1
|
Healey Akearok GK, Chaliak AJ, Cueva K, Cook D, Larsen CVL, Jóhannsdóttir L, Nilsson LM, San Sebastián M, Peterson M, Timlin U, Broderstadt AR, Dagsvold I, Siri S, Olesen I, Stoor JPA, Rautio A, Rink E, Lavoie JG. Diverse methodological approaches to a Circumpolar multi-site case study which upholds and responds to local and Indigenous community research processes in the Arctic. Int J Circumpolar Health 2024; 83:2336284. [PMID: 38573784 PMCID: PMC10997363 DOI: 10.1080/22423982.2024.2336284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/25/2024] [Indexed: 04/06/2024] Open
Abstract
This paper outlines the methodological approaches to a multi-site Circumpolar case study exploring the impacts of COVID-19 on Indigenous and remote communities in 7 of 8 Arctic countries. Researchers involved with the project implemented a three-phase multi-site case study to assess the positive and negative societal outcomes associated with the COVID-19 pandemic in Arctic communities from 2020 to 2023. The goal of the multi-site case study was to identify community-driven models and evidence-based promising practices and recommendations that can help inform cohesive and coordinated public health responses and protocols related to future public health emergencies in the Arctic. Research sites included a minimum of 1 one community each from Canada (Nunavut,) United States of America (Alaska), Greenland, Iceland, Norway, Sweden, Finland. The approaches used for our multi-site case study provide a comprehensive, evidence-based account of the complex health challenges facing Arctic communities, offering insights into the effectiveness of interventions, while also privileging Indigenous local knowledge and voices. The mixed method multi-site case study approach enriched the understanding of unique regional health disparities and strengths during the pandemic. These methodological approaches serve as a valuable resource for policymakers, researchers, and healthcare professionals, informing future strategies and interventions.
Collapse
Affiliation(s)
| | | | - Katie Cueva
- Department of Psychology, University of Alaska, Anchorage, AK, USA
| | - David Cook
- Environment and Natural Resources Programme, University of Iceland, Reykjavík, Iceland
| | - Christina VL Larsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | - Lára Jóhannsdóttir
- Environment and Natural Resources Programme, University of Iceland, Reykjavík, Iceland
| | - Lena Maria Nilsson
- Department of Epidemiology and Global Health, Lávvuo-Research and Education for Sámi Health, Umeå University, Umeå, Sweden
| | - Miguel San Sebastián
- Department of Epidemiology and Global Health, Lávvuo-Research and Education for Sámi Health, Umeå University, Umeå, Sweden
| | - Malory Peterson
- Department of Human Development and Community Health, Montana State University, Bozeman, MT, USA
| | - Ulla Timlin
- Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Ann Ragnhild Broderstadt
- Centre for Sámi Health Research, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Inger Dagsvold
- Centre for Sámi Health Research, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Susanna Siri
- Centre for Sámi Health Research, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Ingelise Olesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | - Jon Petter A. Stoor
- Department of Epidemiology and Global Health, Lávvuo-Research and Education for Sámi Health, Umeå University, Umeå, Sweden
- Centre for Sámi Health Research, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Arja Rautio
- Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Elizabeth Rink
- Department of Human Development and Community Health, Montana State University, Bozeman, MT, USA
| | - Josée G. Lavoie
- Ongomiizwin Research, University of Manitoba, Winnipeg, MB, Canada
| |
Collapse
|
2
|
Nielsen JH, Jepsen I, Eriksen SA, Maimburg RD. Development and early implementation of telemonitoring of complicated pregnancies - A qualitative study with the perspectives of health professionals. Midwifery 2024; 138:104149. [PMID: 39173535 DOI: 10.1016/j.midw.2024.104149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 08/12/2024] [Accepted: 08/17/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Telemonitoring may offer promising opportunities in health care. In obstetric health care, there is a need to expand and improve digitalization. Nevertheless, there is limited knowledge based on healthcare professionals' perspectives regarding the use of telemedicine and remote cardiotocography during pregnancy, as well as its implementation. AIM To explore the perspectives of health-care professionals who manage telemonitoring of complicated pregnancies. DESIGN AND SETTING A qualitative interview study undertaken in a hospital with a tertiary obstetric unit in Northen Denmark. METHODS Based on a purposive sample strategy, 11 semi-structured interviews of health-care professionals involved in the management of telemonitoring in women with complicated pregnancies were conducted and analyzed using a reflexive thematic analytical approach. FINDINGS The findings are assembled into two main themes. The experience of relevance to own practice: included the embedded potentials in telemonitoring providing women-centred care, but also challenges related to the implementation of a new technology. Experience of challenges and potential in day-to-day operation: included frustrations regarding the technological devices and software, working experiences increasing confidence in telemonitoring, and perspectives on the required interdependence across departments. CONCLUSION This study adds important knowledge to support awareness and reflection on how challenges impact the successful implementation of telemonitoring in obstetric and midwifery care. This includes knowledge of important processes and resources to ensure ongoing implementation and evaluation. Implementation strategies and collaborations to support a multiple-level system change, such as an interdisciplinary team, seem crucial to minimize challenges, build shared visions, and engage staff.
Collapse
Affiliation(s)
- Jane Hyldgaard Nielsen
- Department of Midwifery, University College of Northern Denmark, Denmark; Research Centre of Health and Applied Technology, University College Northern Denmark, Aalborg, Denmark.
| | - Ingrid Jepsen
- Department of Midwifery, University College of Northern Denmark, Denmark; Research Centre of Health and Applied Technology, University College Northern Denmark, Aalborg, Denmark
| | | | - Rikke Damkjær Maimburg
- Department of Midwifery, University College of Northern Denmark, Denmark; Department of Clinical Medicine, Aarhus University, Denmark; Department of Occupational Health, Danish Ramazzini Centre, Aarhus University Hospital, Denmark; School of Nursing and Midwifery, Western Sydney University, Australia
| |
Collapse
|
3
|
Michelle Nettleton Pearce L, Howell M, Parma Yamato T, Maria Ribeiro Bacha J, Eduardo Pompeu J, Howard K, Sherrington C, Hassett L. What attributes of digital devices are important to clinicians in rehabilitation? A cross-cultural best-worst scaling study. Int J Med Inform 2024; 191:105589. [PMID: 39137666 DOI: 10.1016/j.ijmedinf.2024.105589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 07/25/2024] [Accepted: 08/04/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Digital interventions are becoming increasingly popular in rehabilitation. Understanding of device features which impact clinician adoption and satisfaction is limited. Research in the field should be conducted across diverse settings to ensure digital interventions do not exacerbate healthcare inequities. OBJECTIVE This study aimed to understand rehabilitation clinicians' preferences regarding device attributes and included a cross-cultural comparison. MATERIALS AND METHODS Choice experiment methodology (best-worst scaling) was used to survey rehabilitation clinicians across Australia and Brazil. Participants completed 10 best-worst questions, choosing the most and least important device attributes from subsets of 31 attributes in a partially balanced block design. Results were analysed using multinomial models by country and latent class. Attribute preference scores (PS) were scaled to 0-100 (least to most important). RESULTS A total of 122 clinicians from Brazil and 104 clinicians from Australia completed the survey. Most respondents were physiotherapists (83%) working with neurological populations (51%) in the private/self-employed sector (51%) who had experience using rehabilitation devices (87%). Despite preference heterogeneity across country and work sector (public/not-for-profit versus private/self-employed/other), clinicians consistently prioritised patient outcomes (PS 100.0, 95%CI: 86.2-100.0), patient engagement (PS 93.9, 95%CI: 80.6-94.2), usability (PS 81.3, 95%CI: 68.8-82.5), research evidence (PS 80.4, 95%CI: 68.1-81.7) and risk (PS 75.7, 95%CI: 63.8-77.3). In Australia, clinicians favoured device attributes which facilitate increased therapy dosage (PS 79.2, 95%CI: 62.6-81.1) and encourage patient independent practice (PS 66.8, 95%CI: 52.0-69.2). In Brazil, clinicians preferred attributes enabling device use for providing clinical data (PS 67.6, 95%CI: 51.8-70.9) and conducting clinical assessments (PS 65.6, 95%CI: 50.2-68.8). CONCLUSION Clinicians prioritise patients' needs and practical application over technical aspects of digital rehabilitation devices. Contextual factors shape clinician preferences rather than individual clinician characteristics. Future device design and research should consider preferences and influences, involving diverse stakeholders to account for context-driven variations across cultures and healthcare settings.
Collapse
Affiliation(s)
- Louise Michelle Nettleton Pearce
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia; Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal Rehab Group, Sydney, Australia.
| | - Martin Howell
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney Australia; Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney, Australia.
| | - Tiê Parma Yamato
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Universidade Cidade de Sao Paulo, Brazil.
| | | | | | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney Australia; Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney, Australia.
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney Australia.
| | - Leanne Hassett
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia; Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Implementation Science Academy, Sydney Health Partners, Sydney, Australia.
| |
Collapse
|
4
|
Ayyaswami V, Chang A. Avoiding burnout from AI in busy clinical practice. Heart Rhythm 2024; 21:e271-e273. [PMID: 39207348 DOI: 10.1016/j.hrthm.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 08/01/2024] [Indexed: 09/04/2024]
Affiliation(s)
- Varun Ayyaswami
- Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts
| | - Allen Chang
- Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts.
| |
Collapse
|
5
|
Balis LE, Yaroch A, Palmer S, Shaw E, Lima Dos Santos P, Byker Shanks C. Implementation and Impact of Perinatal Food Is Medicine Programs: A Qualitative Research Study. J Acad Nutr Diet 2024; 124:1255-1265.e21. [PMID: 38354853 DOI: 10.1016/j.jand.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Improving social determinants of health, such as access to nutritious food, is crucial for achieving health equity. Nutrition insecurity, especially during pregnancy and postpartum, can lead to poor maternal and birth outcomes. Food is Medicine (FIM) programs, which integrate food into the health care system to prevent or manage disease, have the potential to improve nutrition insecurity, but research about perinatal FIM programs is limited. OBJECTIVE The purpose of this study was to explore perceptions of public health impacts of perinatal FIM programs from the perspectives of both program implementers and program supporters and implementation strategies used to enhance program adoption, implementation, and maintenance. DESIGN Qualitative data were collected through semi-structured interviews. The interview guide was based on the Reach, Effectiveness, Adoption, Implementation, Maintenance framework. PARTICIPANTS/SETTING Program implementers (n = 16) and program supporters (n = 20) were recruited across the United States through purposive sampling in 2022 and 2023. ANALYSIS Data were analyzed using deductive thematic analysis and an iterative feedback loop with the project partner. RESULTS Interviews were completed with program implementers and program supporters and generated meaning units (n = 1,942), which were coded into themes aligned with each Reach, Effectiveness, Adoption, Implementation, Maintenance dimension. Perinatal FIM programs reached multiple priority populations who were mainly recruited through health care systems. Effectiveness measures typically included nutrition patterns and practices, as well as return on investment. Motivations for adopting programs primarily included partnerships and connections, financing, and policies and laws. Program components varied and were adapted to meet participants and setting needs. Policy, evidence, funding, and partnerships could lead to program maintenance. Implementation strategies applied by the program supporters included financial strategies and infrastructure changes. CONCLUSIONS There is a need to identify the core functions and adaptable forms of perinatal FIM programs, which could lead to identification of standard evaluation metrics. This could result in greater uptake by potential delivery agents, increased funding and policy support, and enhanced benefits for perinatal population experiencing health disparities.
Collapse
Affiliation(s)
- Laura E Balis
- Gretchen Swanson Center for Nutrition, Omaha, Nebraska.
| | - Amy Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, Nebraska
| | - Shelly Palmer
- Gretchen Swanson Center for Nutrition, Omaha, Nebraska
| | - Emily Shaw
- Gretchen Swanson Center for Nutrition, Omaha, Nebraska
| | - Paloma Lima Dos Santos
- Gretchen Swanson Center for Nutrition, Omaha, Nebraska; Translational Biomedical Sciences, Ohio University, Athens, Ohio
| | | |
Collapse
|
6
|
Smith AM, Prom MC, Ng LC. A Qualitative Investigation of Characteristics Impacting Clinical Decision-Making in Integrated Behavioral Health Care. J Behav Health Serv Res 2024; 51:561-587. [PMID: 38982024 PMCID: PMC11445319 DOI: 10.1007/s11414-024-09891-6] [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] [Accepted: 06/04/2024] [Indexed: 07/11/2024]
Abstract
To support implementation of integrated behavioral health care (IBHC) models in local settings, providers may benefit from clinical decision-making support. The present analysis examines perspectives on patient characteristics appropriate or inappropriate for, and currently managed within, IBHC at a large medical center to inform recommendations for provider decision-making. Twenty-four participants (n = 13 primary care providers; n = 6 behavioral health providers; n = 5 administrators) in an IBHC setting were interviewed. Thematic analysis was conducted with acceptable interrater reliability (κ = 0.75). Responses indicated behavioral health symptom and patient characteristics that impact perceptions of appropriateness for management in IBHC, with high variability between providers. Many patients with characteristics identified as inappropriate for IBHC were nonetheless currently managed in IBHC. Interactions between patient ability to engage in care and provider ability to manage patient needs guided decisions to refer a patient to IBHC or specialty care. A heuristic representing this dimensional approach to clinical decision-making is presented to suggest provider decision-making guidance informed by both patient and provider ability.
Collapse
Affiliation(s)
- Ash M Smith
- Boston Medical Center, 720 Harrison Ave, Boston, MA, 02118, USA
- Psychology Department, The Graduate Center, City University of New York, New York, NY, USA
| | - Maria C Prom
- Boston Medical Center, 720 Harrison Ave, Boston, MA, 02118, USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Lauren C Ng
- Boston Medical Center, 720 Harrison Ave, Boston, MA, 02118, USA.
- Psychiatry Department, Boston University School of Medicine, Boston, MA, USA.
- Department of Psychology, University of California Los Angeles, Psychology Building 1285, Box 951563, Los Angeles, CA, 90095, USA.
| |
Collapse
|
7
|
Benzies KM, Zanoni P, McNeil DA. Mobilizing strategic inflection points for sustainment of an effective intervention in an integrated learning health system: an interpretive description. Implement Sci Commun 2024; 5:106. [PMID: 39350292 PMCID: PMC11441001 DOI: 10.1186/s43058-024-00644-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 09/16/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Innovative models of care have the potential to improve the sustainability of health systems by improving patient and provider experiences and population outcomes while simultaneously reducing costs. Yet, it is challenging to recognize the distinctive points during research and quality improvement processes that contribute to sustainment of effective interventions. The business concept of an inflection point-the position on the curve of a trajectory where the progress in implementation of an intervention is accelerated or decelerated-may be useful to understand implementation and improve sustainability and ultimately sustainment of effective interventions. The purpose of this study was to retrospectively identify and describe strategic inflection points that accelerated the sustainability process and led to the sustainment of Alberta Family Integrated Care. METHODS This qualitative study was conducted in Alberta, Canada and employed an interpretive description design. Purposively sampled documents (proposals, project management plans, reports to funders and sponsors, meeting minutes, and fidelity audit and feedback checklists) from the Alberta Family Integrated Care cluster randomized controlled trial and quality improvement project constituted data for this study. RESULTS To accelerate sustainability in the research context, we identified (1) alignment with strategic priorities, (2) iterative, user-centered co-design, and (3) contextualization of implementation as strategic inflection points. To accelerate sustainability in the health system context, we identified (1) the learning health system, (2) enduring partnerships, (3) responsivity to societal and system change, (4) embedded governance, and (5) intentional integration into the health system as strategic inflection points. Capitalizing on these strategic inflection points led to sustainment of Alberta Family Integrated Care in the provincial health system. CONCLUSIONS We identified key inflection points in the research and health system contexts that led to sustainment of Alberta Family Integrated Care. By anticipating, recognizing, and leveraging inflection points in the sustainability process, researchers may be able to accelerate implementation and achieve sustainment of multi-component interventions in complex systems. TRIAL REGISTRATION ClinicalTrials.gov: NCT02879799. Registration date: May 27, 2016. Protocol version: June 9, 2016; version 2. Protocol publication: https://doi.org/10.1186/s13063-017-2181-3 .
