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Singh S, Dafoe A, Cagle J, Messersmith WA, Kessler ER, Lum HD, Holliman BD, Fischer S. Respect for the Patient-Oncologist Relationship May Limit Serious Illness Communication by Acute and Postacute Care Clinicians After Discharge to a Skilled Nursing Facility. JCO Oncol Pract 2024:OP2400197. [PMID: 38857462 DOI: 10.1200/op.24.00197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/09/2024] [Accepted: 05/01/2024] [Indexed: 06/12/2024] Open
Abstract
PURPOSE There is a need to increase palliative care access for hospitalized older adults with cancer discharged to a skilled nursing facility (SNF) at risk of poor outcomes. Assessing and Listening to Individual Goals and Needs (ALIGN) is a palliative care intervention developed to address this gap. This study gathered perspectives from clinicians across care settings to describe perceptions on serious illness communication and care coordination for patients with cancer after discharge to a SNF to guide ALIGN refinements. METHODS We conducted 37 semistructured interviews with clinicians and leaders in hospital medicine (n = 12), oncology (n = 9), palliative care (n = 12), home health care (n = 6), and hospice (n = 4). Some participants had experience working in more than one specialty. The Practical Robust Implementation and Sustainability Model framework was used to develop the interview guide that explored barriers to care, prognosis discussions, and hospice recommendations. Interviews were coded and analyzed using thematic content analysis. RESULTS Analysis identified four themes: (1) discharge to a SNF is recognized as a time of worsening prognosis; (2) care silos create communication and information barriers during a period of increasing palliative care need; (3) family caregiver distress escalates following care transitions; and (4) lack of clarity of roles and respect for the patient-oncologist relationship limits prognostic communication and changes in focus of treatment. CONCLUSION These findings suggest that acute and postacute care clinicians defer serious illness conversations to the oncologist when patients are on a steep trajectory of decline, experiencing multiple care transitions, and may have limited contact with their oncologist. There is a need to clarify roles among nononcology and oncology clinicians in discussing prognosis and recommending hospice for older adults discharged to SNF.
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Affiliation(s)
- Sarguni Singh
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO
| | - Ashley Dafoe
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado, Aurora, CO
| | - John Cagle
- University of Maryland School of Social Work, Baltimore, MD
| | - Wells A Messersmith
- Division of Medical Oncology, Department of Medicine, University of Colorado, Aurora, CO
| | - Elizabeth R Kessler
- Division of Medical Oncology, Department of Medicine, University of Colorado, Aurora, CO
| | - Hillary D Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado, Aurora, CO
| | - Brooke Dorsey Holliman
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado, Aurora, CO
| | - Stacy Fischer
- Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, CO
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2
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Treichler EBH, McBride LE, Gomez E, Jain J, Seaton S, Yu KE, Oakes D, Perivoliotis D, Girard V, Reznik S, Salyers MP, Thomas ML, Spaulding WD, Granholm EL, Rabin BA, Light GA. Enhancing patient-clinician collaboration during treatment decision-making: study protocol for a community-engaged, mixed method hybrid type 1 trial of collaborative decision skills training (CDST) for veterans with psychosis. Trials 2024; 25:363. [PMID: 38840160 PMCID: PMC11155075 DOI: 10.1186/s13063-024-08127-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 04/22/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Patient participation in treatment decision making is a pillar of recovery-oriented care and is associated with improvements in empowerment and well-being. Although demand for increased involvement in treatment decision-making is high among veterans with serious mental illness, rates of involvement are low. Collaborative decision skills training (CDST) is a recovery-oriented, skills-based intervention designed to support meaningful patient participation in treatment decision making. An open trial among veterans with psychosis supported CDST's feasibility and demonstrated preliminary indications of effectiveness. A randomized control trial (RCT) is needed to test CDST's effectiveness in comparison with an active control and further evaluate implementation feasibility. METHODS The planned RCT is a hybrid type 1 trial, which will use mixed methods to systematically evaluate the effectiveness and implementation feasibility of CDST among veterans participating in a VA Psychosocial Rehabilitation and Recovery Center (PRRC) in Southern California. The first aim is to assess the effectiveness of CDST in comparison with the active control via the primary outcome, collaborative decision-making behavior during usual care appointments between veterans and their VA mental health clinicians, and secondary outcomes (i.e., treatment engagement, satisfaction, and outcome). The second aim is to characterize the implementation feasibility of CDST within the VA PRRC using the Practical Robust Implementation and Sustainability Model framework, including barriers and facilitators within the PRRC context to support future implementation. DISCUSSION If CDST is found to be effective and feasible, implementation determinants gathered throughout the study can be used to ensure sustained and successful implementation at this PRRC and other PRRCs and similar settings nationally. TRIAL REGISTRATION ClinicalTrials.gov NCT04324944. Registered on March 27, 2020. Trial registration data can be found in Appendix 1.
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Affiliation(s)
- Emily B H Treichler
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA.
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0804, La Jolla, CA, 92093, USA.
- UC San Diego Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, USA.
