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Kettlewell J, Radford K, Timmons S, Jones T, Fallon S, Westley R, White S, Kendrick D. What affects implementation of the UK major trauma rehabilitation prescription? A survey informed by the behaviour change wheel. Injury 2024; 55:111722. [PMID: 39019749 DOI: 10.1016/j.injury.2024.111722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/26/2024] [Accepted: 07/05/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVE Major trauma 'Rehabilitation Prescriptions' aim to facilitate continuity of care and describe patient needs following discharge from UK Major Trauma Centre (MTCs), however research suggests rehabilitation prescriptions are not being implemented as intended. We aimed to identify factors influencing completion and use of rehabilitation prescriptions using the Behaviour Change Wheel (BCW) and Theoretical Domains Framework (TDF). DESIGN Online survey informed by the TDF and BCW. SETTING UK trauma rehabilitation pathway. POPULATION Rehabilitation and trauma service providers involved in completing and/or using rehabilitation prescriptions (n = 78). ANALYSIS Mean scores were calculated for TDF behavioural domains, identifying facilitators (score ≥5) and barriers (≤3.5) to rehabilitation prescription implementation. Thematic analysis of free text data informed by the BCW/TDF identified further facilitators and barriers, plus potential behaviour change strategies. RESULTS Most respondents worked in UK MTCs (n = 63) and were physiotherapists (n = 34), trauma rehabilitation coordinators (n = 16) or occupational therapists (n = 15). 'Social/professional role and identity', 'knowledge' and 'emotion' (the highest-scoring TDF domains) were facilitators to implementing rehabilitation prescriptions. Qualitative data identified barriers to rehabilitation prescription completion, including 'seen as tick-box exercise','not a priority', lack of resources (IT and workforce), poor inter-service communication, limited knowledge/training. Facilitators included therapist buy-in, standardised training, easy inter-service rehabilitation prescription transfer, usefulness for sharing patient needs. CONCLUSIONS Although rehabilitation prescriptions are valued by some service providers, their effectiveness is hindered by negative attitudes, limited knowledge and poor communication. Uncertainties exist about whether rehabilitation prescriptions achieve their goals, particularly in documenting patient needs, engaging patients in rehabilitation, and informing onward referrals following MTC discharge. Improving IT systems, empowering patients, redirecting funding, and providing training might improve their usage. Further research should explore service provider and patient perspectives, and prospective long-term follow-up on outcomes of rehabilitation prescription recommendations.
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Affiliation(s)
- Jade Kettlewell
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, UK.
| | - Kate Radford
- Centre for Rehabilitation & Ageing Research, School of Medicine, University of Nottingham, UK
| | - Stephen Timmons
- Nottingham University Business School, University of Nottingham, UK
| | - Trevor Jones
- School of Medicine, University of Nottingham, UK
| | | | - Ryan Westley
- School of Medicine, University of Nottingham, UK
| | - Susan White
- School of Medicine, University of Nottingham, UK
| | - Denise Kendrick
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, UK
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Mithi B, Sambala EZ, Bula A, Jere Z, Kumilonde E, Gondwe G, Chikuse MM, Manda S, Muula AS. Strategies for scaling up pre-ART advanced HIV disease screening at a secondary referral hospital-Malawi: a qualitative study. BMC Health Serv Res 2024; 24:915. [PMID: 39123198 PMCID: PMC11312806 DOI: 10.1186/s12913-024-11412-2] [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: 02/04/2024] [Accepted: 08/06/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Implementation of the World Health Organization (WHO) recommended Advanced HIV Disease screening package, remains poor in most settings with limited resources. More than 50% of newly diagnosed-HIV clients are missed on screening as a result of implementation barriers. It is important to mitigate the existing barriers and leverage enablers' inorder to maximize uptake of the advanced HIV disease screening. This study aimed to identify strategies for scaling up implementation of advanced HIV disease screening among newly HIV-diagnosed clients in pre-ART phase using a Consolidated Framework for Implementation Research-Expert Recommendation for Implementing Change (CFIR-ERIC) guiding tool. METHODS A qualitative study was conducted at Rumphi district hospital in Malawi (August - September, 2023). Two sessions of Focus group discussions (FDGs) involving key stakeholders were facilitated to identify specific strategies following the initial study on exploration of barriers and facilitators of advanced HIV disease screening package. Participants comprised healthcare providers, purposively selected from key hospital departments. A deductive approach was used to analyze FDG transcripts where emerging themes were mapped with ERIC list of strategies. CFIR-ERIC Matching tool version 1.0, was used to generate an output of the most to least expert-endorsed Level 1 and Level 2 strategies. FINDINGS About 25 key healthcare workers participated in FDGs. Overall, 6 Level 1 strategies (≥ 50% expert endorsement score) and 4 Level 2 strategies (≥ 20%, ≤ 49% expert endorsement score) were identified, targeting barriers associated with availability of resources, intervention complexity, access to knowledge and information, communication; and implementation leads. Most of the reported strategies were cross-cutting and aimed at enhancing clinical knowledge of the intervention (distributing training materials, educational meetings), developing stakeholders' interrelations (network weaving) as well as improving clinical workflow (environmental restructuring). Use of evaluative and iterative strategies such as monthly data collection for evaluation were also recommended as part of continuous improvement while an AHD coordinator was recommended to be formally appointed inorder to spearhead coordination of AHD screening services. CONCLUSION Through the involvement of key stakeholders and the use of CFIR-ERIC matching tool, this study has identified cross-cutting strategies that if well implemented, can help to mitigate contextual barriers and leverage enablers for an improved delivery of AHD screening package.
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Affiliation(s)
- Brany Mithi
- Diagnostic Department, Rumphi District Hospital, Rumphi, Malawi.
| | - Evanson Z Sambala
- Department of Public Health, School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | - Agatha Bula
- University of North Carolina (UNC) Project -Malawi, Lilongwe, Malawi
| | - Ziliro Jere
- Department of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Emily Kumilonde
- Clinical Department, Ntcheu District Hospital, Ntcheu, Malawi
| | - Grant Gondwe
- Diagnostic Department, Rumphi District Hospital, Rumphi, Malawi
| | | | - Simion Manda
- ART Department, Rumphi District Hospital, PO BOX 225, Rumphi, Malawi
| | - Adamson S Muula
- Department of Public Health, School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
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Huffstetler AN, Villalobos G, Webel B, Rockwell MS, Funk A, Sabo RT, Epling JW, Brooks EM, Britz JB, Bortz BA, Svikis DS, Arias AJ, Tran RN, Krist AH. Practice Facilitation to Address Unhealthy Alcohol Use in Primary Care: A Cluster Randomized Clinical Trial. JAMA HEALTH FORUM 2024; 5:e242371. [PMID: 39120895 PMCID: PMC11316228 DOI: 10.1001/jamahealthforum.2024.2371] [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: 04/23/2024] [Accepted: 06/12/2024] [Indexed: 08/10/2024] Open
Abstract
Importance Unhealthy alcohol use (UAU) is the fourth most preventable cause of death in the US. The US Preventive Services Task Force recommends that primary care clinicians routinely screen all adults 18 years and older for UAU; however, this preventive service is poorly implemented. Objective To determine if practice facilitation improved delivery of the recommended care for UAU compared to usual care. Design, Setting, and Participants This practice-level cluster randomized clinical trial was conducted across diverse and representative primary care practices throughout Virginia. A total of 76 primary care practices enrolled between October 2019 and January 2023. Intervention Practices received immediate (intervention) or 6-month delayed (control) practice facilitation, which included tailored educational sessions, workflow management, and tools for addressing UAU. Main Outcomes and Measures Outcomes included the increase in recommended screening for UAU, brief interventions, referral for counseling, and medication treatment. Data were collected via medical record review (structured and free text data) and transcripts of practice facilitator sessions and exits interviews. Results Of the 76 primary care practices enrolled, 32 were randomized to intervention and 35 to control; 11 789 patients (mean [SD] age, 50.1 [16.3] years; 61.1% women) were randomly selected for analysis, with patient demographics similar to Virginia at large. From baseline to 6 months after intervention, screening with a validated instrument increased from 2.1% (95% CI, 0.5%-8.4%) to 35.5% (95% CI, 11.5%-69.9%) in the intervention group compared to 0.4% (95% CI, 0.1%-1.8%) to 1.4% (95% CI, 0.3%-5.8%) in the control group (P < .001). Brief office-based interventions for the intervention group increased from 26.2% (95% CI, 14.2%-45.8%) to 62.6% (95% CI, 43.6%-78.3%) vs 45.5% (95% CI, 28.0%-64.1%) to 55.1% (95% CI, 36.5%-72.3%) in the control group (P = .008). Identification of UAU, referral for counseling, and medication treatment had similar changes for both groups. Qualitative analyses of transcripts revealed that few clinicians understood the preventive service prior to practice facilitation, but at the end most felt much more competent and confident with screening and brief intervention for UAU. Conclusions and Relevance This cluster randomized clinical trial demonstrated that practice facilitation can help primary care practices to better implement screening and counseling for UAU into their routine workflow. Effective primary care practice implementation interventions such as this can have a profound effect on the health of communities. Given the number of people that the participating practices care for, this intervention resulted in an additional 114 604 patients being screened annually for UAU who would not have been otherwise. Trial Registration ClinicalTrials.gov Identifier: NCT04248023.
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Affiliation(s)
- Alison N. Huffstetler
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond
- Inova Fairfax Family Practice, Fairfax, Virginia
| | - Gabriela Villalobos
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond
| | - Ben Webel
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond
| | - Michelle S. Rockwell
- Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke
| | - Adam Funk
- Department of Biostatistics, Virginia Commonwealth University, Richmond
| | - Roy T. Sabo
- Department of Biostatistics, Virginia Commonwealth University, Richmond
| | - John W. Epling
- Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke
| | - E. Marshall Brooks
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond
| | - Jacqueline B. Britz
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond
| | | | - Dace S. Svikis
- Department of Psychology, Virginia Commonwealth University, Richmond
| | - Albert J. Arias
- Department of Psychiatry, Virginia Commonwealth University, Richmond
| | - Ryan Nguyen Tran
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond
| | - Alex H. Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond
- Inova Fairfax Family Practice, Fairfax, Virginia
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Cheng R, Aggarwal A, Chakraborty A, Harish V, McGowan M, Roy A, Szulewski A, Nolan B. Implementation considerations for the adoption of artificial intelligence in the emergency department. Am J Emerg Med 2024; 82:75-81. [PMID: 38820809 DOI: 10.1016/j.ajem.2024.05.020] [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: 03/19/2024] [Revised: 05/15/2024] [Accepted: 05/24/2024] [Indexed: 06/02/2024] Open
Abstract
OBJECTIVE Artificial intelligence (AI) has emerged as a potentially transformative force, particularly in the realm of emergency medicine (EM). The implementation of AI in emergency departments (ED) has the potential to improve patient care through various modalities. However, the implementation of AI in the ED presents unique challenges that influence its clinical adoption. This scoping review summarizes the current literature exploring the barriers and facilitators of the clinical implementation of AI in the ED. METHODS We systematically searched Embase (Ovid), MEDLINE (Ovid), Web of Science, and Engineering Village. All articles were published in English through November 20th, 2023. Two reviewers screened the search results, with disagreements resolved through third-party adjudication. RESULTS A total of 8172 studies were included in the preliminary search, with 22 selected for the final data extraction. 10 studies were reviews and the remaining 12 were primary quantitative, qualitative, and mixed-methods studies. Out of the 22, 13 studies investigated a specific AI tool or application. Common barriers to implementation included a lack of model interpretability and explainability, encroachment on physician autonomy, and medicolegal considerations. Common facilitators to implementation included educating staff on the model, efficient integration into existing workflows, and sound external validation. CONCLUSION There is increasing literature on AI implementation in the ED. Our research suggests that the most common barrier facing AI implementation in the ED is model interpretability and explainability. More primary research investigating the implementation of specific AI tools should be undertaken to help facilitate their successful clinical adoption in the ED.
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Affiliation(s)
- R Cheng
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - A Aggarwal
- School of Medicine, McMaster University, Hamilton, ON, Canada
| | - A Chakraborty
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - V Harish
- School of Medicine, University of Toronto, Toronto, ON, Canada
| | - M McGowan
- Department of Emergency Medicine, St Michael's Hospital, Toronto, ON, Canada
| | - A Roy
- Bracken Health Sciences Library, Queen's University, Kingston, ON, Canada
| | - A Szulewski
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - B Nolan
- Department of Emergency Medicine, St Michael's Hospital, Toronto, ON, Canada..
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Mullen J, Sattari S, Rauch M, Stein F, Roy K, Acorda DE. Utilizing Data and Alarm Champions to Enhance Alarm Management: A Pediatric Quality Improvement Initiative. J Nurs Care Qual 2024:00001786-990000000-00147. [PMID: 38936411 DOI: 10.1097/ncq.0000000000000787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
BACKGROUND Nuisance and false alarms distract clinicians from urgent alerts, raising patient safety risks. LOCAL PROBLEM High alarm rates in a pediatric progressive care unit resulted in experiencing 180-250 alarms per day or 1 alarm every 3 to 4 minutes per clinician. METHODS Through Plan-Do-Study-Act cycles, environmental, policy, and technology changes were implemented to decrease the average alarms/day/bed and percentage of time in alarm. INTERVENTIONS Alarm settings tailored to patient needs using features embedded within the patient monitoring system were implemented and monitored with the assistance of alarm champions. RESULTS The average number of alarms/day/bed decreased from 177.69 to 96.94 over the course of 10 years, a 45.45% reduction. The percentage of time in alarm decreased from 7.52% to 2.83%, a 62.37% reduction. CONCLUSIONS Arming clinicians with technology to analyze real-time clinical data made alarms meaningful and actionable, decreasing false alarms without compromising patient safety.
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Affiliation(s)
- Joellan Mullen
- Author Affiliations: Medical Informatics Corp, Houston, Texas (Mullen and Sattari); Texas Children's Hospital, Houston, Texas (Rauch and Acorda); Section of Critical Care, Department of Pediatrics, Baylor College of Medicine, Houston, Texas (Stein and Roy); and University of Texas Health Science Center- Cizik School of Nursing, Houston, Texas (Acorda)
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Moldovan F, Moldovan L. An Orthopedic Healthcare Facility Governance Assessed with a New Indicator System. Healthcare (Basel) 2024; 12:1080. [PMID: 38891155 PMCID: PMC11172014 DOI: 10.3390/healthcare12111080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES A sustainability-oriented hospital governance has the potential to increase the efficiency of healthcare services and reduce the volume of expenses. The objective of this research is to develop a new complex tool for evaluating healthcare facility governance as a component of social responsibility, integrated into sustainability. MATERIALS AND METHODS We designed the research to develop the domains of a new reference framework for evaluating healthcare facility governance. The methodology for designing the indicators that make up the new reference framework consists of collecting and processing the most recent and relevant practices regarding the governance of healthcare facilities that have been reported by representative hospitals around the world. RESULTS We designed eight indicators that are brought together in the healthcare facility governance indicators matrix. They have descriptions and qualitative and quantitative rating scales with values from 0 to 5 that allow the degree of fulfillment to be quantified. The importance of the indicators is evaluated on a specific scale described qualitatively and quantitatively by values from 0 to 5. The values of the degree of achievement-importance couples of the indicators allow the development of improvement measures with priority according to the results revealed by the Eisenhower-type assessment diagram. CONCLUSIONS Validation in practice of the system of indicators at an emergency hospital in an orthopedic profile highlighted the fact that they can be integrated into other national and international reference frameworks implemented in the hospital. The added value of the implementation consists of the facilitation of sustainable development and the orientation of health personnel, patients, and interested parties toward sustainability.
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Affiliation(s)
- Flaviu Moldovan
- Orthopedics-Traumatology Department, Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Liviu Moldovan
- Faculty of Engineering and Information Technology, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
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Saleem A, Appannah A, Meyer C, Hutchinson AM, Mills A, Smit DV, Boyd L, Rose M, Sutherland F, O'Keefe F, Lowthian JA. A qualitative exploration of challenges recruiting older adults for Being Your Best, a co-designed holistic intervention to manage and reduce frailty: lessons learnt amidst the COVID-19 pandemic in Melbourne, Australia. BMJ Open 2024; 14:e082618. [PMID: 38803255 DOI: 10.1136/bmjopen-2023-082618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVES Researchers face numerous challenges when recruiting participants for health and social care research. This study reports on the challenges faced recruiting older adults for Being Your Best, a co-designed holistic intervention to manage and reduce frailty, and highlights lessons learnt amidst the COVID-19 pandemic. DESIGN A qualitative study design was used. Referrer interviews were conducted to explore the recruitment challenges faced by the frontline workers. An audit of the research participant (aged ≥65) database was also undertaken to evaluate the reasons for refusal to participate and withdrawal from the study. SETTING Hospital emergency departments (EDs) and a home care provider in Melbourne, Australia. PARTICIPANTS Frontline workers and older adults. RESULTS From May 2022 to June 2023, 71 referrals were received. Of those referrals, only 13 (18.3%) agreed to participate. Three participants withdrew immediately after baseline data collection, and the remaining 10 continued to participate in the programme. Reasons for older adult non-participation were (1) health issues (25.3%), (2) ineligibility (18.3%), (3) lack of interest (15.5%), (4) perceptions of being 'too old' (11.2%) and (5) perceptions of being too busy (5.6%). Of those participating, five were female and five were male. Eleven referrer interviews were conducted to explore challenges with recruitment, and three themes were generated after thematic analysis: (1) challenges arising from the COVID-19 pandemic, (2) characteristics of the programme and (3) health of older adults. CONCLUSION Despite using multiple strategies, recruitment was much lower than anticipated. The ED staff were at capacity associated with pandemic-related activities. While EDs are important sources of participants for research, they were not suitable recruitment sites at the time of this study, due to COVID-19-related challenges. Programme screening characteristics and researchers' inability to develop rapport with potential participants also contributed to low recruitment numbers. TRIAL REGISTRATION NUMBER ACTRN12620000533998; Pre-results.
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Affiliation(s)
- Ahsan Saleem
- Bolton Clarke Research Institute, Melbourne, Victoria, Australia
| | - Arti Appannah
- Bolton Clarke Research Institute, Melbourne, Victoria, Australia
| | - Claudia Meyer
- Bolton Clarke Research Institute, Melbourne, Victoria, Australia
- Centre for Health Communication and Participation, La Trobe University, Melbourne, Victoria, Australia
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Victoria, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Barwon Health, Geelong, Victoria, Australia
| | - Amber Mills
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | | | - Leanne Boyd
- Eastern Health, Melbourne, Victoria, Australia
| | | | - Fran Sutherland
- Cabrini Health Consumer Representative, Melbourne, Victoria, Australia
| | | | - Judy A Lowthian
- Bolton Clarke Research Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Savas LS, Shegog R, Frost EL, Healy CM, Mantey DS, Coan SP, Shay LA, Teague TA, Ferreris JJ, Preston SM, Vernon SW. Effect of an HPV Vaccination Multi-Level, Multi-Component Program on HPV Vaccination Initiation and Completion in a Pediatric Clinic Network. Vaccines (Basel) 2024; 12:510. [PMID: 38793761 PMCID: PMC11126005 DOI: 10.3390/vaccines12050510] [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: 02/26/2024] [Revised: 04/13/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
Despite clear evidence of the public health benefits of the human papillomavirus (HPV) vaccine in preventing HPV-related cancers and genital warts, underutilization of HPV vaccination in the United States persists. Interventions targeting multi-level determinants of vaccination behavior are crucial for improving HPV vaccination rates. The study's purpose was to implement and evaluate the adapted Adolescent Vaccination Program (AVP), a clinic-based, multi-level, multi-component intervention aimed at increasing HPV vaccine initiation and completion rates in a five-clinic pediatric network in Bexar County, Texas. The adaptation process was guided by established frameworks and involved formative work with clinic stakeholders. The study utilized a quasi-experimental single group pre- and post- study design, with an external comparison data using the National Immunization Survey-Teen (NIS-Teen) datasets for the same time period to examine the AVP's effect on HPV vaccination initiation and completion. A series of interrupted time series analyses (ITSA) compared the clinic system patient outcomes (HPV vaccination initiation and completion rates) in the post-intervention to the general adolescent population (NIS-Teen). Of the 6438 patients (11-17 years) with clinic visits during the 3-year study period, HPV vaccination initiation rates increased from 64.7% to 80.2% (p < 0.05) and completion rates increased from 43.2% to 60.2% (p < 0.05). The AVP was effective across various demographic and economic subgroups, demonstrating its generalizability. ITSA findings indicated the AVP improved HPV vaccination initiation and completion rates in clinic settings and that AVP strategies facilitated resilience during the pandemic. The minimal adaptation required for implementation in a new clinic system underscores its feasibility and potential for widespread adoption.
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Affiliation(s)
- Lara S. Savas
- Center for Health Promotion and Prevention Research, UTHealth Houston School of Public Health, Houston, TX 77030, USA; (R.S.); (E.L.F.); (S.P.C.); (T.A.T.); (S.W.V.)
| | - Ross Shegog
- Center for Health Promotion and Prevention Research, UTHealth Houston School of Public Health, Houston, TX 77030, USA; (R.S.); (E.L.F.); (S.P.C.); (T.A.T.); (S.W.V.)
| | - Erica L. Frost
- Center for Health Promotion and Prevention Research, UTHealth Houston School of Public Health, Houston, TX 77030, USA; (R.S.); (E.L.F.); (S.P.C.); (T.A.T.); (S.W.V.)
| | - C. Mary Healy
- Department of Pediatrics, Infectious Diseases Section, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Dale S. Mantey
- Michael & Susan Dell Center for Healthy Living, UTHealth Houston School of Public Health in Austin, Austin, TX 78701, USA;
| | - Sharon P. Coan
- Center for Health Promotion and Prevention Research, UTHealth Houston School of Public Health, Houston, TX 77030, USA; (R.S.); (E.L.F.); (S.P.C.); (T.A.T.); (S.W.V.)
| | - L. Aubree Shay
- Center for Health Promotion and Prevention Research, UTHealth Houston School of Public Health in San Antonio, San Antonio, TX 78229, USA;
| | - Travis A. Teague
- Center for Health Promotion and Prevention Research, UTHealth Houston School of Public Health, Houston, TX 77030, USA; (R.S.); (E.L.F.); (S.P.C.); (T.A.T.); (S.W.V.)
| | - Juan J. Ferreris
- Christus Health, Children’s General Pediatric Clinic, San Antonio, TX 78257, USA;
| | - Sharice M. Preston
- Center for Health Promotion and Prevention Research, UTHealth Houston School of Public Health, Houston, TX 77030, USA; (R.S.); (E.L.F.); (S.P.C.); (T.A.T.); (S.W.V.)
| | - Sally W. Vernon
- Center for Health Promotion and Prevention Research, UTHealth Houston School of Public Health, Houston, TX 77030, USA; (R.S.); (E.L.F.); (S.P.C.); (T.A.T.); (S.W.V.)
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Pettersen S, Eide H, Berg A. The role of champions in the implementation of technology in healthcare services: a systematic mixed studies review. BMC Health Serv Res 2024; 24:456. [PMID: 38605304 PMCID: PMC11007964 DOI: 10.1186/s12913-024-10867-7] [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: 06/19/2023] [Accepted: 03/14/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Champions play a critical role in implementing technology within healthcare services. While prior studies have explored the presence and characteristics of champions, this review delves into the experiences of healthcare personnel holding champion roles, as well as the experiences of healthcare personnel interacting with them. By synthesizing existing knowledge, this review aims to inform decisions regarding the inclusion of champions as a strategy in technology implementation and guide healthcare personnel in these roles. METHODS A systematic mixed studies review, covering qualitative, quantitative, or mixed designs, was conducted from September 2022 to March 2023. The search spanned Medline, Embase, CINAHL, and Scopus, focusing on studies published from 2012 onwards. The review centered on health personnel serving as champions in technology implementation within healthcare services. Quality assessments utilized the Mixed Methods Appraisal Tool (MMAT). RESULTS From 1629 screened studies, 23 were included. The champion role was often examined within the broader context of technology implementation. Limited studies explicitly explored experiences related to the champion role from both champions' and health personnel's perspectives. Champions emerged as promoters of technology, supporting its adoption. Success factors included anchoring and selection processes, champions' expertise, and effective role performance. DISCUSSION The specific tasks and responsibilities assigned to champions differed across reviewed studies, highlighting that the role of champion is a broad one, dependent on the technology being implemented and the site implementing it. Findings indicated a correlation between champion experiences and organizational characteristics. The role's firm anchoring within the organization is crucial. Limited evidence suggests that volunteering, hiring newly graduated health personnel, and having multiple champions can facilitate technology implementation. Existing studies predominantly focused on client health records and hospitals, emphasizing the need for broader research across healthcare services. CONCLUSIONS With a clear mandate, dedicated time, and proper training, health personnel in champion roles can significantly contribute professional, technological, and personal competencies to facilitate technology adoption within healthcare services. The review finds that the concept of champions is a broad one and finds varied definitions of the champion role concept. This underscores the importance of describing organizational characteristics, and highlights areas for future research to enhance technology implementation strategies in different healthcare settings with support of a champion.