Collapse
Affiliation(s)
- Karen M Benzies
- Faculty of Nursing, Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, Social Innovation Initiative, PF3280C Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada.
| | - Pilar Zanoni
- PF4240-A2, Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary AB, T2N 1N4, Canada
| | - Deborah A McNeil
- Maternal Newborn Child and Youth Strategic Clinical NetworkTM, Provincial Clinical Excellence, Alberta Health Services, 10301 Southport Lane SW, Calgary, AB, T2W 1S7, Canada
- Faculty of Nursing and Department of Community Health Sciences, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| |
Collapse
|
8
|
Heggie R, Boyd K, Kamaruzaman H, Wu O. What methods are currently available for incorporating implementation considerations within the economic evaluation of health technologies? A scoping review. Health Res Policy Syst 2024; 22:134. [PMID: 39350148 PMCID: PMC11441006 DOI: 10.1186/s12961-024-01220-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 08/29/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND When clinically effective, cost-effective health interventions are not fully implemented in clinical practice, population health suffers. Economic factors are among the most commonly cited reasons for suboptimal implementation. Despite this, implementation and economic evaluation are not routinely performed in conjunction with one another. This review sought to identify and describe what methods are available for researchers to incorporate implementation within economic evaluation, how these methods differ, when they should be used, and where gaps remain. METHODS We conducted a scoping review using systematic methods. A pearl-growing approach was used to identify studies. References and citations were identified using Web of Science and Scopus. We included for review any study that contained terms relating to economic evaluation and a series of implementation-related terms in the title or abstract. The search was conducted and validated using two independent researchers. RESULTS Our review identified 42 unique studies that included a methodology for combining implementation and economic evaluation. The methods identified could be categorized into four broad themes: (i) policy cost-effectiveness approach (11 studies), (ii) value of information and value of implementation approach (16 studies), (iii) mixed methods approach (6 studies), and (iv) costing approach (9 studies). We identified a trend over time from methods that adopted the policy cost-effectiveness approach to methods that considered the trade-off between the value of information and value of implementation. More recently, mixed methods approaches to incorporate economic evaluation and implementation have been developed, alongside methods to define, measure and cost individual components of the implementation process for use in economic evaluation. CONCLUSION Our review identified a range of methods currently available for researchers considering implementation alongside economic evaluation. There is no single method or tool that can incorporate all the relevant issues to fully incorporate implementation within an economic evaluation. Instead, there are a suite of tools available, each of which can be used to answer a specific question relating to implementation. Researchers, reimbursement agencies and national and local decision-makers need to consider how best to utilize these tools to improve implementation.
Collapse
Affiliation(s)
- Robert Heggie
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, Clarice Pears Building, 90 Byres Rd, Glasgow, G12 8TB, UK.
| | - Kathleen Boyd
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, Clarice Pears Building, 90 Byres Rd, Glasgow, G12 8TB, UK
| | - Hanin Kamaruzaman
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, Clarice Pears Building, 90 Byres Rd, Glasgow, G12 8TB, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, Clarice Pears Building, 90 Byres Rd, Glasgow, G12 8TB, UK
| |
Collapse
|
9
|
Ajumobi O, Friedman S, Granner M, Lucero J, Westhoff J, Koch B, Wagner KD. Emergency department buprenorphine program: staff concerns and recommended implementation strategies. Implement Sci Commun 2024; 5:104. [PMID: 39334346 PMCID: PMC11429138 DOI: 10.1186/s43058-024-00649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 09/18/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Patients presenting to Emergency Departments (ED) with opioid use disorder may be candidates for buprenorphine treatment, making EDs an appropriate setting to initiate this underused, but clinically proven therapy. Hospitals are devoting increased efforts to routinizing buprenorphine initiation in the ED where clinically appropriate, with the greatest successes occurring in academic medical centers. Overall, however, clinician participation in these efforts is suboptimal. Hospitals need more information to inform the standardized implementation of these programs nationally. Using an implementation science framework, we investigated ED providers' concerns about ED buprenorphine programs and their willingness to prescribe buprenorphine in the ED. METHODS We conducted Consolidated Framework for Implementation Research (CFIR)-informed interviews with 11 ED staff in Nevada and analyzed the transcripts using a six-step thematic approach. Results were organized within the CFIR 1.0 domains of inner setting, outer setting, intervention characteristics, and individual characteristics; potential implementation strategies were recommended. RESULTS Physicians expressed that the ED is a suitable location for prescribing buprenorphine. However, they expressed concerns about: information gaps in the prescribing protocols (inner setting), patient outcomes beyond the ED, buprenorphine effectiveness and appropriate timing of treatment initiation (intervention characteristics), and their own competence in managing opioid withdrawal (individual characteristics). Some were anxious about patients' outcomes and continuity of care in the community (outer setting), others desired access to prospective data that demonstrate buprenorphine effectiveness. Additional concerns included a lack of availability of the required support to prescribe buprenorphine, a lack of physicians' experience and competence, and concerns about opioid withdrawal. Recommended implementation strategies to address these concerns include: designating personnel at the ED to bridge the information gap, engaging emergency physicians through educational meetings, creating a community of practice, facilitating mentorship opportunities, and leveraging existing collaborative learning platforms. CONCLUSION Overall, physicians in our study believed that implementing a buprenorphine program in the ED is appropriate, but had concerns. Implementation strategies could be deployed to address concerns at multiple levels to increase physician willingness and program uptake.
Collapse
Affiliation(s)
- Olufemi Ajumobi
- School of Public Health, University of Nevada, Reno, NV, USA.
| | - Sarah Friedman
- School of Public Health, University of Nevada, Reno, NV, USA
| | | | - Julie Lucero
- College of Health, University of Utah, Salt Lake City, UT, USA
| | - John Westhoff
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Brandon Koch
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Karla D Wagner
- School of Public Health, University of Nevada, Reno, NV, USA
| |
Collapse
|
10
|
Straiton N, Lauck SB, Lewis KB. The nurse, the framework, and the digital future. Eur J Cardiovasc Nurs 2024:zvae123. [PMID: 39316550 DOI: 10.1093/eurjcn/zvae123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Accepted: 09/05/2024] [Indexed: 09/26/2024]
Affiliation(s)
- Nicola Straiton
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, New South Wales, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Sandra B Lauck
- St. Paul's Hospital, School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Krystina B Lewis
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
11
|
Robinson A, Flom M, Forman-Hoffman VL, Histon T, Levy M, Darcy A, Ajayi T, Mohr DC, Wicks P, Greene C, Montgomery RM. Equity in Digital Mental Health Interventions in the United States: Where to Next? J Med Internet Res 2024; 26:e59939. [PMID: 39316436 DOI: 10.2196/59939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 08/07/2024] [Accepted: 08/10/2024] [Indexed: 09/25/2024] Open
Abstract
Health care technologies have the ability to bridge or hinder equitable care. Advocates of digital mental health interventions (DMHIs) report that such technologies are poised to reduce the documented gross health care inequities that have plagued generations of people seeking care in the United States. This is due to a multitude of factors such as their potential to revolutionize access; mitigate logistical barriers to in-person mental health care; and leverage patient inputs to formulate tailored, responsive, and personalized experiences. Although we agree with the potential of DMHIs to advance health equity, we articulate several steps essential to mobilize and sustain meaningful forward progression in this endeavor, reflecting on decades of research and learnings drawn from multiple fields of expertise and real-world experience. First, DMHI manufacturers must build diversity, equity, inclusion, and belonging (DEIB) processes into the full spectrum of product evolution itself (eg, product design, evidence generation) as well as into the fabric of internal company practices (eg, talent recruitment, communication principles, and advisory boards). Second, awareness of the DEIB efforts-or lack thereof-in DMHI research trials is needed to refine and optimize future study design for inclusivity as well as proactively address potential barriers to doing so. Trials should incorporate thoughtful, inclusive, and creative approaches to recruitment, enrollment, and measurement of social determinants of health and self-identity, as well as a prioritization of planned and exploratory analyses examining outcomes across various groups of people. Third, mental health care advocacy, research funding policies, and local and federal legislation can advance these pursuits, with directives from the US Preventive Services Taskforce, National Institutes of Health, and Food and Drug Administration applied as poignant examples. For products with artificial intelligence/machine learning, maintaining a "human in the loop" as well as prespecified and adaptive analytic frameworks to monitor and remediate potential algorithmic bias can reduce the risk of increasing inequity. Last, but certainly not least, is a call for partnership and transparency within and across ecosystems (academic, industry, payer, provider, regulatory agencies, and value-based care organizations) to reliably build health equity into real-world DMHI product deployments and evidence-generation strategies. All these considerations should also extend into the context of an equity-informed commercial strategy for DMHI manufacturers and health care organizations alike. The potential to advance health equity in innovation with DMHI is apparent. We advocate the field's thoughtful and evergreen advancement in inclusivity, thereby redefining the mental health care experience for this generation and those to come.
Collapse
Affiliation(s)
| | - Megan Flom
- Woebot Health, San Francisco, CA, United States
| | | | | | | | | | - Toluwalase Ajayi
- Joan & Irwin Jacobs Center for Health Innovation, University of California, San Diego, San Diego, CA, United States
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | | | - Carolyn Greene
- United States Department of Veterans Affairs, Mann-Grandstaff Veterans Affairs Medical Center, Spokane, WA, United States
| | | |
Collapse
|
12
|
Osorio NG, Vik FN, Helle C, Hillesund ER, Øverby NC, Helland SH, Love P, Barker ME, van Daele W, Abel MH, Rutter H, Bjørkkjær T, Gebremariam MK, Lian H, Medin AC. Implementing an early-life nutrition intervention through primary healthcare: staff perspectives. BMC Health Serv Res 2024; 24:1106. [PMID: 39304886 DOI: 10.1186/s12913-024-11582-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 09/12/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Nutrition interventions targeting early childhood can be cost-effective and may provide lifelong, intergenerational benefits. From October 2022 to April 2023 the Nutrition Now (NN) e-learning resource was implemented within Early Childhood Education and Care centres and the Maternal and Child Healthcare Centre (MCHC) in a southern Norwegian municipality. As part of the NN project, the present study aims to explore the MCHC staff's experiences with implementing the NN resource, to gain insights into measures important to scale up digital early-life nutrition interventions. METHODS Three group interviews were conducted among public health nurses and midwives alongside one individual interview with the department leader of a MCHC in May 2023. An inductive thematic analysis, as described by Braun and Clarke, was conducted to generate the key themes and subthemes regarding the implementation process of NN within the MCHC. RESULTS Three main themes were generated: [1] Important resource but not always utilized; [2] Parents are interested but had issues with access; and [3] Staff and stakeholder buy-in and commitment needed from the start. Overall, the staff viewed the NN resource as a potential tool for promoting diet-related topics and believed it could support the guidance they were already providing parents. However, few staff members fully familiarized themselves with the resource. While staff perceived parents as positive when informed about NN, they believed issues such as access challenges, competing platforms, and time constraints reduced parental engagement. Lastly, staff suggested improvements for NN's implementation, including enhanced training, better planning, assigning champions, and lowering the threshold for access. CONCLUSION The findings of this study suggest that the real-world implementation of digital evidence-based health behaviour interventions is feasible but would be enhanced by employing strategies focusing on engagement and utilization. TRIAL REGISTRATION The main study is registered in the ISRCTN registry with ID ISRCTN10694967, https://doi.org/10.1186/ISRCTN10694967 . (Registration date: 19-06-2022).
Collapse
Affiliation(s)
- Natalie Garzon Osorio
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway.
| | - Frøydis Nordgård Vik
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Christine Helle
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Elisabet Rudjord Hillesund
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Nina Cecilie Øverby
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Sissel H Helland
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Penelope Love
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Mary Elizabeth Barker
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
- School of Health Sciences, University of Southampton, Southampton, UK
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Wim van Daele
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Marianne Hope Abel
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | - Harry Rutter
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Tormod Bjørkkjær
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Mekdes Kebede Gebremariam
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Henrik Lian
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Anine Christine Medin
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| |
Collapse
|
13
|
Dulay E, Griffin B, Brannigan J, McBride C, Hudson A, Ullman A. Interventions to optimise preoperative fasting in paediatrics: a scoping review. Br J Anaesth 2024:S0007-0912(24)00479-3. [PMID: 39304471 DOI: 10.1016/j.bja.2024.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 07/18/2024] [Accepted: 08/13/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Preoperative fasting is the standard of care for patients undergoing a procedure under general anaesthesia. Despite the increased leniency of fasting guideline recommendations, prolonged preoperative fasting periods continue to disproportionally affect paediatric patients. This review maps existing interventions optimising paediatric fasting practices, to explore strategies that can be best applied in clinical practice. METHODS A search strategy applied to PubMed, CINAHL, Embase, Scopus, and the Cochrane Database involved four key concepts: (1) fasting, (2) preoperative, (3) paediatric, and (4) quality improvement intervention. The Preferred Reporting Items of Systematic Reviews and Meta-analyses extension for Scoping Reviews was utilised in this review. RESULTS Thirteen heterogeneous studies, involving approximately 31 000 children across five continents, were included. Each intervention studied fell into at least one of the following six themes: (1) change in facility protocol, (2) technology-based intervention, (3) individualised fasting programs, (4) processes to improve communication between clinicians, (5) processes to improve communication to parents and families, and (6) staff education. CONCLUSIONS A variety of interventions have been studied to optimise paediatric preoperative fasting duration. These interventions show potential in reducing preoperative fasting duration.
Collapse
Affiliation(s)
- Erika Dulay
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia.
| | - Bronwyn Griffin
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
| | - James Brannigan
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Craig McBride
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Adrienne Hudson
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia; Learning and Workforce, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia; School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Amanda Ullman
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia; Children's Health Research Centre, Faculty of Medicine, Brisbane, QLD, Australia
| |
Collapse
|
14
|
Ku CW, Yusoff MA, Ng ECB, Zheng RT, Yap F, Chan JKY, Loy SL. Development and Validation of an Evaluation Questionnaire for the Healthy Early Life Moments in Singapore (HELMS) Program. J Pers Med 2024; 14:989. [PMID: 39338243 PMCID: PMC11433546 DOI: 10.3390/jpm14090989] [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: 07/20/2024] [Revised: 09/02/2024] [Accepted: 09/14/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND/OBJECTIVES Global fertility rates are declining due to metabolic and mental health challenges in women trying to conceive. The Healthy Early Life Moments in Singapore (HELMS) program aims to address these challenges through mobile health (mHealth)-enabled lifestyle interventions. However, the lack of validated evaluation tools for such programs makes it difficult to assess their feasibility and acceptability. To tackle this, a comprehensive evaluation questionnaire was developed and validated to determine if the HELMS preconception program's implementation outcomes were achieved. METHODS The questionnaire development process included a literature review and a two-step validation process: content validation by five content experts and face validation by 20 HELMS participants. Content validation was assessed using the scale content validity index (S-CVI) based on relevance, clarity, simplicity, and ambiguity. Face validation with participants evaluated these criteria and the ease of completing the questionnaire. Internal consistency was assessed using Cronbach's alpha among 49 participants. RESULTS The questionnaire achieved good S-CVI values for relevance (0.93), clarity (0.91), simplicity (0.94), and ambiguity (0.71). After expert feedback, the revised version scored highly among HELMS participants for relevance (100%), clarity (95%), simplicity (95%), and non-ambiguity (90%). A Cronbach's alpha of 0.93 indicated good internal consistency. CONCLUSION The HELMS evaluation questionnaire shows promise for evaluating similar mHealth-based lifestyle intervention programs globally.
Collapse
Affiliation(s)
- Chee Wai Ku
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore; (J.K.Y.C.); (S.L.L.)
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore;
| | - Muhammad Ashraf Yusoff
- Department of Obstetrics and Gynecology, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore;
| | - Elvia Chin Boon Ng
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore;
| | - Ruther Teo Zheng
- Endocrinology Service, Department of Pediatrics, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore;
| | - Fabian Yap
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore;
- Endocrinology Service, Department of Pediatrics, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore;
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Experimental Medicine Building, Singapore 636921, Singapore
| | - Jerry Kok Yen Chan
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore; (J.K.Y.C.); (S.L.L.)
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore;
| | - See Ling Loy
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore; (J.K.Y.C.); (S.L.L.)
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore;
| |
Collapse
|
15
|
Borsoi L, Listorti E, Ciani O. Artificial-Intelligence Cloud-Based Platform to Support Shared Decision-Making in the Locoregional Treatment of Breast Cancer: Protocol for a Multidimensional Evaluation Embedded in the CINDERELLA Clinical Trial. PHARMACOECONOMICS - OPEN 2024:10.1007/s41669-024-00519-1. [PMID: 39264499 DOI: 10.1007/s41669-024-00519-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/05/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Shared decision-making (SDM) plays a crucial role in breast cancer care by empowering patients and reducing decision regret. Patient decision aids (PtDAs) are valuable tools for facilitating SDM, now available in digital and artificial intelligence (AI)-powered formats to offer increasingly personalized contents. The ongoing CINDERELLA clinical trial (ClinicalTrials.gov: NCT05196269) evaluates an innovative AI cloud-based approach using a web platform and a mobile application (CINDERELLA APProach) versus the conventional approach to support SDM in breast cancer patients undergoing locoregional treatment. This protocol outlines a trial-based multidimensional evaluation, encompassing economic, financial, implementability, and environmental considerations associated with the CINDERELLA APProach. METHODS A within-trial cost-consequence and cost-utility analysis from a societal perspective will be performed using patient-level data on outcomes and resource use. The latter will be valued in monetary terms using country-specific unit costs or patient valuations. A budget impact analysis will be performed over 1 and 5 years from the budget holder perspectives. The CINDERELLA APProach implementability will be assessed through an evaluation of its usability, acceptability, organizational impact, and overall feasibility. The environmental impact will be quantitatively assessed across several dimensions, such as quantity, appropriateness, and emissions, supplemented by qualitative insights. Overall, data for the evaluation will be gathered from patient questionnaires, interviews with patients and managers, focus groups with healthcare professionals, and app electronic data. DISCUSSION A thorough understanding of the broad consequences of the CINDERELLA APProach may foster its successful translation into real-world settings, hopefully benefiting breast cancer patients and clinical practice.
Collapse
Affiliation(s)
- Ludovica Borsoi
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy.
| | - Elisabetta Listorti
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
| | - Oriana Ciani
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
| |
Collapse
|
16
|
Fernandez K, Hoetink A, Konrad-Martin D, Berndtson D, Clark K, Dreisbach L, Geller JI, Goffi-Gomez MV, Grosnik A, Jamis C, Knight K, Lee DS, Lee J, Liberman PHP, Milnes T, Meijer AJM, Ortiz CE, Rooker J, Sanchez VA, van den Heuvel-Eibrink MM, Brewer CC, Poling GL. Roadmap to a Global Template for Implementation of Ototoxicity Management for Cancer Treatment. Ear Hear 2024:00003446-990000000-00345. [PMID: 39261989 DOI: 10.1097/aud.0000000000001592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Ototoxicity is among the adverse events related to cancer treatment that can have far-reaching consequences and negative impacts on quality-of-life for cancer patients and survivors of all ages. Ototoxicity management (OtoM) comprises the prevention, diagnosis, monitoring, and treatment, including rehabilitation and therapeutic intervention, of individuals who experience hearing loss, tinnitus, or balance/vestibular difficulties following exposures to ototoxic agents, including platinum chemotherapy (cisplatin, carboplatin) and cranial radiation. Despite the well-established physical, socioeconomic, and psychological consequences of hearing and balance dysfunction, there are no widely adopted standards for clinical management of cancer treatment-related ototoxicity. Consensus recommendations and a roadmap are needed to guide development of effective and feasible OtoM programs, direct research efforts, address the needs of caregivers and patients at all stages of cancer care and survivorship. Here we review current evidence and propose near-term to longer-term goals to advance OtoM in five strategic areas: (1) beneficiary awareness, empowerment, and engagement, (2) workforce enhancement, (3) program development, (4) policy, funding, and sustainability, and (5) research and evaluation. The goal is to identify needs and establish a roadmap to guide worldwide adoption of standardized OtoM for cancer treatment and improved outcomes for patients and survivors.
Collapse
Affiliation(s)
- Katharine Fernandez
- Division of Intramural Research, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA
| | - Alex Hoetink
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Audiology, Utrecht Medical Center Utrecht Brain Center, Utrecht, the Netherlands
- Audiology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Audiology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Dawn Konrad-Martin
- National Center for Rehabilitative Auditory Research, Veterans Affairs Rehabilitation Research and Development, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Department of Otolaryngology/Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Deborah Berndtson
- International Ototoxicity Management Group, Cancer Survivor and Advocate, Vienna, Virginia, USA
| | - Khaya Clark
- National Center for Rehabilitative Auditory Research, Veterans Affairs Rehabilitation Research and Development, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Department of Otolaryngology/Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
- Veterans Affairs Health Services Research & Development Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66), Portland, Oregon, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Laura Dreisbach
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, California, USA
| | - James I Geller
- Division of Audiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Amy Grosnik
- Division of Audiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Carmen Jamis
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kristin Knight
- Department of Audiology, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, USA
| | - David S Lee
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John Lee
- Division of Intramural Research, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Trisha Milnes
- Department of Audiology, Veterans Affairs Augusta Health Care System, Augusta, Georgia, USA
| | - Annelot J M Meijer
- Audiology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Audiology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Candice E Ortiz
- Capital Institute of Hearing & Balance, Silver Spring, Maryland, USA
| | - Jennessa Rooker
- College of Nursing, University of South Florida, Tampa, Florida, USA
| | - Victoria A Sanchez
- Department of Otolaryngology-Head & Neck Surgery, University of South Florida, Tampa, Florida, USA
| | - Mary M van den Heuvel-Eibrink
- Audiology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Audiology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Carmen C Brewer
- Division of Intramural Research, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA
| | - Gayla L Poling
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
17
|
Martínez C, Camarelles Guillem F, González-Viana A, Sánchez Á, Tigova O, Fernández E. [From evidence to practice: The Disemination and Implementation Science in primary care]. Aten Primaria 2024; 57:103077. [PMID: 39265319 DOI: 10.1016/j.aprim.2024.103077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 09/14/2024] Open
Abstract
Dissemination and Implementation Science focuses on bridging the gap between scientific research and its practical application in the real world. By identifying and promoting effective strategies, the Science of Dissemination and Implementation disseminates and implements evidence-based interventions in healthcare settings, taking into account the needs, barriers, context, resources, and end users. This special article introduces and debates the most recent advances in this field, highlighting key approaches, theoretical frameworks, as well as specific challenges and opportunities applied to primary and community care. Additionally, concrete examples tailored to the Spanish context are presented. Given the nascent state of the use of the Dissemination and Implementation Science in Spain, the authors recommend strategically adopting this approach and its principles in primary and community care to expedite the adoption of effective interventions that promote health.
Collapse
Affiliation(s)
- Cristina Martínez
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, España; Grupo de Prevención y Control del Cáncer, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; CIBER en Enfermedades Respiratorias (CIBERES), Madrid, España; Departamento de Salut Pública, Materno Infantil y Salud Mental, Facultad de Enfermería, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, EE. UU..
| | - Francisco Camarelles Guillem
- Centro de Salud Infanta Mercedes, Programa Actividades Preventivas y Promoción de la Salud PAPPS de semFYC, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | - Angelina González-Viana
- Servicio Catalán de la Salud - CatSalut, España; Grup d'Atenció Primària Orientada a la Comunitat (APOC) de CAMFIC, Barcelona, España
| | - Álvaro Sánchez
- Unidad de Investigación Atención Primaria de Bizkaia, Subdirección para la Coordinación de la Atención Primaria, Dirección General OSAKIDETZA, España; Grupo de Investigación en Ciencias de la Diseminación e Implementación en Servicios Sanitarios, Instituto Investigación Biobizkaia, España; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España
| | - Olena Tigova
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, España; Grupo de Prevención y Control del Cáncer, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; CIBER en Enfermedades Respiratorias (CIBERES), Madrid, España; Departamento de Ciencias Clínicas, Facultad de Medicina, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
| | - Esteve Fernández
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, España; Grupo de Prevención y Control del Cáncer, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; CIBER en Enfermedades Respiratorias (CIBERES), Madrid, España; Departamento de Ciencias Clínicas, Facultad de Medicina, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
| |
Collapse
|
18
|
Williams FS, Garofalo R, Karnik NS, Donenberg G, Centola H, Becker S, Welch S, Kuhns L. Universal substance use care for adolescents with chronic medical conditions: a protocol to examine equitable implementation determinants and strategies for SBIRT at a pediatric hospital. Addict Sci Clin Pract 2024; 19:67. [PMID: 39261950 PMCID: PMC11391670 DOI: 10.1186/s13722-024-00492-4] [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: 12/31/2023] [Accepted: 08/08/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Adolescents with chronic medical conditions (CMC) use alcohol and marijuana at levels equal to or even greater than their peers without CMC and are more likely to initiate substance use at 14 years or younger. Approximately 33% of adolescents with CMC binge drink alcohol and 20% use marijuana. When using substances, adolescents with CMC are at elevated risk for problem use and adverse consequences given their medical conditions. Although there has recently been progress integrating substance use services into adult hospitals, there has been almost no implementation of standardized substance use services into pediatric hospitals for adolescents with CMC. Screening, Brief Intervention, and Referral to Treatment (SBIRT) for adolescents is an evidence-based, public health approach to promote the early detection and intervention of risky alcohol use in high-risk youth. This paper describes a study protocol combining two leading implementation science frameworks, the Consolidated Framework for Implementation Research (CFIR) and the Health Equity Implementation framework (HEIF), to engage pediatric hospital partners (hospital staff and clinicians, patients with CMC, and caregivers) to identify and specify contextual determinants of SBIRT implementation, which can be used to derive implementation strategies to optimize SBIRT adoption, reach, and fidelity. METHOD This study will use semi-structured interviews and focus groups with pediatric hospital partners (e.g., hospital staff and clinicians, adolescent patients, and caregivers) to identify SBIRT implementation determinants, using semi-structured interview and focus group guides that integrate CFIR and HEIF dimensions. DISCUSSION Understanding implementation determinants is one of the first steps in the implementation science process. The use of two determinant frameworks highlighting a comprehensive set of determinants including health equity and justice will enable identification of barriers and facilitators that will then map on to strategies that address these factors. This study will serve as an essential precursor to further work evaluating the feasibility of and the degree of engagement with SBIRT among this vulnerable pediatric population.
Collapse
Affiliation(s)
- Faith Summersett Williams
- Department of Pediatrics, Feinberg School of Medicine, The Potocsnak Family Division of Adolescent and Young Adult Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA.
| | - Robert Garofalo
- Department of Pediatrics, Feinberg School of Medicine, The Potocsnak Family Division of Adolescent and Young Adult Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Niranjan S Karnik
- Institute for Juvenile Research, Department of Psychiatry, College of Medicine, Institute for Juvenile Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Geri Donenberg
- Department of Medicine, Center for Dissemination and Implementation Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Hayley Centola
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Sara Becker
- Department of Psychiatry, Feinberg School of Medicine, The Center for Dissemination and Implementation Science (CDIS), Northwestern University, Chicago, IL, USA
| | - Sarah Welch
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lisa Kuhns
- Department of Pediatrics, Feinberg School of Medicine, The Potocsnak Family Division of Adolescent and Young Adult Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| |
Collapse
|
19
|
Harden SM, Brow K, Zoellner J, Armbruster SD. Identification of weight loss interventions for translation among endometrial cancer survivors: A RE-AIM analysis. Transl Behav Med 2024; 14:527-536. [PMID: 38907663 PMCID: PMC11370635 DOI: 10.1093/tbm/ibae030] [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: 06/24/2024] Open
Abstract
Interventions for obesity-related cancers that combine nutrition and physical activity for weight loss exist; however, their application to survivors of endometrial cancer is unknown. Furthermore, little is known about pre-implementation perceptions of existing programs from a variety of interested persons (physicians, researchers) who may be part of the implementation team. Adapting an existing intervention rather than developing a new intervention may speed the translational lag time as long as intervention characteristics and fit within the delivery system are considered during the planning phase. To describe the process of determining the core elements of obesity-related interventions for cancer survivors and determine which one might be best delivered by an urban healthcare system that predominantly serves individuals who live in rural areas of Virginia and West Virginia. A pragmatic review of the literature was conducted via PubMed and Google Scholar with broad search terms of cancer survivor AND weight loss AND health intervention. Identified interventions were scored related to the Practical, Robust Implementation and Sustainability Model-which is an extension of RE-AIM framework to guide the understanding of who, what, where, when, and how the intervention was conducted. Intervention characteristics are reported. In addition, ratings from three independent reviewers on the validated 5-point Likert scale of an intervention's acceptability, appropriateness, and feasibility in the intended delivery system were collected and summarized. Twelve interventions were identified with an average sample size of 241(±195) and a range of 48-683 participants. Target populations included survivors of colorectal, breast, and endometrial cancers as well as general cancer survivors and included both men and women or only women. Most participants (74%) identified as white/Caucasian and average age ranged from 47.1 to 65.9 years. Program duration ranged from 4 weeks to 18 months, with an average duration of 32 weeks. Intervention dosage ranged from three times a week to once a month. Intervention acceptability, appropriateness, and feasibility had average and standard deviation ratings of 3.52(±0.46), 3.41(±0.45), and 3.21(±0.46), respectively, out of 5. The four interventions with the highest combined acceptable, appropriate, and feasible scores are being considered for potential use as an obesity-related intervention for survivors of endometrial cancer. Future work is needed to determine relevant adaptations and efficacy among survivors of endometrial cancer with obesity. Our approach may be beneficial for other interventionists aiming to speed intervention development and implementation.
Collapse
Affiliation(s)
- Samantha M Harden
- Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
- Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Katie Brow
- Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Jamie Zoellner
- Public Health Sciences, University of Virginia, Christiansburg, VA, USA
| | - Shannon D Armbruster
- Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
- Obstetrics and Gynecology, Carilion Clinic, Roanoke, VA, USA
| |
Collapse
|
20
|
Szeszulski J, Guastaferro K. Optimization of implementation strategies using the Multiphase Optimization STratgey (MOST) framework: Practical guidance using the factorial design. Transl Behav Med 2024; 14:505-513. [PMID: 38906703 DOI: 10.1093/tbm/ibae035] [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: 06/23/2024] Open
Abstract
The Multiphase Optimization STrategy (MOST) is a framework that uses three phases-preparation, optimization, and evaluation-to develop multicomponent interventions that achieve intervention EASE by strategically balancing Effectiveness, Affordability, Scalability, and Efficiency. In implementation science, optimization of the intervention requires focus on the implementation strategies-things that we do to deliver the intervention-and implementation outcomes. MOST has been primarily used to optimize the components of the intervention related to behavioral or health outcomes. However, innovative opportunities to optimize discrete (i.e. single strategy) and multifaceted (i.e. multiple strategies) implementation strategies exist and can be done independently, or in conjunction with, intervention optimization. This article details four scenarios where the MOST framework and the factorial design can be used in the optimization of implementation strategies: (i) the development of new multifaceted implementation strategies; (ii) evaluating interactions between program components and a discrete or multifaceted implementation strategies; (iii) evaluating the independent effects of several discrete strategies that have been previously evaluated as a multifaceted implementation strategy; and (iv) modification of a discrete or multifaceted implementation strategy for the local context. We supply hypothetical school-based physical activity examples to illustrate these four scenarios, and we provide hypothetical data that can help readers make informed decisions derived from their trial data. This manuscript offers a blueprint for implementation scientists such that not only is the field using MOST to optimize the effectiveness of an intervention on a behavioral or health outcome, but also that the implementation of that intervention is optimized.
