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Hudon C, Chouinard MC, Doucet S, Piccinini-Vallis H, Fairman K, Sampalli T, Zed J, Brodeur M, Chênevert D, Dépelteau A, Dupont M, Karam M, Légaré F, Luke A, Macdonald M, Morvannou A, Ramsden VR, Rodriguez Del Barrio L, Wong ST, Lambert M, Bisson M, Schwarz C, Benoit R, Poirier MD, Rock-Hervieux AL, Rubenstein D, Wilhelm L. Case management in primary healthcare for people with complex needs to improve integrated care: a large-scale implementation study protocol. BMJ Open 2024; 14:e083783. [PMID: 39134438 PMCID: PMC11331999 DOI: 10.1136/bmjopen-2023-083783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 07/15/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION Case management (CM) is among the most studied effective models of integrated care for people with complex needs. The goal of this study is to scale up and assess CM in primary healthcare for people with complex needs. METHODS AND ANALYSIS The research questions are: (1) which mechanisms contribute to the successful scale-up of CM for people with complex needs in primary healthcare?; (2) how do contextual factors within primary healthcare organisations contribute to these mechanisms? and (3) what are the relationships between the actors, contextual factors, mechanisms and outcomes when scaling-up CM for people with complex needs in primary healthcare? We will conduct a mixed methods Canadian interprovincial project in Quebec, New-Brunswick and Nova Scotia. It will include a scale-up phase and an evaluation phase. At inception, a scale-up committee will be formed in each province to oversee the scale-up phase. We will assess scale-up using a realist evaluation guided by the RAMESES checklist to develop an initial programme theory on CM scale-up. Then we will test and refine the programme theory using a mixed-methods multiple case study with 10 cases, each case being the scalable unit of the intervention in a region. Each primary care clinic within the case will recruit 30 adult patients with complex needs who frequently use healthcare services. Qualitative data will be used to identify contexts, mechanisms and certain outcomes for developing context-mechanism-outcome configurations. Quantitative data will be used to describe patient characteristics and measure scale-up outcomes. ETHICS AND DISSEMINATION Ethics approval was obtained. Engaging researchers, decision-makers, clinicians and patient partners on the study Steering Committee will foster knowledge mobilisation and impact. The dissemination plan will be developed with the Steering Committee with messages and dissemination methods targeted for each audience.
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Affiliation(s)
- Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | | | - Kimberly Fairman
- Institute for Circumpolar Health Research, Yellowknife, Northwest Territories, Canada
| | - Tara Sampalli
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Joanna Zed
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Magaly Brodeur
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Denis Chênevert
- Department of Human Resources Management, HEC Montreal, Montreal, Quebec, Canada
| | - Andréa Dépelteau
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mariève Dupont
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marlène Karam
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
| | - France Légaré
- Faculty of Medicine, Universite Laval, Quebec, Quebec, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Marilyn Macdonald
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Adele Morvannou
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Sabrina T Wong
- Centre for Health Services and Policy Research and School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mireille Lambert
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Charlotte Schwarz
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
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Berry J, Berry S, Chizema E, Fundafunda B, Hamer DH, Tembo S, Ramchandani R. Institutionalizing Innovation: From Pilot to Scale for Co-Packaged Oral Rehydration Salts and Zinc-A Case Study in Zambia. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300286. [PMID: 38242636 PMCID: PMC10906556 DOI: 10.9745/ghsp-d-23-00286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/06/2023] [Indexed: 01/21/2024]
Abstract
We document the development and institutionalization in Zambia of a health innovation for diarrhea treatment aimed at children aged younger than 5 years: a unique oral rehydration salts and zinc (ORSZ) co-pack. Seven recommendations from the World Health Organization/ExpandNet are used retrospectively to analyze and describe the successful scale-up of this innovation from its concept stage, including in-country expansion and policy, institutional, and regulatory changes. The 7 recommendations comprise using a participatory process, tailoring to the country context, designing research to test the innovation, testing the innovation, identifying success factors, and scaling up. The scale-up of co-packaged ORSZ in Zambia is shown to be sustainable. Five years after donor funding ended in 2018, an independent, local manufacturer continues to supply the private and public sectors on a commercially viable basis. Furthermore, national coverage of ORSZ increased from less than 1% in 2012 to 34% in 2018. A key success factor was the continuous facilitation over 8 years (spanning planning, trial, evaluation, and scale-up) by a learning and steering group chaired by the Ministry of Health, open to all and focused on learning transfer and ongoing alignment with other initiatives. Other success factors included a long lead-in of inclusive initial consultation, ideation, and planning with all key stakeholders to build on and mobilize existing resources, knowledge, structures, and systems; alignment with government policy; thorough testing and radical review of the product and its value chain before scale-up, including manufacture, distribution, policy, and regulatory matters; and adoption by the government of a co-packaging strategy to ensure cases of childhood diarrhea are treated with ORSZ. With appropriate local adaptations, this approach to scale-up could be replicated in other low- and middle-income countries as a strategy to increase coverage of ORSZ and potentially other health products.
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Affiliation(s)
| | | | - Elizabeth Chizema
- African Leaders Malaria Alliance, Zambia End Malaria Council; Formerly of Zambian Ministry of Health, Lusaka, Zambia
| | - Bonface Fundafunda
- Africa Resource Centre; Formerly of Medical Stores Limited, Lusaka, Zambia
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | | | - Rohit Ramchandani
- ColaLife, London, United Kingdom.
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
- Balsillie School of International Affairs, Waterloo, Canada
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3
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daSilva M, Dissanayake M, Sibbald SL. Beyond implementation: A collective case study exploring the conceptions and facilitators of sustainability in a quality improvement collaborative. EVALUATION AND PROGRAM PLANNING 2024; 102:102384. [PMID: 37948901 DOI: 10.1016/j.evalprogplan.2023.102384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 07/27/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a primary cause of adult hospitalizations and imposes substantial burdens on patients and healthcare systems. Initiatives that support providers and patients in addressing needs at each stage of this illness are needed. The INSPIRED COPD Outreach Program™ was introduced in 2010 in Halifax, Nova Scotia, Canada to improve care for those with advanced COPD. The huge success of the program led to its expansion to various contexts and geographic locations through a pan-Canadian quality improvement collaborative (QIC). Our study explored early elements of program planning and practice with an aim to understand factors that influence program sustainability. We evaluated the implementation process of 19 teams across Canada; post-collaborative team reports, focus groups, interviews and self-ratings of progress were collected from all teams. Analysis of data revealed three phases important to fostering sustainability (facilitating implementation, keeping the momentum, and securing sustainability) and each phase had unique supporting themes. Not surprisingly, teams that planned for sustainability early in the implementation process were more likely to successfully achieve program sustainability. However, teams also benefited more broadly from sustainability planning; this included being better able to plan for program spread as well as skill retention and knowledge transfer. This was also seen for quality improvement skills introduced early in the program that were more likely to be maintained and used through other contexts when sustainability planning was present. This study highlights that a QIC can be effective in not only influencing program sustainability but also beyond program implementation through improving knowledge and skill acquisition.
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Affiliation(s)
- Madelyn daSilva
- Faculty of Health Sciences at Western University, 1151 Richmond St., London, Ontario N6A 3K7, Canada
| | - Melanie Dissanayake
- Faculty of Health Sciences at Western University, 1151 Richmond St., London, Ontario N6A 3K7, Canada
| | - Shannon L Sibbald
- Faculty of Health Sciences at Western University, 1151 Richmond St., London, Ontario N6A 3K7, Canada; Department of Family Medicine and the Schulich Interfaculty Program in Public Health at the Schulich School of Medicine and Dentistry, 1151 Richmond St., London, Ontario N6A 3K7, Canada.
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4
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Leeman J, Boisson A, Go V. Scaling Up Public Health Interventions: Engaging Partners Across Multiple Levels. Annu Rev Public Health 2021; 43:155-171. [PMID: 34724390 DOI: 10.1146/annurev-publhealth-052020-113438] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Advancing the science of intervention scale-up is essential to increasing the impact of effective interventions at the regional and national levels. In contrast with work in high-income countries (HICs), where scale-up research has been limited, researchers in low- and middle-income countries (LMICs) have conducted numerous studies on the regional and national scale-up of interventions. In this article, we review the state of the science on intervention scale-up in both HICs and LMICs. We provide an introduction to the elements of scale-up followed by a description of the scale-up process, with an illustrative case study from our own research. We then present findings from a scoping review comparing scale-up studies in LMIC and HIC settings. We conclude with lessons learned and recommendations for improving scale-up research. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Jennifer Leeman
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA;
| | - Alix Boisson
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA;
| | - Vivian Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA;
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Hourani D, Darling S, Cameron E, Dromey J, Crossley L, Kanagalingam S, Muscara F, Gwee A, Gell G, Hiscock H, Anderson V. What Makes for a Successful Digital Health Integrated Program of Work? Lessons Learnt and Recommendations From the Melbourne Children's Campus. Front Digit Health 2021; 3:661708. [PMID: 34713136 PMCID: PMC8521853 DOI: 10.3389/fdgth.2021.661708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Embedding digital technologies in healthcare has the potential to streamline and personalize medical care. However, healthcare systems are often fragmented, and therefore achieving a truly integrated digital health program can be challenging. To promote a streamlined, evidence-based approach to implementing digital health solutions in a healthcare system, the Murdoch Children's Research Institute (MCRI) established the Digital Health Translation and Implementation Program (DHTI) bringing together clinicians, researchers and digital health experts. From the program commencement, frontline clinical innovators have collaborated with DHTI team members to develop and implement digital solutions to address pain-points in the healthcare system. Throughout this program, important lessons have been learnt relating to the development, evaluation and implementation of digital solutions in the healthcare system. This paper explores these lessons and makes recommendations for the successful implementation of digital health solutions in healthcare systems under five main categories: (1) design and usability, (2) stakeholder engagement and uptake, (3) project management and resourcing, (4) process and implementation, and (5) evaluation. Recommendations suggested here are designed to support future healthcare-based digital health programs to maximize the impact digital solutions can have on the healthcare system and patients.
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Affiliation(s)
- Danah Hourani
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Simone Darling
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.,Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Eloise Cameron
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - James Dromey
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Louise Crossley
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | | | - Frank Muscara
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Amanda Gwee
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.,The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Grace Gell
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.,Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,The Royal Children's Hospital, Melbourne, VIC, Australia.,Health Services Research Unit, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.,The Royal Children's Hospital, Melbourne, VIC, Australia
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Tremblay D, Touati N, Bilodeau K, Prady C, Usher S, Leblanc Y. Risk-Stratified Pathways for Cancer Survivorship Care: Insights from a Deliberative Multi-Stakeholder Consultation. Curr Oncol 2021; 28:3408-3419. [PMID: 34590587 PMCID: PMC8482148 DOI: 10.3390/curroncol28050295] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 11/23/2022] Open
Abstract
Risk-stratified pathways of survivorship care seek to optimize coordination between cancer specialists and primary care physicians based on the whole person needs of the individual. While the principle is supported by leading cancer institutions, translating knowledge to practice confronts a lack of clarity about the meaning of risk stratification, uncertainties around the expectations the model holds for different actors, and health system structures that impede communication and coordination across the care continuum. These barriers must be better understood and addressed to pave the way for future implementation. Recognizing that an innovation is more likely to be adopted when user experience is incorporated into the planning process, a deliberative consultation was held as a preliminary step to developing a pilot project of risk-stratified pathways for patients transitioning from specialized oncology teams to primary care providers. This article presents findings from the deliberative consultation that sought to understand the perspectives of cancer specialists, primary care physicians, oncology nurses, allied professionals, cancer survivors and researchers regarding the following questions: what does a risk stratified model of cancer survivorship care mean to care providers and users? What are the prerequisites for translating risk stratification into practice? What challenges are involved in establishing these prerequisites? The multi-stakeholder consultation provides empirical data to guide actions that support the development of risk-stratified pathways to coordinate survivorship care.
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Affiliation(s)
- Dominique Tremblay
- Faculté de Médecine et des Sciences de la Santé, Campus de Longueuil-Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada; (C.P.); (S.U.)
- Centre de Recherche Hôpital Charles-Le Moyne, Centre Intégré de Santé et de Services Sociaux de la Montérégie-Centre, Longueuil, QC J4K 0A8, Canada;
- Correspondence: ; Tel.: +1-450-466-5000 (ext. 2885)
| | - Nassera Touati
- École Nationale d’Administration Publique, 4750 Henri-Julien Avenue, Montréal, QC H2T 3E5, Canada;
| | - Karine Bilodeau
- Faculté des Sciences Infirmières et Centre D’Innovation en Formation Infirmière, Université de Montréal, Montréal, QC H3T 1A8, Canada;
| | - Catherine Prady
- Faculté de Médecine et des Sciences de la Santé, Campus de Longueuil-Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada; (C.P.); (S.U.)
- Centre de Recherche Hôpital Charles-Le Moyne, Centre Intégré de Santé et de Services Sociaux de la Montérégie-Centre, Longueuil, QC J4K 0A8, Canada;
- Centre Intégré de Cancérologie de la Montérégie, 3120 Boulevard Taschereau, Greenfield Park, QC J4V 2H1, Canada
| | - Susan Usher
- Faculté de Médecine et des Sciences de la Santé, Campus de Longueuil-Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada; (C.P.); (S.U.)
- École Nationale d’Administration Publique, 4750 Henri-Julien Avenue, Montréal, QC H2T 3E5, Canada;
| | - Yves Leblanc
- Centre de Recherche Hôpital Charles-Le Moyne, Centre Intégré de Santé et de Services Sociaux de la Montérégie-Centre, Longueuil, QC J4K 0A8, Canada;
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7
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Saka AK, Ferenbok J. Improving the Uptake of Transcatheter Aortic Valve Replacement in Ontario. Cureus 2021; 13:e16364. [PMID: 34395141 PMCID: PMC8360318 DOI: 10.7759/cureus.16364] [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: 07/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background The rising costs of healthcare delivery globally and the increasing research production rate create immense opportunities for implementing novel and more effective medical interventions that significantly benefit patient outcomes. However, the successful uptake of medical innovations is complex and often extremely contextual based on many sociopolitical and economic factors. These barriers to implementation can delay or derail new practices, procedures, products, and pharmaceuticals. Understanding the barriers to the successful implementation of medical innovations and the best practices and strategies to mitigate them is an extremely important area for translational research in health sciences. This study examines the barriers and potential challenges in implementing medical innovations and the possible preemptive measures that can be addressed early to increase the use of life-saving medical innovations. We consider the importance of appropriate, timely, and user-defined implementation techniques as a critical component of the successful uptake of medical innovations and use the uptake of transcatheter valve replacement therapy (TAVR), which is an alternative life-saving intervention for patients at risk for surgical complications, in Ontario, Canada as the practical case study of the challenges and potential instructive opportunities to establish best practices for systematic and effective innovation uptake. Methodology In addition to contextual and informal investigations, a small pilot survey of decision-makers across the University of Toronto-affiliated teaching hospitals helped compare and contrast the barriers to medical innovation uptake (in the literature) with the suggested barriers to the successful implementation of TAVR. This study looks primarily at the role of funding, physician preference, clinical guidelines, and patient comorbidities as decision-making factors contributing to TAVR uptake. The study also explores how the differences and similarities of TAVR uptake related to the decision-making factors above can help develop recommended strategies to address future implementation barriers. Results We observed that the decision-makers across the surveyed institutions refer patients with intermediate to high risk for surgery for TAVR. Funding and physician preference were identified as possible barriers to TAVR uptake, with underlying comorbidities of patients being a primary decision determinant for TAVR referral. Physician preferences were based on multiple factors such as clinical judgment, patient comorbidities, clinical guidelines, knowledge, TAVR, and surgical valve replacement skills. Conclusions To the best of our knowledge, this study is one of the first to use the Toronto Translational Thinking Framework to assess an innovative treatment uptake in the Ontario healthcare system. Although the study sample size was 11 and did not reflect the views of all decision-makers regarding TAVR use in Ontario, the survey reflected participants who directly make decisions regarding TAVR use, strengthening the credibility of the survey results. The insights from this study are intended to inform both the continued implementation of TAVR and to contribute to a broader field of investigation that aims to identify and operationalize the principles and best practices of translational research that may contribute to the efficacy of implementing other medical innovations in Ontario hospitals and beyond.
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Affiliation(s)
- Abimbola K Saka
- Institute of Medical Science, University of Toronto, Toronto, CAN
| | - Joseph Ferenbok
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, CAN
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8
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Rissanen M. Translational health technology and system schemes: enhancing the dynamics of health informatics. Health Inf Sci Syst 2020; 8:39. [PMID: 33194173 PMCID: PMC7652954 DOI: 10.1007/s13755-020-00133-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/31/2020] [Indexed: 11/17/2022] Open
Abstract
Translational health technology and design schemes reflect certain themes in systems approach and its dynamics. This paper discusses these aligned ideas in view of their value to translational design processes. The ideas embedded in these two approaches are considered in the light of critical questions associated with the development of health informatics. Health care processes for patients might be very fragmented. Synergy thinking is required in all areas of design: it is crucial to understand the theoretical frames and issues associated with focus environments, administration, and cost policy. By internalizing common nuances in these approaches, designers can ease the interaction and communication between experts from different backgrounds. Synergistic thinking aids designers in health informatics to produce more sophisticated products. Maturing in recognizing the whole aids to take into account “the very essentials” more easily. These skills are very vital in prioritizing development substances in health informatics area.
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9
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Kueper JK, Terry AL, Zwarenstein M, Lizotte DJ. Artificial Intelligence and Primary Care Research: A Scoping Review. Ann Fam Med 2020; 18:250-258. [PMID: 32393561 PMCID: PMC7213996 DOI: 10.1370/afm.2518] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/11/2019] [Accepted: 11/21/2019] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Rapid increases in technology and data motivate the application of artificial intelligence (AI) to primary care, but no comprehensive review exists to guide these efforts. Our objective was to assess the nature and extent of the body of research on AI for primary care. METHODS We performed a scoping review, searching 11 published or gray literature databases with terms pertaining to AI (eg, machine learning, bayes* network) and primary care (eg, general pract*, nurse). We performed title and abstract and then full-text screening using Covidence. Studies had to involve research, include both AI and primary care, and be published in Eng-lish. We extracted data and summarized studies by 7 attributes: purpose(s); author appointment(s); primary care function(s); intended end user(s); health condition(s); geographic location of data source; and AI subfield(s). RESULTS Of 5,515 unique documents, 405 met eligibility criteria. The body of research focused on developing or modifying AI methods (66.7%) to support physician diagnostic or treatment recommendations (36.5% and 13.8%), for chronic conditions, using data from higher-income countries. Few studies (14.1%) had even a single author with a primary care appointment. The predominant AI subfields were supervised machine learning (40.0%) and expert systems (22.2%). CONCLUSIONS Research on AI for primary care is at an early stage of maturity. For the field to progress, more interdisciplinary research teams with end-user engagement and evaluation studies are needed.
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Affiliation(s)
- Jacqueline K Kueper
- Departments of Epidemiology & Biostatistics and Computer Science, Western University, London, Ontario, Canada
| | - Amanda L Terry
- Departments of Epidemiology & Biostatistics, Family Medicine, Schulich Interfaculty Program in Public Health, Western University, London, Ontario, Canada
| | - Merrick Zwarenstein
- Departments of Epidemiology & Biostatistics and Family Medicine, Western University, London, Ontario, Canada
| | - Daniel J Lizotte
- Departments of Epidemiology & Biostatistics, Computer Science, Schulich Interfaculty Program in Public Health, Statistical & Actuarial Sciences, Western University, London, Ontario, Canada
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10
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Zomahoun HTV, Ben Charif A, Freitas A, Garvelink MM, Menear M, Dugas M, Adekpedjou R, Légaré F. The pitfalls of scaling up evidence-based interventions in health. Glob Health Action 2020; 12:1670449. [PMID: 31575331 PMCID: PMC6781190 DOI: 10.1080/16549716.2019.1670449] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Policy-makers worldwide are increasingly interested in scaling up evidence-based interventions (EBIs) to larger populations, and implementation scientists are developing frameworks and methodologies for achieving this. But scaling-up does not always produce the desired results. Why not? We aimed to enhance awareness of the various pitfalls to be anticipated when planning scale-up. In lower- and middle-income countries (LMICs), the scale-up of health programs to prevent or respond to outbreaks of communicable diseases has been occurring for many decades. In high-income countries, there is new interest in the scaling up of interventions that address communicable and non-communicable diseases alike. We scanned the literature worldwide on problems encountered when implementing scale-up plans revealed a number of potential pitfalls that we discuss in this paper. We identified and discussed the following six major pitfalls of scaling-up EBIs: 1) the cost-effectiveness estimation pitfall, i.e. accurate cost-effectiveness estimates about real-world implementation are almost impossible, making predictions of economies of scale unreliable; 2) the health inequities pitfall, i.e. some people will necessarily be left out and therefore not benefit from the scaled-up EBIs; 3) the scaled-up harm pitfall, i.e. the harms as well as the benefits may be amplified by the scaling-up; 4) the ethical pitfall, i.e. informed consent may be a challenge on a grander scale; 5) the top-down pitfall, i.e. the needs, preferences and culture of end-users may be forgotten when scale-up is directed from above; and 6) the contextual pitfall, i.e. it may not be possible to adapt the EBIs to every context. If its pitfalls are addressed head on, scaling-up may be a powerful process for translating research data into practical improvements in healthcare in both LMICs and high-income countries, ensuring that more people benefit from EBIs.
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Affiliation(s)
- Hervé Tchala Vignon Zomahoun
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval , Quebec , QC , Canada.,Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada
| | - Ali Ben Charif
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval , Quebec , QC , Canada.,Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval , Quebec , QC , Canada.,Department of Family Medicine and Emergency Medicine, Université Laval , Quebec , QC , Canada
| | - Adriana Freitas
- Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval , Quebec , QC , Canada
| | - Mirjam Marjolein Garvelink
- Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada
| | - Matthew Menear
- Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval , Quebec , QC , Canada.,Department of Family Medicine and Emergency Medicine, Université Laval , Quebec , QC , Canada
| | - Michèle Dugas
- Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada
| | - Rhéda Adekpedjou
- Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval , Quebec , QC , Canada
| | - France Légaré
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval , Quebec , QC , Canada.,Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval , Quebec , QC , Canada.,Department of Family Medicine and Emergency Medicine, Université Laval , Quebec , QC , Canada.,Population Health and Practice-Changing Research Group, CHU de Québec Research Centre , Quebec , QC , Canada
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11
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Desveaux L, Soobiah C, Bhatia RS, Shaw J. Identifying and Overcoming Policy-Level Barriers to the Implementation of Digital Health Innovation: Qualitative Study. J Med Internet Res 2019; 21:e14994. [PMID: 31859679 PMCID: PMC6942191 DOI: 10.2196/14994] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/08/2019] [Accepted: 10/22/2019] [Indexed: 12/31/2022] Open
Abstract
Background High-level policy barriers impede widespread adoption for even the most well-positioned innovations. Most of the work in this field assumes rather than analyzes the driving forces of health innovation. Objective: The aim of this study was to explore the challenges and opportunities experienced by health system stakeholders in the implementation of digital health innovation in Ontario. Objective The aim of this study was to explore the challenges and opportunities experienced by health system stakeholders in the implementation of digital health innovation in Ontario. Methods We completed semistructured interviews with 10 members of senior leadership across key organizations that are engaged in health care–related digital health activities. Data were analyzed using qualitative description. Results A total of 6 key policy priorities emerged, including the need for (1) a system-level definition of innovation, (2) a clear overarching mission, and (3) clearly defined organizational roles. Operationally, there is a need to (4) standardize processes, (5) shift the emphasis to change management, and (6) align funding structures. Conclusions These findings emphasize the critical role of the government in developing a vision and creating the foundation upon which innovation activities will be modeled.
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Affiliation(s)
- Laura Desveaux
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Charlene Soobiah
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - R Sacha Bhatia
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - James Shaw
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
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12
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Côté-Boileau É, Denis JL, Callery B, Sabean M. The unpredictable journeys of spreading, sustaining and scaling healthcare innovations: a scoping review. Health Res Policy Syst 2019; 17:84. [PMID: 31519185 PMCID: PMC6744644 DOI: 10.1186/s12961-019-0482-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/01/2019] [Indexed: 11/20/2022] Open
Abstract
Innovation has the potential to improve the quality of care and health service delivery, but maximising the reach and impact of innovation to achieve large-scale health system transformation remains understudied. Interest is growing in three processes of the innovation journey within health systems, namely the spread, sustainability and scale-up (3S) of innovation. Recent reviews examine what we know about these processes. However, there is little research on how to support and operationalise the 3S. This study aims to improve our understanding of the 3S of healthcare innovations. We focus specifically on the definitions of the 3S, the mechanisms that underpin them, and the conditions that either enable or limit their potential. We conducted a scoping review, systematically investigating six bibliographic databases to search, screen and select relevant literature on the 3S of healthcare innovations. We screened 641 papers, then completed a full-text review of 112 identified as relevant based on title and abstract. A total of 24 papers were retained for analysis. Data were extracted and synthesised through descriptive and inductive thematic analysis. From this, we develop a framework of actionable guidance for health system actors aiming to leverage the 3S of innovation across five key areas of focus, as follows: (1) focus on the why, (2) focus on perceived-value and feasibility, (3) focus on what people do, rather than what they should be doing, (4) focus on creating a dialogue between policy and delivery, and (5) focus on inclusivity and capacity building. While there is no standardised approach to foster the 3S of healthcare innovations, a variety of practical frameworks and tools exist to support stakeholders along this journey.
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Affiliation(s)
- Élizabeth Côté-Boileau
- Health Sciences Research, Faculty of Medicine and Health Sciences, University of Sherbrooke, Quebec, Canada. .,Charles-Le Moyne - Saguenay-Lac-Saint-Jean Research Center on Health Innovations, Quebec, Canada. .,Doctoral Award Fellow from Quebec's Fonds de recherche du Québec - Santé (FRQS), Quebec, Canada. .,Health Standards Organization, Ottawa, Canada.
| | - Jean-Louis Denis
- Health Administration Department, School of Public Health, University of Montreal, Quebec, Canada.,University of Montreal Hospital Research Center, Quebec, Canada.,Canada Research Chair (Tier I) holder on Health system design and adaptation (Canadian Institutes of Health Research), Montreal, Canada
| | - Bill Callery
- Canadian Foundation for Healthcare Improvement, Corporate Strategy and Program Development, Ottawa, Canada
| | - Meghan Sabean
- Canadian Foundation for Healthcare Improvement, Corporate Strategy and Program Development, Ottawa, Canada
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13
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Hudon C, Chouinard MC, Aubrey-Bassler K, Burge F, Doucet S, Ramsden VR, Brodeur M, Bush PL, Couturier Y, Dubois MF, Guénette L, Légare F, Morin P, Poder TG, Poitras MÈ, Roberge P, Valaitis R, Bighead S, Campbell C, Couture M, Davis B, Deschenes É, Edwards L, Gander S, Gauthier G, Gauthier P, Gibson RJ, Godbout J, Landry G, Longjohn C, Rabbitskin N, Roy DA, Roy J, Sabourin V, Sampalli T, Saulnier A, Spence C, Splane J, Warren M, Young J, Pluye P. Case management in primary care for frequent users of healthcare services with chronic diseases and complex care needs: an implementation and realist evaluation protocol. BMJ Open 2018; 8:e026433. [PMID: 30478129 PMCID: PMC6254422 DOI: 10.1136/bmjopen-2018-026433] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Significant evidence in the literature supports case management (CM) as an effective intervention to improve care for patients with complex healthcare needs. However, there is still little evidence about the facilitators and barriers to CM implementation in primary care setting. The three specific objectives of this study are to: (1) identify the facilitators and barriers of CM implementation in primary care clinics across Canada; (2) explain and understand the relationships between the actors, contextual factors, mechanisms and outcomes of the CM intervention; (3) identify the next steps towards CM spread in primary care across Canada. METHODS AND ANALYSIS We will conduct a multiple-case embedded mixed methods study. CM will be implemented in 10 primary care clinics in five Canadian provinces. Three different units of analysis will be embedded to obtain an in-depth understanding of each case: the healthcare system (macro level), the CM intervention in the clinics (meso level) and the individual/patient (micro level). For each objective, the following strategy will be performed: (1) an implementation analysis, (2) a realist evaluation and (3) consensus building among stakeholders using the Technique for Research of Information by Animation of a Group of Experts method. ETHICS AND DISSEMINATION This study, which received ethics approval, will provide innovative knowledge about facilitators and barriers to implementation of CM in different primary care jurisdictions and will explain how and why different mechanisms operate in different contexts to generate different outcomes among frequent users. Consensual and prioritised statements about next steps for spread of CM in primary care from the perspectives of all stakeholders will be provided. Our results will offer context-sensitive explanations that can better inform local practices and policies and contribute to improve the health of patients with complex healthcare needs who frequently use healthcare services. Ultimately, this will increase the performance of healthcare systems and specifically mitigate ineffective use and costs.
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Affiliation(s)
- Catherine Hudon
- Département de Médecine de Famille et Médecine d’urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Maud-Christine Chouinard
- Département des Sciences de la Santé, Université du Québec à Chicoutimi, Chicoutimi, Quebec, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University, St-John’s, Newfoundland and Labrador, Canada
| | - Frederick Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Magaly Brodeur
- Département de Médecine de Famille et Médecine d’urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Paula L Bush
- Department of Family Medicine, Université McGill, Montréal, Quebec, Canada
| | - Yves Couturier
- School of Social Work, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-France Dubois
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - France Légare
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | - Paul Morin
- School of Social Work, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Thomas G Poder
- Département de Médecine de Famille et Médecine d’urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- UETMIS and CRCHUS, CIUSSS de l’Estrie - CHUS, Sherbrooke, Quebec, Canada
| | - Marie-Ève Poitras
- Département des Sciences de la Santé, Université du Québec à Chicoutimi, Chicoutimi, Quebec, Canada
| | - Pasquale Roberge
- Département de Médecine de Famille et Médecine d’urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Ruta Valaitis
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Shirley Bighead
- Sturgeon Lake First Nation, Sturgeon Lake, Saskatchewan, Canada
| | - Cameron Campbell
- Department of Health and Community Services, St-John’s, Newfoundland and Labrador, Canada
| | - Martine Couture
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Quebec, Canada
| | - Breanna Davis
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Élaine Deschenes
- Centre de pédiatrie sociale Sud-Est (CPSSE), Memramcook, New Brunswick, Canada
| | - Lynn Edwards
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Sarah Gander
- Horizon Health Network, Miramichi, New Brunswick, Canada
| | | | - Patricia Gauthier
- Centre intégré universitaire de santé et services sociaux de l’Estrie – Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Julie Godbout
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Quebec, Canada
| | - Geneviève Landry
- Ministere de la Sante et des Services sociaux Quebec, Quebec, Quebec, Canada
| | | | | | - Denis A Roy
- Institut national d’excellence en santé et en services sociaux, Québec, Quebec, Canada
| | - Judy Roy
- Maritime SPOR SUPPORT Unit, Halifax, Nova Scotia, Canada
| | | | - Tara Sampalli
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | | | | | | | - Mike Warren
- NL SPOR SUPPORT Unit, St. John’s, Newfoundland and Labrador, Canada
| | - Joanne Young
- Chronic Disease Prevention and Management Health, Government of New Brunswick, Fredericton, New Brunswick, Canada
| | - Pierre Pluye
- Department of Family Medicine, Université McGill, Montréal, Quebec, Canada
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14
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Grooten L, Borgermans L, Vrijhoef HJM. An Instrument to Measure Maturity of Integrated Care: A First Validation Study. Int J Integr Care 2018; 18:10. [PMID: 29588644 PMCID: PMC5853880 DOI: 10.5334/ijic.3063] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 11/28/2017] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Lessons captured from interviews with 12 European regions are represented in a new instrument, the B3-Maturity Model (B3-MM). B3-MM aims to assess maturity along 12 dimensions reflecting the various aspects that need to be managed in order to deliver integrated care. The objective of the study was to test the content validity of B3-MM as part of SCIROCCO (Scaling Integrated Care into Context), a European Union funded project. METHODS A literature review was conducted to compare B3-MM's 12 dimensions and their measurement scales with existing measures and instruments that focus on assessing the development of integrated care. Subsequently, a three-round survey conducted through a Delphi study with international experts in the field of integrated care was performed to test the relevance of: 1) the dimensions, 2) the maturity indicators and 3) the assessment scale used in B3-MM. RESULTS The 11 articles included in the literature review confirmed all the dimensions described in the original version of B3-MM. The Delphi study rounds resulted in various phrasing amendments of indicators and assessment scale. Full agreement among the experts on the relevance of the 12 B3-MM dimensions, their indicators, and assessment scale was reached after the third Delphi round. CONCLUSION AND DISCUSSION The B3-MM dimensions, maturity indicators and assessment scale showed satisfactory content validity. While the B3-MM is a unique instrument based on existing knowledge and experiences of regions in integrated care, further testing is needed to explore other measurement properties of B3-MM.
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Affiliation(s)
- Liset Grooten
- Department of Family Medicine and Chronic Care, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, B-1090 Brussels, BE
| | - Liesbeth Borgermans
- Department of Family Medicine and Chronic Care, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, B-1090 Brussels, BE
| | - Hubertus JM Vrijhoef
- Department of Family Medicine and Chronic Care, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, B-1090 Brussels, BE
- Department Patient and Care, Maastricht University Medical Center, Maastricht, NL
- Panaxea B.V., Amsterdam, NL
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15
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Tremblay D, Prady C, Bilodeau K, Touati N, Chouinard MC, Fortin M, Gaboury I, Rodrigue J, L'Italien MF. Optimizing clinical and organizational practice in cancer survivor transitions between specialized oncology and primary care teams: a realist evaluation of multiple case studies. BMC Health Serv Res 2017; 17:834. [PMID: 29246224 PMCID: PMC5732430 DOI: 10.1186/s12913-017-2785-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 12/06/2017] [Indexed: 01/22/2023] