framework are most common. CONCLUSIONS NPT appears to be a consistent and generalisable framework for explaining the dynamics of implementation processes within RCTs. However, operationalisation of the theory to its full extent is necessary to improve its use in practice, as it is currently deployed in varying capacities. Recommendations for future research include investigation of NPT alongside other frameworks, as well as earlier operationalisation and greater use of NPT sub-constructs. TRIAL REGISTRATION The protocol for this systematic review was accepted for public registration on PROSPERO (registration number: CRD42022345427) on 26 July 2022.
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Affiliation(s)
- Allison Williams
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, Charing Cross Campus, London, W6 8RP, UK.
| | - Laura Lennox
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, Charing Cross Campus, London, W6 8RP, UK
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, Chelsea and Westminster Campus, London, SW10 9N, UK
| | - Matthew Harris
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, Charing Cross Campus, London, W6 8RP, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Grazia Antonacci
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, Charing Cross Campus, London, W6 8RP, UK
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, Chelsea and Westminster Campus, London, SW10 9N, UK
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Laur C, Ladak Z, Hall A, Solbak NM, Nathan N, Buzuayne S, Curran JA, Shelton RC, Ivers N. Sustainability, spread, and scale in trials using audit and feedback: a theory-informed, secondary analysis of a systematic review. Implement Sci 2023; 18:54. [PMID: 37885018 PMCID: PMC10604689 DOI: 10.1186/s13012-023-01312-0] [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: 05/19/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Audit and feedback (A&F) is a widely used implementation strategy to influence health professionals' behavior that is often tested in implementation trials. This study examines how A&F trials describe sustainability, spread, and scale. METHODS This is a theory-informed, descriptive, secondary analysis of an update of the Cochrane systematic review of A&F trials, including all trials published since 2011. Keyword searches related to sustainability, spread, and scale were conducted. Trials with at least one keyword, and those identified from a forward citation search, were extracted to examine how they described sustainability, spread, and scale. Results were qualitatively analyzed using the Integrated Sustainability Framework (ISF) and the Framework for Going to Full Scale (FGFS). RESULTS From the larger review, n = 161 studies met eligibility criteria. Seventy-eight percent (n = 126) of trials included at least one keyword on sustainability, and 49% (n = 62) of those studies (39% overall) frequently mentioned sustainability based on inclusion of relevant text in multiple sections of the paper. For spread/scale, 62% (n = 100) of trials included at least one relevant keyword and 51% (n = 51) of those studies (31% overall) frequently mentioned spread/scale. A total of n = 38 studies from the forward citation search were included in the qualitative analysis. Although many studies mentioned the need to consider sustainability, there was limited detail on how this was planned, implemented, or assessed. The most frequent sustainability period duration was 12 months. Qualitative results mapped to the ISF, but not all determinants were represented. Strong alignment was found with the FGFS for phases of scale-up and support systems (infrastructure), but not for adoption mechanisms. New spread/scale themes included (1) aligning affordability and scalability; (2) balancing fidelity and scalability; and (3) balancing effect size and scalability. CONCLUSION A&F trials should plan for sustainability, spread, and scale so that if the trial is effective, the benefits can continue. A deeper empirical understanding of the factors impacting A&F sustainability is needed. Scalability planning should go beyond cost and infrastructure to consider other adoption mechanisms, such as leadership, policy, and communication, that may support further scalability. TRIAL REGISTRATION Registered with Prospero in May 2022. CRD42022332606.
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Affiliation(s)
- Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
- Institute of Health Policy, Management and Evaluation, Health Sciences Building, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.
| | - Zeenat Ladak
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
- Ontario Institute for Studies in Education, University of Toronto, 252 Bloor Street West, Toronto, ON, M5S 1V6, Canada
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Nathan M Solbak
- Physician Learning Program, Continuing Medical Education and Professional Development, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
- Health Quality Programs, Queen's University, 92 Barrie Street, Kingston, ON, K7L 3N6, Canada
| | - Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Shewit Buzuayne
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Janet A Curran
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Noah Ivers
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
- Institute of Health Policy, Management and Evaluation, Health Sciences Building, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, M5G 1V7, Canada
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8
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López Seguí F, Cos Codina J, Ricou Ríos L, Martínez Segura MI, Miró Mezquita L, Escrich Navarro R, Davins Riu M, Estrada Cuxart O, Anashkin Kachalin G, Moreno-Martínez D. Readiness for Change in the Implementation of a 3D Printing Initiative in a Catalan Tertiary Hospital Using the Normalization Process Theory: Survey Study. JMIR Hum Factors 2023; 10:e47390. [PMID: 37801353 PMCID: PMC10589830 DOI: 10.2196/47390] [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: 03/18/2023] [Revised: 07/13/2023] [Accepted: 08/12/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The high failure rate of innovation projects motivates us to understand the perceptions about resistances and barriers of the main stakeholders to improving success rates. OBJECTIVE This study aims to analyze the readiness for change in the implementation of a 3D printing project in a Catalan tertiary hospital prior to its implementation. METHODS We used a web-based, voluntary, and anonymous survey using the Normalization Measurement Development questionnaire (NoMAD) to gather views and perceptions from a selected group of health care professionals at Germans Trias i Pujol University Hospital. RESULTS In this study, 58 professionals, including heads of service (n=30, 51%), doctors (n=18, 31%), nurses (n=7, 12%), and support staff (n=3, 5%), responded to the questionnaire. All groups saw the value of the project and were willing to enroll and support it. Respondents reported the highest scores (out of 5) in cognitive participation (mean 4.45, SD 0.04), coherence (mean 3.72, SD 0.13), and reflective monitoring (mean 3.80, SD 0.25). The weakest score was in collective action (mean 3.52, SD 0.12). There were no statistically significant differences in scores among professions in the survey. CONCLUSIONS The 3D printing project implementation should pay attention to preparing, defining, sharing, and supporting the operational work involved in its use and implementation. It should also understand, assess, and communicate the ways in which the new set of practices can affect the users and others around them. We suggest that health officers and politicians consider this experience as a solid ground toward the development of a more efficient health innovation system and as a catalyst for transformation.