Collapse
Affiliation(s)
- Jacob Szeszulski
- Department of Nutrition, Institute for Advancing Health Through Agriculture (IHA), Texas A&M AgriLife Research, Dallas, TX, USA
| | - Kate Guastaferro
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| |
Collapse
|
21
|
DeSalvo AM, Spellman SR, Coles JAS, Robb D, McCann M, Yusuf RA, Hengen M, Auletta JJ. Applying Implementation Science in the Field of Transplant and Cellular Therapy. Transplant Cell Ther 2024; 30:864-875. [PMID: 38909780 DOI: 10.1016/j.jtct.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/07/2024] [Accepted: 06/17/2024] [Indexed: 06/25/2024]
Abstract
Implementation science (IS) is a systematic way to approach the broader adoption of evidence-based practices and has as its goal to understand and address the gap between research and practice, ensuring that research findings are effectively translated into practice and policy to improve health outcomes and service. We describe the various facets of IS and their relevance to the field of hematopoietic cell transplantation and cellular therapy (HCT/CT) with an emphasis on health equity, community engagement, and systems approach. We also review the similarities and differences among clinical research, quality improvement, and IS. Additionally, we describe how the Center for International Blood and Marrow Transplant Research applies IS across various phases: dissemination, analyzing current practices, and developing implementation intervention strategies. This includes designing studies and evaluations, scaling up operations, and ensuring sustainability. Lastly, we discuss further applications of IS in HCT/CT including the application to prospective research studies, collaboration across the field, and standardization and adoption of best practices. The application of IS in HCT/CT is pivotal to bringing research benefits directly to all patients. Through partnership, open-mindedness, and a commitment to evidence-based practice, we can collectively ensure the greatest impact of research on improving patient outcomes following HCT/CT.
Collapse
Affiliation(s)
- Anna M DeSalvo
- CIBMTR® (Center for International Blood and Marrow Transplant Research), NMDP, Minneapolis, Minnesota.
| | - Stephen R Spellman
- CIBMTR® (Center for International Blood and Marrow Transplant Research), NMDP, Minneapolis, Minnesota
| | - Jennifer A Sees Coles
- CIBMTR® (Center for International Blood and Marrow Transplant Research), NMDP, Minneapolis, Minnesota
| | - Delilah Robb
- CIBMTR® (Center for International Blood and Marrow Transplant Research), NMDP, Minneapolis, Minnesota
| | - Meggan McCann
- CIBMTR® (Center for International Blood and Marrow Transplant Research), NMDP, Minneapolis, Minnesota
| | - Rafeek A Yusuf
- CIBMTR® (Center for International Blood and Marrow Transplant Research), NMDP, Minneapolis, Minnesota
| | - Mary Hengen
- CIBMTR® (Center for International Blood and Marrow Transplant Research), NMDP, Minneapolis, Minnesota
| | - Jeffery J Auletta
- CIBMTR® (Center for International Blood and Marrow Transplant Research), NMDP, Minneapolis, Minnesota
| |
Collapse
|
22
|
Oshita JY, MacLean CD, Couture AE, Morris MA. How Health Care Organizations Are Implementing Disability Accommodations for Effective Communication: A Qualitative Study. Jt Comm J Qual Patient Saf 2024; 50:664-672. [PMID: 38879438 DOI: 10.1016/j.jcjq.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Prior studies have documented that, despite federal mandates, clinicians infrequently provide accommodations that enable equitable health care engagement for patients with communication disabilities. To date, there has been a paucity of empirical research describing the organizational approach to implementing these accommodations. The authors asked US health care organizations how they were delivering these accommodations in the context of clinical care, what communication accommodations they provided, and what disability populations they addressed. METHODS In this study, 19 qualitative interviews were conducted with disability coordinators representing 15 US health care organizations actively implementing communication accommodations. A conventional qualitative content analysis approach was used to code the data and derive themes. RESULTS The authors identified three major themes related to how US health care organizations are implementing the provision of this service: (1) Operationalizing the delivery of communication accommodations in health care required executive leadership support and preparatory work at clinic and organization levels; (2) The primary focus of communication accommodations was sign language interpreter services for Deaf patients and, secondarily, other hearing- and visual-related accommodations; and (3) Providing communication accommodations for patients with speech and language and cognitive disabilities was less frequent, but when done involved more than providing a single aid or service. CONCLUSION These findings suggest that, in addition to individual clinician efforts, there are organization-level factors that affect consistent provision of communication accommodations across the full range of communication disabilities. Future research should investigate these factors and test targeted implementation strategies to promote equitable access to health care for all patients with communication disabilities.
Collapse
|
23
|
Peters-Corbett A, Parke S, Bear H, Clarke T. Barriers and facilitators of implementation of evidence-based interventions in children and young people's mental health care - a systematic review. Child Adolesc Ment Health 2024; 29:242-265. [PMID: 37608642 DOI: 10.1111/camh.12672] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Effective evidence-based practices (EBP) for children and young people's (CYP) mental health exist, however, there is low uptake in clinical practice and interventions do not always reach those in need. This review aimed to comprehensively identify and synthesise the barriers and facilitators to implementing EBP in CYP mental health care, mapped according to an implementation framework in order to make pragmatic recommendations for practitioners, commissioners and researchers. METHODS Following the PRISMA guidelines, an electronic search of PsycINFO, MEDLINE, CINAHL and Embase in 2021 yielded 1830 results. In total, 107 abstracts were screened, 57 of which were included for full-text review and 26 were included for data extraction and analysis. RESULTS We identified a number of organisational and clinician-level barriers which impede the implementation of evidence in 'real world' practice. Barriers included lack of access to funding; poor access to resources; clinician attitudes and flexibility of EBP. Facilitators included targeted funding and access to resources; supportive staff and leadership committed to innovation and skills in the EBP. CONCLUSIONS Although the process of translating research into practice is challenging and the solutions are not straightforward, we have identified a set of practical recommendations for ways in which implementation practices can improve. Researchers, commissioners, funders and practitioners can work together to improve the implementation of EBP in CYP mental health settings by ensuring funding is available, prioritise implementation beyond the end of trials, upskill staff on integrating EBP into care, ensure EBPs are flexible and are co-produced with service users. REGISTRATION This review was registered on PROSPERO international prospective register of systematic reviews (CRD42021252995).
Collapse
Affiliation(s)
| | - Sheryl Parke
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
| | - Holly Bear
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Timothy Clarke
- University of Cardiff, Cardiff, UK
- East of England NIHR Applied Research Collaborative, Norwich, UK
| |
Collapse
|
24
|
Harden SM, Chang K, Chen S. Integrating a Dissemination and Implementation Science Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework as a Cornerstone of a Masters in Dietetics Training Program. J Acad Nutr Diet 2024; 124:1099-1108. [PMID: 38750789 DOI: 10.1016/j.jand.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 06/16/2024]
Affiliation(s)
- Samantha M Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia.
| | - Kristen Chang
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia
| | - Susan Chen
- Department of Nutrition, Food Science, and Packaging, San José State University, San José, California
| |
Collapse
|
25
|
Kang E, Chen J, Lipsey KL, Foster ER. Community-Engaged Implementation Strategies in Occupational Therapy: A Scoping Review. Am J Occup Ther 2024; 78:7805205030. [PMID: 39197014 DOI: 10.5014/ajot.2024.050526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024] Open
Abstract
IMPORTANCE Despite the potential of community-engaged implementation research (CEIR) in developing strategies to accelerate the translation of evidence-based interventions (EBIs), there is a noticeable knowledge gap in the current state of CEIR in occupational therapy. A synthesis of the concept, purpose, and operationalization of CEIR is necessary. OBJECTIVE To identify the contexts, purposes, and operationalization of CEIR, focusing on implementation strategies in occupational therapy. DATA SOURCES PubMed/MEDLINE, Embase, CINAHL, Scopus, and Web of Science. STUDY SELECTION AND DATA COLLECTION We included studies that were explicit and intentional about CEIR and that focused on implementation strategies to support the translation of occupational therapy interventions, clinical guidelines, practice models, theories, or assessments. We extracted the research context (e.g., partners, recruitment), purpose (e.g., why community-engaged research was used), and operationalization (e.g., community engagement [CE] activities, how their findings inform the research) using thematic analysis. FINDINGS Of 3,219 records, 6 studies were included. Involved partners were mainly occupational therapy practitioners from existing networks. CEIR that focuses on implementation strategies informs various aspects of research design, ranging from study design to sustainability, by developing community-academia partnerships, building implementation capacity, and creating implementation strategies across diverse research areas. Current research has used various but mostly traditional CE activities (e.g., focus groups). CONCLUSIONS AND RELEVANCE We synthesized evidence on CEIR focused on implementation strategies in occupational therapy. Intentional efforts are needed to collaborate with diverse partners, explore innovative CE activities, produce equitable outputs, and develop multilevel implementation strategies to accelerate the translation of EBIs into practice. Plain-Language Summary: In this review, we synthesize evidence on the contexts, purposes, and operationalization of community-engaged implementation research (CEIR), focusing on implementation strategies in occupational therapy research. We found that current implementation efforts mainly rely on occupational therapy practitioners as community partners and use traditional recruitment methods and community engagement activities. In turn, they develop implementation strategies that mainly target practitioners without comprehensive, multilevel implementation support. We suggest more equitable collaboration with diverse partners to effectively promote the implementation and dissemination of evidence-based interventions in occupational therapy practice.
Collapse
Affiliation(s)
- Eunyoung Kang
- Eunyoung Kang, PhD, BOT, is Postdoctoral Research Fellow, Program in Occupational Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO;
| | - Julie Chen
- Julie Chen, BS, is Occupational Therapy Student, Program in Occupational Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Kim L Lipsey
- Kim L. Lipsey, MLS, is Medical Librarian, Bernard Becker Medical Library, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Erin R Foster
- Erin R. Foster, PhD, OTD, OTR/L, is Associate Professor, Program in Occupational Therapy, Departments of Neurology and Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO
| |
Collapse
|
26
|
Kajankova M, Tsaousides T, Dudek E, Ashman T. Evaluation of the Implementation of a Day-Treatment Program for Executive Functioning for Individuals With Traumatic Brain Injury in Rehabilitation Settings Using the Consolidated Framework for Implementation Research. J Head Trauma Rehabil 2024:00001199-990000000-00194. [PMID: 39177480 DOI: 10.1097/htr.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
OBJECTIVE To identify barriers and facilitators to implementation of a cognitive rehabilitation intervention (Short-Term Executive Plus [STEP]) into routine clinical practice using the Consolidated Framework for Implementation Research (CFIR) by comparing high (HI) and low implementation (LI) sites. SETTING Qualitative interviews conducted with professionals who work with people who have sustained brain injuries at various rehabilitations sites across the United States. PARTICIPANTS Seven sites completed training, consultation, and agreed to implement STEP. DESIGN Retrospective qualitative study. MAIN MEASURES Qualitative interview developed for the purposes of this study and the CFIR for evaluation of implementation efforts and identification of barriers and facilitators. RESULTS Out of 7 sites, 6 completed interviews. Out of the 39 CFIR constructs, 4 distinguished between HI and LI sites. Four distinguishing factors included evidence strength and quality, needs and resources of those served by the organization, leadership engagement, and engaging champions. Five common factors were identified (4 positive and 1 negative) across HI and LI sites, which may reflect aspects of implementation that could inform future implementation efforts. Ten inconclusive factors were identified, having both a positive and a negative influence on implementation. CONCLUSIONS While there were several factors that were viewed positively by all sites, only 4 factors made a difference in implementation outcomes. These distinguishing factors can help inform future implementation efforts, highlighting a need for strong evidence supporting an intervention, a match between the intervention and the needs of the population served, engaging those in leadership and decision-making roles and ensuring their buy-in, and having a strong champion directly involved in implementation. In addition, taking a closer look at common and inconclusive factors may enable us to identify areas in which the implementation efforts could be strengthened.
Collapse
Affiliation(s)
- Maria Kajankova
- Author Affiliations: Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York State (Drs Kajankova and Tsaousides; Department of Psychology, University of Houston, Houston, Texas (Dudek); Physical Medicine and Rehabilitation, Rusk Rehabilitation, NYU Langone Medical Center, New York, New York State (Dr Ashman)
| | | | | | | |
Collapse
|
27
|
Prior A, Taylor I, Gibson KS, Allen C. Severe Hypertension in Pregnancy: Progress Made and Future Directions for Patient Safety, Quality Improvement, and Implementation of a Patient Safety Bundle. J Clin Med 2024; 13:4973. [PMID: 39274186 PMCID: PMC11396117 DOI: 10.3390/jcm13174973] [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: 06/26/2024] [Revised: 08/12/2024] [Accepted: 08/21/2024] [Indexed: 09/16/2024] Open
Abstract
Hypertensive disorders of pregnancy account for approximately 5% of pregnancy-related deaths in the United States and are one of the leading causes of maternal morbidity. Focus on improving patient outcomes in the setting of hypertensive disorders of pregnancy has increased in recent years, and quality improvement initiatives have been implemented across the United States. This paper discusses patient safety and quality initiatives for hypertensive disorders of pregnancy, with an emphasis on progress made and a patient safety tool: the Alliance for Innovation on Maternal Health's Severe Hypertension in Pregnancy patient safety bundle. Future patient safety and quality directions for the treatment of hypertensive disorders of pregnancy will be reviewed.
Collapse
Affiliation(s)
- Alissa Prior
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The MetroHealth System, Cleveland, OH 44109, USA
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University Hospitals, Cleveland, OH 44106, USA
| | - Isabel Taylor
- American College of Obstetricians and Gynecologists, Washington, DC 20024, USA
| | - Kelly S Gibson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The MetroHealth System, Cleveland, OH 44109, USA
| | - Christie Allen
- American College of Obstetricians and Gynecologists, Washington, DC 20024, USA
| |
Collapse
|
28
|
Northrop A, Christofferson A, Umashankar S, Melisko M, Castillo P, Brown T, Heditsian D, Brain S, Simmons C, Hieken T, Ruddy KJ, Mainor C, Afghahi A, Tevis S, Blaes A, Kang I, Asare A, Esserman L, Hershman DL, Basu A. Implementation and impact of an electronic patient reported outcomes system in a phase II multi-site adaptive platform clinical trial for early-stage breast cancer. J Am Med Inform Assoc 2024:ocae190. [PMID: 39158353 DOI: 10.1093/jamia/ocae190] [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: 04/03/2024] [Revised: 06/30/2024] [Accepted: 07/08/2024] [Indexed: 08/20/2024] Open
Abstract
OBJECTIVES We describe the development and implementation of a system for monitoring patient-reported adverse events and quality of life using electronic Patient Reported Outcome (ePRO) instruments in the I-SPY2 Trial, a phase II clinical trial for locally advanced breast cancer. We describe the administration of technological, workflow, and behavior change interventions and their associated impact on questionnaire completion. MATERIALS AND METHODS Using the OpenClinica electronic data capture system, we developed rules-based logic to build automated ePRO surveys, customized to the I-SPY2 treatment schedule. We piloted ePROs at the University of California, San Francisco (UCSF) to optimize workflow in the context of trial treatment scenarios and staggered rollout of the ePRO system to 26 sites to ensure effective implementation of the technology. RESULTS Increasing ePRO completion requires workflow solutions and research staff engagement. Over two years, we increased baseline survey completion from 25% to 80%. The majority of patients completed between 30% and 75% of the questionnaires they received, with no statistically significant variation in survey completion by age, race or ethnicity. Patients who completed the screening timepoint questionnaire were significantly more likely to complete more of the surveys they received at later timepoints (mean completion of 74.1% vs 35.5%, P < .0001). Baseline PROMIS social functioning and grade 2 or more PRO-CTCAE interference of Abdominal Pain, Decreased Appetite, Dizziness and Shortness of Breath was associated with lower survey completion rates. DISCUSSION AND CONCLUSION By implementing ePROs, we have the potential to increase efficiency and accuracy of patient-reported clinical trial data collection, while improving quality of care, patient safety, and health outcomes. Our method is accessible across demographics and facilitates an ease of data collection and sharing across nationwide sites. We identify predictors of decreased completion that can optimize resource allocation by better targeting efforts such as in-person outreach, staff engagement, a robust technical workflow, and increased monitoring to improve overall completion rates. TRIAL REGISTRATION https://clinicaltrials.gov/study/NCT01042379.