| | - Lauren E McBride
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0804, La Jolla, CA, 92093, USA
| | - Elissa Gomez
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Joanna Jain
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Sydney Seaton
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Kasey E Yu
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - David Oakes
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
| | - Dimitri Perivoliotis
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0804, La Jolla, CA, 92093, USA
- VA San Diego Psychology Service, San Diego, CA, USA
| | | | - Samantha Reznik
- University of Texas at Austin, Texas Institute for Excellence in Mental Health, Austin, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, IN, USA
| | - Michael L Thomas
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | | | - Eric L Granholm
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0804, La Jolla, CA, 92093, USA
- VA San Diego Psychology Service, San Diego, CA, USA
| | - Borsika A Rabin
- UC San Diego Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- Center of Excellence in Stress and Mental Health, San Diego VA, La Jolla, CA, USA
| | - Gregory A Light
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0804, La Jolla, CA, 92093, USA
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Rivera Rivera JN, AuBuchon KE, Schubel LC, Starling C, Tran J, Locke M, Grady M, Mete M, Blumenthal HJ, Galarraga JE, Arem H. Supporting ColoREctal Equitable Navigation (SCREEN): a protocol for a stepped-wedge cluster randomized trial for patient navigation in primary care. Implement Sci Commun 2024; 5:60. [PMID: 38831365 PMCID: PMC11149321 DOI: 10.1186/s43058-024-00598-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/27/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Black individuals in the United States (US) have a higher incidence of and mortality from colorectal cancer (CRC) compared to other racial groups, and CRC is the second leading cause of death among Hispanic/Latino populations in the US. Patient navigation is an evidence-based approach to narrow inequities in cancer screening among Black and Hispanic/Latino patients. Despite this, limited healthcare systems have implemented patient navigation for screening at scale. METHODS We are conducting a stepped-wedge cluster randomized trial of 15 primary care clinics with six steps of six-month duration to scale a patient navigation program to improve screening rates among Black and Hispanic/Latino patients. After six months of baseline data collection with no intervention we will randomize clinics, whereby three clinics will join the intervention arm every six months until all clinics cross over to intervention. During the intervention roll out we will conduct training and education for clinics, change infrastructure in the electronic health record, create stakeholder relationships, assess readiness, and deliver iterative feedback. Framed by the Practical, Robust Implementation Sustainment Model (PRISM) we will focus on effectiveness, reach, provider adoption, and implementation. We will document adaptations to both the patient navigation intervention and to implementation strategies. To address health equity, we will engage multilevel stakeholder voices through interviews and a community advisory board to plan, deliver, adapt, measure, and disseminate study progress. Provider-level feedback will include updates on disparities in screening orders and completions. DISCUSSION Primary care clinics are poised to close disparity gaps in CRC screening completion but may lack an understanding of the magnitude of these gaps and how to address them. We aim to understand how to tailor a patient navigation program for CRC screening to patients and providers across diverse clinics with wide variation in baseline screening rates, payor mix, proximity to specialty care, and patient volume. Findings from this study will inform other primary care practices and health systems on effective and sustainable strategies to deliver patient navigation for CRC screening among racial and ethnic minorities. TRIAL REGISTRATION NCT06401174.
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Affiliation(s)
- Jessica N Rivera Rivera
- Healthcare Delivery Research Network, MedStar Health Research Institute, Washington, DC, USA
| | - Katarina E AuBuchon
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Laura C Schubel
- Healthcare Delivery Research Network, MedStar Health Research Institute, Washington, DC, USA
| | - Claire Starling
- Healthcare Delivery Research Network, MedStar Health Research Institute, Washington, DC, USA
| | - Jennifer Tran
- Department of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Marjorie Locke
- Department of Surgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Melanie Grady
- MedStar Health Institute for Quality and Safety, Washington, DC, USA
| | - Mihriye Mete
- Department of Behavioral Health Research, MedStar Health Research Institute, Washington, DC, USA
- Department of Psychiatry, Georgetown University School of Medicine, Washington, DC, USA
| | - H Joseph Blumenthal
- Center for Biostatistics, Informatics and Data Science, MedStar Health Research Institute, Washington, DC, USA
| | | | - Hannah Arem
- Healthcare Delivery Research Network, MedStar Health Research Institute, Washington, DC, USA.
- Department of Oncology, Georgetown University, Washington, DC, USA.
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Smith LR, Perez-Brumer A, Nicholls M, Harris J, Allen Q, Padilla A, Yates A, Samore E, Kennedy R, Kuo I, Lake JE, Denis C, Goodman-Meza D, Davidson P, Shoptaw S, El-Bassel N. A data-driven approach to implementing the HPTN 094 complex intervention INTEGRA in local communities. Implement Sci 2024; 19:39. [PMID: 38831415 PMCID: PMC11149235 DOI: 10.1186/s13012-024-01363-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: 12/11/2023] [Accepted: 04/22/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND HIV burden in the US among people who inject drugs (PWID) is driven by overlapping syndemic factors such as co-occurring health needs and environmental factors that synergize to produce worse health outcomes among PWID. This includes stigma, poverty, and limited healthcare access (e.g. medication to treat/prevent HIV and for opioid use disorder [MOUD]). Health services to address these complex needs, when they exist, are rarely located in proximity to each other or to the PWID who need them. Given the shifting drug use landscapes and geographic heterogeneity in the US, we evaluate a data-driven approach to guide the delivery of such services to PWID in local communities. METHODS We used a hybrid, type I, embedded, mixed method, data-driven approach to identify and characterize viable implementation neighborhoods for the HPTN 094 complex intervention, delivering integrated MOUD and HIV treatment/prevention through a mobile unit to PWID across five US cities. Applying the PRISM framework, we triangulated geographic and observational pre-implementation phase data (epidemiological overdose and HIV surveillance data) with two years of implementation phase data (weekly ecological assessments, study protocol meetings) to characterize environmental factors that affected the viability of implementation neighborhoods over time and across diverse settings. RESULTS Neighborhood-level drug use and geographic diversity alongside shifting socio-political factors (policing, surveillance, gentrification) differentially affected the utility of epidemiological data in identifying viable implementation neighborhoods across sites. In sites where PWID are more geographically dispersed, proximity to structural factors such as public transportation and spaces where PWID reside played a role in determining suitable implementation sites. The utility of leveraging additional data from local overdose and housing response systems to identify viable implementation neighborhoods was mixed. CONCLUSIONS Our findings suggest that data-driven approaches provide a contextually relevant pragmatic strategy to guide the real-time implementation of integrated care models to better meet the needs of PWID and help inform the scale-up of such complex interventions. This work highlights the utility of implementation science methods that attend to the impact of local community environmental factors on the implementation of complex interventions to PWID across diverse drug use, sociopolitical, and geographic landscapes in the US. TRIAL REGISTRATION ClincalTrials.gov, Registration Number: NCT04804072 . Registered 18 February 2021.
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Affiliation(s)
- Laramie R Smith
- School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA.