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Affiliation(s)
- Francesc López Seguí
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
- Chair in ICT and Health, Centre for Health and Social Care Research, University of Vic - Central University of Catalonia, Vic, Spain
| | - Joan Cos Codina
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Laura Ricou Ríos
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
| | - María Isabel Martínez Segura
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
| | - Laura Miró Mezquita
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
| | - Raquel Escrich Navarro
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
| | - Meritxell Davins Riu
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
| | - Oriol Estrada Cuxart
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
| | - German Anashkin Kachalin
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
| | - Daniel Moreno-Martínez
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Badalona, Spain
- Hospital Germans Trias i Pujol, Institut Català de la Salut, Badalona, Spain
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9
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Hogg HDJ, Al-Zubaidy M, Keane PA, Hughes G, Beyer FR, Maniatopoulos G. Evaluating the translation of implementation science to clinical artificial intelligence: a bibliometric study of qualitative research. FRONTIERS IN HEALTH SERVICES 2023; 3:1161822. [PMID: 37492632 PMCID: PMC10364639 DOI: 10.3389/frhs.2023.1161822] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023]
Abstract
Introduction Whilst a theoretical basis for implementation research is seen as advantageous, there is little clarity over if and how the application of theories, models or frameworks (TMF) impact implementation outcomes. Clinical artificial intelligence (AI) continues to receive multi-stakeholder interest and investment, yet a significant implementation gap remains. This bibliometric study aims to measure and characterize TMF application in qualitative clinical AI research to identify opportunities to improve research practice and its impact on clinical AI implementation. Methods Qualitative research of stakeholder perspectives on clinical AI published between January 2014 and October 2022 was systematically identified. Eligible studies were characterized by their publication type, clinical and geographical context, type of clinical AI studied, data collection method, participants and application of any TMF. Each TMF applied by eligible studies, its justification and mode of application was characterized. Results Of 202 eligible studies, 70 (34.7%) applied a TMF. There was an 8-fold increase in the number of publications between 2014 and 2022 but no significant increase in the proportion applying TMFs. Of the 50 TMFs applied, 40 (80%) were only applied once, with the Technology Acceptance Model applied most frequently (n = 9). Seven TMFs were novel contributions embedded within an eligible study. A minority of studies justified TMF application (n = 51,58.6%) and it was uncommon to discuss an alternative TMF or the limitations of the one selected (n = 11,12.6%). The most common way in which a TMF was applied in eligible studies was data analysis (n = 44,50.6%). Implementation guidelines or tools were explicitly referenced by 2 reports (1.0%). Conclusion TMFs have not been commonly applied in qualitative research of clinical AI. When TMFs have been applied there has been (i) little consensus on TMF selection (ii) limited description of selection rationale and (iii) lack of clarity over how TMFs inform research. We consider this to represent an opportunity to improve implementation science's translation to clinical AI research and clinical AI into practice by promoting the rigor and frequency of TMF application. We recommend that the finite resources of the implementation science community are diverted toward increasing accessibility and engagement with theory informed practices. The considered application of theories, models and frameworks (TMF) are thought to contribute to the impact of implementation science on the translation of innovations into real-world care. The frequency and nature of TMF use are yet to be described within digital health innovations, including the prominent field of clinical AI. A well-known implementation gap, coined as the "AI chasm" continues to limit the impact of clinical AI on real-world care. From this bibliometric study of the frequency and quality of TMF use within qualitative clinical AI research, we found that TMFs are usually not applied, their selection is highly varied between studies and there is not often a convincing rationale for their selection. Promoting the rigor and frequency of TMF use appears to present an opportunity to improve the translation of clinical AI into practice.
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Affiliation(s)
- H. D. J. Hogg
- Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
- The Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - M. Al-Zubaidy
- The Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - P. A. Keane
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
| | - G. Hughes
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, United Kingdom
- University ofLeicester School of Business, University of Leicester, Leicester, United Kingdom
| | - F. R. Beyer
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - G. Maniatopoulos
- Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
- University ofLeicester School of Business, University of Leicester, Leicester, United Kingdom
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10
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Khanal S, Schmidtke KA, Talat U, Turner AM, Vlaev I. Using multi-criteria decision analysis to describe stakeholder preferences for new quality improvement initiatives that could optimise prescribing in England. FRONTIERS IN HEALTH SERVICES 2023; 3:1155523. [PMID: 37409178 PMCID: PMC10318338 DOI: 10.3389/frhs.2023.1155523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/26/2023] [Indexed: 07/07/2023]
Abstract
Background Hospital decision-makers have limited resources to implement quality improvement projects. To decide which interventions to take forward, trade-offs must be considered that inevitably turn on stakeholder preferences. The multi-criteria decision analysis (MCDA) approach could make this decision process more transparent. Method An MCDA was conducted to rank-order four types of interventions that could optimise medication use in England's National Healthcare System (NHS) hospitals, including Computerised Interface, Built Environment, Written Communication, and Face-to-Face Interactions. Initially, a core group of quality improvers (N = 10) was convened to determine criteria that could influence which interventions are taken forward according to the Consolidated Framework for Implementation Research. Next, to determine preference weightings, a preference survey was conducted with a diverse group of quality improvers (N = 356) according to the Potentially All Pairwise Ranking of All Possible Alternatives method. Then, rank orders of four intervention types were calculated according to models with criteria unweighted and weighted according to participant preferences using an additive function. Uncertainty was estimated by probabilistic sensitivity analysis using 1,000 Monte Carlo Simulation iterations. Results The most important criteria influencing what interventions were preferred was whether they addressed "patient needs" (17.6%)' and their financial "cost (11.5%)". The interventions' total scores (unweighted score out of 30 | weighted out of 100%) were: Computerised Interface (25 | 83.8%), Built Environment (24 | 79.6%), Written Communication (22 | 71.6%), and Face-to-Face (22 | 67.8%). The probabilistic sensitivity analysis revealed that the Computerised Interface would be the most preferred intervention over various degrees of uncertainty. Conclusions An MCDA was conducted to rank order intervention types that stand to increase medication optimisation across hospitals in England. The top-ranked intervention type was the Computerised Interface. This finding does not imply Computerised Interface interventions are the most effective interventions but suggests that successfully implementing lower-ranked interventions may require more conversations that acknowledge stakeholder concerns.