Collapse
Affiliation(s)
- Anna Northrop
- Department of Surgery, University of California San Francisco, San Francisco, CA 94158, United States
| | - Anika Christofferson
- Department of Surgery, University of California San Francisco, San Francisco, CA 94158, United States
| | - Saumya Umashankar
- Department of Surgery, University of California San Francisco, San Francisco, CA 94158, United States
| | - Michelle Melisko
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA 94158, United States
| | - Paolo Castillo
- Department of Surgery, University of California San Francisco, San Francisco, CA 94158, United States
| | - Thelma Brown
- Patient Advocate, Breast Science Advocacy Core, University of California San Francisco, San Francisco, CA 94158, United States
| | - Diane Heditsian
- Patient Advocate, Breast Science Advocacy Core, University of California San Francisco, San Francisco, CA 94158, United States
| | - Susie Brain
- Patient Advocate, Breast Science Advocacy Core, University of California San Francisco, San Francisco, CA 94158, United States
| | - Carol Simmons
- Patient Advocate, Breast Science Advocacy Core, University of California San Francisco, San Francisco, CA 94158, United States
| | - Tina Hieken
- Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN 55905, United States
| | - Kathryn J Ruddy
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, United States
| | - Candace Mainor
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, United States
| | - Anosheh Afghahi
- Department of Medicine, University of Colorado, Aurora, CO 80045, United States
| | - Sarah Tevis
- Department of Surgery, University of Colorado, Aurora, CO 80045, United States
| | - Anne Blaes
- Department of Medicine, Division of Hematology/Oncology, University of Minnesota, Minneapolis, MN 55455, United States
| | - Irene Kang
- Department of Medical Oncology & Therapeutics Research, City of Hope Orange County, Irvine, CA 92618, United States
- Department of Medicine, University of Southern California, Los Angeles, CA 90089, United States
| | - Adam Asare
- Department of Surgery, University of California San Francisco, San Francisco, CA 94158, United States
- Quantum Leap Healthcare Collaborative, San Francisco, CA 94158, United States
| | - Laura Esserman
- Department of Surgery, University of California San Francisco, San Francisco, CA 94158, United States
| | - Dawn L Hershman
- Division of Hematology/Oncology, Department of Medicine, Columbia University, New York, NY 10032, United States
| | - Amrita Basu
- Department of Surgery, University of California San Francisco, San Francisco, CA 94158, United States
| |
Collapse
|
29
|
Domingo A, Yessis J, Zupko B, McEachern LW, Valaitis R, Skinner K, Hanning RM. Scale up of the learning circles: a participatory action approach to support local food systems in four diverse First Nations school communities within Canada. BMC Public Health 2024; 24:2222. [PMID: 39148046 PMCID: PMC11325755 DOI: 10.1186/s12889-024-19391-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/06/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Addressing Indigenous food security and food sovereignty calls for community-driven strategies to improve access to and availability of traditional and local food. Participatory approaches that integrate Indigenous leadership have supported successful program implementation. Learning Circles: Local Healthy Food to School is a participatory program that convenes a range of stakeholders including food producers, educators and Knowledge Keepers to plan, implement and monitor local food system action. Pilot work (2014-2015) in Haida Gwaii, British Columbia (BC), showed promising results of the Learning Circles (LC) approach in enhancing local and traditional food access, knowledge and skills among youth and adolescents. The objective of the current evaluation was therefore to examine the process of scaling-up the LC vertically within the Haida Nation; and horizontally across three diverse First Nations contexts: Gitxsan Nation, Hazelton /Upper Skeena, BC; Ministikwan Lake Cree Nation, Saskatchewan; and Black River First Nation, Manitoba between 2016 and 2019. METHODS An implementation science framework, Foster-Fishman and Watson's (2012) ABLe Change Framework, was used to understand the LC as a participatory approach to facilitate community capacity building to strengthen local food systems. Interviews (n = 52), meeting summaries (n = 44) and tracking sheets (n = 39) were thematically analyzed. RESULTS The LC facilitated a collaborative process to: (1) build on strengths and explore ways to increase readiness and capacity to reclaim traditional and local food systems; (2) strengthen connections to land, traditional knowledge and ways of life; (3) foster community-level action and multi-sector partnerships; (4) drive actions towards decolonization through revitalization of traditional foods; (5) improve availability of and appreciation for local healthy and traditional foods in school communities; and (6) promote holistic wellness through steps towards food sovereignty and food security. Scale-up within Haida Gwaii supported a growing, robust local and traditional food system and enhanced Haida leadership. The approach worked well in other First Nations contexts, though baseline capacity and the presence of champions were enabling factors. CONCLUSIONS Findings highlight LC as a participatory approach to build capacity and support iterative planning-to-action in community food systems. Identified strengths and challenges support opportunities to expand, adopt and modify the LC approach in other Indigenous communities with diverse food systems.
Collapse
Affiliation(s)
- Ashleigh Domingo
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada.
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, N1G 2W1, Canada.
| | - Jennifer Yessis
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Barbara Zupko
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Louise Watson McEachern
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
- Department of Geography, Western University, London, ON, N6A 3K7, Canada
| | - Renata Valaitis
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Kelly Skinner
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Rhona M Hanning
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| |
Collapse
|
30
|
Hudon C, Chouinard MC, Doucet S, Piccinini-Vallis H, Fairman K, Sampalli T, Zed J, Brodeur M, Chênevert D, Dépelteau A, Dupont M, Karam M, Légaré F, Luke A, Macdonald M, Morvannou A, Ramsden VR, Rodriguez Del Barrio L, Wong ST, Lambert M, Bisson M, Schwarz C, Benoit R, Poirier MD, Rock-Hervieux AL, Rubenstein D, Wilhelm L. Case management in primary healthcare for people with complex needs to improve integrated care: a large-scale implementation study protocol. BMJ Open 2024; 14:e083783. [PMID: 39134438 PMCID: PMC11331999 DOI: 10.1136/bmjopen-2023-083783] [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: 12/28/2023] [Accepted: 07/15/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION Case management (CM) is among the most studied effective models of integrated care for people with complex needs. The goal of this study is to scale up and assess CM in primary healthcare for people with complex needs. METHODS AND ANALYSIS The research questions are: (1) which mechanisms contribute to the successful scale-up of CM for people with complex needs in primary healthcare?; (2) how do contextual factors within primary healthcare organisations contribute to these mechanisms? and (3) what are the relationships between the actors, contextual factors, mechanisms and outcomes when scaling-up CM for people with complex needs in primary healthcare? We will conduct a mixed methods Canadian interprovincial project in Quebec, New-Brunswick and Nova Scotia. It will include a scale-up phase and an evaluation phase. At inception, a scale-up committee will be formed in each province to oversee the scale-up phase. We will assess scale-up using a realist evaluation guided by the RAMESES checklist to develop an initial programme theory on CM scale-up. Then we will test and refine the programme theory using a mixed-methods multiple case study with 10 cases, each case being the scalable unit of the intervention in a region. Each primary care clinic within the case will recruit 30 adult patients with complex needs who frequently use healthcare services. Qualitative data will be used to identify contexts, mechanisms and certain outcomes for developing context-mechanism-outcome configurations. Quantitative data will be used to describe patient characteristics and measure scale-up outcomes. ETHICS AND DISSEMINATION Ethics approval was obtained. Engaging researchers, decision-makers, clinicians and patient partners on the study Steering Committee will foster knowledge mobilisation and impact. The dissemination plan will be developed with the Steering Committee with messages and dissemination methods targeted for each audience.
Collapse
Affiliation(s)
- Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | | | - Kimberly Fairman
- Institute for Circumpolar Health Research, Yellowknife, Northwest Territories, Canada
| | - Tara Sampalli
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Joanna Zed
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Magaly Brodeur
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Denis Chênevert
- Department of Human Resources Management, HEC Montreal, Montreal, Quebec, Canada
| | - Andréa Dépelteau
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mariève Dupont
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marlène Karam
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
| | - France Légaré
- Faculty of Medicine, Universite Laval, Quebec, Quebec, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Marilyn Macdonald
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Adele Morvannou
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Sabrina T Wong
- Centre for Health Services and Policy Research and School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mireille Lambert
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Charlotte Schwarz
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | | | | | | | | | | |
Collapse
|
31
|
Freitas de Mello N, Nascimento Silva S, Gomes DF, da Motta Girardi J, Barreto JOM. Models and frameworks for assessing the implementation of clinical practice guidelines: a systematic review. Implement Sci 2024; 19:59. [PMID: 39113109 PMCID: PMC11305041 DOI: 10.1186/s13012-024-01389-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 08/01/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND The implementation of clinical practice guidelines (CPGs) is a cyclical process in which the evaluation stage can facilitate continuous improvement. Implementation science has utilized theoretical approaches, such as models and frameworks, to understand and address this process. This article aims to provide a comprehensive overview of the models and frameworks used to assess the implementation of CPGs. METHODS A systematic review was conducted following the Cochrane methodology, with adaptations to the "selection process" due to the unique nature of this review. The findings were reported following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. Electronic databases were searched from their inception until May 15, 2023. A predetermined strategy and manual searches were conducted to identify relevant documents from health institutions worldwide. Eligible studies presented models and frameworks for assessing the implementation of CPGs. Information on the characteristics of the documents, the context in which the models were used (specific objectives, level of use, type of health service, target group), and the characteristics of each model or framework (name, domain evaluated, and model limitations) were extracted. The domains of the models were analyzed according to the key constructs: strategies, context, outcomes, fidelity, adaptation, sustainability, process, and intervention. A subgroup analysis was performed grouping models and frameworks according to their levels of use (clinical, organizational, and policy) and type of health service (community, ambulatorial, hospital, institutional). The JBI's critical appraisal tools were utilized by two independent researchers to assess the trustworthiness, relevance, and results of the included studies. RESULTS Database searches yielded 14,395 studies, of which 80 full texts were reviewed. Eight studies were included in the data analysis and four methodological guidelines were additionally included from the manual search. The risk of bias in the studies was considered non-critical for the results of this systematic review. A total of ten models/frameworks for assessing the implementation of CPGs were found. The level of use was mainly policy, the most common type of health service was institutional, and the major target group was professionals directly involved in clinical practice. The evaluated domains differed between the models and there were also differences in their conceptualization. All the models addressed the domain "Context", especially at the micro level (8/12), followed by the multilevel (7/12). The domains "Outcome" (9/12), "Intervention" (8/12), "Strategies" (7/12), and "Process" (5/12) were frequently addressed, while "Sustainability" was found only in one study, and "Fidelity/Adaptation" was not observed. CONCLUSIONS The use of models and frameworks for assessing the implementation of CPGs is still incipient. This systematic review may help stakeholders choose or adapt the most appropriate model or framework to assess CPGs implementation based on their specific health context. TRIAL REGISTRATION PROSPERO (International Prospective Register of Systematic Reviews) registration number: CRD42022335884. Registered on June 7, 2022.
Collapse
Affiliation(s)
- Nicole Freitas de Mello
- Department of Management and Incorporation of Health Technologies, Ministry of Health of Brazil, Brasília, Federal District, 70058-900, Brazil.
- Postgraduate Program in Public Health, FS, University of Brasília (UnB), Brasília, Federal District, 70910-900, Brazil.
| | - Sarah Nascimento Silva
- René Rachou Institute, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, 30190-002, Brazil
| | - Dalila Fernandes Gomes
- Department of Management and Incorporation of Health Technologies, Ministry of Health of Brazil, Brasília, Federal District, 70058-900, Brazil
- Postgraduate Program in Public Health, FS, University of Brasília (UnB), Brasília, Federal District, 70910-900, Brazil
| | | | - Jorge Otávio Maia Barreto
- Postgraduate Program in Public Health, FS, University of Brasília (UnB), Brasília, Federal District, 70910-900, Brazil
- Oswaldo Cruz Foundation - Brasília, Brasília, Federal District, 70904-130, Brazil
| |
Collapse
|
32
|
Austin JD, Finney Rutten LJ, Fischer K, Ridgeway J, Minteer S, Griffin JM, Pachman DR, Ruddy KJ, Cheville A. Advancing Care Team Adoption of Electronic Health Record Systems for Cancer Symptom Management: Findings From a Hybrid Type II, Cluster-Randomized, Stepped-Wedge Trial. JCO Oncol Pract 2024:OP2400280. [PMID: 39106420 DOI: 10.1200/op.24.00280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 06/20/2024] [Accepted: 07/12/2024] [Indexed: 08/09/2024] Open
Abstract
PURPOSE The enhanced, electronic health record (EHR)-facilitated cancer symptom control (E2C2) trial is a cohort cluster-randomized, stepped-wedge, hybrid type II trial that leverages EHR systems to facilitate a collaborative care model (CCM) approach with the goal of improving cancer symptom management. Understanding factors that influence care team adoption of EHR systems remains a critical understudied area of research. This study examines how oncology care teams' perceptions regarding the feasibility, acceptability, and appropriateness of E2C2 EHR systems preimplementation were associated with adoption 3 months after implementation and characterizes differences in adoption by individual- and system-level factors. METHODS Care team members completed an electronic survey before and 3 months after implementation of E2C2 for their respective sequence. Adoption was defined as frequency of use to statements aligned with care team-directed EHR systems designed to facilitate CCM approaches. Chi-square tests assessed differences in adoption while logistic regression models estimated associations between baseline mean scores of acceptability, feasibility, and appropriateness on care team adoption at 3 months. RESULTS Results from 94 care team members (37.2% oncologists, 72.6% female, 55.3% in their role for 6+ years) found that adoption rates ranged from 48.9% to 71.7%, with significant differences observed by location (community-based health care systems v tertiary medical center) and professional role. Adjusting for professional role, care team members reporting higher levels of perceived acceptability and appropriateness at baseline had greater odds of adopting EHR systems at 3 months. CONCLUSION EHR systems perceived as acceptable and appropriate are more likely to be adopted by oncology care teams in our sample. Future implementation efforts should consider tailored strategies to facilitate adoption of EHR systems designed to promote CCM-based approaches to improve cancer symptom management.
Collapse
Affiliation(s)
- Jessica D Austin
- Division of Epidemiology, Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ
| | - Lila J Finney Rutten
- Division of Epidemiology, Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | - Jennifer Ridgeway
- Division of Health Care Delivery Research and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Sarah Minteer
- Division of Medical Rehabilitation, Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Joan M Griffin
- Division of Health Care Delivery Research and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Deirdre R Pachman
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN
| | | | - Andrea Cheville
- Division of Medical Rehabilitation, Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| |
Collapse
|
33
|
Bucher A, Chaudhry BM, Davis JW, Lawrence K, Panza E, Baqer M, Feinstein RT, Fields SA, Huberty J, Kaplan DM, Kusters IS, Materia FT, Park SY, Kepper M. How to design equitable digital health tools: A narrative review of design tactics, case studies, and opportunities. PLOS DIGITAL HEALTH 2024; 3:e0000591. [PMID: 39172776 PMCID: PMC11340894 DOI: 10.1371/journal.pdig.0000591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
With a renewed focus on health equity in the United States driven by national crises and legislation to improve digital healthcare innovation, there is a need for the designers of digital health tools to take deliberate steps to design for equity in their work. A concrete toolkit of methods to design for health equity is needed to support digital health practitioners in this aim. This narrative review summarizes several health equity frameworks to help digital health practitioners conceptualize the equity dimensions of importance for their work, and then provides design approaches that accommodate an equity focus. Specifically, the Double Diamond Model, the IDEAS framework and toolkit, and community collaboration techniques such as participatory design are explored as mechanisms for practitioners to solicit input from members of underserved groups and better design digital health tools that serve their needs. Each of these design methods requires a deliberate effort by practitioners to infuse health equity into the approach. A series of case studies that use different methods to build in equity considerations are offered to provide examples of how this can be accomplished and demonstrate the range of applications available depending on resources, budget, product maturity, and other factors. We conclude with a call for shared rigor around designing digital health tools that deliver equitable outcomes for members of underserved populations.
