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McCleary NJ, Merle JL, Richardson JE, Bass M, Garcia SF, Cheville AL, Mitchell SA, Jensen R, Minteer S, Austin JD, Tesch N, DiMartino L, Hassett MJ, Osarogiagbon RU, Wong S, Schrag D, Cella D, Smith AW, Smith JD. Bridging clinical informatics and implementation science to improve cancer symptom management in ambulatory oncology practices: experiences from the IMPACT consortium. JAMIA Open 2024; 7:ooae081. [PMID: 39234146 PMCID: PMC11373565 DOI: 10.1093/jamiaopen/ooae081] [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: 05/25/2023] [Revised: 07/04/2024] [Accepted: 08/22/2024] [Indexed: 09/06/2024] Open
Abstract
Objectives To report lessons from integrating the methods and perspectives of clinical informatics (CI) and implementation science (IS) in the context of Improving the Management of symPtoms during and following Cancer Treatment (IMPACT) Consortium pragmatic trials. Materials and Methods IMPACT informaticists, trialists, and implementation scientists met to identify challenges and solutions by examining robust case examples from 3 Research Centers that are deploying systematic symptom assessment and management interventions via electronic health records (EHRs). Investigators discussed data collection and CI challenges, implementation strategies, and lessons learned. Results CI implementation strategies and EHRs systems were utilized to collect and act upon symptoms and impairments in functioning via electronic patient-reported outcomes (ePRO) captured in ambulatory oncology settings. Limited EHR functionality and data collection capabilities constrained the ability to address IS questions. Collecting ePRO data required significant planning and organizational champions adept at navigating ambiguity. Discussion Bringing together CI and IS perspectives offers critical opportunities for monitoring and managing cancer symptoms via ePROs. Discussions between CI and IS researchers identified and addressed gaps between applied informatics implementation and theory-based IS trial and evaluation methods. The use of common terminology may foster shared mental models between CI and IS communities to enhance EHR design to more effectively facilitate ePRO implementation and clinical responses. Conclusion Implementation of ePROs in ambulatory oncology clinics benefits from common understanding of the concepts, lexicon, and incentives between CI implementers and IS researchers to facilitate and measure the results of implementation efforts.
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Affiliation(s)
- Nadine Jackson McCleary
- Department of Medical Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA 02115, United States
| | - James L Merle
- Division of Health System Innovation and Research, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84132, United States
| | - Joshua E Richardson
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Michael Bass
- Department of Medical Social Science, Northwestern University, Chicago, IL 60611, United States
| | - Sofia F Garcia
- Department of Medical Social Science, Northwestern University, Chicago, IL 60611, United States
| | - Andrea L Cheville
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, MN 55905, United States
| | - Sandra A Mitchell
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD 20850, United States
| | - Roxanne Jensen
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD 20850, United States
| | - Sarah Minteer
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, MN 55905, United States
| | - Jessica D Austin
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic Arizona, Mayo Clinic Cancer Center, Population Sciences Program, Scottsdale, AZ 85054, United States
| | - Nathan Tesch
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, MN 55905, United States
| | - Lisa DiMartino
- University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
- RTI International, Research Triangle Park, NC 27709, United States
| | - Michael J Hassett
- Department of Medical Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA 02115, United States
| | | | - Sandra Wong
- Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH 03766, United States
| | - Deborah Schrag
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - David Cella
- Institute for Public Health and Medicine, Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Ashley Wilder Smith
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD 20850, United States
| | - Justin D Smith
- Division of Health System Innovation and Research, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84132, United States
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Aschbrenner KA, Haines ER, Kruse GR, Olugbenga AO, Thomas AN, Khan T, Martinez S, Emmons KM, Bartels SJ. Applying cognitive walkthrough methodology to improve the usability of an equity-focused implementation strategy. Implement Sci Commun 2024; 5:95. [PMID: 39227912 PMCID: PMC11373107 DOI: 10.1186/s43058-024-00630-8] [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: 02/12/2024] [Accepted: 08/18/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Our research team partnered with primary care and quality improvement staff in Federally Qualified Community Health Centers (CHCs) to develop Partnered and Equity Data-Driven Implementation (PEDDI) to promote equitable implementation of evidence-based interventions. The current study used a human-centered design methodology to evaluate the usability of PEDDI and generate redesign solutions to address usability issues in the context of a cancer screening intervention. METHODS We applied the Cognitive Walkthrough for Implementation Strategies (CWIS), a pragmatic assessment method with steps that include group testing with end users to identify and prioritize usability problems. We conducted three facilitated 60-min CWIS sessions with end users (N = 7) from four CHCs that included scenarios and related tasks for implementing a colorectal cancer (CRC) screening intervention. Participants rated the likelihood of completing each task and identified usability issues and generated ideas for redesign solutions during audio-recorded CWIS sessions. Participants completed a pre-post survey of PEDDI usability. Our research team used consensus coding to synthesize usability problems and redesign solutions from transcribed CWIS sessions. RESULTS Usability ratings (scale 0-100: higher scores indicating higher usability) of PEDDI averaged 66.3 (SD = 12.4) prior to the CWIS sessions. Scores averaged 77.8 (SD = 9.1) following the three CWIS sessions improving usability ratings from "marginal acceptability" to "acceptable". Ten usability problems were identified across four PEDDI tasks, comprised of 2-3 types of usability problems per task. CWIS participants suggested redesign solutions that included making data fields for social determinants of health and key background variables for identifying health equity targets mandatory in the electronic health record and using asynchronous communication tools to elicit ideas from staff for adaptations. CONCLUSIONS Usability ratings indicated PEDDI was in the acceptable range following CWIS sessions. Staff identified usability problems and redesign solutions that provide direction for future improvements in PEDDI. In addition, this study highlights opportunities to use the CWIS methodology to address inequities in the implementation of cancer screening and other clinical innovations in resource-constrained healthcare settings.
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Affiliation(s)
- Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA.
- Dartmouth Health Merrimack Family Practice, 294 Daniel Webster Highway, Merrimack, NH, 03054, USA.
| | - Emily R Haines
- Wake Forest University School of Medicine, 525 Vine Street, Winston-Salem, NC, 27101, USA
| | - Gina R Kruse
- Division of General Internal Medicine, University of Colorado School of Medicine, 13001 E 17th PL, Aurora, CO, 80045, USA
| | - Ayotola O Olugbenga
- Brockton Neighborhood Health Center, 63 Main Street, Brockton, MA, 02301, USA
| | - Annette N Thomas
- Brockton Neighborhood Health Center, 63 Main Street, Brockton, MA, 02301, USA
| | - Tanveer Khan
- Harvard Street Neighborhood Health Center, 632 Blue Hill Ave, Dorchester, MA, 02121, USA
| | | | - Karen M Emmons
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Stephen J Bartels
- Massachusetts General Hospital, 125 Nashua St, Boston, MA, 02114, USA
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
- The Mongan Institute, Massachusetts General Hospital, 100 Cambridge Street Suite 1600, Boston, MA, 02114, USA
- Harvard Medical School, 25 ShaAuck Street, Boston, MA, 02115, USA
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Dunlap JJ, Waldrop JB, Brewer TL, Mainous RO. Differentiation and Integration of Research, Evidence-Based Practice, and Quality Improvement. J Nurs Educ 2024:1-4. [PMID: 39212322 DOI: 10.3928/01484834-20240514-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND Substantial discrepancies exist in how research, evidence-based practice (EBP), and quality improvement (QI) are taught to nursing students across academic levels. As nursing education programs adopt the new The Essentials: Core Competencies for Professional Nursing Education and move toward competency-based education, prelicensure and advanced nursing students will need to demonstrate research, EBP, and QI competencies; therefore, faculty must possess the knowledge and skills to teach these paradigms' differences and integration. METHOD An evidence-based approach that builds on the literature and our experience as nurses and educators was used to develop this educational innovation. RESULTS An innovative representation in table and figure format of the differences and interdependence of research, EBP, and QI is presented herein. CONCLUSION These documents clarify the evolving differences, similarities, and synergies as a framework for faculty development. [J Nurs Educ. 2024;63(X):XXX-XXX.].
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Giordano NA, Phan Q, Kimble LP, Chicas R, Brasher S, Nicely KW, Sheridan T, Starks S, Ferranti E, Moore E, Clement D, Weston JB, Febres-Cordero S, Chance-Revels R, Woods E, Baker H, Muirhead L, Stapel-Wax J, Jones KD, Swan BA. The nurse-led equitable learning framework for training programs: A framework to grow, bolster and diversify the nursing and public health workforce. J Prof Nurs 2024; 53:25-34. [PMID: 38997196 DOI: 10.1016/j.profnurs.2024.04.006] [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: 11/13/2023] [Revised: 04/10/2024] [Accepted: 04/17/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Addressing threats to the nursing and public health workforce, while also strengthening the skills of current and future workers, requires programmatic solutions. Training programs should be guided by frameworks, which leverage nursing expertise and leadership, partnerships, and integrate ongoing evaluation. PURPOSE STATEMENT This article provides a replicable framework to grow, bolster, and diversify the nursing and public health workforces, known as the Nurse-led Equitable Learning (NEL) Framework for Training Programs. The framework has been applied by several multipronged, federally funded training programs led by investigators embedded in an academic nursing institution. METHODS The NEL framework focuses on: (1) increasing equitable access to the knowledge, skills, and competencies needed to prepare a diverse workforce to deliver effective interventions; (2) fostering academic-practice linkages and community partnerships to facilitate the deployment of newly gained knowledge and skills to address ongoing and emerging challenges in care delivery; and (3) continuously evaluating and disseminating findings to inform expansion and replication of programs. RESULTS Ten programs using this framework have successfully leveraged $18.3 million in extramural funding to support over 1000 public health professionals and trainees. Longitudinal evaluation efforts indicate that public health workers, including nurses, are benefiting from the programs' workplace trainings, future clinicians are being rigorously trained to identify and address determinants of health to improve patient and community well-being, and educators are engaging in novel pedagogical opportunities to enhance their ability to deliver high quality public health education. CONCLUSIONS Training programs may apply the NEL framework to ensure that the nursing and public health workforces achieve equitable, sustainable growth and deliver high quality evidence-based care.
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Affiliation(s)
- Nicholas A Giordano
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA.
| | - Quyen Phan
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA
| | - Laura P Kimble
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA
| | - Roxana Chicas
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA
| | - Susan Brasher
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA
| | - Kelly Wiltse Nicely
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA
| | - Trisha Sheridan
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA
| | - Shaquita Starks
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA
| | - Erin Ferranti
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA
| | - Erica Moore
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA
| | - Desireé Clement
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA
| | - Jeannie Bowen Weston
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA
| | - Sarah Febres-Cordero
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA
| | - Rebekah Chance-Revels
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA
| | - Elizabeth Woods
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA
| | - Helen Baker
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA
| | - Lisa Muirhead
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA
| | - Jennifer Stapel-Wax
- Emory School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, USA; Children's Healthcare of Atlanta, 1920 Briarcliff Road Atlanta, GA 30329, USA
| | - Kim Dupree Jones
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA
| | - Beth Ann Swan
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA
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Howe CJ, Carsey E, Gamboa J, Zhang Y, Lewis B. Communicate to Care: Implementing Health Literacy in a Pediatric Ears, Nose, and Throat Clinic. Health Lit Res Pract 2024; 8:e166-e174. [PMID: 39251191 PMCID: PMC11383560 DOI: 10.3928/24748307-20240819-02] [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: 09/11/2024] Open
Abstract
BACKGROUND Despite positive outcomes in controlled trials, organizations have been slow to adopt health literacy practices. The purpose of the Communicate to CARE (Clear Communication, Achieve Understanding with Teach-Back, Receptive to our patient family needs, Empathetic care delivery) study was to use theories and strategies from implementation science to scale up health literacy practices in a pediatric Ears, Nose, and Throat (ENT) clinic. BRIEF DESCRIPTION OF ACTIVITY Expanding on previous efforts that simply reflected on barriers, the CARE team identified barriers within the local context pre-implementation to select strategies to directly address barriers during health literacy implementation. The RE-AIM framework was used to evaluate the reach, effectiveness, adoption, implementation, and maintenance of health literacy practices. IMPLEMENTATION Over 18 months, the CARE team delivered multiple implementation strategies, including external facilitator, microlessons, preparing champions, audit and feedback, local consensus discussions, and small test of change. We tailored health literacy practices to clinic team roles to accommodate the clinic workflow. RESULTS ENT team mean ratings on acceptability, appropriateness, and feasibility remained >4 indicating a high likelihood of successful implementation. Caregiver always ratings significantly increased from baseline to 12 months for easy-to-understand medication instructions (74%-96%), test results (54%-96%), know what to do if had questions (89%-96%), and encouraged to talk about health problems (76%-90%). Caregiver ratings dropped slightly at 18 months, indicating a need for booster training. While one third of caregivers reported Teach-Back practice across all time periods, the ENT team reported increased practice from baseline (42%), 6 (61%) and 12 months (70%). LESSONS LEARNED Over the first 12 months, the external facilitator delivered implementation strategies with weekly contact, tapering contact over the final 6 months. The local champion became engaged in the CARE study through a quality improvement project with meaningful outcomes for the clinic and an incentivization program for scholarly endeavors. Lunch and learn sessions helped build relationships between the CARE and ENT team to discuss and problem solve issues. The 5-item CAHPS health literacy composite proved to be sensitive to changes during implementation of health literacy practices. Integrating these items into standard follow up surveys with patients and families would help realize the return on investment for health literacy implementation. [HLRP: Health Literacy Research and Practice. 2024;8(3):e166-e174.].
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Fullaondo A, Hamu Y, Txarramendieta J, de Manuel E. Scaling-Out Digitally Enabled Integrated Care in Europe Through Good Practices Transfer: The JADECARE Study. Int J Integr Care 2024; 24:15. [PMID: 39131232 PMCID: PMC11312721 DOI: 10.5334/ijic.8605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 08/01/2024] [Indexed: 08/13/2024] Open
Abstract
Introduction The absence of a coordinated approach to health and social care compromises the ability of health systems to provide universal, equitable, high-quality, and financially sustainable care. Transferring evidence-based practices focused on digitally-enabled integrated care to new contexts can overcome this challenge if implementation is satisfactory. This paper presents the scaling-out methodology that JADECARE has designed to spread effective innovative practices across Europe. Methodology The scaling-out methodology pretends to guide the Next Adopters in the transfer and adoption of practices, whereas increasing their implementation capacity and providing an evaluation framework to assess impact and success. Discussion JADECARE scaling-out effort is based on guiding principles found in the literature such as the balance between fidelity to the original practice and the degree of adaptation required to fit the new context, the need for capacity building in implementation to bridge the gap between research and routine practice and the focus on explaining why, for whom and in what circumstances an intervention works. Conclusion The JADECARE scaling-out methodology is theory-driven and pragmatic and aims to facilitate the transfer of complex interventions across different contexts.
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Affiliation(s)
- Ane Fullaondo
- Biosistemak Institute for Health Systems Research, Basque Country, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - Yhasmine Hamu
- Biosistemak Institute for Health Systems Research, Basque Country, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - Jon Txarramendieta
- Biosistemak Institute for Health Systems Research, Basque Country, Spain
- Osakidetza, Gorliz Hospital, Basque Country, Spain
| | - Esteban de Manuel
- Biosistemak Institute for Health Systems Research, Basque Country, Spain
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Leeman J, Rohweder C, Lafata JE, Wangen M, Ferrari R, Shea CM, Brenner A, Roth I, Fleming O, Toles M. A streamlined approach to classifying and tailoring implementation strategies: recommendations to speed the translation of research to practice. Implement Sci Commun 2024; 5:65. [PMID: 38886763 PMCID: PMC11181609 DOI: 10.1186/s43058-024-00606-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Implementation science emerged from the recognized need to speed the translation of effective interventions into practice. In the US, the science has evolved to place an ever-increasing focus on implementation strategies. The long list of implementation strategies, terminology used to name strategies, and time required to tailor strategies all may contribute to delays in translating evidence-based interventions (EBIs) into practice. To speed EBI translation, we propose a streamlined approach to classifying and tailoring implementation strategies. MAIN TEXT A multidisciplinary team of eight scholars conducted an exercise to sort the Expert Recommendations for Implementing Change (ERIC) strategies into three classes: implementation processes (n = 25), capacity-building strategies (n = 20), and integration strategies (n = 28). Implementation processes comprise best practices that apply across EBIs and throughout the phases of implementation from exploration through sustainment (e.g., conduct local needs assessment). Capacity-building strategies target either general or EBI-specific knowledge and skills (e.g., conduct educational meetings). Integration strategies include "methods and techniques" that target barriers or facilitators to implementation of a specific EBI beyond those targeted by capacity building. Building on these three classes, the team collaboratively developed recommendations for a pragmatic, five-step approach that begins with the implementation processes and capacity-building strategies practice-settings are already using prior to tailoring integration strategies. A case study is provided to illustrate use of the five-step approach to tailor the strategies needed to implement a transitional care intervention in skilled nursing facilities. CONCLUSIONS Our proposed approach streamlines the formative work required prior to implementing an EBI by building on practice partner preferences, expertise, and infrastructure while also making the most of prior research findings.
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Affiliation(s)
- Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Catherine Rohweder
- University of North Carolina at Chapel Hill, Center for Women's Health Research, Chapel Hill, NC, USA
| | - Jennifer Elston Lafata
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Mary Wangen
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Renee Ferrari
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christopher M Shea
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alison Brenner
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Isabel Roth
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Oscar Fleming
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mark Toles
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Chandler CE, Louison L, Madenyika N, Robertson N, Hardy B, Allin S, Kimberg D, Fleming WO. Using Quality Improvement as a Mechanism for Fostering Partnerships and Promoting Equity in a Health System Change Model. Matern Child Health J 2024; 28:984-989. [PMID: 38407716 DOI: 10.1007/s10995-024-03916-4] [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] [Accepted: 02/12/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE Quality improvement (QI) processes provide a framework for systematically examining target outcomes and what changes can be made to result in improvement and ensure equity. We present a case study of how QI processes were used as a means of partnership building to enhance equity in designing materials for a Medicaid pilot program, North Carolina Integrated Care for Kids (NC InCK). DESCRIPTION The NC InCK model addresses social determinants of health by providing structured care integration across core child health and social service areas and using an alternative payment model to incentivize high quality child outcomes. During the two-year planning period prior to the NC InCK model launch, we used Plan-Do-Study-Act (PDSA) cycles to conduct usability testing as a QI strategy for a component of the NC InCK model: the Shared Action Plan (SAP). ASSESSMENT We conducted usability testing with four Family Council members, nine care managers, and one physician. Participants reviewed the SAP and provided feedback via a survey. After reviewing feedback with InCK leadership and the Family Council, we implemented recommendations that led to a SAP that uses clear and accessible language, that highlights family strengths and family-identified goals, and that is distinct from other care management plans. CONCLUSION Usability testing forced refinement of materials before NC InCK launched, created opportunities for building and enhancing community partnerships and promoted equity within the NC InCK team and Family Council by considering multiple perspectives when deciding on SAP revisions.
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Affiliation(s)
- Caroline E Chandler
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.
| | - Laura Louison
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro St #3550, Chapel Hill, NC, 27599, USA
| | - Nancy Madenyika
- Duke Population Health Management Office, 3100 Tower Blvd Suite 1100, Durham, NC, 27707, USA
| | - Nakenge Robertson
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro St #3550, Chapel Hill, NC, 27599, USA
| | - Brie Hardy
- Families & Communities Rising, 4220 NC-55, Suite 300, Durham, NC, 27713, USA
| | - Sarah Allin
- Duke Population Health Management Office, 3100 Tower Blvd Suite 1100, Durham, NC, 27707, USA
| | - Dan Kimberg
- UNC Health, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - W Oscar Fleming
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
- Public Health Leadership Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
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Ryan Pinto A, Nkemdirim Okere A. Exposing Pharmacy Residents to Implementation Science. Innov Pharm 2024; 15:10.24926/iip.v15i2.5898. [PMID: 39166150 PMCID: PMC11333094 DOI: 10.24926/iip.v15i2.5898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2024] Open
Abstract
The American Society of Health-System Pharmacists (ASHP) aims to improve patient care by innovating pharmacy practices. ASHP-accredited pharmacy residencies require projects that enhance pharmacy practice, focusing on effective project management and quality improvement. However, only a few of these innovations smoothly become part of routine clinical practice. One solution worth exploring involves teaching Implementation Science in residencies. Exposing residents and mentors to Implementation Science offers two main benefits. First, it helps learn from failed interventions by considering alternative thoughts and grasping environmental influences, leading to smarter decisions in future implementations. Second, applying implementation science improves patient care by turning evidence-based practices into practical actions, ensuring better care, consistency across healthcare setups, fewer errors, and tailoring innovative services to specific institutional needs. Exposing pharmacy residents to implementation science pushes forward pharmacy practice by actively applying evidence-based innovations in broader pharmacy or clinical practice.
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Affiliation(s)
- Anthony Ryan Pinto
- Florida A&M University/Community Health Northwest Florida Community-based Pharmacy Residency Program
| | - Arinze Nkemdirim Okere
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University
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Schmitz KH, Chongaway A, Saeed A, Fontana T, Wood K, Gibson S, Trilk J, Adsul P, Baker S. An initiative to implement a triage and referral system to make exercise and rehabilitation referrals standard of care in oncology. Support Care Cancer 2024; 32:259. [PMID: 38561546 PMCID: PMC10984878 DOI: 10.1007/s00520-024-08457-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Clinical guidelines suggest that patients should be referred to exercise while undergoing cancer treatment. Oncology clinicians report being supportive of exercise referrals but not having the time to make referrals. Toward the goal of making exercise referrals standard of care, we implemented and evaluated a novel clinical workflow. METHODS For this QI project, a rehabilitation navigator was inserted in chemotherapy infusion clinics. Patients were offered a validated electronic triage survey. Exercise or rehabilitation recommendations were communicated to patients during a brief counseling visit by the rehabilitation navigator. The implementation approach was guided by the EPIS framework. Acceptability and feasibility were assessed. RESULTS Initial meetings with nursing and cancer center leadership ensured buy-in (exploration). The education of medical assistants contributed to the adoption of the triage process (preparation). Audit and feedback ensured leadership was aware of medical assistants' performance (implementation). 100% of medical assistants participated in implementing the triage tool. A total of 587 patients visited the infusion clinics during the 6-month period when this QI project was conducted. Of these, 501 (85.3%) were offered the triage survey and 391 (78%) completed the survey (acceptability). A total of 176 (45%) of triaged patients accepted a referral to exercise or rehabilitation interventions (feasibility). CONCLUSIONS Implementation of a validated triage tool by medical assistants and brief counseling by a rehabilitation navigator resulted in 45% of infusion patients accepting a referral to exercise or rehabilitation. The triage process showed promise for making exercise referrals standard of care for patients undergoing cancer treatment.
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Affiliation(s)
- Kathryn H Schmitz
- Division of Hematology and Oncology, School of Medicine, UPMC Hillman Cancer Center, University of Pittsburgh, 580 S. Aiken Ave, Suite 610, Pittsburgh, PA, 15232, USA.
| | - Andrew Chongaway
- Division of Hematology and Oncology, School of Medicine, UPMC Hillman Cancer Center, University of Pittsburgh, 580 S. Aiken Ave, Suite 610, Pittsburgh, PA, 15232, USA
| | - Anwaar Saeed
- Division of Hematology and Oncology, School of Medicine, UPMC Hillman Cancer Center, University of Pittsburgh, 580 S. Aiken Ave, Suite 610, Pittsburgh, PA, 15232, USA
| | - Toni Fontana
- Division of Hematology and Oncology, School of Medicine, UPMC Hillman Cancer Center, University of Pittsburgh, 580 S. Aiken Ave, Suite 610, Pittsburgh, PA, 15232, USA
| | - Kelley Wood
- ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA, USA
| | - Susan Gibson
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jennifer Trilk
- Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, SC, USA
| | - Prajakta Adsul
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA
- Comprehensive Cancer Center, Cancer Control and Population Sciences Research Program, University of New Mexico, Albuquerque, NM, USA
| | - Stephen Baker
- Division of Hematology and Oncology, School of Medicine, UPMC Hillman Cancer Center, University of Pittsburgh, 580 S. Aiken Ave, Suite 610, Pittsburgh, PA, 15232, USA
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Aschbrenner KA, Kruse G, Emmons KM, Singh D, Barber-Dubois ME, Miller AM, Thomas AN, Bartels SJ. Stakeholder and Equity Data-Driven Implementation: a Mixed Methods Pilot Feasibility Study. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:136-146. [PMID: 36194312 PMCID: PMC9530430 DOI: 10.1007/s11121-022-01442-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 10/30/2022]
Abstract
We conducted a mixed methods pilot feasibility study of a Stakeholder and Equity Data-Driven Implementation (SEDDI) process to facilitate using healthcare data to identify patient groups experiencing gaps in the use of evidence-based interventions (EBIs) and rapidly adapt EBIs to achieve greater access and equitable outcomes. We evaluated the feasibility and acceptability of SEDDI in a pilot hybrid type 2 effectiveness-implementation trial of a paired colorectal cancer (CRC) and social needs screening intervention at four federally qualified community health centers (CHCs). An external facilitator partnered with CHC teams to support initial implementation, followed by the SEDDI phase focused on advancing health equity. Facilitation sessions were delivered over 8 months. Preliminary evaluation of SEDDI involved convergent mixed methods with quantitative survey and focus group data. CHCs used data to identify gaps in outreach and completion of CRC screening with respect to race/ethnicity, gender, age, and language. Adaptations to improve access and use of the intervention included cultural, linguistic, and health literacy tailoring. CHC teams reported that facilitation and systematic review of data were helpful in identifying and prioritizing gaps. None of the four CHCs completed rapid cycle testing of adaptations largely due to competing priorities during the COVID-19 response. SEDDI has the potential for advancing chronic disease prevention and management by providing a stakeholder and data-driven approach to identify and prioritize health equity targets and guide adaptations to improve health equity. ClinicalTrials.gov Identifier: NCT04585919.
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Affiliation(s)
| | - Gina Kruse
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Karen M Emmons
- Clinical Research Coordinator, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | - Annette N Thomas
- Department of Social & Behavioral Science, Harvard TH Chan School of Public Health, Boston, MA, USA
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12
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King C, Laynor G, McNeely J, Fawole A, Lee M, Terplan M, Choi S. Strategies to improve delivery of equitable and evidence-informed care for pregnant and birthing people with a substance use disorder in acute care settings: A scoping review protocol. PLoS One 2024; 19:e0300183. [PMID: 38498563 PMCID: PMC10947689 DOI: 10.1371/journal.pone.0300183] [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: 02/13/2024] [Accepted: 02/22/2024] [Indexed: 03/20/2024] Open
Abstract
This protocol outlines a proposed scoping review to characterize evidence on implementation and quality improvement (QI) strategies that aim to improve equitable, evidence-informed care delivery for pregnant and birthing people with substance use disorder (SUD) in acute care. Untreated SUD during pregnancy is associated with an increased risk of overdose and severe maternal morbidity. Acute care settings are one important place to deliver equitable, evidence-informed clinical care. While clinical practice guidelines for substance use treatment and care of pregnant and birthing people with SUD exist, there are gaps in implementation. Our population of interest is pregnant and birthing people with SUD in an acute care setting. We will include US-based studies that describe or evaluate implementation or QI strategies, including experimental, observational, and descriptive studies published from 2016 to 2023. The proposed scoping review will be conducted in accordance with JBI methodology for scoping reviews and registered at OSF (registration number: BC4VZ). We will search MEDLINE (PubMed), CINAHL Complete (EBSCO), Scopus (Elsevier), and APA PsychInfo (Ovid) for published studies. Conference proceedings and Perinatal Quality Collaborative websites will be searched for grey literature. Two reviewers will independently screen then extract studies that meet inclusion criteria using a data extraction tool. The completion of this scoping review will help illuminate strengths and gaps in research and practice that aim to inform substance use treatment and care in acute care settings for pregnant and birthing people with SUD.
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Affiliation(s)
- Carla King
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Gregory Laynor
- Health Sciences Library, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Jennifer McNeely
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Adetayo Fawole
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Matthew Lee
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Mishka Terplan
- Friends Research Institute, Baltimore, Maryland, United States of America
| | - Sugy Choi
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
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13
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Moodie STF, Moeller MP, Szarkowski A, Gale E, Smith T, Birdsey BC, Carr G, Stredler-Brown A, Yoshinaga-Itano C, Holzinger D. Family-Centered Early Intervention Deaf/Hard of Hearing (FCEI-DHH): Methods. JOURNAL OF DEAF STUDIES AND DEAF EDUCATION 2024; 29:SI40-SI52. [PMID: 38422446 DOI: 10.1093/deafed/enad034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 03/02/2024]
Abstract
This is the fourth article in a series of eight that comprise a special issue on family-centered early intervention (FCEI) for children who are deaf or hard of hearing (DHH) and their families, FCEI-DHH. This article describes the co-production team and the consensus review method used to direct the creation of the 10 Principles described in this special issue. Co-production is increasingly being used to produce evidence that is useful, usable, and used. A draft set of 10 Principles for FCEI-DHH and associated Tables of recommended behaviors were developed using the knowledge creation process. Principles were refined through two rounds of eDelphi review. Results for each round were analyzed using measures of overall group agreement and measures that indicated the extent to which the group members agreed with each other. After Round 2, with strong agreement and low to moderate variation in extent of agreement, consensus was obtained for the 10 Principles for FCEI-DHH presented in this special issue. This work can be used to enhance evolution of FCEI-DHH program/services and systems world-wide and adds to knowledge in improvement science.
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Affiliation(s)
- Sheila T F Moodie
- Health Sciences, School of Communication Sciences & Disorders, Western University, London, ON, Canada
| | - Mary Pat Moeller
- Center for Childhood Deafness, Language & Learning, Boys Town National Research Hospital, Omaha, NE, United States
| | - Amy Szarkowski
- The Institute, Children's Center for Communication/Beverly School for the Deaf, Beverly, MA, United States
- Institute for Community Inclusion, University of Massachusetts Boston, Boston, MA, United States
| | - Elaine Gale
- School of Education, Deaf and Hard-of-Hearing Program, Hunter College, City University of New York, New York, NY, United States
| | | | - Bianca C Birdsey
- Global Coalition of Parents of Children who are Deaf or Hard of Hearing (GPODHH), Durban, South Africa
| | - Gwen Carr
- Early Hearing Detection and Intervention and Family Centered Practice, London, United Kingdom
| | - Arlene Stredler-Brown
- Colorado Department of Human Services, Colorado Early Hearing Detection and Intervention Program, Denver, CO, United States
| | | | - Daniel Holzinger
- Institute of Neurology of Senses and Language, Hospital of St. John of God, Linz, Austria
- Research Institute for Developmental Medicine, Johannes Kepler University, Linz, Austria
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Wenden EJ, Budgeon CA, Pearce NL, Christian HE. Organizational readiness and implementation fidelity of an early childhood education and care-specific physical activity policy intervention: findings from the Play Active trial. J Public Health (Oxf) 2024; 46:158-167. [PMID: 37993975 PMCID: PMC10901271 DOI: 10.1093/pubmed/fdad221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 10/10/2023] [Accepted: 10/25/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Many children do not accumulate sufficient physical activity for good health and development at early childhood education and care (ECEC). This study examined the association between ECEC organizational readiness and implementation fidelity of an ECEC-specific physical activity policy intervention. METHODS Play Active aimed to improve the ECEC educator's physical activity practices. We investigated the implementation of Play Active using a Type 1 hybrid study (January 2021-March 2022). Associations between organizational readiness factors and service-level implementation fidelity were examined using linear regressions. Fidelity data were collected from project records, educator surveys and website analytics. RESULTS ECEC services with higher levels of organizational commitment and capacity at pre-implementation reported higher fidelity scores compared to services with lower organizational commitment and capacity (all Ps < 0.05). Similarly, services who perceived intervention acceptability and appropriateness at pre-implementation to be high had higher fidelity scores (P < 0.05). Perceived feasibility and organizational efficacy of Play Active were associated with higher but nonsignificant fidelity scores. CONCLUSIONS Results indicate that organizational readiness factors may influence the implementation of ECEC-specific physical activity policy interventions. Therefore, strategies to improve organizational readiness should be developed and tested. These findings warrant confirmation in the ECEC and other settings and with other health behavior interventions.
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Affiliation(s)
- Elizabeth J Wenden
- Telethon Kids Institute, University of Western Australia, Crawley, WA, Australia
- School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
| | - Charley A Budgeon
- School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
| | - Natasha L Pearce
- Telethon Kids Institute, University of Western Australia, Crawley, WA, Australia
- School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
| | - Hayley E Christian
- Telethon Kids Institute, University of Western Australia, Crawley, WA, Australia
- School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
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15
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Rohweder CL, Morrison A, Mottus K, Young A, Caton L, Booth R, Reed C, Shea CM, Stover AM. Virtual quality improvement collaborative with primary care practices during COVID-19: a case study within a clinically integrated network. BMJ Open Qual 2024; 13:e002400. [PMID: 38351031 PMCID: PMC10868276 DOI: 10.1136/bmjoq-2023-002400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 01/25/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Quality improvement collaboratives (QICs) are a common approach to facilitate practice change and improve care delivery. Attention to QIC implementation processes and outcomes can inform best practices for designing and delivering collaborative content. In partnership with a clinically integrated network, we evaluated implementation outcomes for a virtual QIC with independent primary care practices delivered during COVID-19. METHODS We conducted a longitudinal case study evaluation of a virtual QIC in which practices participated in bimonthly online meetings and monthly tailored QI coaching sessions from July 2020 to June 2021. Implementation outcomes included: (1) level of engagement (meeting attendance and poll questions), (2) QI capacity (assessments completed by QI coaches), (3) use of QI tools (plan-do-check-act (PDCA) cycles started and completed) and (4) participant perceptions of acceptability (interviews and surveys). RESULTS Seven clinics from five primary care practices participated in the virtual QIC. Of the seven sites, five were community health centres, three were in rural counties and clinic size ranged from 1 to 7 physicians. For engagement, all practices had at least one member attend all online QIC meetings and most (9/11 (82%)) poll respondents reported meeting with their QI coach at least once per month. For QI capacity, practice-level scores showed improvements in foundational, intermediate and advanced QI work. For QI tools used, 26 PDCA cycles were initiated with 9 completed. Most (10/11 (91%)) survey respondents were satisfied with their virtual QIC experience. Twelve interviews revealed additional themes such as challenges in obtaining real-time data and working with multiple electronic medical record systems. DISCUSSION A virtual QIC conducted with independent primary care practices during COVID-19 resulted in high participation and satisfaction. QI capacity and use of QI tools increased over 1 year. These implementation outcomes suggest that virtual QICs may be an attractive alternative to engage independent practices in QI work.
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Affiliation(s)
- Catherine L Rohweder
- Center for Women's Health Research, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- The North Carolina Translational and Clinical Sciences Institute (NC TraCS), The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Abigail Morrison
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Kathleen Mottus
- The North Carolina Translational and Clinical Sciences Institute (NC TraCS), The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Cecil G. Sheps Center for Health Services Research, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Alexa Young
- Center for Health Promotion and Disease Prevention, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lauren Caton
- The North Carolina Translational and Clinical Sciences Institute (NC TraCS), The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Maternal and Child Health, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Ronni Booth
- UNC Health Alliance, UNC Health Care System, Chapel Hill, North Carolina, USA
| | - Christine Reed
- UNC Health Alliance, UNC Health Care System, Chapel Hill, North Carolina, USA
| | - Christopher M Shea
- The North Carolina Translational and Clinical Sciences Institute (NC TraCS), The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Health Policy and Management, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Angela M Stover
- The North Carolina Translational and Clinical Sciences Institute (NC TraCS), The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Health Policy and Management, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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Sowan A, Chinman M. Model for Doctor of Nursing Practice Projects Based on Cross-Fertilization Between Improvement and Implementation Sciences: Protocol for Quality Improvement and Program Evaluation Studies. JMIR Res Protoc 2024; 13:e54213. [PMID: 38294860 PMCID: PMC10867758 DOI: 10.2196/54213] [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: 11/01/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Hundreds of nursing professionals graduate each year from Doctor of Nursing Practice (DNP) programs, entrusted with roles as practice scholars and leaders. Graduates are tasked to lead multidisciplinary knowledge implementation projects to improve safety, quality, and key performance metrics. Nevertheless, there is a continued lack of agreement and faculty dissatisfaction with the format, focus, and results of the DNP graduation projects. The use of a wide range of models and methodologies from different sciences for knowledge implementation introduces challenges to DNP students; affects the scientific rigor of the projects; and results in the overuse, superficial use, or misuse of the models. Quality improvement (QI) and program evaluation studies are substantial investments that may lead to waste and even harm if not well conducted. Traditional QI methodologies, commonly used in DNP projects, were found to be uncertain in improving health care outcomes. The complexity of health care systems calls for cross-fertilization between improvement and implementation sciences to improve health care outcomes. OBJECTIVE This study describes the development, implementation, and evaluation of a hybrid model for QI and program evaluation studies to guide scholarship in the DNP program. METHODS The hybrid model was based on cross-fertilization between improvement and implementation sciences. The model adapted the Getting to Outcome (GTO) and Knowledge to Action (KTA) models as the overarching process models for knowledge implementation. Within each phase of the GTO and KTA models, expected barriers and facilitators for the implementation and adoption of innovation were identified based on the CFIR (Consolidated Framework for Implementation Research). Accordingly, strategies to facilitate the implementation and adoption of innovations were identified based on a refined list of implementation strategies and QI tools. The choice of these models was based on the top 5 criteria for selecting implementation science theories and frameworks. Seven DNP students used the hybrid model to conduct QI projects. Students evaluated their experiences by responding to a Qualtrics survey. RESULTS The hybrid model encouraged a comprehensive systematic way of thinking, provided tools essential to implementation success, emphasized the need for adaptability in implementation, maintained rigor in QI, and guided the sustainability of change initiatives. Some of the challenges faced by students included finding reliable and valid measures, attaining and maintaining staff buy-in, and competing organizational priorities. CONCLUSIONS Cross-fertilization between improvement and implementation sciences provided a roadmap and systematic thinking for successful QI projects in the DNP program. The integration of the CFIR with the GTO or KTA process models, enforced by the use of evidence-based implementation strategies and QI tools, reflected the complexity of health care systems and emphasized the need for adaptability in implementation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/54213.
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Affiliation(s)
- Azizeh Sowan
- School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Matthew Chinman
- RAND Corporation, Santa Monica, CA, United States
- VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
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White A, Sabatino SA, White MC, Vinson C, Chambers DA, Richardson LC. Twenty years of collaborative research to enhance community practice for cancer prevention and control. Cancer Causes Control 2023; 34:1-5. [PMID: 37191768 PMCID: PMC10185931 DOI: 10.1007/s10552-023-01700-3] [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: 11/04/2022] [Accepted: 04/10/2023] [Indexed: 05/17/2023]
Abstract
The Cancer Prevention and Control Research Network (CPCRN) was established in 2002 to conduct applied research and undertake related activities to translate evidence into practice, with a special focus on the unmet needs of populations at higher risk of getting cancer and dying from it. A network of academic, public health and community partners, CPCRN is a thematic research network of the Prevention Research Centers Program at the Centers for Disease Control and Prevention (CDC). The National Cancer Institute's Division of Cancer Control and Population Sciences (DCCPS) has been a consistent collaborator. The CPCRN has fostered research on geographically dispersed populations through cross-institution partnerships across the network. Since its inception, the CPCRN has applied rigorous scientific methods to fill knowledge gaps in the application and implementation of evidence-based interventions, and it has developed a generation of leading investigators in the dissemination and implementation of effective public health practices. This article reflects on how CPCRN addressed national priorities, contributed to CDC's programs, emphasized health equity and impacted science over the past twenty years and potential future directions.
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Affiliation(s)
- Arica White
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Susan A. Sabatino
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Mary C. White
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Cynthia Vinson
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD USA
| | - David A. Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD USA
| | - Lisa C. Richardson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
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O'Leary MC, Hassmiller Lich K, Mayorga ME, Hicklin K, Davis MM, Brenner AT, Reuland DS, Birken SA, Wheeler SB. Engaging stakeholders in the use of an interactive simulation tool to support decision-making about the implementation of colorectal cancer screening interventions. Cancer Causes Control 2023; 34:135-148. [PMID: 37147411 PMCID: PMC10689514 DOI: 10.1007/s10552-023-01692-0] [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: 11/04/2022] [Accepted: 03/29/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE We aimed to understand how an interactive, web-based simulation tool can be optimized to support decision-making about the implementation of evidence-based interventions (EBIs) for improving colorectal cancer (CRC) screening. METHODS Interviews were conducted with decision-makers, including health administrators, advocates, and researchers, with a strong foundation in CRC prevention. Following a demonstration of the microsimulation modeling tool, participants reflected on the tool's potential impact for informing the selection and implementation of strategies for improving CRC screening and outcomes. The interviews assessed participants' preferences regarding the tool's design and content, comprehension of the model results, and recommendations for improving the tool. RESULTS Seventeen decision-makers completed interviews. Themes regarding the tool's utility included building a case for EBI implementation, selecting EBIs to adopt, setting implementation goals, and understanding the evidence base. Reported barriers to guiding EBI implementation included the tool being too research-focused, contextual differences between the simulated and local contexts, and lack of specificity regarding the design of simulated EBIs. Recommendations to address these challenges included making the data more actionable, allowing users to enter their own model inputs, and providing a how-to guide for implementing the simulated EBIs. CONCLUSION Diverse decision-makers found the simulation tool to be most useful for supporting early implementation phases, especially deciding which EBI(s) to implement. To increase the tool's utility, providing detailed guidance on how to implement the selected EBIs, and the extent to which users can expect similar CRC screening gains in their contexts, should be prioritized.
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Affiliation(s)
- Meghan C O'Leary
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maria E Mayorga
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC, USA
| | - Karen Hicklin
- Department of Industrial and Systems Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, USA
| | - Melinda M Davis
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, OR, USA
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
- School of Public Health, Oregon Health & Science University, Portland State University, Portland, OR, USA
| | - Alison T Brenner
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel S Reuland
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sarah A Birken
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Schoenthaler A, Colella D, De La Calle F, Bueno G, Nay J, Garcia M, Shahin G, Gago C, Dapkins I. Key Principles Underlying a Research-Practice Alignment in a Federally Qualified Health Center. Ethn Dis 2023; DECIPHeR:6-11. [PMID: 38846732 PMCID: PMC11099517 DOI: 10.18865/ed.decipher.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Context Minoritized populations such as racial and ethnic minorities and individuals of less privileged socioeconomic status experience a disproportionate burden of poor hypertension (HTN) control in the United States. Multilevel systems interventions have been shown to improve patient-level outcomes in minoritized populations; however, there remains a large translational gap in implementing these approaches into federally qualified health centers (FQHC), which serve those at highest risk of HTN-related morbidity and mortality. The paucity of purposeful collaborations between academic researchers and practice staff throughout the research process remains a significant roadblock to the timely translation of evidence to practice. Design This commentary describes the key principles and best practices that underlie the development and sustainment of an equitable research-practice alignment, which is supporting the implementation of multilevel systems intervention for improved HTN care in a large FQHC in Brooklyn, New York. The key principles, which are derived from the central tenants of relationship development and maintenance in community-engaged participatory research, patient-centered outcomes research, and organizational alignment theory include (1) cocreation of a shared mental model, (2) bridging multilevel communication, (3) ensuring mutual accountability, and (4) creating a culture of continuous improvement. Conclusions Together, the principles guide how the research and practice teams work together to achieve a shared goal of improving the health and well-being of minoritized patients through the provision of high quality, community-oriented HTN care. Best practices to sustain our alignment require an ongoing and deliberate investment in honest and transparent communication by all members.
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Affiliation(s)
| | | | - Franze De La Calle
- NYU Institute for Excellence in Health Equity, NYU Langone Health, New York, NY
| | | | - Jacalyn Nay
- Family Health Centers at NYU Langone, Brooklyn, NY
| | | | | | | | - Isaac Dapkins
- Family Health Centers at NYU Langone, Brooklyn, NY
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
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O'Leary MC, Hassmiller Lich K, Reuland DS, Brenner AT, Moore AA, Ratner S, Birken SA, Wheeler SB. Optimizing process flow diagrams to guide implementation of a colorectal cancer screening intervention in new settings. Cancer Causes Control 2023; 34:89-98. [PMID: 37731072 PMCID: PMC10689519 DOI: 10.1007/s10552-023-01769-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: 11/05/2022] [Accepted: 07/26/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE The goal of this study was to assess acceptability of using process flow diagrams (or process maps) depicting a previously implemented evidence-based intervention (EBI) to inform the implementation of similar interventions in new settings. METHODS We developed three different versions of process maps, each visualizing the implementation of the same multicomponent colorectal cancer (CRC) screening EBI in community health centers but including varying levels of detail about how it was implemented. Interviews with community health professionals and practitioners at other sites not affiliated with this intervention were conducted. We assessed their preferences related to the map designs, their potential utility for guiding EBI implementation, and the feasibility of implementing a similar intervention in their local setting given the information available in the process maps. RESULTS Eleven community health representatives were interviewed. Participants were able to understand how the intervention was implemented and engage in discussions around the feasibility of implementing this type of complex intervention in their local system. Potential uses of the maps for supporting implementation included staff training, role delineation, monitoring and quality control, and adapting the components and implementation activities of the existing intervention. CONCLUSION Process maps can potentially support decision-making about the adoption, implementation, and adaptation of existing EBIs in new contexts. Given the complexities involved in deciding whether and how to implement EBIs, these diagrams serve as visual, easily understood tools to inform potential future adopters of the EBI about the activities, resources, and staffing needed for implementation.
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Affiliation(s)
- Meghan C O'Leary
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel S Reuland
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Alison T Brenner
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alexis A Moore
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shana Ratner
- Department of Medicine, Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sarah A Birken
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Ramaswamy R, Bogdewic S, Williams CR, Deganus S, Bonzi GA, Boakye J, Koranteng E, Mensah R, Amanor A, Bryce F, Owen MD. Implementation matters: assessing the effectiveness and sustainment of an obstetric triage program at a high-volume facility in Ghana. Implement Sci Commun 2023; 4:138. [PMID: 37968768 PMCID: PMC10647175 DOI: 10.1186/s43058-023-00527-y] [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: 06/13/2023] [Accepted: 11/03/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Maternal mortality remains stubbornly high in Ghana. Current national efforts are focused on improving the quality of care offered in health facilities. Obstetric triage is one intervention that has been proposed to improve the timeliness and appropriateness of care, two key elements of quality. In this study, we describe and evaluate a theory-based implementation approach to introduce obstetric triage into Tema General Hospital, a high-volume maternity hospital in Greater Accra, that blends concepts from implementation science and quality improvement. This implementation project was a first attempt to scale this intervention into a new facility, following initial development in the Greater Accra Regional Hospital (formerly Ridge Hospital) in Accra. METHODS This was a retrospective mixed-methods evaluation of two stages of implementation: active implementation and sustainment. We triangulated monitoring data captured during active implementation with clinical outcome data (timeliness of first assessment, accuracy of diagnosis, and appropriateness of care plan) from direct observation or patient obstetric triage assessment forms at baseline, at the completion of the active implementation stage, and following a 12-month "washout" period with no contact between hospital staff and the purveyor organization. Finally, we assessed embeddedness of the new triage procedures using the NoMad, a quantitative assessment of constructs from normalization process theory (NPT). RESULTS Patient waiting time decreased substantially during the study. At baseline, the median arrival-to-assessment waiting time was 70.5 min (IQR: 30.0-443.0 min). Waiting time decreased to 6.0 min (IQR: 3.0-15.0 min) following active implementation and to 5.0 min (IQR: 2.0-10.0 min) during the sustainment period. Accuracy of diagnosis was high at the end of active implementation (75.7% correct) and improved during the sustainment period (to 77.9%). The appropriateness of care plans also improved during the sustainment period (from 66.0 to 78.9%). Per NoMad data, hospital staff generally perceive obstetric triage to be well integrated into the facility. CONCLUSIONS This theory-based implementation approach proved to be successful in introducing a novel obstetric triage concept to a busy high-volume hospital, despite resource constraints and a short implementation window. Results proved long-lasting, suggesting this approach has high potential for engendering sustainability in other facilities as well. Our approach will be useful to other initiatives that aim to utilize program data to create and test implementation theories.
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Affiliation(s)
- Rohit Ramaswamy
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Stephanie Bogdewic
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Caitllin R Williams
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sylvia Deganus
- Tema General Hospital, Ghana Health Service, Tema, Ghana
| | | | - Joana Boakye
- Tema General Hospital, Ghana Health Service, Tema, Ghana
| | | | | | - Alice Amanor
- Tema General Hospital, Ghana Health Service, Tema, Ghana
| | | | - Medge D Owen
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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22
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Mianda S, Todowede O, Schneider H. Service delivery interventions to improve maternal and newborn health in low- and middle-income countries: scoping review of quality improvement, implementation research and health system strengthening approaches. BMC Health Serv Res 2023; 23:1223. [PMID: 37940974 PMCID: PMC10634015 DOI: 10.1186/s12913-023-10202-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023] Open
Abstract
INTRODUCTION This review explores the characteristics of service delivery-related interventions to improve maternal and newborn health (MNH) in low-and middle-income countries (LMICs) over the last two decades, comparing three common framings of these interventions, namely, quality improvement (QI), implementation science/research (IS/IR), and health system strengthening (HSS). METHODS The review followed the staged scoping review methodology proposed by Levac et al. (2010). We developed and piloted a systematic search strategy, limited to English language peer-reviewed articles published on LMICs between 2000 and March 2022. Analysis was conducted in two-quantitative and qualitative-phases. In the quantitative phase, we counted the year of publication, country(-ies) of origin, and the presence of the terms 'quality improvement', 'health system strengthening' or 'implementation science'/ 'implementation research' in titles, abstracts and key words. From this analysis, a subset of papers referred to as 'archetypes' (terms appearing in two or more of titles, abstract and key words) was analysed qualitatively, to draw out key concepts/theories and underlying mechanisms of change associated with each approach. RESULTS The searches from different databases resulted in a total of 3,323 hits. After removal of duplicates and screening, a total of 231 relevant articles remained for data extraction. These were distributed across the globe; more than half (n = 134) were published since 2017. Fifty-five (55) articles representing archetypes of the approach (30 QI, 16 IS/IR, 9 HSS) were analysed qualitatively. As anticipated, we identified distinct patterns in each approach. QI archetypes tended towards defined process interventions (most typically, plan-do-study-act cycles); IS/IR archetypes reported a wide variety of interventions, but had in common evaluation methodologies and explanatory theories; and HSS archetypes adopted systemic perspectives. Despite their distinctiveness, there was also overlap and fluidity between approaches, with papers often referencing more than one approach. Recognising the complexity of improving MNH services, there was an increased orientation towards participatory, context-specific designs in all three approaches. CONCLUSIONS Programmes to improve MNH outcomes will benefit from a better appreciation of the distinctiveness and relatedness of different approaches to service delivery strengthening, how these have evolved and how they can be combined.
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Affiliation(s)
- Solange Mianda
- School of Public Health & SAMRC Health Services to Systems Research Unit, University of the Western Cape, Private Bag X17, Bellville, 7535, Cape Town, South Africa.
| | - Olamide Todowede
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Helen Schneider
- School of Public Health & SAMRC Health Services to Systems Research Unit, University of the Western Cape, Private Bag X17, Bellville, 7535, Cape Town, South Africa
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23
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Fernando M, Abell B, Tyack Z, Donovan T, McPhail SM, Naicker S. Using Theories, Models, and Frameworks to Inform Implementation Cycles of Computerized Clinical Decision Support Systems in Tertiary Health Care Settings: Scoping Review. J Med Internet Res 2023; 25:e45163. [PMID: 37851492 PMCID: PMC10620641 DOI: 10.2196/45163] [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: 12/18/2022] [Revised: 08/18/2023] [Accepted: 09/14/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Computerized clinical decision support systems (CDSSs) are essential components of modern health system service delivery, particularly within acute care settings such as hospitals. Theories, models, and frameworks may assist in facilitating the implementation processes associated with CDSS innovation and its use within these care settings. These processes include context assessments to identify key determinants, implementation plans for adoption, promoting ongoing uptake, adherence, and long-term evaluation. However, there has been no prior review synthesizing the literature regarding the theories, models, and frameworks that have informed the implementation and adoption of CDSSs within hospitals. OBJECTIVE This scoping review aims to identify the theory, model, and framework approaches that have been used to facilitate the implementation and adoption of CDSSs in tertiary health care settings, including hospitals. The rationales reported for selecting these approaches, including the limitations and strengths, are described. METHODS A total of 5 electronic databases were searched (CINAHL via EBSCOhost, PubMed, Scopus, PsycINFO, and Embase) to identify studies that implemented or adopted a CDSS in a tertiary health care setting using an implementation theory, model, or framework. No date or language limits were applied. A narrative synthesis was conducted using full-text publications and abstracts. Implementation phases were classified according to the "Active Implementation Framework stages": exploration (feasibility and organizational readiness), installation (organizational preparation), initial implementation (initiating implementation, ie, training), full implementation (sustainment), and nontranslational effectiveness studies. RESULTS A total of 81 records (42 full text and 39 abstracts) were included. Full-text studies and abstracts are reported separately. For full-text studies, models (18/42, 43%), followed by determinants frameworks (14/42,33%), were most frequently used to guide adoption and evaluation strategies. Most studies (36/42, 86%) did not list the limitations associated with applying a specific theory, model, or framework. CONCLUSIONS Models and related quality improvement methods were most frequently used to inform CDSS adoption. Models were not typically combined with each other or with theory to inform full-cycle implementation strategies. The findings highlight a gap in the application of implementation methods including theories, models, and frameworks to facilitate full-cycle implementation strategies for hospital CDSSs.
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Affiliation(s)
- Manasha Fernando
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Bridget Abell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Zephanie Tyack
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Thomasina Donovan
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- Digital Health and Informatics Directorate, Metro South Health, Brisbane, Australia
| | - Sundresan Naicker
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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Reszel J, Daub O, Dunn SI, Cassidy CE, Hafizi K, Lightfoot M, Pervez D, Quosdorf A, Wood A, Graham ID. Planning and implementing practice changes in Ontario maternal-newborn hospital units: a secondary qualitative analysis. BMC Pregnancy Childbirth 2023; 23:735. [PMID: 37848826 PMCID: PMC10583424 DOI: 10.1186/s12884-023-06042-1] [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: 07/27/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Moving evidence into practice is complex, and pregnant and birthing people and their infants do not always receive care that aligns with the best available evidence. Implementation science can inform how to effectively move evidence into practice. While there are a growing number of examples of implementation science being studied in maternal-newborn care settings, it remains unknown how real-world teams of healthcare providers and leaders approach the overall implementation process when making practice changes. The purpose of this study was to describe maternal-newborn hospital teams' approaches to implementing practice changes. We aimed to identify what implementation steps teams take (or not) and identify strengths and potential areas for improvement based on best practices in implementation science. METHODS We conducted a supplementary qualitative secondary analysis of 22 interviews completed in 2014-2015 with maternal-newborn nursing leaders in Ontario, Canada. We used directed content analysis to code the data to seven steps in an implementation framework (Implementation Roadmap): identify the problem and potential best practice; assemble local evidence; select and customize best practice; discover barriers and drivers; tailor implementation strategies; field-test, plan evaluation, prepare to launch; launch, evaluate, and sustain. Frequency counts are presented for each step. RESULTS Participants reported completing a median of 4.5 of 7 Implementation Roadmap steps (range = 3-7), with the most common being identifying a practice problem. Other steps were described less frequently (e.g., selecting and adapting evidence, field-testing, outcome evaluation) or discussed frequently but not optimally (e.g., barriers assessment). Participants provided examples of how they engaged point-of-care staff throughout the implementation process, but provided fewer examples of engaging pregnant and birthing people and their families. Some participants stated they used a formal framework or process to guide their implementation process, with the most common being quality improvement approaches and tools. CONCLUSIONS We identified variability across the 22 hospitals in the implementation steps taken. While we observed many strengths, we also identified areas where further support may be needed. Future work is needed to create opportunities and resources to support maternal-newborn healthcare providers and leaders to apply principles and tools from implementation science to their practice change initiatives.
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Affiliation(s)
- Jessica Reszel
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
| | - Olivia Daub
- School of Communication Sciences and Disorders, Western University, 1201 Western Road, London, ON, N6G 1H1, Canada
| | - Sandra I Dunn
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Christine E Cassidy
- School of Nursing, Dalhousie University, 5869 University Avenue, Halifax, NS, B3H 4R2, Canada
- IWK Health Centre, 5980 University Avenue, Halifax, NS, B3K 6R8, Canada
| | - Kaamel Hafizi
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Marnie Lightfoot
- Women and Children's Health Network, Orillia Soldiers' Memorial Hospital, 170 Colborne St W, Orillia, ON, L3V 2Z3, Canada
| | | | - Ashley Quosdorf
- Neonatal Intensive Care Unit, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Allison Wood
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Ian D Graham
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
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Yakovchenko V, Lamorte C, Chinman MJ, Goodrich DE, Gibson S, Park A, Bajaj JS, McCurdy H, Morgan TR, Rogal SS. Comparing the CFIR-ERIC matching tool recommendations to real-world strategy effectiveness data: a mixed-methods study in the Veterans Health Administration. Implement Sci 2023; 18:49. [PMID: 37828539 PMCID: PMC10571268 DOI: 10.1186/s13012-023-01307-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 09/25/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Practical and feasible methods for matching implementation strategies to diagnosed barriers of evidence-based interventions in real-world contexts are lacking. This evaluation compared actual implementation strategies applied with those recommended by an expert opinion-based tool to improve guideline-concordant cirrhosis care in a Veterans Health Administration national learning collaborative effort. METHODS This convergent parallel mixed-methods study aimed to (1) identify pre-implementation Consolidated Framework for Implementation Research (CFIR) barriers to cirrhosis care through focus groups with frontline providers, (2) generate 20 recommended strategies using focus group identified barriers entered into the CFIR-Expert Recommendations for Implementing Change (ERIC) Implementation Strategy Matching Tool, (3) survey providers over two consecutive years on the actual use of 73 ERIC strategies and determine strategy effectiveness, (4) compare actual versus recommended strategy use, and (5) compare actual versus expected barriers by reverse applying the CFIR-ERIC Matching Tool. RESULTS Eighteen semi-structured focus groups were conducted with 197 providers representing 95 VA sites to identify barriers to quality improvement, including cirrhosis care complexity, clarity of national goals, and local leadership support. The CFIR-ERIC Matching Tool recommended strategies such as assessing for readiness and needs, promoting adaptability, building local groups, preparing champions, and working with opinion leaders and early adopters. Subsequent strategy surveys found that sites used the top 20 "recommended" strategies no more frequently than other strategies. However, 14 (70%) of the top recommended strategies were significantly positively associated with cirrhosis care compared to 48% of actual strategies. Reverse CFIR-ERIC matching found that the strategies most used in the first year corresponded to the following barriers: opinion leaders, access to knowledge and information, and resources. The strategies most frequently employed in the second year addressed barriers such as champions, cosmopolitanism, readiness for implementation, relative priority, and patient needs and resources. Strategies used in both years were those that addressed adaptability, trialability, and compatibility. CONCLUSIONS This study is among the first to empirically evaluate the relationship between CFIR-ERIC Matching Tool recommended strategies and actual strategy selection and effectiveness in the real world. We found closer connections between recommended strategies and strategy effectiveness compared to strategy frequency, suggesting validity of barrier identification, and application of the expert-informed tool.
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Affiliation(s)
- Vera Yakovchenko
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive C (151C), Building 30, Pittsburgh, PA, 15240-1001, USA
| | - Carolyn Lamorte
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive C (151C), Building 30, Pittsburgh, PA, 15240-1001, USA
| | - Matthew J Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive C (151C), Building 30, Pittsburgh, PA, 15240-1001, USA
- Mental Health Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- RAND Corporation, Pittsburgh, PA, USA
| | - David E Goodrich
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive C (151C), Building 30, Pittsburgh, PA, 15240-1001, USA
| | - Sandra Gibson
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive C (151C), Building 30, Pittsburgh, PA, 15240-1001, USA
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Angela Park
- Department of Veterans Affairs, Office of Healthcare Transformation, Washington, DC, USA
| | - Jasmohan S Bajaj
- Division of Gastroenterology and Hepatology, Central Virginia VA Health Care System, Richmond, VA, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Timothy R Morgan
- Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, CA, USA
- Department of Medicine, University of California Irvine, Orange, CA, USA
| | - Shari S Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive C (151C), Building 30, Pittsburgh, PA, 15240-1001, USA.
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
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Faro JM, Yue KL, Leach HJ, Crisafio ME, Lemon SC, Wang B, McManus DD, Sadasivam RS. Development and pilot testing of a clinic implementation program delivering physical activity electronic referrals to cancer survivors. Transl Behav Med 2023; 13:794-803. [PMID: 37318360 PMCID: PMC10538473 DOI: 10.1093/tbm/ibad035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
Provider physical activity referrals are recommended for cancer survivors, though barriers exist to clinical system integration. To develop and test ActivityChoice, an electronic referral (eReferral) clinic implementation program referring cancer survivors to physical activity programs of their choice. In Phase 1, we conducted semi-structured interviews with Cancer Center clinicians (n = 4) and cancer-focused physical activity program leaders (n = 3) assessing adaptations needed to implement an eReferral previously designed for another context. In Phase 2, we pilot-tested clinician-delivered referrals to survivors in two 12-week Plan, Do, Study, Act (PDSA) cycles. We examined feasibility using descriptive statistics (clinicians' adoption and engagement, patient referrals, and physical activity program enrollment) and acceptability through semi-structured interviews with enrolled clinicians (n = 4) and referred patients (n = 9). ActivityChoice included a secure referral webform, text message/email referral confirmations, clinician training/booster sessions, visual reminders, and referrals to in-person or virtual group physical activity programs. Results for each PDSA cycle respectively included: 41% (n = 7) and 53% (n = 8) of clinicians adopted ActivityChoice; 18 and 36 patients were referred; 39% (n = 7) and 33% (n = 12) of patients enrolled in programs, and 30% (n = 4) and 14% (n = 5) of patients deferred enrollment. Patients and clinicians appreciated the referrals and choices. A printed handout describing both programs was added to the clinic workflow for Cycle 2, which yielded more referrals, but lower program enrollment rates. Clinic-based eReferrals to choices of physical activity programs were feasible and acceptable by clinicians and patients. Added clinic workflow support may facilitate referrals.
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Affiliation(s)
- Jamie M Faro
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Kai-Lou Yue
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Heather J Leach
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Mary E Crisafio
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Stephenie C Lemon
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - David D McManus
- Department of Medicine, Division of Cardiology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Rajani S Sadasivam
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Ferrari RM, Leeman J, Brenner AT, Correa SY, Malo TL, Moore AA, O'Leary MC, Randolph CM, Ratner S, Frerichs L, Farr D, Crockett SD, Wheeler SB, Lich KH, Beasley E, Hogsed M, Bland A, Richardson C, Newcomer M, Reuland DS. Implementation strategies in the Exploration and Preparation phases of a colorectal cancer screening intervention in community health centers. Implement Sci Commun 2023; 4:118. [PMID: 37730659 PMCID: PMC10512568 DOI: 10.1186/s43058-023-00485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 08/06/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Adoption of colorectal cancer (CRC) screening has lagged in community health center (CHC) populations in the USA. To address this implementation gap, we developed a multilevel intervention to improve screening in CHCs in our region. We used the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to guide this effort. Here, we describe the use of implementation strategies outlined in the Expert Recommendations for Implementing Change (ERIC) compilation in both the Exploration and Preparation phases of this project. During these two EPIS phases, we aimed to answer three primary questions: (1) What factors in the inner and outer contexts may support or hinder colorectal cancer screening in North Carolina CHCs?; (2) What evidence-based practices (EBPs) best fit the needs of North Carolina CHCs?; and (3) How can we best integrate the selected EBPs into North Carolina CHC systems? METHODS During the Exploration phase, we conducted local needs assessments, built a coalition, and conducted local consensus discussions. In the Preparation phase, we formed workgroups corresponding to the intervention's core functional components. Workgroups used cyclical small tests of change and process mapping to identify implementation barriers and facilitators and to adapt intervention components to fit inner and outer contexts. RESULTS Exploration activities yielded a coalition of stakeholders, including two rural CHCs, who identified barriers and facilitators and reached consensus on two EBPs: mailed FIT and navigation to colonoscopy. Stakeholders further agreed that the delivery of those two EBPs should be centralized to an outreach center. During Preparation, workgroups developed and refined protocols for the following centrally-delivered intervention components: a registry to identify and track eligible patients, a centralized system for mailing at-home stool tests, and a process to navigate patients to colonoscopy after an abnormal stool test. CONCLUSIONS This description may be useful both to implementation scientists, who can draw lessons from applied implementation studies such as this to refine their implementation strategy typologies and frameworks, as well as to implementation practitioners seeking exemplars for operationalizing strategies in early phases of implementation in healthcare.