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Affiliation(s)
- Sissel Pettersen
- Faculty of Nursing and Health Sciences, Nord university, P.O. Box 474, N-7801, Namsos, Norway.
| | - Hilde Eide
- Centre for Health and Technology, Faculty of Health Sciences, University of South-Eastern Norway, PO Box 7053, N-3007, Drammen, Norway
| | - Anita Berg
- Faculty of Nursing and Health Sciences, Nord university, P.O. Box 474, N-7801, Namsos, Norway
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Brewington MK, Queen TL, Heisler-MacKinnon J, Calo WA, Weaver S, Barry C, Kong WY, Kennedy KL, Shea CM, Gilkey MB. Who are vaccine champions and what implementation strategies do they use to improve adolescent HPV vaccination? Findings from a national survey of primary care professionals. Implement Sci Commun 2024; 5:28. [PMID: 38520032 PMCID: PMC10958944 DOI: 10.1186/s43058-024-00557-0] [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: 08/25/2023] [Accepted: 02/12/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Implementation science researchers often cite clinical champions as critical to overcoming organizational resistance and other barriers to the implementation of evidence-based health services, yet relatively little is known about who champions are or how they effect change. To inform future efforts to identify and engage champions to support HPV vaccination, we sought to describe the key characteristics and strategies of vaccine champions working in adolescent primary care. METHODS In 2022, we conducted a national survey with a web-based panel of 2527 primary care professionals (PCPs) with a role in adolescent HPV vaccination (57% response rate). Our sample consisted of pediatricians (26%), family medicine physicians (22%), advanced practice providers (24%), and nursing staff (28%). Our survey assessed PCPs' experience with vaccine champions, defined as health care professionals "known for helping their colleagues improve vaccination rates." RESULTS Overall, 85% of PCPs reported currently working with one or more vaccine champions. Among these 2144 PCPs, most identified the champion with whom they worked most closely as being a physician (40%) or nurse (40%). Almost all identified champions worked to improve vaccination rates for vaccines in general (45%) or HPV vaccine specifically (49%). PCPs commonly reported that champion implementation strategies included sharing information (79%), encouragement (62%), and vaccination data (59%) with colleagues, but less than half reported that champions led quality improvement projects (39%). Most PCPs perceived their closest champion as being moderately to extremely effective at improving vaccination rates (91%). PCPs who did versus did not work with champions more often recommended HPV vaccination at the earliest opportunity of ages 9-10 rather than later ages (44% vs. 33%, p < 0.001). CONCLUSIONS Findings of our national study suggest that vaccine champions are common in adolescent primary care, but only a minority lead quality improvement projects. Interventionists seeking to identify champions to improve HPV vaccination rates can expect to find them among both physicians and nurses, but should be prepared to offer support to more fully engage them in implementing interventions.
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Affiliation(s)
- Micaela K Brewington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
| | - Tara L Queen
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer Heisler-MacKinnon
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Sandra Weaver
- UNC Family Medicine and Pediatrics, UNC Health, Chapel Hill, NC, USA
| | | | - Wei Yi Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Kathryn L Kennedy
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Christopher M Shea
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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11
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Sier MAT, Godina E, Tweed TTT, Daher I, Stoot JHMB. Views and experiences of healthcare professionals and patients on the implementation of a 23-hour accelerated enhanced recovery programme: a mixed-method study. BMC Health Serv Res 2024; 24:330. [PMID: 38475839 DOI: 10.1186/s12913-024-10837-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/07/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND An accumulating body of research suggests that an accelerating enhanced recovery after colon surgery protocol is beneficial for patients, however, to obtain these effects, adherence to all elements of the protocol is important. The implementation of complex interventions, such as the Enhanced Recovery After Surgery protocol (ERAS), and their strict adherence have proven to be difficult. The same challenges can be expected in the implementation of the accelerated Enhanced Recovery Pathways (ERPs). This study aimed to understand the perspectives of both healthcare professionals (HCPs) and patients on the locally studied acCelerated enHanced recovery After SurgEry (CHASE) protocol. METHODS For this mixed-method study, HCPs who provided CHASE care and patients who received CHASE care were recruited using purposive sampling. Ethical approval was obtained by the Medical Ethical Committee of the Zuyderland Medical Centre (NL71804.096.19, METCZ20190130, October 2022). Semi-structured, in-depth, one-on-one interviews were conducted with HCPs (n = 13) and patients (n = 11). The interviews consisted of a qualitative and quantitative part, the protocol evaluation and the Measurement Instrument or Determinant of Innovations-structured questionnaire. We explored the perspectives, barriers, and facilitators of the CHASE protocol implementation. The interviews were audiotaped, transcribed verbatim and analysed independently by two researchers using direct content analysis. RESULTS The results showed that overall, HCPs support the implementation of the CHASE protocol. The enablers were easy access to the protocol, the relevance of the intervention, and thorough patient education. Some of the reported barriers included the difficulty of recognizing CHASE patients, the need for regular feedback, and the updates on the implementation progress. Most patients were enthusiastic about early discharge after surgery and expressed satisfaction with the care they received. On the other hand, the patients sometimes received different information from different HCPs, considered the information to be too extensive and few experienced some discomfort with CHASE care. CONCLUSION Bringing CHASE care into practice was challenging and required adaptation from HCPs. The experiences of HCPs showed that the protocol can be improved further, and the mostly positive experiences of patients are a motivation for this improvement. These results yielded practical implications to improve the implementation of accelerated ERPs.
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Affiliation(s)
- Misha A T Sier
- Department of Surgery, Zuyderland Medical Centre, Henri Dunantstraat 5, Heerlen, 6419 PC, The Netherlands.
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Universiteitssingel 40, Maastricht, 6229 ER, The Netherlands.
| | - Eva Godina
- Department of Surgery, Zuyderland Medical Centre, Henri Dunantstraat 5, Heerlen, 6419 PC, The Netherlands
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Universiteitssingel 40, Maastricht, 6229 ER, The Netherlands
| | - Thaís T T Tweed
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Universiteitssingel 40, Maastricht, 6229 ER, The Netherlands
- Department of Surgery, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht, 6229 HX, the Netherlands
| | - Imane Daher
- Department of Gastroenterology, Zuyderland Medical Centre, Henri Dunantstraat 5, Heerlen, 6419 PC, the Netherlands
| | - Jan H M B Stoot
- Department of Surgery, Zuyderland Medical Centre, Henri Dunantstraat 5, Heerlen, 6419 PC, The Netherlands
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12
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Patton LJ, Morris A, Nash A, Richards K, Huntington L, Batchelor L, Harris J, Young V, Howe CJ. Formative Evaluation of CLABSI Adoption and Sustainment Interventions in a Pediatric Intensive Care Unit. Pediatr Qual Saf 2024; 9:e719. [PMID: 38576891 PMCID: PMC10990306 DOI: 10.1097/pq9.0000000000000719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/17/2024] [Indexed: 04/06/2024] Open
Abstract
Background Pediatric patients require central venous catheters to maintain adequate hydration, nutritional status, and delivery of life-saving medications in the pediatric intensive care unit. Although central venous catheters provide critical medical therapies, their use increases the risk of severe infection, morbidity, and mortality. Adopting an evidence-based central line-associated bloodstream infection (CLABSI) bundle to guide nursing practice can decrease and sustain low CLABSI rates, but reliable and consistent implementation is challenging. This study aimed to conduct a mixed-methods formative evaluation to explore CLABSI bundle implementation strategies in a PICU. Methods The team used The Consolidated Framework for Implementation Research to develop the interview guide and data analysis plan. Results Facilitators and barriers for the CLABSI bundle occurred in four domains: inner setting, process, characteristics of individuals, and innovation characteristics in each cycle that led to recommended implementation strategy opportunities. The champion role was a major implementation strategy that facilitated the adoption and sustainment of the CLABSI bundle. Conclusions Implementation Science Frameworks, such as Consolidated Framework for Implementation Research (CFIR), can be a beneficial framework to guide quality improvement efforts for evidence-based practices such as the CLABSI bundle. Using a champion role in the critical care setting may be an important implementation strategy for CLABSI bundle adoption and sustainment efforts.