Collapse
Affiliation(s)
- Amy Bucher
- Behavioral Reinforcement Learning Lab (BReLL), Lirio, Inc., Knoxville, Tennessee, United States of America
| | - Beenish M. Chaudhry
- School of Computing and Informatics, University of Louisiana at Lafayette, Lafayette, Louisiana, United States of America
| | - Jean W. Davis
- College of Nursing, University of Central Florida, Orlando, Florida, United States of America
| | - Katharine Lawrence
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Emily Panza
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island, United States of America
| | - Manal Baqer
- Neamah Health Consulting, Boston, Massachusetts, United States of America
| | - Rebecca T. Feinstein
- AIHealth4All Center for Health Equity using Machine Learning and Artificial Intelligence, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Sherecce A. Fields
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, United States of America
| | | | - Deanna M. Kaplan
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Department of Spiritual Health, Woodruff Health Science Center, Emory University, Atlanta, Georgia, United States of America
| | - Isabelle S. Kusters
- Department of Clinical, Health, and Applied Sciences, University of Houston-Clear Lake, Houston, Texas, United States of America
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, United States of America
| | - Frank T. Materia
- Otolaryngology and Population Health, University of Kansas Medical Center, Kansas City, Kansas, United States of America
| | - Susanna Y. Park
- Radiant Foundation, Salt Lake City, Utah, United States of America
| | - Maura Kepper
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| |
Collapse
|
34
|
Stuart CM, Dyas AR, Chanes N, Bronsert MR, Kelleher AD, Bata KE, Henderson WG, Randhawa SK, David EA, Mitchell JD, Meguid RA. Strict compliance to a thoracic enhanced recovery after surgery protocol is associated with improved outcomes compared with partial compliance: A prospective cohort study. Surgery 2024; 176:477-484. [PMID: 38839431 PMCID: PMC11246801 DOI: 10.1016/j.surg.2024.04.044] [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: 02/14/2024] [Revised: 03/29/2024] [Accepted: 04/29/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Benefits of thoracic enhanced recovery after surgery programs have been described. However, there is ongoing discussion on the importance of full protocol compliance. The objective of this study was to determine whether strict adherence to an enhanced recovery after surgery protocol leads to further improvement in outcomes compared with less strict compliance. METHODS This was a multihospital prospective cohort study of all consecutive anatomic lung resection patients on the thoracic enhanced recovery after surgery pathway from May 2021 to March 2023, with comparison with a historical control from January 2019 to April 2021. Compliance to 5 key protocol elements was tracked. Patients were grouped into high- and low-compliance cohorts, defined as adherence to 4-5/5 or 0-3/5 elements, respectively. The primary outcome was overall morbidity; secondary outcomes included cardiac, respiratory, and infectious morbidity and length of stay. RESULTS Of the 960 patients, 429 (44.7%) were enhanced recovery after surgery patients and 531 (55.3%) were in the historical control group. Across all patients, 250 (26.0%) were considered high compliance and 710 (74.0%) were considered low compliance. After adjustment for enhanced recovery after surgery status and confounders, the association between high compliance and improved outcomes persisted for all but infectious morbidity. Compared with low compliance, high compliance was associated with decreased odds of any morbidity (0.41 [95% CI, 0.22-0.77]), cardiac morbidity (0.31 [0.11-0.91]), respiratory morbidity (0.46 [0.23-0.90]) and decreased length of stay (0.38 [0.18-0.87]). CONCLUSION Enhanced recovery after surgery protocols improve outcomes after anatomic lung resection. Increasing compliance to individual elements (>80%) further improves patient outcomes. Continued efforts should be directed at increasing compliance to individual protocol elements.
Collapse
Affiliation(s)
- Christina M Stuart
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO.
| | - Adam R Dyas
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO
| | - Nicolas Chanes
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Michael R Bronsert
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO
| | - Alyson D Kelleher
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Kyle E Bata
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - William G Henderson
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO
| | - Simran K Randhawa
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Elizabeth A David
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - John D Mitchell
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Robert A Meguid
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO
| |
Collapse
|
35
|
Lugossy AM, Anton K, Dako F, Dixon RG, DuCharme PA, Duggan C, Durand MA, Einstein SA, Elahi A, Kesselman A, Kulinski LF, Mango VL, Pollack EB, Scheel JR, Schweitzer A, Svolos P, Wetherall M, Mollura DJ. Building Radiology Equity: Themes from the 2023 RAD-AID Conference on International Radiology and Global Health. J Am Coll Radiol 2024; 21:1194-1200. [PMID: 38763441 DOI: 10.1016/j.jacr.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/12/2024] [Accepted: 04/24/2024] [Indexed: 05/21/2024]
Abstract
Low- and middle-income countries are significantly impacted by the global scarcity of medical imaging services. Medical imaging is an essential component for diagnosis and guided treatment, which is needed to meet the current challenges of increasing chronic diseases and preparedness for acute-care response. We present some key themes essential for improving global health equity, which were discussed at the 2023 RAD-AID Conference on International Radiology and Global Health. They include (1) capacity building, (2) artificial intelligence, (3) community-based patient navigation, (4) organizational design for multidisciplinary global health strategy, (5) implementation science, and (6) innovation. Although not exhaustive, these themes should be considered influential as we guide and expand global health radiology programs in low- and middle-income countries in the coming years.
Collapse
Affiliation(s)
| | - Kevin Anton
- Director of Interventional Radiology, RAD-AID International; Assistant Professor of Radiology, Director Global Health Elective, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Farouk Dako
- Director, RAD-AID Nigeria, RAD-AID International; Assistant Professor of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert G Dixon
- Director, RAD-AID Kenya, RAD-AID International; Professor of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Catherine Duggan
- Research Project Manager for RAD-AID USA Women's Health Access Initiative, RAD-AID International; Director, Collaborative Data Services, Public Health Sciences, Fred Hutch Cancer Center, Seattle, Washington
| | - Melissa A Durand
- Program Manager of Breast Imaging, RAD-AID International; Associate Professor of Radiology & Biomedical Imaging, Department of Radiology and Biomedical Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Samuel A Einstein
- Director of Medical Physics, RAD-AID International; Assistant Professor, Department of Radiology, Pennsylvania State University, University Park, Pennsylvania
| | - Ameena Elahi
- Operations Director of Informatics, RAD-AID International; IS Application Manager, Department of Information Services, Penn Medicine, Philadelphia, Pennsylvania
| | - Andrew Kesselman
- Associate Director of Interventional Radiology, RAD-AID International; Clinical Assistant Professor, Radiology, Stanford University School of Medicine, Stanford, Cailfornia
| | | | - Victoria L Mango
- Program Manager (Breast Imaging), RAD-AID Nigeria, RAD-AID International; Associate Attending Radiologist, Breast Imaging Service, Assistant Director, Global Cancer Disparities Initiatives, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erica B Pollack
- Director of Breast Imaging, RAD-AID International; Associate Professor, Diagnostic Radiology, Division of Breast Imaging and Intervention, University of Colorado School of Medicine, Aurora, Colorado
| | - John R Scheel
- Director, RAD-AID USA Women's Health Access Initiative, RAD-AID Peru, RAD-AID International; Professor of Radiology and Radiological Sciences, Vice Chair of Global and Planetary Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Patricia Svolos
- Program Manager of Medical Physics, RAD-AID International; Assistant Professor, Department of Diagnostic and Interventional Imaging, UTHealth McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Mary Wetherall
- Nursing Director, RAD-AID USA Women's Health Access Initiative, Associate Program Manager, RAD-AID Nursing, RAD-AID International
| | | |
Collapse
|
36
|
Du S, Hu Y, Zhou Y, Xing W, Zhu Z, Meng A, Zhi X, Dong G, Mao C. The implementation study of nurses' work related low back pain prevention and care guideline: A quasi-experimental study. Appl Nurs Res 2024; 78:151818. [PMID: 39053998 DOI: 10.1016/j.apnr.2024.151818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/15/2023] [Accepted: 06/25/2024] [Indexed: 07/27/2024]
Abstract
AIM To understand the implementation process and outcomes of nurses' work related low back pain (WLBP) prevention and care guideline. BACKGROUND WLBP is a common occupational injury for clinical nurses. We developed the first evidence-based guideline of nurses' WLBP prevention and care of its kind both at home and abroad, and it is necessary for us to explore its feasibility, appropriateness and effectiveness in practice. METHODS Based on the model of the integrated Promoting Action on Research Implementation in Health Services, we performed a four-phase implementation study in a tertiary hospital. The study was a non-randomized concurrent controlled trial design,and multilevel measures were examined including implementation outcomes and clinical outcomes. RESULTS For the implementation outcomes, the tailored recommendations of the guideline were found to be acceptable, appropriate, feasible, and well adopted both at the unit level and the hospital level. The clinical outcomes indicated that, compared with the control unit, nurses of the treatment unit performed better in awareness, knowledge, practice of WLBP prevention and care. CONCLUSIONS The implementation study supports the successful application of the guideline, which can serve as a valuable evidence-based document to improve back health of nursing personnel.
Collapse
Affiliation(s)
- Shizheng Du
- School of Nursing, Nanjing University of Chinese Medicine, #138 Xianlin Avenue, Nanjing 210023, China; School of Nursing, Fudan University, 305 Fenglin Road, Shanghai 200032, China
| | - Yan Hu
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai 200032, China.
| | - Yingfeng Zhou
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai 200032, China
| | - Weijie Xing
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai 200032, China
| | - Zheng Zhu
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai 200032, China
| | - Aifeng Meng
- Jiangsu Cancer Hospital, Jiangsu Cancer Research Institute, Cancer Hospital Affiliated to Nanjing Medical University, #42 Baiziting, Nanjing 210009, China
| | - Xiaoxu Zhi
- Jiangsu Cancer Hospital, Jiangsu Cancer Research Institute, Cancer Hospital Affiliated to Nanjing Medical University, #42 Baiziting, Nanjing 210009, China
| | - Gaoyue Dong
- Jiangsu Cancer Hospital, Jiangsu Cancer Research Institute, Cancer Hospital Affiliated to Nanjing Medical University, #42 Baiziting, Nanjing 210009, China
| | - Changmin Mao
- Jiangsu Cancer Hospital, Jiangsu Cancer Research Institute, Cancer Hospital Affiliated to Nanjing Medical University, #42 Baiziting, Nanjing 210009, China
| |
Collapse
|
37
|
Tong G, Tong J, Jiang Y, Esserman D, Harhay MO, Warren JL. Hierarchical Bayesian modeling of heterogeneous outcome variance in cluster randomized trials. Clin Trials 2024; 21:451-460. [PMID: 38197388 PMCID: PMC11233424 DOI: 10.1177/17407745231222018] [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: 01/11/2024]
Abstract
BACKGROUND Heterogeneous outcome correlations across treatment arms and clusters have been increasingly acknowledged in cluster randomized trials with binary endpoints, where analytical methods have been developed to study such heterogeneity. However, cluster-specific outcome variances and correlations have yet to be studied for cluster randomized trials with continuous outcomes. METHODS This article proposes models fitted in the Bayesian setting with hierarchical variance structure to quantify heterogeneous variances across clusters and explain it with cluster-level covariates when the outcome is continuous. The models can also be extended to analyzing heterogeneous variances in individually randomized group treatment trials, with arm-specific cluster-level covariates, or in partially nested designs. Simulation studies are carried out to validate the performance of the newly introduced models across different settings. RESULTS Simulations showed that overall the newly introduced models have good performance, reporting low bias and approximately 95% coverage for the intraclass correlation coefficients and regression parameters in the variance model. When variances are heterogeneous, our proposed models had improved model fit over models with homogeneous variances. When used to analyze data from the Kerala Diabetes Prevention Program study, our models identified heterogeneous variances and intraclass correlation coefficients across clusters and examined cluster-level characteristics associated with such heterogeneity. CONCLUSION We proposed new hierarchical Bayesian variance models to accommodate cluster-specific variances in cluster randomized trials. The newly developed methods inform the understanding of how an intervention strategy is implemented and disseminated differently across clusters and can help improve future trial design.
Collapse
Affiliation(s)
- Guangyu Tong
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut, USA
| | - Jiaqi Tong
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut, USA
| | - Yi Jiang
- Department of Biostatistics, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Denise Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
- Yale Center for Analytical Science, Yale School of Public Health, New Haven, Connecticut, USA
| | - Michael O Harhay
- Clinical Trials Methods and Outcomes Lab, Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joshua L Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| |
Collapse
|
38
|
Fjordkvist E, Hälleberg Nyman M, Winberg M, Joelsson-Alm E, Eldh AC. First-line managers' experience of guideline implementation in orthopaedic nursing and rehabilitation: a qualitative study. BMC Health Serv Res 2024; 24:871. [PMID: 39085940 PMCID: PMC11293162 DOI: 10.1186/s12913-024-11353-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: 03/09/2024] [Accepted: 07/24/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND First-line managers have a unique role and potential in encouraging the use of evidence-based clinical practice guidelines (CPGs) and thus serve the provision of safe patient care. In acute and planned hospital care, effective yet safeguarded nursing procedures are a necessity. Little is currently known about how first-line managers engage in supporting the adoption of evidence-based nursing care and about what barriers and enablers there are for implementation of CPGs in the orthopaedic care context. PURPOSE To investigate first-line managers' experience of clinical practice guideline implementation in orthopaedic care. METHODS This qualitative interview study included 30 first-line nursing and rehabilitation managers in 17 orthopaedic units in Sweden. A deductive content analysis, with the Ottawa Model of Implementation Leadership as a guide, was employed. RESULTS To the first-line managers, any guideline implementation required them to balance contexts, including their outer context (signified by the upper-level management and decision-makers) and their inner context, including staff and patients in their unit(s). Acting in response to these contexts, the managers described navigating the organization and its terms and conditions; using relations-, change-, and task-oriented leadership, such as involving the staff; motivating the change by emphasizing the patient benefits; and procuring resources, such as time and training. Even though they knew from past experience what worked when implementing CPGs, the first-line managers often encountered barriers within the contexts that hampered successful implementation. CONCLUSIONS Although first-line managers know how to effectively implement CPGs, an organization's terms and conditions can limit their opportunities to fully do so. Organizational awareness of what supports and hinders first-line managers to offer implementation leadership can enhance opportunities to alter behaviours and conditions for the benefit of CPG implementation. TRIAL REGISTRATION The study was registered as NCT04700969 with the U.S. National Institutes of Health Clinical Trials Registry on 8 January 2021.
Collapse
Affiliation(s)
- Erika Fjordkvist
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, 701 82, Örebro, Sweden.
- Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden.
| | - Maria Hälleberg Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, 701 82, Örebro, Sweden
- Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, 701 82, Örebro, Sweden
| | - Madeleine Winberg
- Faculty of Medicine and Health Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, 118 83Stockholm, , Södersjukhuset, Karolinska Institutet, Sweden
| | - Ann Catrine Eldh
- Faculty of Medicine and Health Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden
| |
Collapse
|
39
|
Gyawali R, Gamboa S, Rolfe K, Westbrook JI, Raban MZ. Consumer perspectives on antibiotic use in residential aged care: A mixed-methods systematic review. Am J Infect Control 2024:S0196-6553(24)00608-4. [PMID: 39067702 DOI: 10.1016/j.ajic.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/12/2024] [Accepted: 07/14/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Aged care staff and doctors frequently highlight consumers' role in antibiotic treatment decisions. However, few studies include consumers. This study aimed to investigate consumer perspectives on antibiotic use in residential aged care. METHODS A search across 6 online databases yielded 3,373 studies, with 5 meeting inclusion criteria. Participant quotes, themes, statistical analyses, and authors' interpretive summaries in the included studies were inductively coded and refined to generate themes. RESULTS Three themes emerged: perception of benefits and risks of antibiotics, perceived role in antibiotic treatment decision-making, and information-communication needs. Consumers held positive attitudes toward antibiotics, did not associate antibiotics with the exclusive treatment of bacterial infections, and had limited awareness of potential risks, such as antibiotic resistance. Studies showed diverse perceptions regarding residents' and their families' involvement in antibiotic treatment decision-making with some residents actively seeking antibiotics and others trusting doctors to decide. Studies also described consumer need for effective provider-consumer communication and information sharing that was affected by contextual barriers such as motivation, preferences, available information resources, and provider attitudes. CONCLUSIONS Limited literature is available on consumer perspectives on antibiotic use in aged care. The review highlights that consumer needs are more complex than simply wanting an antibiotic. Antimicrobial stewardship programs should target consumer awareness, beliefs, and provider-consumer communication to enhance antibiotic use in aged care.