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Melanie Nicholls
- School of Social Work, San Diego State University, San Diego, USA
| | - Jayla Harris
- HIV Prevention Trials Network, Family Health International 360, Durham, USA
| | - Qiana Allen
- UTHealth Houston McGovern School of Medicine, Houston, USA
| | - Alan Padilla
- Columbia University, ICAP, Mailman School of Public Health, New York, USA
| | - Autumn Yates
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Eliza Samore
- Center for Behavioral and Addiction Medicine at UCLA, Los Angeles, USA
| | - Rebecca Kennedy
- School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA
| | - Irene Kuo
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Jordan E Lake
- UTHealth Houston McGovern School of Medicine, Houston, USA
| | - Cecile Denis
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | | | - Peter Davidson
- School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, USA
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McCarthy MM, Szerencsy A, Taza-Rocano L, Hopkins S, Mann D, D'Eramo Melkus G, Vorderstrasse A, Katz SD. Implementing a Clinical Decision Support Tool to Improve Physical Activity. Nurs Res 2024; 73:216-223. [PMID: 38207172 PMCID: PMC11039363 DOI: 10.1097/nnr.0000000000000714] [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] [Indexed: 01/13/2024]
Abstract
BACKGROUND Currently, only about half of U.S. adults achieve current physical activity guidelines. Routine physical activity is not regularly assessed, nor are patients routinely counseled by their healthcare provider on achieving recommended levels. The three-question physical activity vital sign (PAVS) was developed to assess physical activity duration and intensity and identify adults not meeting physical activity guidelines. Clinical decision support provided via a best practice advisory in an electronic health record (EHR) system can be triggered as a prompt, reminding healthcare providers to implement the best practice intervention when appropriate. Remote patient monitoring of physical activity can provide objective data in the EHR. OBJECTIVES This study aimed to evaluate the feasibility and clinical utility of embedding the PAVS and a triggered best practice advisor into the EHR in an ambulatory preventive cardiology practice setting to alert providers to patients reporting low physical activity and prompt healthcare providers to counsel these patients as needed. METHODS Three components based in the EHR were integrated for the purpose of this study: Patients completed the PAVS through their electronic patient portal prior to an office visit, a best practice advisory was created to prompt providers to counsel patients who reported low levels of physical activity, and remote patient monitoring via Fitbit synced to the EHR provided objective physical activity data. The intervention was pilot-tested in the Epic EHR for 1 year (July 1, 2021 to June 30, 2022). Qualitative feedback on the intervention from both providers and patients was obtained at the completion of the study. RESULTS Monthly assessments of the use of the PAVS and best practice advisory and remote patient monitoring were completed. Patients' completion of the PAVS varied from 35% to 48% per month. The best practice advisory was signed by providers between 2% and 65% and was acknowledged by 2%-22% per month. The majority (58%) of patients were able to sync a Fitbit device to their EHR for remote monitoring. DISCUSSION Although uptake of each component needs improvement, this pilot demonstrated the feasibility of incorporating a physical activity promotion intervention into the EHR. Qualitative feedback provided guidance for future implementation.
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Glasgow RE, Ford BS, Bradley CJ. Implementation science for cancer control: One center's experience addressing context, adaptation, equity, and sustainment. Transl Behav Med 2024; 14:215-224. [PMID: 38159246 PMCID: PMC10956964 DOI: 10.1093/tbm/ibad078] [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] [Indexed: 01/03/2024] Open
Abstract
Implementation science (IS) has great potential to enhance the frequency, speed, and quality of the translation of evidence-based programs, policies, products, and guidelines into practice. Progress has been made, but with some notable exceptions, this promise has not been achieved for cancer prevention and control. We discuss five interrelated but conceptually distinct, crosscutting issues important to accelerate IS for cancer prevention and control and how our Colorado Implementation Science Center in Cancer Control (COISC3) addressed these issues. These needs and opportunities include more fully addressing changing, multi-level context; guiding rapid, iterative adaptations; evaluating innovative approaches to engagement and health equity; greater attention to costs and economic issues; and sustainability. We summarize conceptual issues; evaluation needs and capacity building activities and then provide examples of how our IS center addressed these five needs for cancer prevention and control. We discuss changes made to address priorities of (i) guiding adaptations of implementation strategies to address changing context and (ii) working on issues identified and prioritized by our primary care partners rather than the research team. We conclude with discussion of lessons learned, limitations, and directions for future research and practice in IS to enhance cancer prevention and control as well as translational behavioral medicine more generally.
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Affiliation(s)
- Russell E Glasgow
- Colorado Implementation Science Center in Cancer Control, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Bryan S Ford
- Colorado Implementation Science Center in Cancer Control, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Cathy J Bradley
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- University of Colorado Comprehensive Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Paniagua-Avila A, Shelton RC, Figueroa JC, Guzman AL, Gutierrez L, Hernandez-Galdamez DR, Ramirez JM, Rodriguez J, Irazola V, Ramirez-Zea M, Fort MP. Assessing the implementation of a multi-component hypertension program in a Guatemalan under-resourced dynamic context: an application of the RE-AIM/PRISM extension for sustainability and health equity. Implement Sci Commun 2024; 5:23. [PMID: 38491376 PMCID: PMC10941412 DOI: 10.1186/s43058-024-00560-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/20/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic necessitated rapid changes in healthcare delivery in Guatemala's public primary care settings. A new hypertension program, implemented as part of a type 2 hybrid trial since 2019, exemplifies an implementation effort amidst a changing context in an under-resourced setting. We assessed the implementation of an evidence-based intervention (EBI; protocol-based hypertension treatment) and one of its main implementation strategies (team-based collaborative care), raising implications for health equity and sustainability. We present innovative application of systems thinking visuals. METHODS Conducting a convergent mixed methods analysis, we assessed implementation in response to contextual changes across five Ministry of Health (MoH) districts at the pandemic's onset. Utilizing quantitative programmatic data and qualitative interviews with stakeholders (n=18; health providers, administrators, study staff), we evaluated dimensions of "Reach, Effectiveness, Adoption, Implementation and Maintenance," RE-AIM (Reach, Implementation delivery + adaptations), and "Practical Robust Implementation and Sustainability Model," PRISM (Organizational perspective on the EBI, Fit, Implementation and sustainability infrastructure) frameworks. We assessed representativeness by comparing participants to census data. To assess implementation delivery, we built behavior-over-time (BOT) graphs with quantitative programmatic data (July 2019-July 2021). To assess adaptations and contextual changes, we performed matrix-based thematic qualitative analysis. We converged quantitative implementation delivery data + qualitative adaptations data in joint displays. Finally, we analyzed qualitative and quantitative results across RE-AIM/PRISM and health districts to identify equity and sustainability considerations. RESULTS Contextual factors that facilitated program delivery included the perception that the EBI was beneficial, program champions, and staff communication. Key barriers to implementation delivery included competition with other primary care activities and limited implementation infrastructure (e.g., equipment, medications). Contextual changes related to COVID-19 hindered implementation delivery, threatened sustainability, and may have exacerbated inequities. However, adaptations that were planned enhanced implementation delivery and may have supported improved equity and sustainability. CONCLUSIONS Recognition of an EBI's benefits and program champions are important for supporting initial uptake. The ability to plan adaptations amid rapid contextual changes has potential advantages for sustainability and equitable delivery. Systems thinking tools and mixed methods approaches may shed light on the relations between context, adaptations, and equitable and sustainable implementation. TRIAL REGISTRATION NCT03504124.
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Affiliation(s)
- Alejandra Paniagua-Avila
- Epidemiology Department, Mailman School of Public Health, Columbia University, New York, NY, USA.
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala.
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Juan Carlos Figueroa
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
- Department of Epidemiology, Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, PA, USA
| | - Ana Lissette Guzman
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Laura Gutierrez
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Diego Rolando Hernandez-Galdamez
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Juan Manuel Ramirez
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Javier Rodriguez
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Manuel Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Meredith P Fort
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
- Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, USA
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Jolles MP, Fort MP, Glasgow RE. Aligning the planning, development, and implementation of complex interventions to local contexts with an equity focus: application of the PRISM/RE-AIM Framework. Int J Equity Health 2024; 23:41. [PMID: 38408990 PMCID: PMC10898074 DOI: 10.1186/s12939-024-02130-6] [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: 11/14/2023] [Accepted: 02/13/2024] [Indexed: 02/28/2024] Open
Abstract
For the fields of implementation science and health equity, understanding and being responsive to local contexts is of utmost importance to better inform the development, implementation, and evaluation of healthcare and public health interventions to increase their uptake and sustainment. Contexts are multi-level and include political, historical, economic, and social factors that influence health, as well as organizational characteristics, reflecting the richness of members' views, resources, values, and needs. Poor alignment between solutions and those contextual characteristics could have an impact on inequities. The PRISM (Practical Robust Implementation and Sustainability Model) is a context-based implementation science framework that incorporates RE-AIM outcomes (Reach, Effectiveness, Adoption, Implementation, Maintenance) and offers guidance to researchers, practitioners, and their patient and community partners on how to conceptualize, assess, and address contextual domains with a focus on health equity. Drawing from systems thinking, participatory engagement, and health equity principles, this commentary expands on previous work to 1) offer a novel perspective on how to align an intervention's core functions and forms with the PRISM's contextual domains, and 2) foster an ongoing and iterative engagement process with diverse partners throughout the research and practice process using a co-creation approach. We recommend intervention-to-context alignment through iterative cycles. To that end, we present the RE-AIM Framework's 'outcomes cascade' to illustrate touch points of opportunity and gaps within and across each of the five RE-AIM outcomes to illustrate 'where things go wrong'. We present a case study to illustrate and offer recommendations for research and practice efforts to increase contextual responsiveness, and enhance alignment with context before, during, and after implementation efforts and to ensure equity is being addressed. We strive to make a conceptual contribution to advance the field of pragmatic research and implementation of evidence-based practices through the application of the contextually-based PRISM framework with a focus on health equity.
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Affiliation(s)
- Monica Pérez Jolles
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Anschutz Medical Campus, Mailstop F443, 1890 North Revere Court, Aurora, CO, 80045, USA.
- Department of General Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.
| | - Meredith P Fort
- Department of Health Systems, Management and Policy and Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, USA
| | - Russell E Glasgow
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Anschutz Medical Campus, Mailstop F443, 1890 North Revere Court, Aurora, CO, 80045, USA
- Department of Family Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
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Studts CR, Ford B, Glasgow RE. RE-AIM implementation outcomes and service outcomes: what's the connection? results of a cross-sectional survey. BMC Health Serv Res 2023; 23:1417. [PMID: 38102634 PMCID: PMC10722784 DOI: 10.1186/s12913-023-10422-w] [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: 04/14/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Implementation science and health services outcomes research each focus on many constructs that are likely interrelated. Both fields would be informed by increased understanding of these relationships. However, there has been little to no investigation of the relationships between implementation outcomes and service outcomes, despite general acknowledgement that both types of outcomes are important in the pathway to individual and population health outcomes. Given the lack of objective data about the links between implementation and service outcomes, an initial step in elucidating these relationships is to assess perceptions of these relationships among researchers and practitioners in relevant fields. The purpose of this paper is to assess perceived relationships between Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework outcomes and service outcomes, testing five a priori hypotheses about which perceived relationships may be strongest. METHODS A cross-sectional online survey was administered to a convenience sample of implementation scientists, health services researchers, and public health and medical practitioners from a variety of settings. Respondents provided information on their discipline, training, practice and research settings, and levels of experience in health service outcomes research, implementation science, and the RE-AIM framework. Next, they rated perceived relationships between RE-AIM and service outcomes. Repeated measures analysis of variance were used to test a priori hypotheses. Exploratory analyses assessed potential differences in mean ratings across groups of respondents categorized by discipline, setting, and levels of implementation science, health services, and RE-AIM experience. RESULTS Surveys were completed by 259 respondents, most of whom were employed in academic and medical settings. The majority were doctoral-level researchers and educators or physicians. Reported levels of experience with implementation research, health services research, and the RE-AIM framework varied. The strongest perceived relationships overall were between Implementation/Fidelity and Effectiveness (as a service outcome); Maintenance and Efficiency; Reach and Equity; Adoption and Equity; Implementation/Adaptation and Patient-Centeredness; Adoption and Patient-Centeredness; and Implementation/Fidelity and Safety. All but one of the a priori hypotheses were supported. No significant differences in ratings of perceived relationships were observed among subgroups of respondents. CONCLUSIONS This study is an initial step in developing conceptual understanding of the links between implementation outcomes, health services outcomes, and health outcomes. Our findings on perceived relationships between RE-AIM and services outcomes suggest some areas of focus and identify several areas for future research to advance both implementation science and health services research toward common goals of improving health outcomes.
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Affiliation(s)
- Christina R Studts
- Department of Pediatrics, Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, 1890 N. Revere Ct., Aurora, CO, 80045, USA.
| | - Bryan Ford
- Department of Family Medicine, Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Russell E Glasgow
- Department of Family Medicine, Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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10
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Harkko J, Sipilä N, Nordquist H, Lallukka T, Appelqvist-Schmidlechner K, Donnelly M, Kouvonen A. External context in individual placement and support implementation: a scoping review with abductive thematic analysis. Implement Sci 2023; 18:61. [PMID: 37946209 PMCID: PMC10636871 DOI: 10.1186/s13012-023-01316-w] [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: 03/31/2023] [Accepted: 10/15/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Context including the external context may considerably affect the adoption, implementation, sustainment, and scale-up of evidence-based practices. We investigated external contextual features by conducting a scoping review of empirical research regarding the implementation of an evidence-based psychiatric or mental health vocational rehabilitation service called Individual Placement and Support (IPS). METHODS The protocol for the scoping review was registered with the Open Science Framework. We used the methodology by Joanna Briggs Institute for conducting the scoping review and reported it according to the PRISMA-ScR checklist. We searched 12 databases for research regarding 'Individual Placement and Support' or 'Evidence-Based Supported Employment'. We retained peer-reviewed empirical studies investigating external contextual factors and their impact on IPS implementation outcomes. We extracted data from the eligible articles and conducted descriptive and thematic analyses. RESULTS Fifty-nine original research papers met our eligibility requirements and were retained after reviewing 1124 titles and abstracts and 119 full texts. The analysis generated two main themes: (1) external contextual determinants of service delivery and (2) external systems influencing the evidence-to-practice process. The first main theme encompassed policies and laws, financing, and administratively instituted support resources, and organizational arrangements associated with external stakeholders that may facilitate or hinder the local implementation. The second main theme comprised strategies and actions used by different stakeholders to facilitate implementation locally or scale-up efforts at a system level. DISCUSSION Our scoping review illustrates the important role that external contextual factors play and how they may facilitate or hinder the implementation and scale-up of the IPS model across mental health services in different countries. Consideration of these factors by decision-makers in mental health and welfare services, planners, providers, and practitioners is likely to facilitate the development of effective strategies for bridging the evidence-practice gap in implementing the EBPs. Finally, the scoping review identified gaps in knowledge and offered suggestions for future research. TRIAL REGISTRATION Open Science Framework.
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Affiliation(s)
- Jaakko Harkko
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.
| | - Noora Sipilä
- The Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hilla Nordquist
- South-Eastern Finland University of Applied Sciences, Kotka, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
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11
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Melhado TV, Schneegans S, Rochat A, Kawasaki K, Finley EP, Wheeler D, Allison WE. Utilizing PRISM and RE-AIM to implement and evaluate the Rural Telementoring Training Center (RTTC) for health care workforce development in rural communities. FRONTIERS IN HEALTH SERVICES 2023; 3:1219308. [PMID: 37927442 PMCID: PMC10620924 DOI: 10.3389/frhs.2023.1219308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023]
Abstract
Introduction Amid rural health worker shortages and hospital closures, it is imperative to build and maintain the local workforce. Telementoring (TM) or technology-enabled mentoring, is a tool for improving health care quality and access by increasing workforce capacity and support. The national Rural Telementoring Training Center (RTTC) was developed to compile and disseminate TM best practices by delivering free training, tools, and technical assistance to support the implementation, sustainability, and evaluation of new and current TM programs for rural health workers. This paper details how the Practical, Robust Implementation and Sustainability Model (PRISM) was used to understand the context that shaped implementation as well as how Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) was concurrently applied to frame outcomes. Methods The RTTC has three implementation strategies: outreach, training and technical assistance (TTA), and a Quality Measure Toolkit. Ongoing periodic reflections with the RTTC team, informed by PRISM, were collected, as were RE-AIM outcomes. Central to this design was the continuous review of incoming data in team meetings to inform programmatic changes by identifying challenges and applying modifications to strategies in real time. Results Major implementation changes discussed during reflections included providing timely and relevant messaging through various platforms, streamlining and customizing a TTA approach, and offering different options for accessing the Toolkit. The outreach strategy resulted in high Reach across the US, with over 300 organizations contacted. The effectiveness of the RTTC was demonstrated by counts of people engaging with outreach (ex. over 8,300 impressions on LinkedIn), the website (over 6,400 views), and e-bursts (33% open rate). Moreover, there were 32 TTA requests and 70 people accessing the Toolkit. Adoption was demonstrated by 27 people participating in TTA and 14 individuals utilizing the Toolkit. Discussion The integration of PRISM and RE-AIM frameworks promoted a holistic implementation and evaluation plan. Using PRISM, the RTTC team was able to reflect on the implementation strategies through the lens of contextual factors and make rapid programmatic changes within team meetings. That process resulted in outcomes framed by RE-AIM. The integration of two frameworks in tandem provided an adaptive and comprehensive approach to implementing a large-scale, national program.
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Affiliation(s)
- Trisha V. Melhado
- Center for Health Policy, Division of Academic Innovation, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Suyen Schneegans
- Center for Research to Advance Community Health (ReACH), The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Andrea Rochat
- Center for Research to Advance Community Health (ReACH), The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Keito Kawasaki
- Center for Research to Advance Community Health (ReACH), The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Erin P. Finley
- Center for Research to Advance Community Health (ReACH), The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Denna Wheeler
- Center for Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Waridibo E. Allison
- Center for Health Policy, Division of Academic Innovation, University of North Texas Health Science Center, Fort Worth, TX, United States
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12
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Stadnick NA, Laurent LC, Cain KL, Seifert M, Burola ML, Salgin L, Watson P, Oswald W, Munoz FA, Velasquez SF, Smith JD, Zou J, Rabin BA. Community-engaged optimization of COVID-19 rapid evaluation and testing experiences: roll-out implementation optimization trial. Implement Sci 2023; 18:46. [PMID: 37784200 PMCID: PMC10544564 DOI: 10.1186/s13012-023-01306-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND There continues to be a need for COVID-19 testing that is pragmatic, community-centered, and sustainable. This study will refine and test implementation strategies prioritized by community partners: (1) walk-up no-cost testing, (2) community health worker (promotores)-facilitated testing and preventive care counseling, (3) vending machines that dispense no-cost, self-testing kits. METHODS A co-designed Theory of Change from an earlier study phase and the Practical, Robust Implementation and Sustainment Model (PRISM) will guide the study design, measures selection, and evaluation. The first aim is to refine and operationalize a multi-component implementation strategy bundle and outcome measures for COVID-19 testing. A Community and Scientific Advisory Board (CSAB) will be established and include community members, clinical providers/staff from the partnering Federally Qualified Health Center (FQHC), public health researchers, policymakers, and a county health department ambassador. Engagement of CSAB members will be assessed through structured ethnography and a survey about the quality and quantity of engagement practices. The second aim is to implement and evaluate the impact of the implementation strategy bundle to optimize COVID-19 testing in communities using a roll-out implementation optimization (ROIO) design. Seven thousand and five hundred community members will be enrolled across four FQHC clinics over 18 months. Participants will be invited to complete an electronic survey about their demographics, health, and COVID-19 testing results and experiences. CSAB members and clinic partners will participate in PRISM fit and determinant assessments prior to each clinic rollout and post-trial. Interviews will be conducted with 60 community participants and 12 providers/staff following a 3-month rollout period at each clinic, inquiring about their experiences with the implementation strategies. Quantitative data will be analyzed using hierarchical multilevel models to determine the impact of implementation strategies. Qualitative data will be analyzed using rapid qualitative approaches to summarize implementation experiences and identify necessary changes prior to subsequent rollouts. A matrix approach will be used to triangulate data from quantitative and qualitative sources based on PRISM domains. DISCUSSION This is one of the first pragmatic implementation trials to use a ROIO design and aims to co-create a sustainable and equitable COVID-19 testing program. Findings are likely to generalize to other public health prevention efforts. TRIAL REGISTRATION NCT05894655 March 2, 2023.
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Affiliation(s)
- Nicole A Stadnick
- University of California San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, USA.
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
- Child and Adolescent Services Research Center, San Diego, USA.
| | - Louise C Laurent
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | - Kelli L Cain
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Marva Seifert
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Maria Linda Burola
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | - Linda Salgin
- San Ysidro Health, San Diego, CA, USA
- Joint Doctoral Program in Public Health School, UC San Diego and San Diego State University, San Diego, CA, USA
| | - Paul Watson
- The Global Action Research Center, San Diego, CA, USA
| | | | | | | | - Justin D Smith
- Department of Population Health Sciences, Division of Health System Innovation and Research, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jingjing Zou
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Borsika A Rabin
- University of California San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
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13
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Trinkley KE, Wright G, Allen LA, Bennett TD, Glasgow RE, Hale G, Heckman S, Huebschmann AG, Kahn MG, Kao DP, Lin CT, Malone DC, Matlock DD, Wells L, Wysocki V, Zhang S, Suresh K. Sustained Effect of Clinical Decision Support for Heart Failure: A Natural Experiment Using Implementation Science. Appl Clin Inform 2023; 14:822-832. [PMID: 37852249 PMCID: PMC10584394 DOI: 10.1055/s-0043-1775566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/02/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVES In a randomized controlled trial, we found that applying implementation science (IS) methods and best practices in clinical decision support (CDS) design to create a locally customized, "enhanced" CDS significantly improved evidence-based prescribing of β blockers (BB) for heart failure compared with an unmodified commercially available CDS. At trial conclusion, the enhanced CDS was expanded to all sites. The purpose of this study was to evaluate the real-world sustained effect of the enhanced CDS compared with the commercial CDS. METHODS In this natural experiment of 28 primary care clinics, we compared clinics exposed to the commercial CDS (preperiod) to clinics exposed to the enhanced CDS (both periods). The primary effectiveness outcome was the proportion of alerts resulting in a BB prescription. Secondary outcomes included patient reach and clinician adoption (dismissals). RESULTS There were 367 alerts for 183 unique patients and 171 unique clinicians (pre: March 2019-August 2019; post: October 2019-March 2020). The enhanced CDS increased prescribing by 26.1% compared with the commercial (95% confidence interval [CI]: 17.0-35.1%), which is consistent with the 24% increase in the previous study. The odds of adopting the enhanced CDS was 81% compared with 29% with the commercial (odds ratio: 4.17, 95% CI: 1.96-8.85). The enhanced CDS adoption and effectiveness rates were 62 and 14% in the preperiod and 92 and 10% in the postperiod. CONCLUSION Applying IS methods with CDS best practices was associated with improved and sustained clinician adoption and effectiveness compared with a commercially available CDS tool.
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Affiliation(s)
- Katy E. Trinkley
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, United States
- UCHealth, Aurora, Colorado, United States
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, United States
| | - Garth Wright
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, United States
| | - Larry A. Allen
- Adult and Child Center for Outcomes Research and Delivery Science, Aurora, Colorado, United States
- Division of Cardiology, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, United States
| | - Tellen D. Bennett
- Adult and Child Center for Outcomes Research and Delivery Science, Aurora, Colorado, United States
- Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Russell E. Glasgow
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, United States
- Adult and Child Center for Outcomes Research and Delivery Science, Aurora, Colorado, United States
- Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado, United States
| | - Gary Hale
- UCHealth, Aurora, Colorado, United States
| | | | - Amy G. Huebschmann
- Adult and Child Center for Outcomes Research and Delivery Science, Aurora, Colorado, United States
- Division of Internal Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, United States
- University of Colorado Anschutz Medical Campus Ludeman Family Center for Women's Health Research, Aurora, Colorado, United States
| | - Michael G. Kahn
- Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - David P. Kao
- UCHealth, Aurora, Colorado, United States
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, United States
| | - Chen-Tan Lin
- UCHealth, Aurora, Colorado, United States
- Division of Internal Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, United States
| | - Daniel C. Malone
- Department of Pharmacotherapy, University of Utah Skaggs College of Pharmacy, Salt Lake City, Utah, United States
| | - Daniel D. Matlock
- Adult and Child Center for Outcomes Research and Delivery Science, Aurora, Colorado, United States
- Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado, United States
- Division of Internal Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, United States
- Division of Geriatrics, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, United States
| | - Lauren Wells
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, United States
| | - Vincent Wysocki
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, United States
| | - Shelley Zhang
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, United States
| | - Krithika Suresh
- Adult and Child Center for Outcomes Research and Delivery Science, Aurora, Colorado, United States
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, United States
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14
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Jaffa MN, Kirschen MP, Tuppeny M, Reynolds AS, Lim-Hing K, Hargis M, Choi RK, Schober ME, LaBuzetta JN. Enhancing Understanding and Overcoming Barriers in Brain Death Determination Using Standardized Education: A Call to Action. Neurocrit Care 2023; 39:294-303. [PMID: 37434103 DOI: 10.1007/s12028-023-01775-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/02/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Matthew N Jaffa
- Division of Neurocritical Care, Department of Neurology, Ayer Neuroscience Institute, Hartford Hospital, Hartford, CT, USA
| | - Matthew P Kirschen
- Departments of Anesthesiology and Critical Care Medicine, Neurology, and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Misti Tuppeny
- Division of Neuroscience and Behavioral Health, Department of Nursing Education and Quality, Advent Health, Orlando, FL, USA
| | - Alexandra S Reynolds
- Departments of Neurosurgery and Neurology, Mount Sinai Health System, New York, NY, USA
| | - Krista Lim-Hing
- Neurocritical Care Division, Department of Neurosurgery, Northwell Health, Bay Shore, NY, USA
| | - Mitch Hargis
- Division of Neurocritical Care, Department of Neurosciences, Novant Health Forsyth Medical Center, Winston-Salem, NC, USA
| | - Richard K Choi
- Division of Neurosciences, ChristianaCare, Newark, DE, USA
| | - Michelle E Schober
- Pediatric Critical Care Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jamie Nicole LaBuzetta
- Division of Neurocritical Care, Department of Neurosciences, University of California San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA.
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Aschbrenner KA, Oh AY, Tabak RG, Hannon PA, Angier HE, Moore WT, Likumahuwa-Ackman S, Carroll JK, Baumann AA, Beidas RS, Mazzucca-Ragan S, Waters EA, Sadasivam RS, Shelton RC. Integrating a focus on health equity in implementation science: Case examples from the national cancer institute's implementation science in cancer control centers (ISC 3) network. J Clin Transl Sci 2023; 7:e226. [PMID: 38028358 PMCID: PMC10643915 DOI: 10.1017/cts.2023.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/11/2023] [Accepted: 09/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background A Health Equity Task Force (HETF) of members from seven Centers funded by the National Cancer Institute's (NCI) Implementation Science in Cancer Control Centers (ISC3) network sought to identify case examples of how Centers were applying a focus on health equity in implementation science to inform future research and capacity-building efforts. Methods HETF members at each ISC3 collected information on how health equity was conceptualized, operationalized, and addressed in initial research and capacity-building efforts across the seven ISC3 Centers funded in 2019-2020. Each Center completed a questionnaire assessing five health equity domains central to implementation science (e.g., community engagement; implementation science theories, models, and frameworks (TMFs); and engaging underrepresented scholars). Data generated illustrative examples from these five domains. Results Centers reported a range of approaches focusing on health equity in implementation research and capacity-building efforts, including (1) engaging diverse community partners/settings in making decisions about research priorities and projects; (2) applying health equity within a single TMF applied across projects or various TMFs used in specific projects; (3) evaluating health equity in operationalizing and measuring health and implementation outcomes; (4) building capacity for health equity-focused implementation science among trainees, early career scholars, and partnering organizations; and (5) leveraging varying levels of institutional resources and efforts to engage, include, and support underrepresented scholars. Conclusions Examples of approaches to integrating health equity across the ISC3 network can inform other investigators and centers' efforts to build capacity and infrastructure to support growth and expansion of health equity-focused implementation science.
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Affiliation(s)
- Kelly A. Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Hanover, NH, USA
| | - April Y. Oh
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Rachel G. Tabak
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Peggy A. Hannon
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Heather E. Angier
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - W. Todd Moore
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | | | | | - Ana A. Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Rinad S. Beidas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Erika A. Waters
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Rajani S. Sadasivam
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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16
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Faro JM, Yue KL, Leach HJ, Crisafio ME, Lemon SC, Wang B, McManus DD, Sadasivam RS. Development and pilot testing of a clinic implementation program delivering physical activity electronic referrals to cancer survivors. Transl Behav Med 2023; 13:794-803. [PMID: 37318360 PMCID: PMC10538473 DOI: 10.1093/tbm/ibad035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
Provider physical activity referrals are recommended for cancer survivors, though barriers exist to clinical system integration. To develop and test ActivityChoice, an electronic referral (eReferral) clinic implementation program referring cancer survivors to physical activity programs of their choice. In Phase 1, we conducted semi-structured interviews with Cancer Center clinicians (n = 4) and cancer-focused physical activity program leaders (n = 3) assessing adaptations needed to implement an eReferral previously designed for another context. In Phase 2, we pilot-tested clinician-delivered referrals to survivors in two 12-week Plan, Do, Study, Act (PDSA) cycles. We examined feasibility using descriptive statistics (clinicians' adoption and engagement, patient referrals, and physical activity program enrollment) and acceptability through semi-structured interviews with enrolled clinicians (n = 4) and referred patients (n = 9). ActivityChoice included a secure referral webform, text message/email referral confirmations, clinician training/booster sessions, visual reminders, and referrals to in-person or virtual group physical activity programs. Results for each PDSA cycle respectively included: 41% (n = 7) and 53% (n = 8) of clinicians adopted ActivityChoice; 18 and 36 patients were referred; 39% (n = 7) and 33% (n = 12) of patients enrolled in programs, and 30% (n = 4) and 14% (n = 5) of patients deferred enrollment. Patients and clinicians appreciated the referrals and choices. A printed handout describing both programs was added to the clinic workflow for Cycle 2, which yielded more referrals, but lower program enrollment rates. Clinic-based eReferrals to choices of physical activity programs were feasible and acceptable by clinicians and patients. Added clinic workflow support may facilitate referrals.