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Affiliation(s)
- Renée M Ferrari
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA.
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.
| | - Jennifer Leeman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- School of Nursing, University of North Carolina at Chapel Hill, 120 North Medical Drive, Chapel Hill, NC, 27599, USA
| | - Alison T Brenner
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, Chapel Hill, NC, 27599, USA
| | - Sara Y Correa
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
| | - Teri L Malo
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
| | - Alexis A Moore
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
| | - Meghan C O'Leary
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Connor M Randolph
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
| | - Shana Ratner
- School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, Chapel Hill, NC, 27599, USA
- UNC Institute for Healthcare Quality Improvement, CB #8005, Chapel Hill, NC, 27599, USA
| | - Leah Frerichs
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Deeonna Farr
- College of Health and Human Performance, East Carolina University, 2307 Carol G. Belk Building, Greenville, NC, 27858, USA
| | - Seth D Crockett
- School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, Chapel Hill, NC, 27599, USA
- Division of Gastroenterology & Hepatology, Oregon Health & Science University, 3161 SW Pavilion Loop, Portland, OR, 97239, USA
| | - Stephanie B Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Kristen Hassmiller Lich
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Evan Beasley
- Blue Ridge Health, UNC Health, 2579 Chimney Rock Road, Hendersonville, NC, 28792, USA
| | - Michelle Hogsed
- Blue Ridge Health, 2759 Chimney Rock Road, Hendersonville, NC, 28792, USA
| | - Ashley Bland
- Blue Ridge Health, 2759 Chimney Rock Road, Hendersonville, NC, 28792, USA
| | - Claudia Richardson
- Ahoskie Comprehensive Care, Roanoke Chowan Community Health Center, 120 Health Center Drive, Ahoskie, NC, 27910, USA
| | - Mike Newcomer
- Digestive Health Partners, 191 Biltmore Avenue, Asheville, NC, 28801, USA
- Western Carolina Medical Society, 304 Summit Street, Asheville, NC, 28803, USA
| | - Daniel S Reuland
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
- School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, Chapel Hill, NC, 27599, USA
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Monsees E, Wirtz AL, Krein S. Stewardship 2.0: Embracing elements of implementation science to enhance everyday antimicrobial Stewardship efforts. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e149. [PMID: 37771743 PMCID: PMC10523543 DOI: 10.1017/ash.2023.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 09/30/2023]
Abstract
This article explores the utility of implementation science (IS) as a method to promote the effective uptake of antimicrobial stewardship processes. Elements of IS can be readily incorporated into QI work and used as a platform to extend stewardship reach. As stewards are stretched to do more, IS can be a potential vehicle to ensure that our collective work is impactful, sustainable, and contributes more broadly to clinically relevant improvements.
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Affiliation(s)
- Elizabeth Monsees
- Performance Excellence, Children’s Mercy Hospital, Kansas City, MO, USA
- School of Medicine, University of Missouri, Kansas City, MO, USA
| | - Ann L. Wirtz
- Pharmacy, Children’s Mercy Hospital, Kansas City, MO, USA
| | - Sarah Krein
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Trivedi KK, Schaffzin JK, Deloney VM, Aureden K, Carrico R, Garcia-Houchins S, Garrett JH, Glowicz J, Lee GM, Maragakis LL, Moody J, Pettis AM, Saint S, Schweizer ML, Yokoe DS, Berenholtz S. Implementing strategies to prevent infections in acute-care settings. Infect Control Hosp Epidemiol 2023; 44:1232-1246. [PMID: 37431239 PMCID: PMC10527889 DOI: 10.1017/ice.2023.103] [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] [Indexed: 07/12/2023]
Abstract
This document introduces and explains common implementation concepts and frameworks relevant to healthcare epidemiology and infection prevention and control and can serve as a stand-alone guide or be paired with the "SHEA/IDSA/APIC Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2022 Updates," which contain technical implementation guidance for specific healthcare-associated infections. This Compendium article focuses on broad behavioral and socio-adaptive concepts and suggests ways that infection prevention and control teams, healthcare epidemiologists, infection preventionists, and specialty groups may utilize them to deliver high-quality care. Implementation concepts, frameworks, and models can help bridge the "knowing-doing" gap, a term used to describe why practices in healthcare may diverge from those recommended according to evidence. It aims to guide the reader to think about implementation and to find resources suited for a specific setting and circumstances by describing strategies for implementation, including determinants and measurement, as well as the conceptual models and frameworks: 4Es, Behavior Change Wheel, CUSP, European and Mixed Methods, Getting to Outcomes, Model for Improvement, RE-AIM, REP, and Theoretical Domains.
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Affiliation(s)
| | - Joshua K. Schaffzin
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Valerie M. Deloney
- Society for Healthcare Epidemiology of America (SHEA), Arlington, Virginia
| | | | - Ruth Carrico
- Division of Infectious Diseases, University of Louisville School of Medicine, Louisville, Kentucky
| | | | - J. Hudson Garrett
- Division of Infectious Diseases, University of Louisville School of Medicine, Louisville, Kentucky
| | - Janet Glowicz
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Grace M. Lee
- Stanford Children’s Health, Stanford, California
| | | | - Julia Moody
- Clinical Services Group, HCA Healthcare, Nashville, Tennessee
| | | | - Sanjay Saint
- VA Ann Arbor Healthcare System and University of Michigan, Ann Arbor, Michigan
| | | | - Deborah S. Yokoe
- University of California San Francisco School of Medicine, UCSF Medical Center, San Francisco, California
| | - Sean Berenholtz
- Clinical Services Group, HCA Healthcare, Nashville, Tennessee
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Hamm RF, Moniz MH, Wahid I, Breman RB, Callaghan-Koru JA. Implementation research priorities for addressing the maternal health crisis in the USA: results from a modified Delphi study among researchers. Implement Sci Commun 2023; 4:83. [PMID: 37480135 PMCID: PMC10360260 DOI: 10.1186/s43058-023-00461-z] [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: 02/02/2023] [Accepted: 06/21/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Maternal health outcomes in the USA are far worse than in peer nations. Increasing implementation research in maternity care is critical to addressing quality gaps and unwarranted variations in care. Implementation research priorities have not yet been defined or well represented in the plans for maternal health research investments in the USA. METHODS This descriptive study used a modified Delphi method to solicit and rank research priorities at the intersection of implementation science and maternal health through two sequential web-based surveys. A purposeful, yet broad sample of researchers with relevant subject matter knowledge was identified through searches of published articles and grant databases. The surveys addressed five implementation research areas in maternal health: (1) practices to prioritize for broader implementation, (2) practices to prioritize for de-implementation, (3) research questions about implementation determinants, (4) research questions about implementation strategies, and (5) research questions about methods/measures. RESULTS Of 160 eligible researchers, 82 (51.2%) agreed to participate. Participants were predominantly female (90%) and White (75%). Sixty completed at least one of two surveys. The practices that participants prioritized for broader implementation were improved postpartum care, perinatal and postpartum mood disorder screening and management, and standardized management of hypertensive disorders of pregnancy. For de-implementation, practices believed to be most impactful if removed from or reduced in maternity care were cesarean delivery for low-risk patients and routine discontinuation of all psychiatric medications during pregnancy. The top methodological priorities of participants were improving the extent to which implementation science frameworks and measures address equity and developing approaches for involving patients in implementation research. CONCLUSIONS Through a web-based Delphi exercise, we identified implementation research priorities that researchers consider to have the greatest potential to improve the quality of maternity care in the USA. This study also demonstrates the feasibility of using modified Delphi approaches to engage researchers in setting implementation research priorities within a clinical area.
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Affiliation(s)
- Rebecca F Hamm
- Maternal and Child Health Research Center, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Michelle H Moniz
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Inaya Wahid
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Rachel Blankstein Breman
- Department of Partnerships, Professional Education and Practice, School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Jennifer A Callaghan-Koru
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Springdale, AR, USA.
- Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
- Center for Implementation Research, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Harvey G, Rycroft-Malone J, Seers K, Wilson P, Cassidy C, Embrett M, Hu J, Pearson M, Semenic S, Zhao J, Graham ID. Connecting the science and practice of implementation - applying the lens of context to inform study design in implementation research. FRONTIERS IN HEALTH SERVICES 2023; 3:1162762. [PMID: 37484830 PMCID: PMC10361069 DOI: 10.3389/frhs.2023.1162762] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023]
Abstract
The saying "horses for courses" refers to the idea that different people and things possess different skills or qualities that are appropriate in different situations. In this paper, we apply the analogy of "horses for courses" to stimulate a debate about how and why we need to get better at selecting appropriate implementation research methods that take account of the context in which implementation occurs. To ensure that implementation research achieves its intended purpose of enhancing the uptake of research-informed evidence in policy and practice, we start from a position that implementation research should be explicitly connected to implementation practice. Building on our collective experience as implementation researchers, implementation practitioners (users of implementation research), implementation facilitators and implementation educators and subsequent deliberations with an international, inter-disciplinary group involved in practising and studying implementation, we present a discussion paper with practical suggestions that aim to inform more practice-relevant implementation research.
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Affiliation(s)
- Gillian Harvey
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Jo Rycroft-Malone
- Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Kate Seers
- Warwick Medical School, Faculty of Science, University of Warwick, Coventry, United Kingdom
| | - Paul Wilson
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
| | - Christine Cassidy
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Mark Embrett
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Jiale Hu
- College of Health Professions, Virginia Commonwealth University, Richmond, VA, United States
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, United Kingdom
| | - Sonia Semenic
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Junqiang Zhao
- Centre for Research on Health and Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Ian D. Graham
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Hoffmann JA, Pergjika A, Liu L, Janssen AC, Walkup JT, Johnson JK, Alpern ER, Corboy JB. Standardizing and Improving Care for Pediatric Agitation Management in the Emergency Department. Pediatrics 2023; 152:e2022059586. [PMID: 37317809 PMCID: PMC10312235 DOI: 10.1542/peds.2022-059586] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Pediatric mental health emergency department (ED) visits are rising in the United States, with more visits involving medication for acute agitation. Timely, standardized implementation of behavioral strategies and medications may reduce the need for physical restraint. Our objective was to standardize agitation management in a pediatric ED and reduce time in physical restraints. METHODS A multidisciplinary team conducted a quality improvement initiative from September 2020 to August 2021, followed by a 6-month maintenance period. A barrier assessment revealed that agitation triggers were inadequately recognized, few activities were offered during long ED visits, staff lacked confidence in verbal deescalation techniques, medication choices were inconsistent, and medications were slow to take effect. Sequential interventions included development of an agitation care pathway and order set, optimization of child life and psychiatry workflows, implementation of personalized deescalation plans, and adding droperidol to the formulary. Measures include standardization of medication choice for severe agitation and time in physical restraints. RESULTS During the intervention and maintenance periods, there were 129 ED visits with medication given for severe agitation and 10 ED visits with physical restraint use. Among ED visits with medication given for severe agitation, standardized medication choice (olanzapine or droperidol) increased from 8% to 88%. Mean minutes in physical restraints decreased from 173 to 71. CONCLUSIONS Implementing an agitation care pathway standardized and improved care for a vulnerable and high-priority population. Future studies are needed to translate interventions to community ED settings and to evaluate optimal management strategies for pediatric acute agitation.
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Affiliation(s)
| | - Alba Pergjika
- Pritzker Department of Psychiatry and Behavioral Sciences
| | - Lynn Liu
- Data Analytics and Reporting, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | | | - John T. Walkup
- Pritzker Department of Psychiatry and Behavioral Sciences
| | - Julie K. Johnson
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Lantta T, Duxbury J, Haines-Delmont A, Björkdahl A, Husum TL, Lickiewicz J, Douzenis A, Craig E, Goodall K, Bora C, Whyte R, Whittington R. Models, frameworks and theories in the implementation of programs targeted to reduce formal coercion in mental health settings: a systematic review. Front Psychiatry 2023; 14:1158145. [PMID: 37398581 PMCID: PMC10311067 DOI: 10.3389/fpsyt.2023.1158145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/29/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Implementation models, frameworks and theories (hereafter tools) provide researchers and clinicians with an approach to understand the processes and mechanisms for the successful implementation of healthcare innovations. Previous research in mental health settings has revealed, that the implementation of coercion reduction programs presents a number of challenges. However, there is a lack of systematized knowledge of whether the advantages of implementation science have been utilized in this field of research. This systematic review aims to gain a better understanding of which tools have been used by studies when implementing programs aiming to reduce formal coercion in mental health settings, and what implementation outcomes they have reported. Methods A systematic search was conducted using PubMed, CINAHL, PsycINFO, Cochrane, Scopus, and Web of Science. A manual search was used to supplement database searches. Quality appraisal of included studies was undertaken using MMAT-Mixed Methods Appraisal Tool. A descriptive and narrative synthesis was formed based on extracted data. Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed in this review. Results We identified 5,295 references after duplicates were removed. Four additional references were found with a manual search. In total eight studies reported in nine papers were included in the review. Coercion reduction programs that were implemented included those that were holistic, and/or used professional judgement, staff training and sensory modulation interventions. Eight different implementation tools were identified from the included studies. None of them reported all eight implementation outcomes sought from the papers. The most frequently reported outcomes were acceptability (4/8 studies) and adaptation (3/8). With regards to implementation costs, no data were provided by any of the studies. The quality of the studies was assessed to be overall quite low. Discussion Systematic implementation tools are seldom used when efforts are being made to embed interventions to reduce coercive measures in routine mental health care. More high-quality studies are needed in the research area that also involves perspectives of service users and carers. In addition, based on our review, it is unclear what the costs and resources are needed to implement complex interventions with the guidance of an implementation tool. Systematic review registration [Prospero], identifier [CRD42021284959].
