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Davis M, Dysart GC, Doupnik SK, Hamm ME, Schwartz KTG, George-Milford B, Ryan ND, Melhem NM, Stepp SD, Brent DA, Young JF. Adolescent, Parent, and Provider Perceptions of a Predictive Algorithm to Identify Adolescent Suicide Risk in Primary Care. Acad Pediatr 2024; 24:645-653. [PMID: 38190885 PMCID: PMC11056301 DOI: 10.1016/j.acap.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/27/2023] [Accepted: 12/30/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To understand adolescent, parent, and provider perceptions of a machine learning algorithm for detecting adolescent suicide risk prior to its implementation primary care. METHODS We conducted semi-structured, qualitative interviews with adolescents (n = 9), parents (n = 12), and providers (n = 10; mixture of behavioral health and primary care providers) across two major health systems. Interviews were audio recorded and transcribed with analyses supported by use of NVivo. A codebook was developed combining codes derived inductively from interview transcripts and deductively from implementation science frameworks for content analysis. RESULTS Reactions to the algorithm were mixed. While many participants expressed privacy concerns, they believed the algorithm could be clinically useful for identifying adolescents at risk for suicide and facilitating follow-up. Parents' past experiences with their adolescents' suicidal thoughts and behaviors contributed to their openness to the algorithm. Results also aligned with several key Consolidated Framework for Implementation Research domains. For example, providers mentioned barriers inherent to the primary care setting such as time and resource constraints likely to impact algorithm implementation. Participants also cited a climate of mistrust of science and health care as potential barriers. CONCLUSIONS Findings shed light on factors that warrant consideration to promote successful implementation of suicide predictive algorithms in pediatric primary care. By attending to perspectives of potential end users prior to the development and testing of the algorithm, we can ensure that the risk prediction methods will be well-suited to the providers who would be interacting with them and the families who could benefit.
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Affiliation(s)
- Molly Davis
- Department of Child and Adolescent Psychiatry and Behavioral Sciences (M Davis, GC Dysart, KTG Schwartz, and JF Young), Children's Hospital of Philadelphia, Philadelphia, Pa; PolicyLab (M Davis, GC Dysart, SK Doupnik, KTG Schwartz, and JF Young), Children's Hospital of Philadelphia, Philadelphia, Pa; Clinical Futures (M Davis and SK Doupnik), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Psychiatry (M Davis and JF Young), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa; Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI) (M Davis and SK Doupnik), University of Pennsylvania, Philadelphia, Pa.
| | - Gillian C Dysart
- Department of Child and Adolescent Psychiatry and Behavioral Sciences (M Davis, GC Dysart, KTG Schwartz, and JF Young), Children's Hospital of Philadelphia, Philadelphia, Pa; PolicyLab (M Davis, GC Dysart, SK Doupnik, KTG Schwartz, and JF Young), Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Stephanie K Doupnik
- PolicyLab (M Davis, GC Dysart, SK Doupnik, KTG Schwartz, and JF Young), Children's Hospital of Philadelphia, Philadelphia, Pa; Clinical Futures (M Davis and SK Doupnik), Children's Hospital of Philadelphia, Philadelphia, Pa; Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI) (M Davis and SK Doupnik), University of Pennsylvania, Philadelphia, Pa; Division of General Pediatrics (SK Doupnik), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics (SK Doupnik), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
| | - Megan E Hamm
- Department of Medicine (ME Hamm), University of Pittsburgh, Pittsburgh, Pa
| | - Karen T G Schwartz
- Department of Child and Adolescent Psychiatry and Behavioral Sciences (M Davis, GC Dysart, KTG Schwartz, and JF Young), Children's Hospital of Philadelphia, Philadelphia, Pa; PolicyLab (M Davis, GC Dysart, SK Doupnik, KTG Schwartz, and JF Young), Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Brandie George-Milford
- University of Pittsburgh Medical Center Western Psychiatric Hospital (B George-Milford and DA Brent), Pittsburgh, Pa
| | - Neal D Ryan