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Affiliation(s)
- Lindsey J. Patton
- From the Children’s Critical Care Services and Nursing Research, Dallas, Tex
| | - Angelica Morris
- From the Children’s Critical Care Services and Nursing Research, Dallas, Tex
| | - Amanda Nash
- From the Children’s Critical Care Services and Nursing Research, Dallas, Tex
| | - Kendel Richards
- From the Children’s Critical Care Services and Nursing Research, Dallas, Tex
| | - Leslie Huntington
- From the Children’s Critical Care Services and Nursing Research, Dallas, Tex
| | - Lori Batchelor
- From the Children’s Critical Care Services and Nursing Research, Dallas, Tex
| | - Jenna Harris
- From the Children’s Critical Care Services and Nursing Research, Dallas, Tex
| | - Virginia Young
- From the Children’s Critical Care Services and Nursing Research, Dallas, Tex
| | - Carol J. Howe
- Harris College of Nursing, Texas Christian University, Fort Worth, Tex
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Jacobs M, Martinussen H, Swart R, Gubbels A, Dirkx M, de Boer H, Speijer G, Mondriaan K, de Jaeger K, Cuijpers J, Mast M, de Vreugt F, Boersma L. A taskforce for national improvement of innovation implementation in radiotherapy. Radiother Oncol 2024; 192:110105. [PMID: 38244780 DOI: 10.1016/j.radonc.2024.110105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND AND PURPOSE Previous research among Dutch radiotherapy centres (RTCs) showed that 69% of innovations was simultaneously implemented in 7/19 centres, with a success rate of 51%. However, no structure to share lessons learned about the implementation process existed. Therefore, a national Taskforce Implementation (TTI) was raised to stimulate efficient implementation of innovations. The aim of the current study was to develop and pilot-evaluate a website for facilitating mutual learning on implementation issues. MATERIAL AND METHODS First, we made an inventory in all Dutch RTCs on their 10 most valuable innovations between 2019 and 2022. In-depth interviews, structured according to the Consolidated Framework for Implementation Research, were performed on the four most mentioned topics. A website was built, and pilot evaluated 1 year after the launch, using a qualitative survey amongst the TTI members. RESULTS In 13/18 centres, 19 interviews were conducted on 1) automation, 2) patient participation, 3) adaptive radiotherapy 4) surface guided radiotherapy and tracking. Most innovations (13/16) were implemented with a delay, with many comparable challenges: e.g. shortage of personnel (7/16) and prioritization of projects (9/16). The website allows users to upload and search for projects, including implementation experiences. After 1 year, 14 projects were uploaded. The qualitative evaluation was largely positive with room for improvement, i.e.75 % would recommend the website to others. CONCLUSION This study showed that RTCs experience comparable challenges when implementing innovations, thereby underlining the need for a platform to share implementation-lessons learned. The first concept of this platform was evaluated positively.
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Affiliation(s)
- Maria Jacobs
- Tilburg School of Economics and Management, Tilburg University, Tilburg, the Netherlands.
| | - Hanneke Martinussen
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Rachelle Swart
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Anne Gubbels
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Maarten Dirkx
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiation Oncology, Rotterdam, the Netherlands
| | - Hans de Boer
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Gabrielle Speijer
- Department of Radiation Oncology, Haga Teaching Hospital, The Hague, the Netherlands
| | - Karin Mondriaan
- Radiotherapeutisch Instituut Friesland, Leeuwarden, the Netherlands
| | - Katrien de Jaeger
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Johan Cuijpers
- Department of Radiation Oncology, Location Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Mirjam Mast
- Haaglanden Medical Center, Department of radiation oncology, Leidschendam, the Netherlands
| | - Floortje de Vreugt
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Liesbeth Boersma
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
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14
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Bello-Manga H, Haliru L, Ahmed K, Ige S, Musa H, Muhammad-Idris ZK, Monday B, Sani AM, Bonnet K, Schlundt DG, Varughese T, Tabari AM, DeBaun MR, Baumann AA, King AA. Barriers and facilitators to a task-shifted stroke prevention program for children with sickle cell anemia in a community hospital: a qualitative study. Implement Sci Commun 2024; 5:10. [PMID: 38225633 PMCID: PMC10790401 DOI: 10.1186/s43058-023-00534-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: 05/29/2023] [Accepted: 11/21/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Children with sickle cell anemia (SCA) are at high risk for stroke. Protocols for stroke prevention including blood transfusions, screening for abnormal non-imaging transcranial Doppler (TCD) measurements, and hydroxyurea therapy are difficult to implement in low-resource environments like Nigeria. This study aimed to examine the contextual factors around TCD screening in a community hospital in Nigeria using qualitative interviews and focus groups. METHODS We conducted a descriptive qualitative study in a community hospital in Kaduna, Nigeria, using focus groups and interviews. Interview guides and analysis were informed by the Consolidated Framework for Implementation Research (CFIR) framework and the Theory of Planned Behavior. Transcripts were coded and analyzed using an iterative deductive (CFIR)/Inductive (transcribed quotes) qualitative methodology. RESULTS We conducted two focus groups and five interviews with health care workers (nurses and doctors) and hospital administrators, respectively. Themes identified key elements of the inner setting (clinic characteristics, resource availability, implementation climate, and tension for change), characteristics of individuals (normative, control, and behavioral beliefs), and the implementation process (engage, implement, and adopt), as well as factors that were influenced by external context, caregiver needs, team function, and intervention characteristics. Task shifting, which is already being used, was viewed by providers and administrators as a necessary strategy to implement TCD screening in a clinic environment that is overstressed and under-resourced, a community stressed by poverty, and a nation with an underperforming health system. CONCLUSION Task shifting provides a viable option to improve health care by making more efficient use of already available human resources while rapidly expanding the human resource pool and building capacity for TCD screening of children with SCD that is more sustainable. TRIAL REGISTRATION NCT05434000.
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Affiliation(s)
- Halima Bello-Manga
- Department of Haematology and Blood Transfusion, Barau Dikko Teaching Hospital/Kaduna State University, Kaduna, Nigeria.
| | - Lawal Haliru
- Department of Paediatrics, Barau Dikko Teaching Hospital/Kaduna State University, Kaduna, Nigeria
| | - Kudirat Ahmed
- Department of Paediatrics, Barau Dikko Teaching Hospital/Kaduna State University, Kaduna, Nigeria
| | - Samuel Ige
- Yusuf Dantsoho Memorial Hospital, Kaduna State Ministry of Health, Kaduna, Nigeria
| | - Hayatu Musa
- Department of Library and Information Science, Ahmadu Bello University, Zaria, Nigeria
| | | | - Binshak Monday
- Department of Library and Information Science, Ahmadu Bello University, Zaria, Nigeria
| | | | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - David G Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Taniya Varughese
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Abdulkadir M Tabari
- Department of Radiology, Barau Dikko Teaching Hospital/Kaduna State University, Kaduna, Nigeria
| | - Michael R DeBaun
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University of School of Medicine, Nashville, TN, USA
| | - Ana A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Allison A King
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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15
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Katz C, Robles N, Novillo-Ortiz D, Saigí-Rubió F. Selection of criteria for a telemedicine framework for designing, implementing, monitoring and evaluating telemedicine interventions: Validation using a modified Delphi process. Digit Health 2024; 10:20552076241251951. [PMID: 38726219 PMCID: PMC11080763 DOI: 10.1177/20552076241251951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
Objectives The call to scale up telemedicine services globally as part of the digital health transformation lacks an agreed-upon set of constructs to guide the implementation process. A lack of guidance hinders the development, consolidation, sustainability and optimisation of telemedicine services. The study aims to reach consensus among telemedicine experts on a set of implementation constructs to be developed into an evidence-based support tool. Methods A modified Delphi study was conducted to evaluate a set of evidence-informed telemedicine implementation constructs comprising cores, domains and items. The study evaluated the constructs consisting of five cores: Assessment of the Current Situation, Development of a Telemedicine Strategy, Development of Organisational Changes, Development of a Telemedicine Service, and Monitoring, Evaluation and Optimisation of Telemedicine Implementation; seven domains: Individual Readiness, Organisational Readiness, Clinical, Economic, Technological and Infrastructure, Regulation, and Monitoring, Evaluation and Optimisation; divided into 53 items. Global telemedicine specialists (n = 247) were invited to participate and evaluate 58 questions. Consensus was set at ≥70%. Results Forty-five experts completed the survey. Consensus was reached on 78% of the constructs evaluated. Regarding the core constructs, Monitoring, Evaluation and Optimisation of Telemedicine Implementation was determined to be the most important one, and Development of a Telemedicine Strategy the least. As for the domains, the Clinical one had the highest level of consensus, and the Economic one had the lowest. Conclusions This research advances the field of telemedicine, providing expert consensus on a set of implementation constructs. The findings also highlight considerable divergence in expert opinion on the constructs of reimbursement and incentive mechanisms, resistance to change, and telemedicine champions. The lack of agreement on these constructs warrants attention and may partly explain the barriers that telemedicine services continue to face in the implementation process.