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Affiliation(s)
- Saval Khanal
- Behavioural Science Group, Warwick Business School, University of Warwick, Coventry, United Kingdom
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Kelly Ann Schmidtke
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Liberal Arts, University of Health Sciences and Pharmacy, St Louis, MO, United States
| | - Usman Talat
- Alliance Manchester Business School, University of Manchester, Manchester, United Kingdom
| | - Alice M. Turner
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Ivo Vlaev
- Behavioural Science Group, Warwick Business School, University of Warwick, Coventry, United Kingdom
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11
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Desveaux L, Nguyen MD, Ivers NM, Devotta K, Upshaw T, Ramji N, Weyman K, Kiran T. Snakes and ladders: A qualitative study understanding the active ingredients of social interaction around the use of audit and feedback. Transl Behav Med 2023; 13:316-326. [PMID: 36694357 PMCID: PMC10182419 DOI: 10.1093/tbm/ibac114] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Explore characteristics of the facilitator, group, and interaction that influence whether a group discussion about data leads to the identification of a clearly specified action plan. Peer-facilitated group discussions among primary care physicians were carried out and recorded. A follow-up focus group was conducted with peer facilitators to explore which aspects of the discussion promoted action planning. Qualitative data was analyzed using an inductive-deductive thematic analysis approach using the conceptual model developed by Cooke et al. Group discussions were coded case-specifically and then analyzed to identify which themes influenced action planning as it relates to performance improvement. Physicians were more likely to interact with practice-level data and explore actions for performance improvement when the group facilitator focused the discussion on action planning. Only one of the three sites (Site C) converged on an action plan following the peer-facilitated group discussion. At Site A, physicians shared skepticism of the data, were defensive about performance, and explained performance as a product of factors beyond their control. Site B identified several potential actions but had trouble focusing on a single indicator or deciding between physician- and group-level actions. None of the groups discussed variation in physician-level performance indicators, or how physician actions might contribute to the reported outcomes. Peer facilitators can support data interpretation and practice change; however their success depends on their personal beliefs about the data and their ability to identify and leverage change cues that arise in conversation. Further research is needed to understand how to create a psychologically safe environment that welcomes open discussion of physician variation.
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Affiliation(s)
- Laura Desveaux
- Institute for Better Health, Trillium Health Partners, 100 Queensway West, Mississauga, OntarioCanada.,Women's College Hospital Institute for Health Systems Solutions and Virtual Care, 76 Grenville Ave Toronto, Toronto, Ontario, Canada.,Institute for Health Policy, Management & Evaluation, University of Toronto, 155 College St, Toronto, Ontario, Canada
| | - Marlena Dang Nguyen
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, 76 Grenville Ave Toronto, Toronto, Ontario, Canada
| | - Noah Michael Ivers
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, 76 Grenville Ave Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, Canada
| | - Kimberly Devotta
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Canada
| | - Tara Upshaw
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Canada
| | - Noor Ramji
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, Canada
| | - Karen Weyman
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, Canada
| | - Tara Kiran
- Institute for Health Policy, Management & Evaluation, University of Toronto, 155 College St, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, Canada.,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, Canada
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12
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Chen W, O’Bryan CM, Gorham G, Howard K, Balasubramanya B, Coffey P, Abeyaratne A, Cass A. Barriers and enablers to implementing and using clinical decision support systems for chronic diseases: a qualitative systematic review and meta-aggregation. Implement Sci Commun 2022; 3:81. [PMID: 35902894 PMCID: PMC9330991 DOI: 10.1186/s43058-022-00326-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/10/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Clinical decision support (CDS) is increasingly used to facilitate chronic disease care. Despite increased availability of electronic health records and the ongoing development of new CDS technologies, uptake of CDS into routine clinical settings is inconsistent. This qualitative systematic review seeks to synthesise healthcare provider experiences of CDS-exploring the barriers and enablers to implementing, using, evaluating, and sustaining chronic disease CDS systems. METHODS A search was conducted in Medline, CINAHL, APA PsychInfo, EconLit, and Web of Science from 2011 to 2021. Primary research studies incorporating qualitative findings were included if they targeted healthcare providers and studied a relevant chronic disease CDS intervention. Relevant CDS interventions were electronic health record-based and addressed one or more of the following chronic diseases: cardiovascular disease, diabetes, chronic kidney disease, hypertension, and hypercholesterolaemia. Qualitative findings were synthesised using a meta-aggregative approach. RESULTS Thirty-three primary research articles were included in this qualitative systematic review. Meta-aggregation of qualitative data revealed 177 findings and 29 categories, which were aggregated into 8 synthesised findings. The synthesised findings related to clinical context, user, external context, and technical factors affecting CDS uptake. Key barriers to uptake included CDS systems that were simplistic, had limited clinical applicability in multimorbidity, and integrated poorly into existing workflows. Enablers to successful CDS interventions included perceived usefulness in providing relevant clinical knowledge and structured chronic disease care; user confidence gained through training and post training follow-up; external contexts comprised of strong clinical champions, allocated personnel, and technical support; and CDS technical features that are both highly functional, and attractive. CONCLUSION This systematic review explored healthcare provider experiences, focussing on barriers and enablers to CDS use for chronic diseases. The results provide an evidence-base for designing, implementing, and sustaining future CDS systems. Based on the findings from this review, we highlight actionable steps for practice and future research. TRIAL REGISTRATION PROSPERO CRD42020203716.