- Department of Psychiatry (ND Ryan, NM Melhem, SD Stepp, and DA Brent), University of Pittsburgh School of Medicine, Pittsburgh, Pa; Clinical and Translational Science Institute (ND Ryan), University of Pittsburgh, Pittsburgh, Pa
| | - Nadine M Melhem
- Department of Psychiatry (ND Ryan, NM Melhem, SD Stepp, and DA Brent), University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Stephanie D Stepp
- Department of Psychiatry (ND Ryan, NM Melhem, SD Stepp, and DA Brent), University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - David A Brent
- University of Pittsburgh Medical Center Western Psychiatric Hospital (B George-Milford and DA Brent), Pittsburgh, Pa; Department of Psychiatry (ND Ryan, NM Melhem, SD Stepp, and DA Brent), University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Jami F Young
- Department of Child and Adolescent Psychiatry and Behavioral Sciences (M Davis, GC Dysart, KTG Schwartz, and JF Young), Children's Hospital of Philadelphia, Philadelphia, Pa; PolicyLab (M Davis, GC Dysart, SK Doupnik, KTG Schwartz, and JF Young), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Psychiatry (M Davis and JF Young), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
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Johnson C, Chen J, McGowan MP, Tricou E, Card M, Pettit AR, Klaiman T, Rader DJ, Volpp KG, Beidas RS. Family cascade screening for equitable identification of familial hypercholesterolemia: study protocol for a hybrid effectiveness-implementation type III randomized controlled trial. Implement Sci 2024; 19:30. [PMID: 38594685 PMCID: PMC11003060 DOI: 10.1186/s13012-024-01355-x] [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: 01/12/2024] [Accepted: 02/25/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Familial hypercholesterolemia (FH) is a heritable disorder affecting 1.3 million individuals in the USA. Eighty percent of people with FH are undiagnosed, particularly minoritized populations including Black or African American people, Asian or Asian American people, and women across racial groups. Family cascade screening is an evidence-based practice that can increase diagnosis and improve health outcomes but is rarely implemented in routine practice, representing an important care gap. In pilot work, we leveraged best practices from behavioral economics and implementation science-including mixed-methods contextual inquiry with clinicians, patients, and health system constituents-to co-design two patient-facing implementation strategies to address this care gap: (a) an automated health system-mediated strategy and (b) a nonprofit foundation-mediated strategy with contact from a foundation-employed care navigator. This trial will test the comparative effectiveness of these strategies on completion of cascade screening for relatives of individuals with FH, centering equitable reach. METHODS We will conduct a hybrid effectiveness-implementation type III randomized controlled trial testing the comparative effectiveness of two strategies for implementing cascade screening with 220 individuals with FH (i.e., probands) per arm identified from a large northeastern health system. The primary implementation outcome is reach, or the proportion of probands with at least one first-degree biological relative (parent, sibling, child) in the USA who is screened for FH through the study. Our secondary implementation outcomes include the number of relatives screened and the number of relatives meeting the American Heart Association criteria for FH. Our secondary clinical effectiveness outcome is post-trial proband cholesterol level. We will also use mixed methods to identify implementation strategy mechanisms for implementation strategy effectiveness while centering equity. DISCUSSION We will test two patient-facing implementation strategies harnessing insights from behavioral economics that were developed collaboratively with constituents. This trial will improve our understanding of how to implement evidence-based cascade screening for FH, which implementation strategies work, for whom, and why. Learnings from this trial can be used to equitably scale cascade screening programs for FH nationally and inform cascade screening implementation efforts for other genetic disorders. TRIAL REGISTRATION ClinicalTrials.gov, NCT05750667. Registered 15 February 2023-retrospectively registered, https://clinicaltrials.gov/study/NCT05750667 .