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Affiliation(s)
- Che Katz
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Noemí Robles
- eHealth Centre, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - David Novillo-Ortiz
- Division of Country Health Policies and Systems, World Health Organization, Regional Office for Europe, Copenhagen, Denmark
| | - Francesc Saigí-Rubió
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
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Weerakkody A, Emmanuel R, White J, Godecke E, Singer B. Unlocking the restraint-Development of a behaviour change intervention to increase the provision of modified constraint-induced movement therapy in stroke rehabilitation. Aust Occup Ther J 2023; 70:661-677. [PMID: 37424149 DOI: 10.1111/1440-1630.12896] [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: 11/16/2022] [Revised: 06/08/2023] [Accepted: 06/20/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Strong evidence supports the provision of modified constraint-induced movement therapy (mCIMT) to improve upper limb function after stroke. A service audit identified that very few patients received mCIMT in a large subacute, early-supported discharge rehabilitation service. A behaviour change intervention was developed to increase the provision of mCIMT following an unsuccessful 'education only' attempt. This paper aims to systematically document the steps undertaken and to provide practical guidance to clinicians and rehabilitation services to implement this complex, yet effective, rehabilitation intervention. METHODS This clinician behaviour change intervention was developed over five stages and led by a working group of neurological experts (n = 3). Data collection methods included informal discussions with clinicians and an online survey (n = 35). The staged process included reflection on why the first attempt did not improve the provision of mCIMT (stage 1), mapping barriers and enablers to the Theoretical Domains Framework (TDF) and behaviour change wheel (BCW) to guide the behaviour change techniques (stages 2 and 3), developing a suitable mCIMT protocol (stage 4), and delivering the behaviour change intervention (stage 5). RESULTS Reflection among the working group identified the need for upskilling in mCIMT delivery and the use of a behaviour change framework to guide the implementation program. Key determinants of behaviour change operated within the TDF domains of knowledge, skills, environmental context and resources, social role and identity, and social influences. Following the development of a context-specific mCIMT protocol, the BCW guided the behaviour change intervention, which included education, training, persuasion, environmental restructuring, and modelling. CONCLUSION This paper provides an example of using the TDF and BCW to support the implementation of mCIMT in a large early-supported discharge service. It outlines the suite of behaviour change techniques used to influence clinician behaviour. The success of this behaviour change intervention will be explored in future research.
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Affiliation(s)
- Ashan Weerakkody
- Rehabilitation in the Home, South Metropolitan Health Service, Department of Health, Fremantle, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Robyn Emmanuel
- Rehabilitation in the Home, South Metropolitan Health Service, Department of Health, Fremantle, Australia
- Neurotherapy Occupational Therapy Services, Perth, Australia
| | - Jocelyn White
- Rehabilitation in the Home, South Metropolitan Health Service, Department of Health, Fremantle, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
- Sir Charles Gairdner Hospital, North Metropolitan Health Service, Department of Health, Nedlands, Australia
| | - Barby Singer
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
- TRAining Centre in Subacute Care (TRACSWA), Department of Health, Fremantle, Australia
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17
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Mena S, Moullin JC, Schneider M, Niquille A. Implementation of interprofessional quality circles on deprescribing in Swiss nursing homes: an observational study. BMC Geriatr 2023; 23:620. [PMID: 37789286 PMCID: PMC10548671 DOI: 10.1186/s12877-023-04335-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Polypharmacy and potentially inappropriate medications (PIMs) are still frequent among older adults in nursing homes. Deprescribing is an intervention that has been shown to be effective in reducing their use. However, the implementation of deprescribing in clinical practice has not yet been widely evaluated. The Quality Circle Deprescribing Module (QC-DeMo) intervention has been trialled through an effectiveness-implementation hybrid type 2 design. The intervention consists of a quality circle workshop session between healthcare professionals HCPs (physicians, nurses, and pharmacists) within a nursing home, in which they define a consensus to deprescribe specific PIMs classes. The aim of this study was to evaluate the implementation of the QC-DeMo intervention in nursing homes. METHODS This observational study focuses on the implementation part of the QC-DeMo trial. Implementation was based on the Framework for Implementation of Pharmacy Services (FISpH). Questionnaires at baseline and follow-up were used to evaluate reach, adoption, implementation effectiveness, fidelity, implementation, maintenance and the implementation strategies. Other data were collected from the QC-DeMo trial and routine data collected as part of the integrated pharmacy service where the QC-Demo trial was embedded. Implementation strategies included training of pharmacists, integration of the intervention into an existing quality circle dynamic and definition of tailored strategies to operationalise the consensus by each nursing home. RESULTS The QC-DeMo intervention was successfully implemented in 26 nursing homes in terms of reach, fidelity, adoption, implementation and implementation effectiveness. However, the intervention was found to be implemented with low maintenance as none of the nursing homes repeated the intervention after the trial. Implementation strategies were well received by HCPs: training was adequate according to pharmacists. Pre-existing quality circle dynamic facilitated interprofessional collaboration as involvement and support of each HCP was rated as high. HCPs recognized a specific and important role for each HCP in the deprescribing process. The most relevant tailored strategies to implement the consensus defined by each nursing home were identification of the patients by the pharmacist and a systematic review of medication's patients. CONCLUSIONS The implementation of a Quality Circle on Deprescribing is feasible but its maintenance in practice remains challenging. This study explores multiple implementation outcomes to better inform future implementation efforts of these types of interventions. TRIAL REGISTRATION ClinicalTrials.gov ( NCT03688542 ), registered on 26.09.2018.
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Affiliation(s)
- Stephanie Mena
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland.
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland.
| | - Joanna C Moullin
- Faculty of Health Sciences, Curtin University, Curtin School of Population Health, Perth, Australia
| | - Marie Schneider
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Anne Niquille
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
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18
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Fakha A, de Boer B, Hamers JP, Verbeek H, van Achterberg T. Systematic development of a set of implementation strategies for transitional care innovations in long-term care. Implement Sci Commun 2023; 4:103. [PMID: 37641112 PMCID: PMC10463528 DOI: 10.1186/s43058-023-00487-3] [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: 02/06/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Numerous transitional care innovations (TCIs) are being developed and implemented to optimize care continuity for older persons when transferring between multiple care settings, help meet their care needs, and ultimately improve their quality of life. Although the implementation of TCIs is influenced by contextual factors, the use of effective implementation strategies is largely lacking. Thus, to improve the implementation of TCIs targeting older persons receiving long-term care services, we systematically developed a set of viable strategies selected to address the influencing factors. METHODS As part of the TRANS-SENIOR research network, a stepwise approach following Implementation Mapping (steps 1 to 3) was applied to select implementation strategies. Building on the findings of previous studies, existing TCIs and factors influencing their implementation were identified. A combination of four taxonomies and overviews of change methods as well as relevant evidence on their effectiveness were used to select the implementation strategies targeting each of the relevant factors. Subsequently, individual consultations with scientific experts were performed for further validation of the process of mapping strategies to implementation factors and for capturing alternative ideas on relevant implementation strategies. RESULTS Twenty TCIs were identified and 12 influencing factors (mapped to the Consolidated Framework for Implementation Research) were designated as priority factors to be addressed with implementation strategies. A total of 40 strategies were selected. The majority of these target factors at the organizational level, e.g., by using structural redesign, public commitment, changing staffing models, conducting local consensus discussions, and organizational diagnosis and feedback. Strategies at the level of individuals included active learning, belief selection, and guided practice. Each strategy was operationalized into practical applications. CONCLUSIONS This project developed a set of theory and evidence-based implementation strategies to address the influencing factors, along further tailoring for each context, and enhance the implementation of TCIs in daily practice settings. Such work is critical to advance the use of implementation science methods to implement innovations in long-term care successfully.