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Affiliation(s)
- Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
- Department of Nursing, Manchester Metropolitan University, Manchester, United Kingdom
| | - Joy Duxbury
- Department of Nursing, Manchester Metropolitan University, Manchester, United Kingdom
| | - Alina Haines-Delmont
- Department of Nursing, Manchester Metropolitan University, Manchester, United Kingdom
| | - Anna Björkdahl
- Centre for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden
| | - Tonje Lossius Husum
- Department of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | - Jakub Lickiewicz
- Department of Health Psychology, Jagiellonian University Medical College, Krakow, Poland
| | - Athanassios Douzenis
- Second Psychiatry Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Elaine Craig
- Department of Nursing, Manchester Metropolitan University, Manchester, United Kingdom
| | - Katie Goodall
- Department of Nursing, Manchester Metropolitan University, Manchester, United Kingdom
| | - Christina Bora
- Second Psychiatry Department, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Rachel Whyte
- Department of Nursing, Manchester Metropolitan University, Manchester, United Kingdom
| | - Richard Whittington
- Centre for Research and Education in Security, Prisons and Forensic Psychiatry, Forensic Department Østmarka, St. Olav's Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
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Callaghan-Koru J, Farzin A, Ridout E, Curran G. Integrating Implementation Science with Quality Improvement to Improve Perinatal Outcomes. Clin Perinatol 2023; 50:343-361. [PMID: 37201985 DOI: 10.1016/j.clp.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Implementation science is an interdisciplinary field that seeks to contribute generalizable knowledge that can improve the translation of clinical evidence in routine care. To promote the integration of implementation science approaches with health care quality improvement, the authors offer a framework that links the Model for Improvement with implementation strategies and methods. Perinatal quality improvement teams can leverage the robust frameworks of implementation science to diagnose implementation barriers, select implementation strategies, and assess the strategies' contribution to improving care. Partnerships between implementation scientists and quality improvement teams could accelerate efforts by both groups to achieve measurable improvements in care.
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Affiliation(s)
- Jennifer Callaghan-Koru
- Department of Internal Medicine, University of Arkansas for Medical Sciences, 1125 North College Avenue, Fayetteville, AR 72703, USA.
| | - Azadeh Farzin
- Pediatrix of Maryland/Adventist Healthcare, 9901 Medical Center Drive, Rockville, MD 20850, USA
| | - Erick Ridout
- American Academy of Pediatrics, 1380 East Medical Center Drive, St George, UT 84790, USA
| | - Geoffrey Curran
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA
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Jeffs L, Merkley J, Ronald K, Newton G, Yang L, Gray CS. Can fundamental care be advanced using the science of care framework? J Adv Nurs 2023; 79:991-1002. [PMID: 35957589 DOI: 10.1111/jan.15404] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/24/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022]
Abstract
AIMS This manuscript aims to provide a description of an evidence-informed Science of Care practice-based research and innovation framework that may serve as a guiding framework to generate new discoveries and knowledge around fundamental care in a more integrated manner. BACKGROUND New ways of thinking about models of care and implementation strategies in transdisciplinary teams are required to accelerate inquiry and embed new knowledge and innovation into practice settings. A new way of thinking starts with an explicit articulation and commitment to the core business of the healthcare industry which is to provide quality fundamental care. DESIGN This discursive paper delineates an iteratively derived Science of Care research and innovation framework (Science of Care Framework) that draws from a targeted literature review. METHOD The Science of Care Framework integrates caring science with safety and symptom sciences with implementation, improvement, innovation and team sciences. Each science dimension is described in terms of seminal and evolving evidence and theoretical explanations, focusing on how these disciplines can support fundamental care. CONCLUSIONS The Science of Care Framework can serve as a catalyst to guide future efforts to propel new knowledge and discoveries around fundamental care and how best to implement it into clinical practice through a transdisciplinary lens. IMPACT ON NURSING SCIENCE, PRACTICE, OR DISCIPLINARY KNOWLEDGE The Science of Care Framework can accelerate nursing discipline-specific knowledge generation alongside inter and transdisciplinary insights. The novel articulation of the Science of Care Framework can be used to guide further inquiries that are co-designed, and led, by nurses into integrated models of care and innovations in clinical practice.
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Affiliation(s)
- Lianne Jeffs
- Sinai Health, Toronto, Ontario, Canada
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Lily Yang
- Sinai Health, Toronto, Ontario, Canada
| | - Carolyn Steele Gray
- Sinai Health, Toronto, Ontario, Canada
- Institute of Health Policy Management, University of Toronto, Toronto, Ontario, Canada
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Kyomuhangi T, Manalili K, Kabakyenga J, Turyakira E, Matovelo D, Khan S, Kyokushaba C, MacIntosh H, Brenner JL. Health system strengthening using a Maximizing Engagement for Readiness and Impact (MERI) Approach: A community case study. Front Public Health 2022; 10:952213. [PMID: 36504976 PMCID: PMC9727261 DOI: 10.3389/fpubh.2022.952213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Health system strengthening initiatives in low and middle-income countries are commonly hampered by limited implementation readiness. The Maximizing Engagement for Readiness and Impact (MERI) Approach uses a system "readiness" theory of change to address implementation obstacles. MERI is documented based on field experiences, incorporating best practices, and lessons learned from two decades of maternal, newborn, and child health (MNCH) programming in East Africa. Context The MERI Approach is informed by four sequential and progressively larger MNCH interventions in Uganda and Tanzania. Intervention evaluations incorporating qualitative and quantitative data sources assessed health and process outcomes. Implementer, technical leader, stakeholder, and policymaker reflections on sequential experiences have enabled MERI Approach adaptation and documentation, using an implementation lens and an implementation science readiness theory of change. Key programmatic elements The MERI Approach comprises three core components. MERI Change Strategies (meetings, equipping, training, mentoring) describe key activity types that build general and intervention-specific capacity to maximize and sustain intervention effectiveness. The SOPETAR Process Model (Scan, Orient, Plan, Equip, Train, Act, Reflect) is a series of purposeful steps that, in sequence, drive each implementation level (district, health facility, community). A MERI Motivational Framework identifies foundational factors (self-reliance, collective-action, embeddedness, comprehensiveness, transparency) that motivate participants and enhance intervention adoption. Components aim to enhance implementer and system readiness while engaging broad stakeholders in capacity building activities toward health outcome goals. Activities align with government policy and programming and are embedded within existing district, health facility, and community structures. Discussion This case study demonstrates feasibility of the MERI Approach to support district wide MNCH programming in two low-income countries, supportive of health outcome and health system improvements. The MERI Approach has potential to engage districts, health facilities, and communities toward sustainable health outcomes, addressing intervention implementation gaps for current and emerging health needs within and beyond East Africa.
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Affiliation(s)
- Teddy Kyomuhangi
- Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda,*Correspondence: Teddy Kyomuhangi
| | - Kimberly Manalili
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jerome Kabakyenga
- Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda,Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Eleanor Turyakira
- Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda,Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Dismas Matovelo
- Department of Obstetrics and Gynecology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Sobia Khan
- The Center for Implementation, Toronto, ON, Canada
| | - Clare Kyokushaba
- Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Heather MacIntosh
- Indigenous, Local and Global Health Office, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer L. Brenner
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada,Indigenous, Local and Global Health Office, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Jesus TS, Stern BZ, Struhar J, Deutsch A, Heinemann AW. The use of patient experience feedback in rehabilitation quality improvement and codesign activities: Scoping review of the literature. Clin Rehabil 2022; 37:261-276. [DOI: 10.1177/02692155221126690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To characterize the literature, reported enablers, and gaps on the use of patient experience feedback for person-centered rehabilitation quality improvement and codesign activities. Design Scoping Review. Data sources Scientific databases (PubMed, CINAHL, Rehabdata, Scopus, Web of Science, ProQuest), website searches (e.g. Beryl Institute), snowballing, and key-informant recommendations. Methods Two independent reviewers performed title and abstract screenings and full-text reviews. Eligibility focused on English-language, peer-reviewed (all time) and gray literature (last five years) that used patient experience feedback in rehabilitation improvement activities. The aims, settings, methods, findings, implications, and reported limitations were extracted, followed by content analyses identifying reported enablers and gaps. Results Among the 901 unique references and 52 full texts reviewed, ten were included: four used patient experience surveys for improving patient experiences; six used codesign methodologies to engage patient feedback in service improvement activities. Implementation enablers included securing managerial support, having a structured methodology and facilitator, using efficient processes, engaging staff experiences, and using appreciative inquiry. Reported study gaps included limited follow-up, low sample sizes, analytical limitations, lack of reported limitations, or narrow range of perspectives (e.g. not from people with severe impairments). Conclusion Few examples of the use of patient experience feedback in quality improvement or codesign activities were found in the rehabilitation literature. Patient experience improvement activities relied exclusively on retrospective survey data, which were not combined with often more actionable forms (e.g. qualitative, real time) of patient experience feedback. Further research might consider design of activities that collect and use patient experience feedback for rehabilitation service improvements.
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Affiliation(s)
- TS Jesus
- Center for Education in Health Sciences, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - BZ Stern
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Struhar
- Nerve, Muscle + Bone Innovation Center & Oncology Innovation Center, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - A Deutsch
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- RTI International, Chicago, IL, USA
| | - AW Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Eisman AB, Kim B, Salloum RG, Shuman CJ, Glasgow RE. Advancing rapid adaptation for urgent public health crises: Using implementation science to facilitate effective and efficient responses. Front Public Health 2022; 10:959567. [PMID: 36091566 PMCID: PMC9448975 DOI: 10.3389/fpubh.2022.959567] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/08/2022] [Indexed: 01/24/2023] Open
Abstract
Responding rapidly to emerging public health crises is vital to reducing their escalation, spread, and impact on population health. These responses, however, are challenging and disparate processes for researchers and practitioners. Researchers often develop new interventions that take significant time and resources, with little exportability. In contrast, community-serving systems are often poorly equipped to properly adopt new interventions or adapt existing ones in a data-driven way during crises' onset and escalation. This results in significant delays in deploying evidence-based interventions (EBIs) with notable public health consequences. This prolonged timeline for EBI development and implementation results in significant morbidity and mortality that is costly and preventable. As public health emergencies have demonstrated (e.g., COVID-19 pandemic), the negative consequences often exacerbate existing health disparities. Implementation science has the potential to bridge the extant gap between research and practice, and enhance equity in rapid public health responses, but is underutilized. For the field to have a greater "real-world" impact, it needs to be more rapid, iterative, participatory, and work within the timeframes of community-serving systems. This paper focuses on rapid adaptation as a developing implementation science area to facilitate system responses during public health crises. We highlight frameworks to guide rapid adaptation for optimizing existing EBIs when responding to urgent public health issues. We also explore the economic implications of rapid adaptation. Resource limitations are frequently a central reason for implementation failure; thus, we consider the economic impacts of rapid adaptation. Finally, we provide examples and propose directions for future research and application.
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Affiliation(s)
- Andria B. Eisman
- Community Health, Division of Kinesiology, Health and Sport Studies, College of Education, Wayne State University, Detroit, MI, United States
- Center for Health and Community Impact (CHCI), Wayne State University, Detroit, MI, United States
| | - Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Ramzi G. Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, United States
| | - Clayton J. Shuman
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, United States
| | - Russell E. Glasgow
- Dissemination and Implementation Science Program of ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science), University of Colorado School of Medicine, Aurora, CO, United States
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Bénard A, Chouinard S, Leavitt BR, Budd N, Wu JW, Schoffer K. Canadian healthcare capacity gaps for disease-modifying treatment in Huntington's disease: a survey of current practice and modelling of future needs. BMJ Open 2022; 12:e062740. [PMID: 35649593 PMCID: PMC9161103 DOI: 10.1136/bmjopen-2022-062740] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Disease-modifying therapies in development for Huntington's disease (HD) may require specialised administration and additional resource capacity. We sought to understand current and future capacity for HD management in Canada considering the possible introduction of an intrathecal (IT) disease-modifying treatment (DMT). DESIGN, SETTING AND PARTICIPANTS Using a case study, mixed methods framework, online surveys followed by semistructured interviews were conducted in late 2020 and early 2021. Neurologists from Canadian HD (n=16) and community (n=11) centres and social workers (n=16) were invited to complete online surveys assessing current HD management and potential capacity to support administration of an IT DMT. OUTCOME MEASURES Survey responses, anticipated demand and assumed resource requirements were modelled to reveal capacity to treat (ie, % of eligible patients) by centre. Resource bottlenecks and incremental support required (full-time equivalent, FTE) were also determined. RESULTS Neurologists from 15/16 HD centres and 5/11 community centres, plus 16/16 social workers participated. HD centres manage 94% of patients with HD currently seeking care in Canada, however, only 20% of IT DMT-eligible patients are currently seen by neurologists. One-third of centres have no access to nursing support. The average national incremental nursing, room, neurologist and social worker support required to provide IT DMT to all eligible patients is 0.73, 0.36, 0.30 and 0.21 FTE per HD centre, respectively. At peak demand, current capacity would support the treatment of 6% of IT DMT-eligible patients. If frequency of administration is halved, capacity for IT-DMT administration only increases to 11%. CONCLUSIONS In Canada, there is little to no capacity to support the administration of an IT DMT for HD. Current inequitable and inadequate resourcing will require solutions that consider regional gaps and patient needs.