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Affiliation(s)
- Jamie M Faro
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Kai-Lou Yue
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Heather J Leach
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Mary E Crisafio
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Stephenie C Lemon
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - David D McManus
- Department of Medicine, Division of Cardiology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Rajani S Sadasivam
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Trinkley KE, Glasgow RE, D'Mello S, Fort MP, Ford B, Rabin BA. The iPRISM webtool: an interactive tool to pragmatically guide the iterative use of the Practical, Robust Implementation and Sustainability Model in public health and clinical settings. Implement Sci Commun 2023; 4:116. [PMID: 37726860 PMCID: PMC10508024 DOI: 10.1186/s43058-023-00494-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/28/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND To increase uptake of implementation science (IS) methods by researchers and implementers, many have called for ways to make it more accessible and intuitive. The purpose of this paper is to describe the iPRISM webtool (Iterative, Practical, Robust Implementation and Sustainability Model) and how this interactive tool operationalizes PRISM to assess and guide a program's (a) alignment with context, (b) progress on pragmatic outcomes, (c) potential adaptations, and (d) future sustainability across the stages of the implementation lifecycle. METHODS We used an iterative human-centered design process to develop the iPRISM webtool. RESULTS We conducted user-testing with 28 potential individual and team-based users who were English and Spanish speaking from diverse settings in various stages of implementing different types of programs. Users provided input on all aspects of the webtool including its purpose, content, assessment items, visual feedback displays, navigation, and potential application. Participants generally expressed interest in using the webtool and high likelihood of recommending it to others. The iPRISM webtool guides English and Spanish-speaking users through the process of iteratively applying PRISM across the lifecycle of a program to facilitate systematic assessment and alignment with context. The webtool summarizes assessment responses in graphical and tabular displays and then guides users to develop feasible and impactful adaptations and corresponding action plans. Equity considerations are integrated throughout. CONCLUSIONS The iPRISM webtool can intuitively guide individuals and teams from diverse settings through the process of using IS methods to iteratively assess and adapt different types of programs to align with the context across the implementation lifecycle. Future research and application will continue to develop and evaluate this IS resource.
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Affiliation(s)
- Katy E Trinkley
- Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave., Mail Stop F496, Aurora, CO, 80045, USA.
- Adult and Child Center for Outcomes Research and Delivery Science Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Russell E Glasgow
- Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave., Mail Stop F496, Aurora, CO, 80045, USA
- Adult and Child Center for Outcomes Research and Delivery Science Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sidney D'Mello
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Meredith P Fort
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Bryan Ford
- Adult and Child Center for Outcomes Research and Delivery Science Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Borsika A Rabin
- Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave., Mail Stop F496, Aurora, CO, 80045, USA
- Adult and Child Center for Outcomes Research and Delivery Science Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- ACTRI Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, USA
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Maw AM, Huebschmann AG, Jones CD. Methods progress note: Applying dissemination and implementation science models to enhance hospital-based quality improvement. J Hosp Med 2023; 18:841-844. [PMID: 37225387 DOI: 10.1002/jhm.13139] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Anna M Maw
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amy G Huebschmann
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Christine D Jones
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Rocky Mountain Regional VA Medical Center, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, University of Colorado School of Medicine, Aurora, Colorado, USA
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
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Fort MP, Manson SM, Glasgow RE. Applying an equity lens to assess context and implementation in public health and health services research and practice using the PRISM framework. FRONTIERS IN HEALTH SERVICES 2023; 3:1139788. [PMID: 37125222 PMCID: PMC10137153 DOI: 10.3389/frhs.2023.1139788] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 03/13/2023] [Indexed: 05/02/2023]
Abstract
Dissemination and implementation science seeks to enhance the uptake, successful implementation, and sustainment of evidence-based programs and policies. While a focus on health equity is implicit in many efforts to increase access to and coverage of evidence-based programs and policies, most implementation frameworks and models do not explicitly address it. Disparities may in fact be increased by emphasizing high intensity interventions or ease of delivery over meeting need within the population, addressing deep-rooted structural inequities, and adapting to local context and priorities. PRISM (Practical, Robust Implementation and Sustainability Model), the contextual expansion of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework has several elements that address health equity, but these have not been explicated, integrated, or illustrated in one place. We present guidance for applying PRISM with an equity lens across its four context domains (external environment; multi-level perspectives on the intervention; characteristics of implementers and intended audience; and the implementation and sustainability infrastructure-as well as the five RE-AIM outcome dimensions. We then present an example with health equity considerations and discuss issues of representation and participation, representativeness and the importance of ongoing, iterative assessment of dynamic context and structural drivers of inequity. We also elaborate on the importance of a continuous process that requires addressing community priorities and responding to capacity and infrastructure needs and changes. We conclude with research and practice recommendations for applying PRISM with an increased emphasis on equity.
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Affiliation(s)
- Meredith P. Fort
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, United States
- Department of Health Systems, Management and Policy, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, United States
| | - Spero M. Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, United States
| | - Russell E. Glasgow
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Anschutz Medical Campus, and Eastern Colorado Veterans Administration, Aurora, CO, United States
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20
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Estabrooks PA, Glasgow RE. Developing a dissemination and implementation research agenda for aging and public health: The what, when, how, and why? Front Public Health 2023; 11:1123349. [PMID: 36815160 PMCID: PMC9939692 DOI: 10.3389/fpubh.2023.1123349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/13/2023] [Indexed: 02/09/2023] Open
Affiliation(s)
- Paul A. Estabrooks
- Department of Health and Kinesiology, College of Health, University of Utah, Salt Lake City, UT, United States
| | - Russell E. Glasgow
- ACCORDS Dissemination & Implementation Science Program and Department of Family Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, United States
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