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Affiliation(s)
- Amal Fakha
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands.
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands.
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium.
| | - Bram de Boer
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Jan P Hamers
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Theo van Achterberg
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
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19
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Ayre J, Zhang M, Mouwad D, Zachariah D, McCaffery KJ, Muscat DM. Systematic review of health literacy champions: who, what and how? Health Promot Int 2023; 38:daad074. [PMID: 37470429 PMCID: PMC10357937 DOI: 10.1093/heapro/daad074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
Health literacy is an important aspect of equitable, safe, and high-quality care. For organizations implementing health literacy initiatives, using 'change champions' appears to be a promising strategy. This systematic review aimed to identify the empirical and conceptual research that exists about health literacy champions. We conducted the systematic literature search using MEDLINE, Embase, CINAHL, Scopus, and PubMed, with additional studies identified by searching references and citations of included studies and reviews of organizational health literacy. Seventeen articles were included in the final review (case studies, n = 9; qualitative research, n = 4; quasi-experimental, n = 2; opinion articles without case studies, n = 2). Using JBI critical appraisal tools, most articles had a high risk of bias. Often champions were not the focus of the article. Champions included staff across frontline, management, and executive levels. Only five studies described training for champions. Key champion activities related to either (i) increasing organizational awareness and commitment to health literacy, or (ii) influencing organizational strategic and operational planning. The most common output was ensuring that the organization's health information materials met health literacy guidelines. Articles recommended engaging multiple champions at varying levels within the organization, including the executive level. Limited funding and resources were key barriers. Two of four articles reported positive impacts of champions on implementation of health literacy initiatives. Overall, few of the articles described health literacy champions in adequate detail. More comprehensive reporting on this implementation strategy and further experimental and process evaluation research are needed to progress this area of research. This systematic review was registered with PROSPERO (CRD42022348816).
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Affiliation(s)
- Julie Ayre
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Literacy Lab, Sydney, NSW, Australia
| | - Michael Zhang
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Literacy Lab, Sydney, NSW, Australia
| | - Dana Mouwad
- Health Literacy Hub, Western Sydney Local Health District, Sydney, NSW, Australia
| | - Dipti Zachariah
- Multicultural Health, Western Sydney Local Health District, Sydney, NSW, Australia
| | - Kirsten J McCaffery
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Literacy Lab, Sydney, NSW, Australia
| | - Danielle M Muscat
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Literacy Lab, Sydney, NSW, Australia
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20
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Lau EY, Small SS, Butcher K, Cragg A, Loh GW, Shalansky S, Hohl CM. An external facilitation intervention to increase uptake of an adverse drug event reporting intervention. FRONTIERS IN HEALTH SERVICES 2023; 3:1106586. [PMID: 37332530 PMCID: PMC10272762 DOI: 10.3389/frhs.2023.1106586] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/09/2023] [Indexed: 06/20/2023]
Abstract
Background Adverse drug events (ADEs) are a leading cause of emergency department visits and hospital admissions in Canada. ActionADE prevents repeat ADEs by enabling clinicians to document and communicate standardized ADE information across care settings. We used an external facilitation intervention to promote the uptake of ActionADE in four hospitals in British Columbia, Canada. This study examined whether, how and in what context external facilitation influenced the uptake of ActionADE. Methods In this convergent-parallel mixed-methods study, an external facilitator used a four-step iterative process to support site champions using context-specific implementation strategies to increase the ADE reporting rate at their sites. We extracted archival data to assess implementation determinants before and after the implementation of the external facilitation and implementation strategies. We also retrieved data on the mean monthly counts of reported ADEs for each user from the ActionADE server. Zero-inflated Poisson models were used to examine changes in mean monthly counts of reported ADEs per user between pre-intervention (June 2021 to October 2021) and intervention (November 2021 to March 2022) periods. Results The external facilitator and site champions co-created three functions: (1) educate pharmacists about what and how to report in ActionADE, (2) educate pharmacists about the impact of ActionADE on patient outcomes, and (3) provide social support for pharmacists to integrate ADE reporting into clinical workflows. Site champions used eight forms to address the three functions. Peer support and reporting competition were the two common strategies used by all sites. Sites' responses to external facilitation varied. The rate of mean monthly counts of reported ADEs per user significantly increased during the intervention period compared to the pre-intervention period at LGH (RR: 3.74, 95% CI 2.78 to 5.01) and RH (RR: 1.43, 95% CI 1.23 to 1.94), but did not change at SPH (RR: 0.68, 95% CI: 0.43 to 1.09) and VGH (RR: 1.17, 95% CI 0.92 to 1.49). Leave of absence of the clinical pharmacist champion and failure to address all identified functions were implementation determinants that influenced the effectiveness of external facilitation. Conclusion External facilitation effectively supported researchers and stakeholders to co-create context-specific implementation strategies. It increased ADE reporting at sites where clinical pharmacist champions were available, and where all functions were addressed.
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Affiliation(s)
- Erica Y. Lau
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health Research Centre, Centre for Clinical Epidemiology andEvaluation, Vancouver, BC, Canada
| | - Serena S. Small
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health Research Centre, Centre for Clinical Epidemiology andEvaluation, Vancouver, BC, Canada
| | - Kate Butcher
- Vancouver Coastal Health Research Centre, Centre for Clinical Epidemiology andEvaluation, Vancouver, BC, Canada
- Pharmaceutical Science, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Amber Cragg
- Vancouver Coastal Health Research Centre, Centre for Clinical Epidemiology andEvaluation, Vancouver, BC, Canada
| | - Gabriel W. Loh
- Richmond Hospital Pharmacy Department, Lower Mainland Pharmacy Services, Richmond, BC, Canada
| | - Steve Shalansky
- Pharmacy Department, St. Paul’s Hospital, Providence Health Care, Vancouver, BC, Canada
| | - Corinne M. Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health Research Centre, Centre for Clinical Epidemiology andEvaluation, Vancouver, BC, Canada
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21
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Wine O, McNeil D, Kromm SK, Foss K, Caine V, Clarke D, Day N, Johnson DW, Rittenbach K, Wood S, Hicks M. The Alberta Neonatal Abstinence Syndrome Mother-Baby Care ImprovEmeNT (NASCENT) program: protocol for a stepped wedge cluster randomized trial of a hospital-level Neonatal Abstinence Syndrome rooming-in intervention. BMC Health Serv Res 2023; 23:448. [PMID: 37149626 PMCID: PMC10164330 DOI: 10.1186/s12913-023-09440-5] [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: 03/24/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Neonatal Abstinence Syndrome (NAS), a problem common in newborns exposed to substances in-utero, is an emerging health concern. In traditional models of care, infants with NAS are routinely separated from their mothers and admitted to the Neonatal Intensive Care Unit (NICU) with long, expensive length of stay (LOS). Research shows a rooming-in approach (keeping mothers and infants together in hospital) with referral support is a safe and effective model of care in managing NAS. The model's key components are facilitating 24-h care by mothers on post-partum or pediatric units with support for breastfeeding, transition home, and access to Opioid Dependency Programs (ODP). This study will implement the rooming-in approach at eight hospitals across one Canadian Province; support practice and culture shift; identify and test the essential elements for effective implementation; and assess the implementation's impact/outcomes. METHODS A stepped wedge cluster randomized trial will be used to evaluate the implementation of an evidence-based rooming-in approach in the postpartum period for infants born to mothers who report opioid use during pregnancy. Baseline data will be collected and compared to post-implementation data. Six-month assessment of maternal and child health and an economic evaluation of cost savings will be conducted. Additionally, barriers and facilitators of the rooming-in model of care within the unique context of each site and across sites will be explored pre-, during, and post-implementation using theory-informed surveys, interviews, and focus groups with care teams and parents. A formative evaluation will examine the complex contextual factors and conditions that influence readiness and sustainability and inform the design of tailored interventions to facilitate capacity building for effective implementation. DISCUSSION The primary expected outcome is reduced NICU LOS. Secondary expected outcomes include decreased rates of pharmacological management of NAS and child apprehension, increased maternal ODP participation, and improved 6-month outcomes for mothers and infants. Moreover, the NASCENT program will generate the detailed, multi-site evidence needed to accelerate the uptake, scale, and spread of this evidence-based intervention throughout Alberta, leading to more appropriate and effective care and use of healthcare resources. TRIAL REGISTRATION ClinicalTrials.gov, NCT0522662. Registered February 4th, 2022.