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Affiliation(s)
- Angèle Bénard
- Huntington Society of Canada, Waterloo, Ontario, Canada
| | - Sylvain Chouinard
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Unité des troubles du mouvement André Barbeau, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Blair R Leavitt
- Department of Medical Genetics and Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Molecular Medicine and Therapeutics, Vancouver, British Columbia, Canada
| | - Nathalie Budd
- Hoffmann-La Roche Limited, Mississauga, Ontario, Canada
| | - Jennifer W Wu
- Hoffmann-La Roche Limited, Mississauga, Ontario, Canada
| | - Kerrie Schoffer
- Division of Neurology, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
- Movement Disorder Clinic, QEII Health Sciences Centre Foundation, Halifax, Nova Scotia, Canada
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O’Leary MC, Hassmiller Lich K, Frerichs L, Leeman J, Reuland DS, Wheeler SB. Extending analytic methods for economic evaluation in implementation science. Implement Sci 2022; 17:27. [PMID: 35428260 PMCID: PMC9013084 DOI: 10.1186/s13012-022-01192-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/24/2022] [Indexed: 12/19/2022] Open
Abstract
Background Economic evaluations of the implementation of health-related evidence-based interventions (EBIs) are conducted infrequently and, when performed, often use a limited set of quantitative methods to estimate the cost and effectiveness of EBIs. These studies often underestimate the resources required to implement and sustain EBIs in diverse populations and settings, in part due to inadequate scoping of EBI boundaries and underutilization of methods designed to understand the local context. We call for increased use of diverse methods, especially the integration of quantitative and qualitative approaches, for conducting and better using economic evaluations and related insights across all phases of implementation. Main body We describe methodological opportunities by implementation phase to develop more comprehensive and context-specific estimates of implementation costs and downstream impacts of EBI implementation, using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. We focus specifically on the implementation of complex interventions, which are often multi-level, resource-intensive, multicomponent, heterogeneous across sites and populations, involve many stakeholders and implementation agents, and change over time with respect to costs and outcomes. Using colorectal cancer (CRC) screening EBIs as examples, we outline several approaches to specifying the “boundaries” of EBI implementation and analyzing implementation costs by phase of implementation. We describe how systems mapping and stakeholder engagement methods can be used to clarify EBI implementation costs and guide data collection—particularly important when EBIs are complex. In addition, we discuss the use of simulation modeling with sensitivity/uncertainty analyses within implementation studies for projecting the health and economic impacts of investment in EBIs. Finally, we describe how these results, enhanced by careful data visualization, can inform selection, adoption, adaptation, and sustainment of EBIs. Conclusion Health economists and implementation scientists alike should draw from a larger menu of methods for estimating the costs and outcomes associated with complex EBI implementation and employ these methods across the EPIS phases. Our prior experiences using qualitative and systems approaches in addition to traditional quantitative methods provided rich data for informing decision-making about the value of investing in CRC screening EBIs and long-term planning for these health programs. Future work should consider additional opportunities for mixed-method approaches to economic evaluations.
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Brownson RC, Shelton RC, Geng EH, Glasgow RE. Revisiting concepts of evidence in implementation science. Implement Sci 2022; 17:26. [PMID: 35413917 PMCID: PMC9004065 DOI: 10.1186/s13012-022-01201-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 04/04/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Evidence, in multiple forms, is a foundation of implementation science. For public health and clinical practice, evidence includes the following: type 1 evidence on etiology and burden; type 2 evidence on effectiveness of interventions; and type 3: evidence on dissemination and implementation (D&I) within context. To support a vision for development and use of evidence in D&I science that is more comprehensive and equitable (particularly for type 3 evidence), this article aims to clarify concepts of evidence, summarize ongoing debates about evidence, and provide a set of recommendations and tools/resources for addressing the "how-to" in filling evidence gaps most critical to advancing implementation science. MAIN TEXT Because current conceptualizations of evidence have been relatively narrow and insufficiently characterized in our opinion, we identify and discuss challenges and debates about the uses, usefulness, and gaps in evidence for implementation science. A set of questions is proposed to assist in determining when evidence is sufficient for dissemination and implementation. Intersecting gaps include the need to (1) reconsider how the evidence base is determined, (2) improve understanding of contextual effects on implementation, (3) sharpen the focus on health equity in how we approach and build the evidence-base, (4) conduct more policy implementation research and evaluation, and (5) learn from audience and stakeholder perspectives. We offer 15 recommendations to assist in filling these gaps and describe a set of tools for enhancing the evidence most needed in implementation science. CONCLUSIONS To address our recommendations, we see capacity as a necessary ingredient to shift the field's approach to evidence. Capacity includes the "push" for implementation science where researchers are trained to develop and evaluate evidence which should be useful and feasible for implementers and reflect community or stakeholder priorities. Equally important, there has been inadequate training and too little emphasis on the "pull" for implementation science (e.g., training implementers, practice-based research). We suggest that funders and reviewers of research should adopt and support a more robust definition of evidence. By critically examining the evolving nature of evidence, implementation science can better fulfill its vision of facilitating widespread and equitable adoption, delivery, and sustainment of scientific advances.
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Affiliation(s)
- Ross C. Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO 63130 USA
- Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63130 USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY 10032 USA
| | - Elvin H. Geng
- Division of Infectious Diseases, Department of Medicine and Center for Dissemination and Implementation in the Institute for Public Health, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110 USA
| | - Russell E. Glasgow
- Department of Family Medicine and Adult & Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045 USA
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Nilsen P, Thor J, Bender M, Leeman J, Andersson-Gäre B, Sevdalis N. Bridging the Silos: A Comparative Analysis of Implementation Science and Improvement Science. FRONTIERS IN HEALTH SERVICES 2022; 1:817750. [PMID: 36926490 PMCID: PMC10012801 DOI: 10.3389/frhs.2021.817750] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022]
Abstract
Background Implementation science and improvement science have similar goals of improving health care services for better patient and population outcomes, yet historically there has been limited exchange between the two fields. Implementation science was born out of the recognition that research findings and effective practices should be more systematically disseminated and applied in various settings to achieve improved health and welfare of populations. Improvement science has grown out of the wider quality improvement movement, but a fundamental difference between quality improvement and improvement science is that the former generates knowledge for local improvement, whereas the latter is aimed at producing generalizable scientific knowledge. Objectives The first objective of this paper is to characterise and contrast implementation science and improvement science. The second objective, building on the first, is to highlight aspects of improvement science that potentially could inform implementation science and vice versa. Methods We used a critical literature review approach. Search methods included systematic literature searches in PubMed, CINAHL, and PsycINFO until October 2021; reviewing references in identified articles and books; and the authors' own cross-disciplinary knowledge of key literature. Findings The comparative analysis of the fields of implementation science and improvement science centred on six categories: (1) influences; (2) ontology, epistemology and methodology; (3) identified problem; (4) potential solutions; (5) analytical tools; and (6) knowledge production and use. The two fields have different origins and draw mostly on different sources of knowledge, but they have a shared goal of using scientific methods to understand and explain how health care services can be improved for their users. Both describe problems in terms of a gap or chasm between current and optimal care delivery and consider similar strategies to address the problems. Both apply a range of analytical tools to analyse problems and facilitate appropriate solutions. Conclusions Implementation science and improvement science have similar endpoints but different starting points and academic perspectives. To bridge the silos between the fields, increased collaboration between implementation and improvement scholars will help to clarify the differences and connections between the science and practice of improvement, to expand scientific application of quality improvement tools, to further address contextual influences on implementation and improvement efforts, and to share and use theory to support strategy development, delivery and evaluation.
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Affiliation(s)
- Per Nilsen
- Division of Society and Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Johan Thor
- Jönköping University, Jönköping Academy for Improvement of Health and Welfare, Jönköping, Sweden
| | - Miriam Bender
- Sue and Bill Gross School of Nursing, University of California, Irvine, Irvine, CA, United States
| | - Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Boel Andersson-Gäre
- Jönköping University, Jönköping Academy for Improvement of Health and Welfare, Jönköping, Sweden
| | - Nick Sevdalis
- Health Service & Population Research Department, Centre for Implementation Science, King's College London, London, United Kingdom
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O’Grady MA, Randrianarivony R, Martin K, Perez-Cubillan Y, Collymore DC, Shapiro-Luft D, Beacham A, Heyward N, Greenfield B, Neighbors CJ. Together in care: Lessons learned at the intersection of integrated care, quality improvement, and implementation practice in opioid treatment programs. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221135265. [PMID: 37091088 PMCID: PMC9924288 DOI: 10.1177/26334895221135265] [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] [Indexed: 11/06/2022] Open
Abstract
Background Integrated care programs that systematically and comprehensively address both behavioral and physical health may improve patient outcomes. However, there are few examples of such programs in addiction treatment settings. This article is a practical implementation report describing the implementation of an integrated care program into two opioid treatment programs (OTPs). Method Strategies used to implement integrated care into two OTPs included external facilitation, quality improvement (QI) processes, staff training, and an integrated organizational structure. Service, implementation, and client outcomes were examined using qualitative interviews with program staff (n = 16), program enrollment data, and client outcome data (n = 593) on mental health (MH), physical health, and functional indicators. Results Staff found the program to generally be acceptable and appropriate, but also noted that the new services added to already busy workflows and more staffing were needed to fully reach the program's potential. The program had a high level of penetration (∼60%-70%), enrolling over 1,200 clients. Staff noted difficulties in connecting clients with some services. Client general functioning and MH symptoms improved, and heavy smoking decreased. The organizational structure and QI activities provided a strong foundation for interactive problem-solving and adaptations that were needed during implementation. Conclusions This article highlights an example of the intersection of QI and implementation practice. Simplified QI processes, consistent post-implementation meetings, and change teams and champions facilitated implementation; however, ongoing training and support, especially related to data are needed. The OTP setting provided a strong foundation to build integrated care, but careful consideration of new workflows and changes in philosophy for staff is necessary.Plain Language Summary: Providing medical and behavioral health treatment services in the same clinic using coordinated treatment teams, also known as integrated care, improves outcomes among those with chronic physical and behavioral health conditions. However, there are few practical examples of implementation of such programs in addiction treatment settings, which are promising, yet underutilized settings for integrated care programs. A multi-sectoral team used quality improvement (QI) and implementation strategies to implement integrated care into two opioid treatment programs (OTPs). The program enrolled over 1,200 clients and client general functioning and mental health (MH) symptoms improved, and heavy smoking decreased. Qualitative interviews provided important information about the barriers, facilitators, and context around implementation of this program. The OTP setting provided a strong foundation to build integrated care, but careful consideration of new workflows and changes in philosophy for staff, as well as ongoing training and supports for staff, are necessary. This project may help to advance the implementation of integrated care in OTPs by identifying barriers and facilitators to implementation, lessons learned, as well as providing a practical example of potentially useful QI and implementation strategies.
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Affiliation(s)
- Megan A. O’Grady
- Departmet of Public Health Sciences, University of Connecticut School of
Medicine, Farmington, CT, USA
| | | | | | | | | | | | | | - Nyasia Heyward
- Bureau of Adult Treatment, New York State Office of Addiction
Services and Supports, New York, USA
| | - Belinda Greenfield
- Bureau of Adult Treatment, New York State Office of Addiction
Services and Supports, New York, USA
| | - Charles J. Neighbors
- Department of Population Health, New York
University Grossman School of Medicine, New York, NY, USA
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An Implementation Science Laboratory as One Approach to Whole System Improvement: A Canadian Healthcare Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312681. [PMID: 34886408 PMCID: PMC8656644 DOI: 10.3390/ijerph182312681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/27/2021] [Accepted: 11/28/2021] [Indexed: 01/04/2023]
Abstract
Implementation science (IS) has emerged as an integral component for evidence-based whole system improvement. IS studies the best methods to promote the systematic uptake of evidence-based interventions into routine practice to improve the quality and effectiveness of health service delivery and patient care. IS laboratories (IS labs) are one mechanism to integrate implementation science as an evidence-based approach to whole system improvement and to support a learning health system. This paper aims to examine if IS labs are a suitable approach to whole system improvement. We retrospectively analyzed an existing IS lab (Alberta, Canada’s Implementation Science Collaborative) to assess the potential of IS labs to perform as a whole system approach to improvement and to identify key activities and considerations for designing IS labs specifically to support learning health systems. Results from our evaluation show the extent to which IS labs support learning health systems through enabling infrastructures for system-wide improvement and research.
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