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Affiliation(s)
- Winnie Chen
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT 0811 Australia
| | - Claire Maree O’Bryan
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT 0811 Australia
| | - Gillian Gorham
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT 0811 Australia
| | - Kirsten Howard
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Bhavya Balasubramanya
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT 0811 Australia
| | - Patrick Coffey
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT 0811 Australia
| | - Asanga Abeyaratne
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT 0811 Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT 0811 Australia
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13
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Hafiz N, Hyun K, Tu Q, Knight A, Hespe C, Chow CK, Briffa T, Gallagher R, Reid CM, Hare DL, Zwar N, Woodward M, Jan S, Atkins ER, Laba TL, Halcomb E, Johnson T, Usherwood T, Redfern J. Data-driven quality improvement program to prevent hospitalisation and improve care of people living with coronary heart disease: Protocol for a process evaluation. Contemp Clin Trials 2022; 118:106794. [PMID: 35589026 PMCID: PMC9110058 DOI: 10.1016/j.cct.2022.106794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Practice-level quality improvement initiatives using rapidly advancing technology offers a multidimensional approach to reduce cardiovascular disease burden. For the "QUality improvement in primary care to prevent hospitalisations and improve Effectiveness and efficiency of care for people Living with heart disease" (QUEL) cluster randomised controlled trial, a 12-month quality improvement intervention was designed for primary care practices to use data and implement progressive changes using "Plan, Do, Study, Act" cycles within their practices with training in a series of interactive workshops. This protocol aims to describe the systematic methods to conduct a process evaluation of the data-driven intervention within the QUEL study. METHODS A mixed-method approach will be used to conduct the evaluation. Quantitative data collected throughout the intervention period, via surveys and intervention materials, will be used to (1) identify the key elements of the intervention and how, for whom and in what context it was effective; (2) determine if the intervention is delivered as intended; and (3) describe practice engagement, commitment and capacity associated with various intervention components. Qualitative data, collected via semi-structured interviews and open-ended questions, will be used to gather in-depth understanding of the (1) satisfaction, utility, barriers and enablers; (2) acceptability, uptake and feasibility, and (3) effect of the COVID-19 pandemic on the implementation of the intervention. CONCLUSION Findings from the evaluation will provide new knowledge on the implementation of a complex, multi-component intervention at practice-level using their own electronic patient data to enhance secondary prevention of cardiovascular disease. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) number ACTRN12619001790134.
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Affiliation(s)
- Nashid Hafiz
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia,Corresponding author at: The University of Sydney, School of Health Sciences, Faculty of Medicine and Health, Level 6, Block K, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia,Department of Cardiology, Concord Hospital, ANZAC Research Institute, Sydney, Australia
| | - Qiang Tu
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Andrew Knight
- Primary and Integrated Care Unit, South Western Sydney Local Health District, Sydney, Australia,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Charlotte Hespe
- The University of Notre Dame, School of Medicine, Sydney, Australia
| | - Clara K. Chow
- Western Sydney Local Health District, Sydney, Australia,Westmead Applied Research Centre, Faculty of Medicine and Health, Westmead, Australia
| | - Tom Briffa
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Robyn Gallagher
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Christopher M. Reid
- School of Public Health, Curtin University, Perth, Australia,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Nicholas Zwar
- Primary and Integrated Care Unit, South Western Sydney Local Health District, Sydney, Australia,Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, Australia,The George Institute for Global Health, School of Public Health, Imperial College London, UK
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Emily R. Atkins
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Tracey-Lea Laba
- University of Technology Sydney Centre for Health Economics Research and Evaluation, Sydney, Australia
| | | | | | - Timothy Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, Australia,Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia,The George Institute for Global Health, University of New South Wales, Sydney, Australia
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14
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van Kasteren Y, Strobel J, Bastiampillai T, Linedale E, Bidargaddi N. Implementation of a web-based computerised decision support system for Community Mental Health Services using national electronic health records (Preprint). JMIR Hum Factors 2021; 9:e35403. [PMID: 35788103 PMCID: PMC9297136 DOI: 10.2196/35403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/14/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background A high proportion of patients with severe mental illness relapse due to nonadherence to psychotropic medication. In this paper, we use the normalization process theory (NPT) to describe the implementation of a web-based clinical decision support system (CDSS) for Community Mental Health Services (CMHS) called Actionable Intime Insights or AI2. AI2 has two distinct functions: (1) it provides an overview of medication and treatment history to assist in reviewing patient adherence and (2) gives alerts indicating nonadherence to support early intervention. Objective Our objective is to evaluate the pilot implementation of the AI2 application to better understand the challenges of implementing a web-based CDSS to support medication adherence and early intervention in CMHS. Methods The NPT and participatory action framework were used to both explore and support implementation. Qualitative data were collected over the course of the 14-month implementation, in which researchers were active participants. Data were analyzed and coded using the NPT framework. Qualitative data included discussions, meetings, and work products, including emails and documents. Results This study explores the barriers and enablers of implementing a CDSS to support early intervention within CMHS using Medicare data from Australia’s national electronic record system, My Health Record (MyHR). The implementation was a series of ongoing negotiations, which resulted in a staged implementation with compromises on both sides. Clinicians were initially hesitant about using a CDSS based on MyHR data and expressed concerns about the changes to their work practice required to support early intervention. Substantial workarounds were required to move the implementation forward. This pilot implementation allowed us to better understand the challenges of implementation and the resources and support required to implement and sustain a model of care based on automated alerts to support early intervention. Conclusions The use of decision support based on electronic health records is growing, and while implementation is challenging, the potential benefits of early intervention to prevent relapse and hospitalization and ensure increased efficiency of the health care system are worth pursuing.
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Affiliation(s)
- Yasmin van Kasteren
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia
| | - Jörg Strobel
- Barossa Fleurieu Adelaide Hills Local Health Network, South Australia, Australia
| | - Tarun Bastiampillai
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Ecushla Linedale
- Health Translation SA, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Niranjan Bidargaddi
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia
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15
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Tossaint-Schoenmakers R, Versluis A, Chavannes N, Talboom-Kamp E, Kasteleyn M. The Challenge of Integrating eHealth Into Health Care: Systematic Literature Review of the Donabedian Model of Structure, Process, and Outcome. J Med Internet Res 2021; 23:e27180. [PMID: 33970123 PMCID: PMC8145079 DOI: 10.2196/27180] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/18/2021] [Accepted: 04/07/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Health care organizations are increasingly working with eHealth. However, the integration of eHealth into regular health care is challenging. It requires organizations to change the way they work and their structure and care processes to be adapted to ensure that eHealth supports the attainment of the desired outcomes. OBJECTIVE The aims of this study are to investigate whether there are identifiable indicators in the structure, process, and outcome categories that are related to the successful integration of eHealth in regular health care, as well as to investigate which indicators of structure and process are related to outcome indicators. METHODS A systematic literature review was conducted using the Donabedian Structure-Process-Outcome (SPO) framework to identify indicators that are related to the integration of eHealth into health care organizations. Data extraction sheets were designed to provide an overview of the study characteristics, eHealth characteristics, and indicators. The extracted indicators were organized into themes and subthemes of the structure, process, and outcome categories. RESULTS Eleven studies were included, covering a variety of study designs, diseases, and eHealth tools. All studies identified structure, process, and outcome indicators that were potentially related to the integration of eHealth. The number of indicators found in the structure, process, and outcome categories was 175, 84, and 88, respectively. The themes with the most-noted indicators and their mutual interaction were inner setting (51 indicators, 16 interactions), care receiver (40 indicators, 11 interactions), and technology (38 indicators, 12 interactions)-all within the structure category; health care actions (38 indicators, 15 interactions) within the process category; and efficiency (30 indicators, 15 interactions) within the outcome category. In-depth examination identified four most-reported indicators, namely "deployment of human resources" (n=11), in the inner setting theme within the structure category; "ease of use" (n=16) and "technical issue" (n=10), both in the technology theme within the structure category; and "health logistics" (n=26), in the efficiency theme within the outcome category. CONCLUSIONS Three principles are important for the successful integration of eHealth into health care. First, the role of the care receiver needs to be incorporated into the organizational structure and daily care process. Second, the technology must be well attuned to the organizational structure and daily care process. Third, the deployment of human resources to the daily care processes needs to be aligned with the desired end results. Not adhering to these points could negatively affect the organization, daily process, or the end results.
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Affiliation(s)
- Rosian Tossaint-Schoenmakers
- Saltro Diagnostic Centre, Utrecht, Netherlands.,National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands.,Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, Netherlands
| | - Anke Versluis
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands.,Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, Netherlands
| | - Niels Chavannes
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands.,Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, Netherlands
| | - Esther Talboom-Kamp
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands.,Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, Netherlands.,Unilabs Group, Geneva, Switzerland
| | - Marise Kasteleyn
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands.,Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, Netherlands
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16
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Webster R, Usherwood T, Joshi R, Saini B, Armour C, Critchley S, Di Tanna GL, Galgey S, Hespe CM, Jan S, Karia A, Kaur B, Krass I, Laba TL, Li Q, Lo S, Peiris DP, Reid C, Rodgers A, Shiel L, Strathdee J, Zamora N, Patel A. An electronic decision support-based complex intervention to improve management of cardiovascular risk in primary health care: a cluster randomised trial (INTEGRATE). Med J Aust 2021; 214:420-427. [PMID: 33899216 DOI: 10.5694/mja2.51030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/13/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine whether a multifaceted primary health care intervention better controlled cardiovascular disease (CVD) risk factors in patients with high risk of CVD than usual care. DESIGN, SETTING Parallel arm, cluster randomised trial in 71 Australian general practices, 5 December 2016 - 13 September 2019. PARTICIPANTS General practices that predominantly used an electronic medical record system compatible with the HealthTracker electronic decision support tool, and willing to implement all components of the INTEGRATE intervention. INTERVENTION Electronic point-of-care decision support for general practices; combination cardiovascular medications (polypills); and a pharmacy-based medication adherence program. MAIN OUTCOME MEASURES Proportion of patients with high CVD risk not on an optimal preventive medication regimen at baseline who had achieved both blood pressure and low-density lipoprotein (LDL) cholesterol goals at study end. RESULTS After a median 15 months' follow-up, primary outcome data were available for 4477 of 7165 patients in the primary outcome cohort (62%). The proportion of patients who achieved both treatment targets was similar in the intervention (423 of 2156; 19.6%) and control groups (466 of 2321; 20.1%; relative risk, 1.06; 95% CI, 0.85-1.32). Further, no statistically significant differences were found for a number of secondary outcomes, including risk factor screening, preventive medication prescribing, and risk factor levels. Use of intervention components was low; it was highest for HealthTracker, used at least once for 347 of 3236 undertreated patients with high CVD risk (10.7%). CONCLUSIONS Despite evidence for the efficacy of its individual components, the INTEGRATE intervention was not broadly implemented and did not improve CVD risk management in participating Australian general practices. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12616000233426 (prospective).