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Affiliation(s)
- Osnat Wine
- Department of Pediatrics, Division of Neonatal-Perinatal Care, College of Health Sciences, Faculty of Medicine & Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Ave., Edmonton, AB, T6G 1C9, Canada
- Maternal Newborn Child & Youth Strategic Clinical Network, Alberta Health Services, Calgary, Canada
| | - Deborah McNeil
- Maternal Newborn Child & Youth Strategic Clinical Network, Alberta Health Services, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Seija K Kromm
- Maternal Newborn Child & Youth Strategic Clinical Network, Alberta Health Services, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karen Foss
- Stollery, Edmonton, Alberta Health Services, Edmonton, AB, Canada
| | - Vera Caine
- University of Victoria, Victoria, BC, Canada
| | - Denise Clarke
- Stollery, Edmonton, Alberta Health Services, Edmonton, AB, Canada
| | | | - David W Johnson
- Departments of Pediatrics, Emergency Medicine and Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Stephen Wood
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Matt Hicks
- Department of Pediatrics, Division of Neonatal-Perinatal Care, College of Health Sciences, Faculty of Medicine & Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Ave., Edmonton, AB, T6G 1C9, Canada.
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22
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Freedman DE, Waddell AE, Bourdon A, Lam HT, Wang K. Educating Mental Health Trainees About Measurement-Based Care: A Scoping Review. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:187-195. [PMID: 36829099 DOI: 10.1007/s40596-023-01749-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Measurement-based care (MBC) refers to the routine use of symptom rating scales to guide treatment decisions. Although effective, it is an underused approach to enhance patient care. A significant barrier to integration of MBC is insubstantial foundational training. This scoping review aims to survey the literature on MBC educational curricula for mental health trainees. METHODS Investigators searched Ovid Medline, PsycINFO, Embase, Cochrane Central, and Ebsco CINAHL through June 2021 to select records that described studies of MBC educational programs for undergraduate, graduate, or postgraduate learners in mental healthcare. RESULTS From 1270 unique records, 1263 were excluded in abstract/title and full-text screening. This scoping review included seven articles, of which most were empirical or case studies and took place in the USA. These curricula involved many delivery formats, including lectures and in-service training. Measured learner outcomes include those that are learner-focused (i.e. learner reaction, or attitudinal/behavioral change) and organizational-focused (i.e. increased clinical use of MBC). Mechanisms of positive outcomes are posited to include enhanced stakeholder support and continual curriculum improvement. CONCLUSIONS MBC curricula can be taught in various formats to diverse learners in mental healthcare. Contextual factors, such as dedicated resources, MBC champions, supervisor training, online measurement feedback systems, simple measures, and gathering and disseminating feedback may facilitate curricular success by fostering stakeholder support and continual program improvement. To address literature gaps, future research in MBC education should involve educational frameworks in designing curriculum and address the use of quality improvement approaches in the implementation of MBC education.
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Affiliation(s)
- David E Freedman
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Andrea E Waddell
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alexander Bourdon
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Karen Wang
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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23
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Luna-Aleixos D, Llagostera-Reverter I, Castelló-Benavent X, Aquilué-Ballarín M, Mecho-Montoliu G, Cervera-Gasch Á, Valero-Chillerón MJ, Mena-Tudela D, Andreu-Pejó L, Martínez-Gonzálbez R, González-Chordá VM. Development and Validation of a Meta-Instrument for the Assessment of Functional Capacity, the Risk of Falls and Pressure Injuries in Adult Hospitalization Units (VALENF Instrument) (Part II). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5003. [PMID: 36981915 PMCID: PMC10049057 DOI: 10.3390/ijerph20065003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
The nursing assessment is the first step of the nursing process and fundamental to detecting patients' care needs and at-risk situations. This article presents the psychometric properties of the VALENF Instrument, a recently developed meta-instrument with only seven items that integrates the assessment of functional capacity, risk of pressure injuries and risk of falls with a more parsimonious approach to nursing assessment in adult hospitalization units. A cross-sectional study based on recorded data in a sample of 1352 nursing assessments was conducted. Sociodemographic variables and assessments of the Barthel, Braden and Downton instruments were included at the time of admission through the electronic health history. Thus, the VALENF Instrument obtained high content validity (S-CVI = 0.961), construct validity (RMSEA = 0.072; TLI = 0.968) and internal consistency (Ω = 0.864). However, the inter-observer reliability results were not conclusive, with Kappa values ranging between 0.213 and 0.902 points. The VALENF Instrument has adequate psychometric properties (content validity, construct validity, internal consistency and inter-observer reliability) for assessing the level of functional capacity, risk of pressure injuries and risk of falls. Future studies are necessary to establish its diagnostic accuracy.
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Affiliation(s)
- David Luna-Aleixos
- Hospital Universitario de La Plana, Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
| | - Irene Llagostera-Reverter
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
| | | | - Marta Aquilué-Ballarín
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
- Hospital Comarcal Universitario de Vinarós, Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
| | | | - Águeda Cervera-Gasch
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
| | - María Jesús Valero-Chillerón
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
| | - Desirée Mena-Tudela
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
| | - Laura Andreu-Pejó
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
| | | | - Víctor M. González-Chordá
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
- Nursing and Healthcare Research Unit (INVESTÉN-ISCIII), Institute of Health Carlos III, 28029 Madrid, Spain
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24
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Parchman ML, Perloff J, Ritter G. Can clinician champions reduce potentially inappropriate medications in people living with dementia? Study protocol for a cluster randomized trial. Implement Sci 2022; 17:63. [PMID: 36163181 PMCID: PMC9513870 DOI: 10.1186/s13012-022-01237-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For people living with dementia (PLWD) the overuse of potentially inappropriate medications (PIMs) remains a persistent problem. De-prescribing trials in the elderly have mixed results. Clinician champions may be uniquely suited to lead efforts to address this challenge. Here we describe the study protocol for a 24-month embedded pragmatic cluster-randomized clinical trial within two accountable care organizations (ACOs) of such a clinician champion intervention. The specific aims are to (1) assess the effectiveness of a clinician champion on de-implementing PIMs in PLWD, (2) determine if the intervention is associated with a reduction in emergency department (ED) visits and hospitalizations attributed to a fall, and (3) examine five implementation outcomes: appropriateness, feasibility, fidelity, penetration, and equity. METHODS/DESIGN Two ACOs agreed to participate: United States Medical Management (USMM) and Oschner Health System. The unit of randomization will be the primary care clinic. A clinician champion will be recruited from each of the intervention clinics to participate in a 6-month training program and then work with clinicians and staff in their clinic for 12 months to reduce the use of PIMs in their PLWD population. For aims 1 and 2, Medicare claims data will be used to assess outcomes. The outcome for aim #1 will be medication possession rates per quarter, for the three therapeutic classes of PIMs among patients with dementia in intervention clinics versus control clinics. For aim #2, we will assess the incidence of falls using a previously validated algorithm. For both aims 1 and 2, we will construct hierarchical models with time period observations nested within patient using generalized estimating equations (GEE) with robust standard errors. The key variable of interest will be the treatment indicator assigned based on practice. For aim #3, we will conduct qualitative thematic analysis of documentation by the clinician champions in their project workbooks to evaluate the five implementation outcomes. DISCUSSION This embedded pragmatic trial will add to our existing knowledge regarding the effectiveness of a clinician champion strategy to de-prescribe potentially inappropriate medication among patients with dementia as well as its appropriateness, feasibility, fidelity, penetration, and equity. TRIAL REGISTRATION Clinicaltrials.gov NCT05359679 , Registered May 4, 2022.
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Affiliation(s)
- Michael L Parchman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
| | - Jennifer Perloff
- Brandeis University, Waltham, MA, USA
- Institute for Accountable Care, Washington, DC, USA
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