Collapse
Affiliation(s)
- Rajendra Gyawali
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia.
| | - Sarah Gamboa
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Kathleen Rolfe
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| |
Collapse
|
40
|
Knoll K, Rhee Y, Fillmore N, Jurivich DA, Lang JJ, McGrath BM, Tomkinson GR, McGrath R. Weakness Status is Differentially Associated with Time to Diabetes in Americans. ADVANCES IN GERIATRIC MEDICINE AND RESEARCH 2024; 6:e240004. [PMID: 39119102 PMCID: PMC11308643 DOI: 10.20900/agmr20240004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Background The purpose of this study was to evaluate the associations of (1) individual absolute and body size normalized weakness cut-points, and (2) the collective weakness classifications on time to diabetes in Americans. Methods We analyzed data from 9577 adults aged at least 50-years from the Health and Retirement Study. Diabetes diagnosis was self-reported. A handgrip dynamometer measured handgrip strength (HGS). Males with HGS <35.5 kg (absolute), <0.45 kg/kg (normalized to body weight), or <1.05 kg/kg/m2 (normalized to BMI) were categorized as weak. Females were classified as weak if their HGS was <20.0 kg, <0.337 kg/kg, or <0.79 kg/kg/m2. Compounding weakness included falling below 1, 2, or all 3 cut-points. Results Persons below the body weight normalized weakness cut-points had a 1.29 (95% confidence interval (CI): 1.15-1.47) higher hazard for incident diabetes, while those below the BMI normalized cut-points had a 1.30 (CI: 1.13-1.51) higher hazard. The association between absolute weakness and incident diabetes was insignificant (hazard ratio: 1.06; CI: 0.91-1.24). Americans below 1, 2, or all 3 collective weakness categories had a 1.28 (CI: 1.10-1.50), 1.29 (CI: 1.08-1.52), and 1.33 (CI: 1.09-1.63) higher hazard for the incidence of diabetes, respectively. Conclusions Our findings indicate that while absolute weakness, which is confounded by body size, was not associated with time to diabetes, adjusting for the influence of body size by normalizing HGS to body weight and BMI was significantly associated with time to diabetes. This suggests that muscle strength, not body size, may be driving such associations with time to diabetes.
Collapse
Affiliation(s)
- Kelly Knoll
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58108, USA
- Healthy Aging North Dakota, North Dakota State University, Fargo, ND 58102, USA
| | - Yeong Rhee
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58108, USA
| | - Natasha Fillmore
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND 58108, USA
| | - Donald A. Jurivich
- Department of Geriatrics, University of North Dakota, Grand Forks, ND 58202, USA
| | - Justin J. Lang
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON K1A 0K9, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia
| | | | - Grant R. Tomkinson
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia
| | - Ryan McGrath
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58108, USA
- Healthy Aging North Dakota, North Dakota State University, Fargo, ND 58102, USA
- Department of Geriatrics, University of North Dakota, Grand Forks, ND 58202, USA
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia
- Fargo VA Healthcare System, Fargo, ND 58102, USA
| |
Collapse
|
41
|
O'Connor CM, Poulos RG, Heldon M, Preti C, Beattie E, Poulos CJ. Implementing Arts on Prescription at Home for People Living With Dementia: A Hybrid-Effectiveness Feasibility Study. J Geriatr Psychiatry Neurol 2024:8919887241267335. [PMID: 39042824 DOI: 10.1177/08919887241267335] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
Arts on prescription at home (AoP@Home) is a participatory art-based approach involving a professional artist engaging a person with dementia (and their family carer) in art-making in their own home. This study evaluated the implementation of AoP@Home within a real-world community aged care context. A hybrid effectiveness-implementation design was used to simultaneously test both the AoP@Home intervention and the implementation process. AoP@Home program outcomes included person with dementia and family carer (dyad) health and wellbeing, and personal goal attainment. Implementation outcomes were evaluated according to feasibility, fidelity, acceptability, uptake, and costs via routinely collected data, artist notes, and interviews with program managers, artists, and participant dyads. Four dyads completed an AoP@Home program during the study period. All participants with dementia reported improvements in their overall health and wellbeing, and wellbeing scores improved for all carers from baseline to post-program. Implementation was feasible using existing government funding mechanisms, and programs were acceptable to all stakeholders. It is possible to deliver participatory arts programs for community-dwelling people with dementia and their family, in their home, using sustainable and available funding models. Programs such as AoP@Home should be made more accessible alongside broader allied health and care services.
Collapse
Affiliation(s)
- Claire Mc O'Connor
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
- Centre for Positive Ageing, HammondCare, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia
| | - Roslyn G Poulos
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Michelle Heldon
- Centre for Positive Ageing, HammondCare, Sydney, NSW, Australia
| | - Costanza Preti
- Centre for Positive Ageing, HammondCare, Sydney, NSW, Australia
| | - Elizabeth Beattie
- School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Christopher J Poulos
- Centre for Positive Ageing, HammondCare, Sydney, NSW, Australia
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
42
|
Kordon A, Carroll AJ, Fu E, Rosenthal LJ, Rado JT, Jordan N, Brown CH, Smith JD. Multilevel perspectives on the implementation of the collaborative care model for depression and anxiety in primary care. BMC Psychiatry 2024; 24:519. [PMID: 39039458 PMCID: PMC11265029 DOI: 10.1186/s12888-024-05930-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/24/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND The Collaborative Care Model (CoCM) is an evidence-based mental health treatment in primary care. A greater understanding of the determinants of successful CoCM implementation, particularly the characteristics of multi-level implementers, is needed. METHODS This study was a process evaluation of the Collaborative Behavioral Health Program (CBHP) study (NCT04321876) in which CoCM was implemented in 11 primary care practices. CBHP implementation included screening for depression and anxiety, referral to CBHP, and treatment with behavioral care managers (BCMs). Interviews were conducted 4- and 15-months post-implementation with BCMs, practice managers, and practice champions (primary care clinicians). We used framework-guided rapid qualitative analysis with the Consolidated Framework for Implementation Research, Version 2.0, focused on the Individuals domain, to analyze response data. These data represented the roles of Mid-Level Leaders (practice managers), Implementation Team Members (clinicians, support staff), Innovation Deliverers (BCMs), and Innovation Recipients (primary care/CBHP patients) and their characteristics (i.e., Need, Capability, Opportunity, Motivation). RESULTS Mid-level leaders (practice managers) were enthusiastic about CBHP (Motivation), appreciated integrating mental health services into primary care (Need), and had time to assist clinicians (Opportunity). Although CBHP lessened the burden for implementation team members (clinicians, staff; Need), some were hesitant to reallocate patient care (Motivation). Innovation deliverers (BCMs) were eager to deliver CBHP (Motivation) and confident in assisting patients (Capability); their opportunity to deliver CBHP could be limited by clinician referrals (Opportunity). Although CBHP alleviated barriers for innovation recipients (patients; Need), it was difficult to secure services for those with severe conditions (Capability) and certain insurance types (Opportunity). CONCLUSIONS Overall, respondents favored sustaining CoCM and highlighted the positive impacts on the practice, health care team, and patients. Participants emphasized the benefits of integrating mental health services into primary care and how CBHP lessened the burden on clinicians while providing patients with comprehensive care. Barriers to CBHP implementation included ensuring appropriate patient referrals, providing treatment for patients with higher-level needs, and incentivizing clinician engagement. Future CoCM implementation should include strategies focused on education and training, encouraging clinician buy-in, and preparing referral paths for patients with more severe conditions or diverse needs. TRIAL REGISTRATION ClinicalTrials.gov(NCT04321876). Registered: March 25,2020. Retrospectively registered.
Collapse
Affiliation(s)
- Avram Kordon
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Allison J Carroll
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily Fu
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lisa J Rosenthal
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey T Rado
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA
| | - C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
43
|
Morken V, Perry LM, Coughlin A, O’Connor M, Chmiel R, Xinos S, Peipert JD, Garcia SF, Linder JA, Ackermann RT, Kircher S, Mohindra NA, Aggarwal V, Weitzel M, Nelson EC, Elwyn G, Van Citters AD, Barnard C, Cella D, Hirschhorn LR. Implementation of a Co-Design Strategy to Develop a Dashboard to Support Shared Decision Making in Advanced Cancer and Chronic Kidney Disease. J Clin Med 2024; 13:4178. [PMID: 39064218 PMCID: PMC11278116 DOI: 10.3390/jcm13144178] [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: 05/26/2024] [Revised: 06/24/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Shared decision making (SDM) is the process by which patients and clinicians exchange information and preferences to come to joint healthcare decisions. Clinical dashboards can support SDM by collecting, distilling, and presenting critical information, such as patient-reported outcomes (PROs), to be shared at points of care and in between appointments. We describe the implementation strategies and outcomes of a multistakeholder collaborative process known as "co-design" to develop a PRO-informed clinical dashboard to support SDM for patients with advanced cancer or chronic kidney disease (CKD). Methods: Across 14 sessions, two multidisciplinary teams comprising patients, care partners, clinicians, and other stakeholders iteratively co-designed an SDM dashboard for either advanced cancer (N = 25) or CKD (N = 24). Eligible patients, care partners, and frontline clinicians were identified by six physician champions. The co-design process included four key steps: (1) define "the problem", (2) establish context of use, (3) build a consensus on design, and (4) define and test specifications. We also evaluated our success in implementing the co-design strategy using measures of fidelity, acceptability, adoption, feasibility, and effectiveness which were collected throughout the process. Results: Mean (M) scores across implementation measures of the co-design process were high, including observer-rated fidelity and adoption of co-design practices (M = 19.1 on a 7-21 scale, N = 36 ratings across 9 sessions), as well as acceptability based on the perceived degree of SDM that occurred during the co-design process (M = 10.4 on a 0 to 12 adapted collaboRATE scale). Capturing the feasibility and adoption of convening multistakeholder co-design teams, min-max normalized scores (ranging from 0 to 1) of stakeholder representation demonstrated that, on average, 95% of stakeholder types were represented for cancer sessions (M = 0.95) and 85% for CKD sessions (M = 0.85). The co-design process was rated as either "fully" or "partially" effective by 100% of respondents, in creating a dashboard that met its intended objective. Conclusions: A co-design process was successfully implemented to develop SDM clinical dashboards for advanced cancer and CKD care. We discuss key strategies and learnings from this process that may aid others in the development and uptake of patient-centered healthcare innovations.
Collapse
Affiliation(s)
- Victoria Morken
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave., Suite 2100, Chicago, IL 60611, USA; (V.M.); (L.M.P.); (A.C.); (M.O.); (S.F.G.)
| | - Laura M. Perry
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave., Suite 2100, Chicago, IL 60611, USA; (V.M.); (L.M.P.); (A.C.); (M.O.); (S.F.G.)
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, 675 N St Clair St Fl 21 Ste 100, Chicago, IL 60611, USA; (S.K.); (D.C.)
| | - Ava Coughlin
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave., Suite 2100, Chicago, IL 60611, USA; (V.M.); (L.M.P.); (A.C.); (M.O.); (S.F.G.)
| | - Mary O’Connor
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave., Suite 2100, Chicago, IL 60611, USA; (V.M.); (L.M.P.); (A.C.); (M.O.); (S.F.G.)
| | - Ryan Chmiel
- Northwestern Medicine, 251 E Huron St., Chicago, IL 60611, USA; (R.C.); (S.X.)
| | - Stavroula Xinos
- Northwestern Medicine, 251 E Huron St., Chicago, IL 60611, USA; (R.C.); (S.X.)
| | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave., Suite 2100, Chicago, IL 60611, USA; (V.M.); (L.M.P.); (A.C.); (M.O.); (S.F.G.)
| | - Sofia F. Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave., Suite 2100, Chicago, IL 60611, USA; (V.M.); (L.M.P.); (A.C.); (M.O.); (S.F.G.)
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, 675 N St Clair St Fl 21 Ste 100, Chicago, IL 60611, USA; (S.K.); (D.C.)
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 425 E Ontario St #7, Chicago, IL 60611, USA
| | - Jeffrey A. Linder
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Arkes Suite 2330, Chicago, IL 60611, USA; (J.A.L.); (R.T.A.); (C.B.)
| | - Ronald T. Ackermann
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Arkes Suite 2330, Chicago, IL 60611, USA; (J.A.L.); (R.T.A.); (C.B.)
- Institute for Public Health and Medicine Northwestern University Feinberg School of Medicine, 420 E. Superior St. 6th Floor, Chicago, IL 60611, USA
| | - Sheetal Kircher
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, 675 N St Clair St Fl 21 Ste 100, Chicago, IL 60611, USA; (S.K.); (D.C.)
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Arkes Suite 2330, Chicago, IL 60611, USA;
| | - Nisha A. Mohindra
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, 675 N St Clair St Fl 21 Ste 100, Chicago, IL 60611, USA; (S.K.); (D.C.)
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Arkes Suite 2330, Chicago, IL 60611, USA;
| | - Vikram Aggarwal
- Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, Suite 2020, Chicago, IL 60611, USA; (V.A.); (M.W.)
| | - Melissa Weitzel
- Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, Suite 2020, Chicago, IL 60611, USA; (V.A.); (M.W.)
| | - Eugene C. Nelson
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, 5 WTRB, Level 5, One Medical Center Drive, Lebanon, NH 03756, USA; (E.C.N.); (G.E.); (A.D.V.C.)
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, 5 WTRB, Level 5, One Medical Center Drive, Lebanon, NH 03756, USA; (E.C.N.); (G.E.); (A.D.V.C.)
| | - Aricca D. Van Citters
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, 5 WTRB, Level 5, One Medical Center Drive, Lebanon, NH 03756, USA; (E.C.N.); (G.E.); (A.D.V.C.)
| | - Cynthia Barnard
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Arkes Suite 2330, Chicago, IL 60611, USA; (J.A.L.); (R.T.A.); (C.B.)
| | - David Cella
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, 675 N St Clair St Fl 21 Ste 100, Chicago, IL 60611, USA; (S.K.); (D.C.)
| | - Lisa R. Hirschhorn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave., Suite 2100, Chicago, IL 60611, USA; (V.M.); (L.M.P.); (A.C.); (M.O.); (S.F.G.)
- Robert J. Havey, MD Institute for Global Health, Northwestern University Feinberg School of Medicine, 259 E Erie St Ste 2350, Chicago, IL 60611, USA
| |
Collapse
|
44
|
Bulaj G, Coleman M, Johansen B, Kraft S, Lam W, Phillips K, Rohaj A. Redesigning Pharmacy to Improve Public Health Outcomes: Expanding Retail Spaces for Digital Therapeutics to Replace Consumer Products That Increase Mortality and Morbidity Risks. PHARMACY 2024; 12:107. [PMID: 39051391 PMCID: PMC11270305 DOI: 10.3390/pharmacy12040107] [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: 05/29/2024] [Revised: 06/26/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024] Open
Abstract
United States healthcare outcomes, including avoidable mortality rates, are among the worst of high-income countries despite the highest healthcare spending per capita. While community pharmacies contribute to chronic disease management and preventive medicine, they also offer consumer products that increase mortality risks and the prevalence of cardiovascular diseases, diabetes, cancer, and depression. To resolve these contradictions, our perspective article describes opportunities for major pharmacy chains (e.g., CVS Pharmacy and Walgreens) to introduce digital health aisles dedicated to prescription and over-the-counter digital therapeutics (DTx), together with mobile apps and wearables that support disease self-management, wellness, and well-being. We provide an evidence-based rationale for digital health aisles to replace spaces devoted to sugar-sweetened beverages and other unhealthy commodities (alcohol, tobacco) that may increase risks for premature death. We discuss how digital health aisles can serve as marketing and patient education resources, informing customers about commercially available DTx and other technologies that support healthy lifestyles. Since pharmacy practice requires symbiotic balancing between profit margins and patient-centered, value-based care, replacing health-harming products with health-promoting technologies could positively impact prevention of chronic diseases, as well as the physical and mental health of patients and caregivers who visit neighborhood pharmacies in order to pick up medicines.