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Affiliation(s)
- Christina Johnson
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jinbo Chen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mary P McGowan
- Family Heart Foundation, Fernandina Beach, FL, USA
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Eric Tricou
- Family Heart Foundation, Fernandina Beach, FL, USA
| | - Mary Card
- Family Heart Foundation, Fernandina Beach, FL, USA
| | | | - Tamar Klaiman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J Rader
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin G Volpp
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
- The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Rinad S Beidas
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Boggs JM, Quintana LM, Beck A, Clarke CL, Richardson L, Conley A, Buckingham ET, Richards JE, Betz ME. A Randomized Control Trial of a Digital Health Tool for Safer Firearm and Medication Storage for Patients with Suicide Risk. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:358-368. [PMID: 38206548 DOI: 10.1007/s11121-024-01641-6] [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] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Abstract
Most patients with suicide risk do not receive recommendations to reduce access to lethal means due to a variety of barriers (e.g., lack of provider time, training). Determine if highly efficient population-based EHR messaging to visit the Lock to Live (L2L) decision aid impacts patient-reported storage behaviors. Randomized trial. Integrated health care system serving Denver, CO. Served by primary care or mental health specialty clinic in the 75-99.5th risk percentile on a suicide attempt or death prediction model. Lock to Live (L2L) is a web-based decision aid that incorporates patients' values into recommendations for safe storage of lethal means, including firearms and medications. Anonymous survey that determined readiness to change: pre-contemplative (do not believe in safe storage), contemplative (believe in safe storage but not doing it), preparation (planning storage changes) or action (safely storing). There were 21,131 patients randomized over a 6-month period with a 27% survey response rate. Many (44%) had access to a firearm, but most of these (81%) did not use any safe firearm storage behaviors. Intervention patients were more likely to be categorized as preparation or action compared to controls for firearm storage (OR = 1.30 (1.07-1.58)). When examining action alone, there were no group differences. There were no statistically significant differences for any medication storage behaviors. Selection bias in those who responded to survey. Efficiently sending an EHR invitation message to visit L2L encouraged patients with suicide risk to consider safer firearm storage practices, but a stronger intervention is needed to change storage behaviors. Future studies should evaluate whether combining EHR messaging with provider nudges (e.g., brief clinician counseling) changes storage behavior.ClinicalTrials.gov: NCT05288517.
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Affiliation(s)
- Jennifer M Boggs
- Kaiser Permanente Colorado, Institute for Health Research, 2550 S Parker Rd., Aurora, CO, 80014, USA.
| | - LeeAnn M Quintana
- Kaiser Permanente Colorado, Institute for Health Research, 2550 S Parker Rd., Aurora, CO, 80014, USA
| | - Arne Beck
- Kaiser Permanente Colorado, Institute for Health Research, 2550 S Parker Rd., Aurora, CO, 80014, USA
| | - Christina L Clarke
- Kaiser Permanente Colorado, Institute for Health Research, 2550 S Parker Rd., Aurora, CO, 80014, USA
| | - Laura Richardson
- Department of Behavioral Health Services, Kaiser Permanente Colorado, 10350 E Dakota Ave. #125, Denver, CO, 80247, USA
| | - Amy Conley
- Department of Behavioral Health Services, Kaiser Permanente Colorado, 10350 E Dakota Ave. #125, Denver, CO, 80247, USA
| | - Edward T Buckingham
- Department of Behavioral Health Services, Kaiser Permanente Colorado, 10350 E Dakota Ave. #125, Denver, CO, 80247, USA
- Colorado Permanente Medical Group, Kaiser Permanente Colorado, 1835 Franklin St., Denver, CO, 80218, USA
| | - Julie E Richards
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Seattle, WA, 98101, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, 12505 E. 16th Ave., Anschutz Inpatient Pav. 2, 1st floor, Aurora, CO, 80045, USA
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Lengnick-Hall R, Williams NJ, Ehrhart MG, Willging CE, Bunger AC, Beidas RS, Aarons GA. Eight characteristics of rigorous multilevel implementation research: a step-by-step guide. Implement Sci 2023; 18:52. [PMID: 37872618 PMCID: PMC10594828 DOI: 10.1186/s13012-023-01302-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/09/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Although healthcare is delivered in inherently multilevel contexts, implementation science has no widely endorsed methodological standards defining the characteristics of rigorous, multilevel implementation research. We identify and describe eight characteristics of high-quality, multilevel implementation research to encourage discussion, spur debate, and guide decision-making around study design and methodological issues. RECOMMENDATIONS Implementation researchers who conduct rigorous multilevel implementation research demonstrate the following eight characteristics. First, they map and operationalize the specific multilevel context for defined populations and settings. Second, they define and state the level of each construct under study. Third, they describe how constructs relate to each other within and across levels. Fourth, they specify the temporal scope of each phenomenon at each relevant level. Fifth, they align measurement choices and construction of analytic variables with the levels of theories selected (and hypotheses generated, if applicable). Sixth, they use a sampling strategy consistent with the selected theories or research objectives and sufficiently large and variable to examine relationships at requisite levels. Seventh, they align analytic approaches with the chosen theories (and hypotheses, if applicable), ensuring that they account for measurement dependencies and nested data structures. Eighth, they ensure inferences are made at the appropriate level. To guide implementation researchers and encourage debate, we present the rationale for each characteristic, actionable recommendations for operationalizing the characteristics in implementation research, a range of examples, and references to make the characteristics more usable. Our recommendations apply to all types of multilevel implementation study designs and approaches, including randomized trials, quantitative and qualitative observational studies, and mixed methods. CONCLUSION These eight characteristics provide benchmarks for evaluating the quality and replicability of multilevel implementation research and promote a common language and reference points. This, in turn, facilitates knowledge generation across diverse multilevel settings and ensures that implementation research is consistent with (and appropriately leverages) what has already been learned in allied multilevel sciences. When a shared and integrated description of what constitutes rigor is defined and broadly communicated, implementation science is better positioned to innovate both methodologically and theoretically.
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Affiliation(s)
| | | | - Mark G Ehrhart
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Cathleen E Willging
- Southwest Center, Pacific Institute for Research and Evaluation, Albuquerque, NM, USA
| | - Alicia C Bunger
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Rinad S Beidas
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Gregory A Aarons
- Department of Psychiatry, UC San Diego ACTRI Dissemination and Implementation Science Center, University of California-San Diego, La Jolla, San Diego, CA, USA
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Larkin C, Arensman E, Boudreaux ED. Preventing Suicide in Health Systems: How Can Implementation Science Help? Arch Suicide Res 2023; 27:1147-1162. [PMID: 36267036 DOI: 10.1080/13811118.2022.2131490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Suicide prevention is an emotive, complex goal for clinicians and health systems. Effective interventions for suicidality do exist; however, many patients do not receive them because implementation efforts tend to be time-limited and unsystematic. Implementation science is the study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice. This narrative review introduces implementation science to suicide researchers, with a special focus on healthcare settings. We outline prominent theories, methods, and measures, as well as examples of implementation research from suicidology. By embracing the principles of implementation science, suicidologists can help to close the gap between evidence-based practice and routine practice, thereby improving the delivery and uptake of suicide-related interventions and prevention programs.
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Jurczuk M, Thakar R, Carroll FE, Phillips L, van der Meulen J, Gurol-Urganci I, Sevdalis N. Design and management considerations for control groups in hybrid effectiveness-implementation trials: Narrative review & case studies. FRONTIERS IN HEALTH SERVICES 2023; 3:1059015. [PMID: 36926502 PMCID: PMC10012616 DOI: 10.3389/frhs.2023.1059015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/06/2023] [Indexed: 03/12/2023]
Abstract
Hybrid effectiveness-implementation studies allow researchers to combine study of a clinical intervention's effectiveness with study of its implementation with the aim of accelerating the translation of evidence into practice. However, there currently exists limited guidance on how to design and manage such hybrid studies. This is particularly true for studies that include a comparison/control arm that, by design, receives less implementation support than the intervention arm. Lack of such guidance can present a challenge for researchers both in setting up but also in effectively managing participating sites in such trials. This paper uses a narrative review of the literature (Phase 1 of the research) and comparative case study of three studies (Phase 2 of the research) to identify common themes related to study design and management. Based on these, we comment and reflect on: (1) the balance that needs to be struck between fidelity to the study design and tailoring to emerging requests from participating sites as part of the research process, and (2) the modifications to the implementation strategies being evaluated. Hybrid trial teams should carefully consider the impact of design selection, trial management decisions, and any modifications to implementation processes and/or support on the delivery of a controlled evaluation. The rationale for these choices should be systematically reported to fill the gap in the literature.
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Affiliation(s)
- Magdalena Jurczuk
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, United Kingdom
| | - Ranee Thakar
- Obstetrics & Gynaecology, Croydon University Hospitals NHS Trust, London, United Kingdom
| | - Fran E Carroll
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, United Kingdom
| | - Lizzie Phillips
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, United Kingdom.,Maternity Services, University Hospital Plymouth NHS Trust, Plymouth, United Kingdom
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ipek Gurol-Urganci
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, United Kingdom.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, United Kingdom
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Hoskins K, Linn KA, Ahmedani BK, Boggs JM, Johnson C, Heintz J, Marcus SC, Kaminer I, Zabel C, Wright L, Quintana LM, Buttenheim AM, Daley MF, Elias ME, Jager-Hyman S, Lieberman A, Lyons J, Maye M, McArdle B, Ritzwoller DP, Small DS, Westphal J, Wolk CB, Zhang S, Shelton RC, Beidas RS. Equitable implementation of S.A.F.E. Firearm: A multi-method pilot study. Prev Med 2022; 165:107281. [PMID: 36191653 PMCID: PMC10013361 DOI: 10.1016/j.ypmed.2022.107281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 02/08/2023]
Abstract
Attention to health equity is critical in the implementation of firearm safety efforts. We present our operationalization of equity-oriented recommendations in preparation for launch of a hybrid effectiveness-implementation trial focused on firearm safety promotion in pediatric primary care as a universal suicide prevention strategy. In Step 1 of our process, pre-trial engagement with clinican partners and literature review alerted us that delivery of a firearm safety program may vary by patients' medical complexity, race, and ethnicity. In Step 2, we selected the Health Equity Implementation Framework to inform our understanding of contextual determinants (i.e., barriers and facilitators). In Step 3, we leveraged an implementation pilot across 5 pediatric primary care clinics in 2 health system sites to study signals of inequities. Eligible well-child visits for 694 patients and 47 clinicians were included. Our results suggested that medical complexity was not associated with program delivery. We did see potential signals of inequities by race and ethnicity but must interpret with caution. Though we did not initially plan to examine differences by sex assigned at birth, we discovered that clinicians may be more likely to deliver the program to parents of male than female patients. Seven qualitative interviews with clinicians provided additional context. In Step 4, we interrogated equity considerations (e.g., why and how do these inequities exist). In Step 5, we will develop a plan to probe potential inequities related to race, ethnicity, and sex in the fully powered trial. Our process highlights that prospective, rigorous, exploratory work is vital for equity-informed implementation trials.
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Affiliation(s)
- Katelin Hoskins
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Kristin A Linn
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Jennifer M Boggs
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Christina Johnson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jonathan Heintz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven C Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Isabelle Kaminer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Celeste Zabel
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Leslie Wright
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - LeeAnn M Quintana
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | | | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Marisa E Elias
- Department of Pediatrics, Henry Ford Health, Detroit, MI, USA
| | - Shari Jager-Hyman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adina Lieberman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason Lyons
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Melissa Maye
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Bridget McArdle
- Department of Pediatrics, Henry Ford Health, Detroit, MI, USA
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Dylan S Small
- Wharton School of Business, University of Pennsylvania, Philadelphia, PA, USA
| | - Joslyn Westphal
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | | | - Shiling Zhang
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Rachel C Shelton
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Rinad S Beidas
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Root HJ, Lininger MR, DiStefano LJ. Hybrid effectiveness-implementation study designs in sports injury prevention research. Front Sports Act Living 2022; 4:981656. [PMID: 36203655 PMCID: PMC9530324 DOI: 10.3389/fspor.2022.981656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
Despite vast evidence supporting the effectiveness of lower extremity injury prevention programs in a variety of sport settings, age groups, and levels of competition, there is limited evidence on implementation strategies that positively impact the feasibility, scale-up and sustainability of such programs. Sport-related injury prevention is affected by the research-to-practice gap, a pervasive issue in healthcare, where high-quality experimental research is not used in routine clinical practice. An intervention shown to be efficacious in a controlled environment, such as a lab or in a field-study conducted by scientists, will demonstrate a decline in benefit when implemented in the intended clinical setting. Real-world considerations, such as foundational knowledge and training, time constraints, or end user motivation, influence the quality and consistency of implementation. Acknowledging and addressing implementation barriers in a systematic way is essential to promote effective program dissemination. Study design methods that measure both clinical effectiveness and implementation strategies need to be identified. Hybrid effectiveness-implementation designs simultaneously measure both an intervention's effect on clinical outcomes as well as critical information related to implementation strategy; however these study designs are not frequently utilized. The purpose of this mini-review is to describe: the basics of hybrid designs, rationale for using hybrid designs, and examples of how these designs could be used in athletic healthcare injury prevention research.
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Affiliation(s)
- Hayley J. Root
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Phoenix, AZ, United States
- *Correspondence: Hayley J. Root
| | - Monica R. Lininger
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, AZ, United States
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Jones J, Knox J, Meanley S, Yang C, Lounsbury DW, Huang TT, Bauermeister J, Gonzalez-Hernandez G, Frye V, Grov C, Patel V, Baral SD, Sullivan PS, Schwartz SR. Explorations of the Role of Digital Technology in HIV-Related Implementation Research: Case Comparisons of Five Ending the HIV Epidemic Supplement Awards. J Acquir Immune Defic Syndr 2022; 90:S226-S234. [PMID: 35703775 PMCID: PMC9204781 DOI: 10.1097/qai.0000000000002983] [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: 06/18/2021] [Accepted: 02/22/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The use of digital technology in HIV-related interventions and implementation strategies is increasing. Whether the use of technology is to directly improve patient outcomes (ie, part of the intervention) or as part of the strategy to implement interventions has important implications. In this article, we present 5 case studies of projects that feature the use of technology in HIV-related implementation research to identify and describe challenges specific to technology-based implementation research about study design, outcome measurement, implementing in an evolving technology landscape, and equity. METHODS For each case study, we identified the technological components, classified the components as intervention or implementation strategy, and identified implications for measuring performance and ensuring equity. The Exploration, Preparation, Implementation, and Sustainment framework was used to identify the research stage of each project. RESULTS Technology is being leveraged across a diverse array of implementation strategies to promote Ending the HIV Epidemic in the United States. The case studies were primarily in the exploration and preparation phases of implementation, yet technology played a different role in each project- developing educational materials, mass media to recruit participants or distribute evidence-based campaigns, providing training, guiding tailoring, and implementing novel methods to democratize intervention development. DISCUSSION Technology can play multiple roles in HIV-related implementation research projects, including serving as the intervention, being leveraged within implementation strategies, or both. We identified multiple considerations across projects that should be taken into account when measuring success and planning for equitable and sustained impact.
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Affiliation(s)
- Jeb Jones
- Department of Epidemiology, Emory University
| | - Justin Knox
- Department of Psychiatry, Columbia University Irving Medical Center
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing
| | - Cui Yang
- Department of Health, Behavior and Society, Johns Hopkins School of Public Health
| | - David W Lounsbury
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine
| | - Terry T Huang
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York
| | - Jose Bauermeister
- Department of Family and Community Health, University of Pennsylvania School of Nursing
| | | | | | - Christian Grov
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York
| | - Viraj Patel
- Department of Medicine, Division of General Internal Medicine, Montefiore Health System
| | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins School of Public Health
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Reifels L, Krishnamoorthy S, Kõlves K, Francis J. Implementation Science in Suicide Prevention. CRISIS 2022; 43:1-7. [PMID: 35016534 DOI: 10.1027/0227-5910/a000846] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Lennart Reifels
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | - Sadhvi Krishnamoorthy
- Australian Institute for Suicide Research and Prevention, Griffith University, Mount Gravatt, QLD, Australia
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, Griffith University, Mount Gravatt, QLD, Australia.,WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Jillian Francis
- School of Health Sciences, The University of Melbourne, VIC, Australia.,Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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11
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Schleider JL, Beidas RS. Harnessing the Single-Session Intervention approach to promote scalable implementation of evidence-based practices in healthcare. FRONTIERS IN HEALTH SERVICES 2022; 2:997406. [PMID: 36925822 PMCID: PMC10012621 DOI: 10.3389/frhs.2022.997406] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022]
Abstract
Effective implementation of evidence-based practices often involves multi-level strategies targeting individual-, organizational-, and system-level determinants of change. Although these multi-level implementation approaches can successfully facilitate EBP uptake, they tend to be complex and resource intensive. Accordingly, there is a need for theory-driven, generalizable approaches that can enhance efficiency, cost-effectiveness, and scalability of existing implementation approaches. We propose the Single-Session Intervention approach as an unexplored path to developing low-cost and scalable implementation strategies, especially those targeting individual-level behavior change. We argue that single-session strategies (S3) for implementation, which can simultaneously target myriad barriers to individual behavior change, may promote clinicians' EBP uptake and sustainment in a manner that is low-resource and scalable. We first overview the evidence-base supporting the Single-Session Intervention approach for patient-level outcomes; situate this approach within the implementation science literature by outlining its intersections with a leading framework, the Theoretical Domains Framework (TDF), as an exemplar; and illustrate how the TDF might directly inform the design and evaluation of single-session strategies for EBP implementation. Overall, single-session strategies (S3) for implementation reflect a promising but yet-to-be-tested means of streamlining and scaling individual-level behavior change efforts in healthcare settings. Future partnered research is needed to gauge the potential of this approach across diverse clinical and community contexts.
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Affiliation(s)
- Jessica L Schleider
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Rinad S Beidas
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, United States.,Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA, United States.,Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States
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12
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Curran GM, Landes SJ, McBain SA, Pyne JM, Smith JD, Fernandez ME, Chambers DA, Mittman BS. Reflections on 10 years of effectiveness-implementation hybrid studies. FRONTIERS IN HEALTH SERVICES 2022; 2:1053496. [PMID: 36925811 PMCID: PMC10012680 DOI: 10.3389/frhs.2022.1053496] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
This article provides new reflections and recommendations from authors of the initial effectiveness-implementation hybrid study manuscript and additional experts in their conceptualization and application. Given the widespread and continued use of hybrid studies, critical appraisals are necessary. The article offers reflections across five conceptual and methodological areas. It begins with the recommendation to replace the term "design" in favor of "study." The use of the term "design" and the explicit focus on trial methodology in the original paper created confusion. The essence of hybrid studies is combining research questions concerning intervention effectiveness and implementation within the same study, and this can and should be achieved by applying a full range of research designs. Supporting this recommendation, the article then offers guidance on selecting a hybrid study type based on evidentiary and contextual information and stakeholder concerns/preferences. A series of questions are presented that have been designed to help investigators select the most appropriate hybrid type for their study situation. The article also provides a critique on the hybrid 1-2-3 typology and offers reflections on when and how to use the typology moving forward. Further, the article offers recommendations on research designs that align with each hybrid study type. Lastly, the article offers thoughts on how to integrate costs analyses into hybrid studies.
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Affiliation(s)
- Geoffrey M Curran
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Center for Mental Health Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Sara J Landes
- Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, Little Rock, AR, United States.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Sacha A McBain
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Jeffrey M Pyne
- Center for Mental Health Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, United States
| | - Maria E Fernandez
- Center for Health Promotion and Prevention Research, University of Texas, Houston, TX, United States
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, United States
| | - Brian S Mittman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, CA, United States
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Hoskins K, Johnson C, Davis M, Pettit AR, Barkin S, Jager-Hyman S, Rivara F, Walton M, Wolk CB, Beidas RS. A mixed methods evaluation of parents' perspectives on the acceptability of the S.A.F.E. Firearm program. THE JOURNAL OF APPLIED RESEARCH ON CHILDREN : INFORMING POLICY FOR CHILDREN AT RISK 2021; 12:2. [PMID: 36883133 PMCID: PMC9987154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
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