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Affiliation(s)
- Ruth Webster
- Centre for Health Economics Research and Evaluation, University of Technology, Sydney, NSW.,The George Institute for Global Health, Sydney, NSW
| | - Tim Usherwood
- Sydney Medical School, University of Sydney, Sydney, NSW
| | - Rohina Joshi
- The George Institute for Global Health, Sydney, NSW.,The George Institute for Global Health India, New Delhi, India
| | | | - Carol Armour
- The Woolcock Institute, University of Sydney, Sydney, NSW
| | | | | | - Shane Galgey
- The George Institute for Global Health, Sydney, NSW
| | | | - Stephen Jan
- The George Institute for Global Health, Sydney, NSW
| | | | - Baldeep Kaur
- The George Institute for Global Health, Sydney, NSW
| | | | - Tracey-Lea Laba
- Centre for Health Economics Research and Evaluation, University of Technology, Sydney, NSW
| | - Qiang Li
- The George Institute for Global Health, Sydney, NSW
| | - Serigne Lo
- Melanoma Institute, University of Sydney, Sydney, NSW
| | | | | | | | | | | | - Nuria Zamora
- The George Institute for Global Health, Sydney, NSW
| | - Anushka Patel
- The George Institute for Global Health, Sydney, NSW.,The University of Sydney, Sydney, NSW
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17
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Taheri Moghadam S, Sadoughi F, Velayati F, Ehsanzadeh SJ, Poursharif S. The effects of clinical decision support system for prescribing medication on patient outcomes and physician practice performance: a systematic review and meta-analysis. BMC Med Inform Decis Mak 2021; 21:98. [PMID: 33691690 PMCID: PMC7944637 DOI: 10.1186/s12911-020-01376-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 12/18/2020] [Indexed: 12/14/2022] Open
Abstract
Background Clinical Decision Support Systems (CDSSs) for Prescribing are one of the innovations designed to improve physician practice performance and patient outcomes by reducing prescription errors. This study was therefore conducted to examine the effects of various CDSSs on physician practice performance and patient outcomes. Methods This systematic review was carried out by searching PubMed, Embase, Web of Science, Scopus, and Cochrane Library from 2005 to 2019. The studies were independently reviewed by two researchers. Any discrepancies in the eligibility of the studies between the two researchers were then resolved by consulting the third researcher. In the next step, we performed a meta-analysis based on medication subgroups, CDSS-type subgroups, and outcome categories. Also, we provided the narrative style of the findings. In the meantime, we used a random-effects model to estimate the effects of CDSS on patient outcomes and physician practice performance with a 95% confidence interval. Q statistics and I2 were then used to calculate heterogeneity. Results On the basis of the inclusion criteria, 45 studies were qualified for analysis in this study. CDSS for prescription drugs/COPE has been used for various diseases such as cardiovascular diseases, hypertension, diabetes, gastrointestinal and respiratory diseases, AIDS, appendicitis, kidney disease, malaria, high blood potassium, and mental diseases. In the meantime, other cases such as concurrent prescribing of multiple medications for patients and their effects on the above-mentioned results have been analyzed. The study shows that in some cases the use of CDSS has beneficial effects on patient outcomes and physician practice performance (std diff in means = 0.084, 95% CI 0.067 to 0.102). It was also statistically significant for outcome categories such as those demonstrating better results for physician practice performance and patient outcomes or both. However, there was no significant difference between some other cases and traditional approaches. We assume that this may be due to the disease type, the quantity, and the type of CDSS criteria that affected the comparison. Overall, the results of this study show positive effects on performance for all forms of CDSSs. Conclusions Our results indicate that the positive effects of the CDSS can be due to factors such as user-friendliness, compliance with clinical guidelines, patient and physician cooperation, integration of electronic health records, CDSS, and pharmaceutical systems, consideration of the views of physicians in assessing the importance of CDSS alerts, and the real-time alerts in the prescription.
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Affiliation(s)
- Sharare Taheri Moghadam
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farahnaz Sadoughi
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Rashid Yasemi Street, Vali-e Asr Avenue, Tehran, 1996713883, Iran.
| | - Farnia Velayati
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Jafar Ehsanzadeh
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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18
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Hunter B, Biezen R, Alexander K, Lumsden N, Hallinan C, Wood A, McMorrow R, Jones J, Nelson C, Manski-Nankervis JA. Future Health Today: codesign of an electronic chronic disease quality improvement tool for use in general practice using a service design approach. BMJ Open 2020; 10:e040228. [PMID: 33371024 PMCID: PMC7751202 DOI: 10.1136/bmjopen-2020-040228] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To codesign an electronic chronic disease quality improvement tool for use in general practice. DESIGN Service design employing codesign strategies. SETTING General practice. PARTICIPANTS Seventeen staff (general practitioners, nurses and practice managers) from general practice in metropolitan Melbourne and regional Victoria and five patients from metropolitan Melbourne. INTERVENTIONS Codesign sessions with general practice staff, using a service design approach, were conducted to explore key design criteria and functionality of the audit and feedback and clinical decision support tools. Think aloud interviews were conducted in which participants articulated their thoughts of the resulting Future Health Today (FHT) prototype as they used it. One codesign session was held with patients. Using inductive and deductive coding, content and thematic analyses explored the development of a new technological platform and factors influencing implementation of the platform. RESULTS Participants identified that the prototype needed to work within their existing workflow to facilitate automated patient recall and track patients with or at-risk of specific conditions. It needed to be simple, provide visual snapshots of information and easy access to relevant guidelines and facilitate quality improvement activities. Successful implementation may be supported by: accuracy of the algorithms in FHT and data held in the practice; the platform supporting planned and spontaneous interactions with patients; the ability to hide tools; links to Medicare Benefits Schedule; and prefilled management plans. Participating patients supported the use of the platform in general practice. They suggested that use of the platform demonstrates a high level of patient care and could increase patient confidence in health practitioners. CONCLUSION Study participants worked together to design a platform that is clear, simple, accurate and useful and that sits within any given general practice setting. The resulting FHT platform is currently being piloted in general practices and will continue to be refined based on user feedback.