Collapse
Affiliation(s)
- Grzegorz Bulaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Melissa Coleman
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Blake Johansen
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Sarah Kraft
- Independent Researcher, Salt Lake City, UT 84112, USA
| | - Wayne Lam
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Katie Phillips
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Aarushi Rohaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- The Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84112, USA
| |
Collapse
|
45
|
Palmer PM, Padilla AH. Linking the impact of aspiration to host variables using the BOLUS framework: support from a rapid review. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1412635. [PMID: 39071771 PMCID: PMC11273940 DOI: 10.3389/fresc.2024.1412635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/06/2024] [Indexed: 07/30/2024]
Abstract
Purpose The purpose of this rapid review was to identify the level of evidence for a previously proposed theoretical framework to assess risks associated with prandial aspiration using the host as a central theme. Methods Covidence software was used to search two databases (PubMed and Web of Science). PEDro scale was utilized to determine the quality of individual studies. Data points were evaluated for level of support and determined to be either conclusive, suggestive, unclear, or not supportive. Within each component of the framework, data points were clustered to determine the level of evidence as strong, moderate, insufficient, or negative. Results The rapid review process resulted in a limited number of publications investigating host variables impact on outcomes for patients with swallowing disorders. Overall, it yielded 937 articles, of which, upon review, 16 articles were selected for data extraction. There was a strong level of evidence to support that (a) as viscosity and density of aspirate increased, so did the likelihood of general medical complications, (b) poor oral care and oral health increase the risk of a pulmonary or general medical complication, and (c) the presence of oropharyngeal or laryngeal tubes increases the risk of a pulmonary consequence. There was moderate evidence to support the impact of amount and frequency of aspiration on outcomes. There was insufficient evidence to determine relationships for all other aspects of the BOLUS framework. Conclusion Additional evidence to support the BOLUS framework was obtained; however, the number of studies was limited. A more thorough review such as a systematic review should be employed.
Collapse
Affiliation(s)
- Phyllis M. Palmer
- Department of Speech and Hearing Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Aaron H. Padilla
- Department of Rehabilitation Services, Presbyterian Healthcare Services, Albuquerque, NM, United States
| |
Collapse
|
46
|
Longworth GR, de Boer J, Goh K, Agnello DM, McCaffrey L, Zapata Restrepo JR, An Q, Chastin S, Davis A, Altenburg T, Verloigne M, Giné-Garriga M. Navigating process evaluation in co-creation: a Health CASCADE scoping review of used frameworks and assessed components. BMJ Glob Health 2024; 9:e014483. [PMID: 38964878 PMCID: PMC11227756 DOI: 10.1136/bmjgh-2023-014483] [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: 11/08/2023] [Accepted: 05/13/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Co-creation is seen as a way to ensure all relevant needs and perspectives are included and to increase its potential for beneficial effects and uptake process evaluation is crucial. However, existing process evaluation frameworks have been built on practices characterised by top-down developed and implemented interventions and may be limited in capturing essential elements of co-creation. This study aims to provide a review of studies planning and/or conducting a process evaluation of public health interventions adopting a co-creation approach and aims to derive assessed process evaluation components, used frameworks and insights into formative and/or participatory evaluation. METHODS We searched for studies on Scopus and the Health CASCADE Co-Creation Database. Co-authors performed a concept-mapping exercise to create a set of overarching dimensions for clustering the identified process evaluation components. RESULTS 54 studies were included. Conceptualisation of process evaluation included in studies concerned intervention implementation, outcome evaluation, mechanisms of impact, context and the co-creation process. 22 studies (40%) referenced ten existing process evaluation or evaluation frameworks and most referenced were the frameworks developed by Moore et al (14%), Saunders et al (5%), Steckler and Linnan (5%) and Nielsen and Randall (5%).38 process evaluation components were identified, with a focus on participation (48%), context (40%), the experience of co-creators (29%), impact (29%), satisfaction (25%) and fidelity (24%).13 studies (24%) conducted formative evaluation, 37 (68%) conducted summative evaluation and 2 studies (3%) conducted participatory evaluation. CONCLUSION The broad spectrum of process evaluation components addressed in co-creation studies, covering both the evaluation of the co-creation process and the intervention implementation, highlights the need for a process evaluation tailored to co-creation studies. This work provides an overview of process evaluation components, clustered in dimensions and reflections which researchers and practitioners can use to plan a process evaluation of a co-creation process and intervention.
Collapse
Affiliation(s)
| | - Janneke de Boer
- Department of Movement and Sports Sciences, Ghent University, Gent, Belgium
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Kunshan Goh
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | | | - Lauren McCaffrey
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Qingfan An
- Department of Community Medicine and Rehabilitation, Umeå University, Umea, Sweden
| | - Sebastien Chastin
- Department of Movement and Sports Sciences, Ghent University, Gent, Belgium
- Glasgow Caledonian University, Glasgow, UK
| | - Aaron Davis
- UniSA Creative, University of South Australia, Adelaide, South Australia, Australia
| | - Teatske Altenburg
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Maite Verloigne
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Maria Giné-Garriga
- Faculty of Psychology, Education and Sport Sciences, Universitat Ramon Llull, Barcelona, Spain
| |
Collapse
|
47
|
Perpetua EM, Palmer R, Le VT, Al-Khatib SM, Beavers CJ, Beckman JA, Bozkurt B, Coylewright M, Lloyd Doherty C, Guibone KA, Hawkey M, Keegan PA, Kirkpatrick JN, Laperle J, Lauck SB, Levine G, Lindman BR, Mack MJ, Price AL, Strong S, Wyman JF, Youmans QR, Gulati M. JACC: Advances Expert Panel Perspective: Shared Decision-Making in Multidisciplinary Team-Based Cardiovascular Care. JACC. ADVANCES 2024; 3:100981. [PMID: 39130036 PMCID: PMC11312306 DOI: 10.1016/j.jacadv.2024.100981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/25/2024] [Accepted: 02/28/2024] [Indexed: 08/13/2024]
Abstract
Shared decision-making (SDM) and multidisciplinary team-based care delivery are recommended across several cardiology clinical practice guidelines. However, evidence for benefit and guidance on implementation are limited. Informed consent, the use of patient decision aids, or the documentation of these elements for governmental or societal agencies may be conflated as SDM. SDM is a bidirectional exchange between experts: patients are the experts on their goals, values, and preferences, and clinicians provide their expertise on clinical factors. In this Expert Panel perspective, we review the current state of SDM in team-based cardiovascular care and propose best practice recommendations for multidisciplinary team implementation of SDM.
Collapse
Affiliation(s)
- Elizabeth M. Perpetua
- Empath Health Services, Seattle, Washington, USA
- School of Nursing, Department of Biobehavioral Nursing and Informatics, University of Washington, Seattle, Washington, USA
| | - Roseanne Palmer
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Viet T. Le
- Intermountain Health, Salt Lake City, Utah, USA
| | - Sana M. Al-Khatib
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Craig J. Beavers
- University of Kentucky College of Pharmacy, Lexington, Kentucky, USA
| | - Joshua A. Beckman
- Southwestern Medical Center, University of Texas, Dallas, Texas, USA
| | | | | | | | | | - Marian Hawkey
- Hackensack University Medical Center, Heart and Vascular Hospital, Hackensack, New Jersey, USA
| | - Patricia A. Keegan
- Columbia University Irving Medical Center, Center of Interventional Therapy, New York, New York, USA
| | - James N. Kirkpatrick
- Emory Healthcare, Heart and Vascular, Atlanta, Georgia, USA
- Departments of Medicine and Bioethics and Humanities, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jessica Laperle
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Sandra B. Lauck
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Brian R. Lindman
- Vanderbilt University Medical Center, Division of Cardiovascular Medicine, Nashville, Tennessee, USA
| | | | | | | | - Janet F. Wyman
- Department of Structural Heart, Division of Cardiovascular Medicine, Henry Ford health System, Detroit, Michigan, USA
| | - Quentin R. Youmans
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Martha Gulati
- Preventive Cardiology, Barbra Streisand Women's Heart Center, Preventive and Cardiac Rehabilitation Center, Women's Cardiovascular Medicine & Research, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| |
Collapse
|
48
|
Tucker JD, Chikwari CD, Tang W, Jarolimova J, Gravett R, Goense CJ, Matoga MM, Tan RKJ, Niaupari S, Morroni C, Van Der Pol B. A Conference Designathon to Spark Innovation: Actionable Ideas to Enhance Sexually Transmitted Disease Control. Sex Transm Dis 2024; 51:e31-e35. [PMID: 38465975 PMCID: PMC11184286 DOI: 10.1097/olq.0000000000001965] [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: 03/12/2024]
Abstract
BACKGROUND Designathons can be used to enhance public health training and spur innovation. A designathon is a 3-stage participatory activity that includes preparation, intensive collaboration, and follow-up activities. We organized a designathon focused on developing actionable sexually transmitted disease (STD) control strategies and examined the content of ideas resulting from an STD designathon. METHODS For this designathon, we created four groups: early career researchers, silver group (people with >10 years of experience), travelers (people from low- and middle-income countries and those who received a conference scholarship) and a community group. Each group developed its own plan to consult members, iteratively develop ideas, and aggregate insights. Each group developed STD control strategies that were presented. Cross-cutting themes across these ideas were identified. RESULTS Designathon participants included a subset of conference participants. Cross-cutting themes from final ideas included cocreating STD interventions with end-users, using sex-positive framing, enhancing open access digital STD resources, and reducing STD stigma. Early career researchers presented a call for community ideas focusing on ending STD epidemics by increasing accessibility to STD care services among all populations. The silver group proposed digital innovations, including an AI-powered tool for testing and treatment and a social game to promote sex positivity. The traveler group conceptualized an information hub to support implementation of STD programs. Community members underscored the importance of a more human-centered approach to STD control, which reduces stigma and normalizes sex and sexual pleasure. CONCLUSION Sex positive campaigns and open access digital resources should be considered within STD programs. Implementation research studies are needed to evaluate these ideas.
Collapse
Affiliation(s)
- Joseph D. Tucker
- Institute for Global Health and Infectious Diseases,
University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- MRC International Statistics & Epidemiology Group,
Department of Infectious Disease Epidemiology, London School of Hygiene &
Tropical Medicine, London, UK
- Dermatology Hospital, Southern Medical University,
Guangzhou, China
| | - Chido Dziva Chikwari
- MRC International Statistics & Epidemiology Group,
Department of Infectious Disease Epidemiology, London School of Hygiene &
Tropical Medicine, London, UK
- The Health Research Unit Zimbabwe, Biomedical Research
Training Institute, Harare, Zimbabwe
| | - Weiming Tang
- Institute for Global Health and Infectious Diseases,
University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Dermatology Hospital, Southern Medical University,
Guangzhou, China
| | - Jana Jarolimova
- Division of Infectious Diseases, Department of Medicine,
Massachusetts General Hospital, Boston, USA
- Department of Medicine, Harvard Medical School, Boston,
USA
| | - Ronnie Gravett
- Division of Infectious Diseases, Department of Medicine,
Heersink School of Medicine, University of Alabama at Birmingham, Birmingham,
USA
| | - Cornelia J.D. Goense
- Department of Social Medicine, Care and Public Health
Research Institute (CAPHRI), Maastricht University, Maastricht, the
Netherlands
- Department of Sexual Health, Infectious Diseases and
Environmental Health, Living Lab Public Health, Public Health Service South Limburg,
Heerlen, the Netherlands
| | - Mitch M. Matoga
- Institute for Global Health and Infectious Diseases,
University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- University of North Carolina at Malawi, Lilongwe,
Malawi
| | - Rayner K. J. Tan
- Saw Swee School of Public Health, National University of
Singapore, Singapore
| | | | - Chelsea Morroni
- MRC Centre for Reproductive Health, University of
Edinburgh, Edinburgh, UK
- Botswana Harvard AIDS Partnership, Gaborone,
Botswana
| | - Barbara Van Der Pol
- Division of Infectious Diseases, Department of Medicine,
Heersink School of Medicine, University of Alabama at Birmingham, Birmingham,
USA
| |
Collapse
|
49
|
Kelly P, Searby A, Goodwin J. An exploration of organizational climate in community-based opiate prescribing services; a mixed methods study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 162:209362. [PMID: 38631657 DOI: 10.1016/j.josat.2024.209362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 02/29/2024] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Assessing the internal dynamics of organizations has been shown to provide information that can help planners and policymakers improve service delivery. A good organizational climate, which in this study incorporates mission clarity, team cohesion, staff autonomy, communication, levels of stress, and openness to change has been shown to be of particular importance. Still, there is a dearth of evidence in this area, and while relationships between organizational factors have been identified, little is known about the mechanisms that might underpin these relationships, and there is little understanding of how to address deficits once they are identified. The objective of this study was to identify relationships between program factors that influence organizational climate and to explore which mechanisms might underpin these relationships. METHODS This paper reports on a cross-sectional, concurrent, mixed-methods study design, across twelve discrete community-based prescribing service providers (organizations) in Ireland. Data was obtained using a staff survey [n = 132] which utilized measurements of organizational readiness to change and one-to-one interviews [n = 12]. Quantitative data was analyzed using multivariate linear regression modeling which assessed relationships between variables, while interviews were analyzed using an abductive approach, both types of data were synthesized at the interpretation stage. RESULTS A range of interdependent factors were considered to affect the climate of organizations. Surveys identified that specific types of resources, such as physical infrastructure, training, and staffing resources were important for supporting a good organizational climate, while programs with greater needs had a poorer climate. Opportunities for professional growth, the skill sets of staff, and having access to e-communication were also significant. Interviewees reported that rigid organizational hierarchies and bureaucracy, philosophical views of addiction, stress, and staff turnover were influenced by the provision of fewer resources. Interdependent factors such as leadership, supervision, staff relationships, and collective training, also thought to be influenced by resources, were considered to positively influence programs. Resources were not the only challenge identified, and practices within programs and how existing resources are used were also thought to contribute both positively and negatively to the internal dynamics of services. CONCLUSION Key findings in this study identified that the organization of effective services is influenced by a range of specific factors, some of which can be addressed without additional resources. Overall, staff views of organizations can provide us with valuable information to support service improvement. Using a mixed methods approach can not only identify where relationships between organizational variables exist but can also help us to understand the mechanisms that underpin these relationships and, importantly, how to address deficits once they are identified. In order to improve how substance misuse services work, the need for a long-term systemic approach to program development, which incorporates some of the findings from this study, is required.
Collapse
Affiliation(s)
- Peter Kelly
- School of Nursing and Midwifery, Trinity College Dublin, Ireland.
| | - Adam Searby
- School of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - John Goodwin
- School of Nursing and Midwifery, University College Cork, Ireland
| |
Collapse
|
50
|
Dolansky MA, Horvat Davey C, Moore SM. Research and Practice in Quality Improvement and Implementation Science: The Synergy for Change Model. J Nurs Care Qual 2024; 39:199-205. [PMID: 38232232 DOI: 10.1097/ncq.0000000000000760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND Nurses play an essential role in the achievement of quality depicted by the Quintuple Aim to improve clinical outcomes, patient experience, equity, provider well-being, and reduction of costs. When quality gaps occur, practice change is required and is facilitated by quality improvement (QI) and implementation science (IS) methods. QI and IS research are required to advance our understanding of the mechanisms that explain how evidence is implemented and improvements are made. PROBLEM Despite past efforts of the evidence-based practice and QI movements, challenges persist in sustaining practice improvements and translating research findings to direct patient care. APPROACH The purpose of this article is to describe the Synergy for Change Model that proposes that both QI and IS research and practice be used to accelerate improvements in health care quality. CONCLUSIONS Recognizing the synergy of QI and IS practice and research will accelerate nursing's contributions to high-quality and safe care.
Collapse
Affiliation(s)
- Mary A Dolansky
- Author Affiliations: Hirsh Institute (Dr Dolansky); and Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio (Drs Dolansky, Horvat Davey, and Moore)
| | | | | |
Collapse
|