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Affiliation(s)
- Barbara Hunter
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ruby Biezen
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Karyn Alexander
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Natalie Lumsden
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
- Western Health Chronic Disease Alliance, Sunshine Hospital, Western Health, Footscray, Victoria, Australia
| | - Christine Hallinan
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anna Wood
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rita McMorrow
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Julia Jones
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
- Western Health Chronic Disease Alliance, Sunshine Hospital, Western Health, Footscray, Victoria, Australia
| | - Craig Nelson
- Western Health Chronic Disease Alliance, Sunshine Hospital, Western Health, Footscray, Victoria, Australia
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19
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Chapman N, Fonseca R, Murfett L, Beazley K, McWhirter RE, Schultz MG, Nelson MR, Sharman JE. Integration of absolute cardiovascular disease risk assessment into routine blood cholesterol testing at pathology services. Fam Pract 2020; 37:675-681. [PMID: 32296818 DOI: 10.1093/fampra/cmaa034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Absolute cardiovascular disease (CVD) risk assessment is recommended for primary prevention of CVD, yet uptake in general practice is limited. Cholesterol requests at pathology services provide an opportunity to improve uptake by integrating absolute CVD risk assessment with this service. OBJECTIVE This study aimed to assess the feasibility of such an additional service. METHODS Two-hundred and ninety-nine patients (45-74 years) referred to pathology services for blood cholesterol had measurement of all variables required to determine absolute CVD risk according to Framingham calculator (blood pressure, age, sex, smoking and diabetes status via self-report). Data were recorded via computer-based application. The absolute risk score was communicated via the report sent to the referring medical practitioner as per usual practice. Evaluation questionnaires were completed immediately post visit and at 1-, 3- and 6-month follow-up via telephone (n = 262). RESULTS Absolute CVD risk reports were issued for 90% of patients. Most patients (95%) reported that the length of time for the pathology service assessment was acceptable, and 91% that the self-directed computer-based application was easy to use. Seventy-eight per cent reported a preference for pathology services to conduct absolute CVD risk assessment. Only 2% preferred a medical practitioner. Of follow-up patients, 202 (75%) had a consultation with a medical practitioner, during which, aspects of CVD risk prevention were discussed (cholesterol and blood pressure 74% and 69% of the time, respectively). CONCLUSIONS Measurement of absolute CVD risk in pathology services is feasible, highly acceptable among middle-to-older adults and may increase uptake of guideline-directed care in general practice.
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Affiliation(s)
- Niamh Chapman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Ricardo Fonseca
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | | | | | - Rebekah E McWhirter
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Centre for Law and Genetics, Faculty of Law, University of Tasmania, Hobart, Australia
| | - Martin G Schultz
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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20
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Nguyen MXB, Chu AV, Powell BJ, Tran HV, Nguyen LH, Dao ATM, Pham MD, Vo SH, Bui NH, Dowdy DW, Latkin CA, Lancaster KE, Pence BW, Sripaipan T, Hoffman I, Miller WC, Go VF. Comparing a standard and tailored approach to scaling up an evidence-based intervention for antiretroviral therapy for people who inject drugs in Vietnam: study protocol for a cluster randomized hybrid type III trial. Implement Sci 2020; 15:64. [PMID: 32771017 PMCID: PMC7414564 DOI: 10.1186/s13012-020-01020-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/08/2020] [Indexed: 12/03/2022] Open
Abstract
Background People who inject drugs (PWID) bear a disproportionate burden of HIV infection and experience poor outcomes. A randomized trial demonstrated the efficacy of an integrated System Navigation and Psychosocial Counseling (SNaP) intervention in improving HIV outcomes, including antiretroviral therapy (ART) and medications for opioid use disorder (MOUD) uptake, viral suppression, and mortality. There is limited evidence about how to effectively scale such intervention. This protocol presents a hybrid type III effectiveness-implementation trial comparing two approaches for scaling-up SNaP. We will evaluate the effectiveness of SNaP implementation approaches as well as cost and the characteristics of HIV testing sites achieving successful or unsuccessful implementation of SNaP in Vietnam. Methods Design: In this cluster randomized controlled trial, two approaches to scaling-up SNaP for PWID in Vietnam will be compared. HIV testing sites (n = 42) were randomized 1:1 to the standard approach or the tailored approach. Intervention mapping was used to develop implementation strategies for both arms. The standard arm will receive a uniform package of these strategies, while implementation strategies for the tailored arm will be designed to address site-specific needs. Participants: HIV-positive PWID participants (n = 6200) will be recruited for medical record assessment at baseline; of those, 1500 will be enrolled for detailed assessments at baseline, 12, and 24 months. Site directors and staff at each of the 42 HIV testing sites will complete surveys at baseline, 12, and 24 months. Outcomes: Implementation outcomes (fidelity, penetration, acceptability) and effectiveness outcomes (ART, MOUD uptake, viral suppression) will be compared between the arms. To measure incremental costs, we will conduct an empirical costing study of each arm and the actual process of implementation from a societal perspective. Qualitative and quantitative site-level data will be used to explore key characteristics of HIV testing sites that successfully or unsuccessfully implement the intervention for each arm. Discussion Scaling up evidence-based interventions poses substantial challenges. The proposed trial contributes to the field of implementation science by applying a systematic approach to designing and tailoring implementation strategies, conducting a rigorous comparison of two promising implementation approaches, and assessing their incremental costs. Our study will provide critical guidance to Ministries of Health worldwide regarding the most effective, cost-efficient approach to SNaP implementation. Trial registration NCT03952520 on Clinialtrials.gov. Registered 16 May 2019.
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Affiliation(s)
- Minh X B Nguyen
- Department of Health Behavior, Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA. .,Department of Epidemiology, Institute of Preventive Medicine and Public Health, 1 Ton That Tung St., Dong Da, Hanoi, Vietnam.
| | - Anh V Chu
- University of North Carolina Project Vietnam, Lot E2 Duong Dinh Nghe St., Cau Giay, Hanoi, Vietnam
| | - Byron J Powell
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Ha V Tran
- Department of Health Behavior, Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA.,University of North Carolina Project Vietnam, Lot E2 Duong Dinh Nghe St., Cau Giay, Hanoi, Vietnam
| | - Long H Nguyen
- Vietnam Authority of HIV/AIDS Control, Land 8 That Thuyet St., Ba Dinh, Hanoi, Vietnam
| | - An T M Dao
- Department of Epidemiology, Institute of Preventive Medicine and Public Health, 1 Ton That Tung St., Dong Da, Hanoi, Vietnam
| | - Manh D Pham
- Vietnam Authority of HIV/AIDS Control, Land 8 That Thuyet St., Ba Dinh, Hanoi, Vietnam
| | - Son H Vo
- Vietnam Authority of HIV/AIDS Control, Land 8 That Thuyet St., Ba Dinh, Hanoi, Vietnam
| | - Ngoc H Bui
- Department of Epidemiology, Institute of Preventive Medicine and Public Health, 1 Ton That Tung St., Dong Da, Hanoi, Vietnam
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Kathryn E Lancaster
- Department of Epidemiology, College of Public Health, Ohio State University, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43210, USA
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Teerada Sripaipan
- Department of Health Behavior, Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Irving Hoffman
- Division of Infectious Diseases, UNC School of Medicine, 321 S Columbia St, Chapel Hill, NC, 27516, USA
| | - William C Miller
- Department of Epidemiology, College of Public Health, Ohio State University, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43210, USA
| | - Vivian F Go
- Department of Health Behavior, Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA.
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21
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Hall Dykgraaf S, Barnard A. The role of cost-effectiveness analyses in investment decision making by primary health networks. Med J Aust 2020; 213:72-73. [PMID: 32598481 DOI: 10.5694/mja2.50689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Amanda Barnard
- Rural Clinical School, Australian National University, Canberra, ACT
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22
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Patel B, Peiris DP, Patel A, Jan S, Harris MF, Usherwood T, Panaretto K, Lung T. A computer-guided quality improvement tool for primary health care: cost-effectiveness analysis based on TORPEDO trial data. Med J Aust 2020; 213:73-78. [PMID: 32594567 DOI: 10.5694/mja2.50667] [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] [Received: 07/15/2019] [Accepted: 05/04/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of a computer-guided quality improvement intervention for primary health care management of cardiovascular disease (CVD) in people at high risk. DESIGN Modelled cost-effectiveness analysis of the HealthTracker intervention and usual care for people with high CVD risk, based on TORPEDO trial data on prescribing patterns, changes in intermediate risk factors (low-density lipoprotein cholesterol, systolic blood pressure), and Framingham risk scores. PARTICIPANTS Hypothetical population of people with high CVD risk attending primary health care services in a New South Wales primary health network (PHN) of mean size. INTERVENTION HealthTracker, integrated into health care provider electronic health record systems, provides real time decision support, risk communication, a clinical audit tool, and a web portal for performance feedback. MAIN OUTCOME MEASURES Incremental cost-effectiveness ratios (ICERs): difference in costs of the intervention and usual care divided by number of CVD events averted with HealthTracker. RESULTS The estimated numbers of major CVD events over five years per 1000 patients at high CVD risk were lower in PHNs using HealthTracker, both for patients with prior CVD events (secondary prevention; 259 v 267 with usual care) and for those without prior events (primary prevention; 168 v 176). Medication costs were higher and hospitalisation costs lower with HealthTracker than with usual care for both primary and secondary prevention. The estimated ICER for one averted CVD event was $7406 for primary prevention and $17 988 for secondary prevention. CONCLUSION Modelled cost-effectiveness analyses provide information that can assist decisions about investing in health care quality improvement interventions. We estimate that HealthTracker could prevent major CVD events for less than $20 000 per event averted. TRIAL REGISTRATION (TORPEDO) Australian New Zealand Clinical Trials Registry, ACTRN 12611000478910.
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Affiliation(s)
- Bindu Patel
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW
| | - David P Peiris
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW
| | - Anushka Patel
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW
| | - Stephen Jan
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW.,Sydney Medical School, the University of Sydney, Sydney, NSW
| | - Tim Usherwood
- Sydney Medical School, the University of Sydney, Sydney, NSW
| | - Kathryn Panaretto
- Centre for Chronic Disease, University of Queensland, Brisbane, QLD.,Medical Centre Queensland, University of Technology, Brisbane, QLD
| | - Thomas Lung
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW
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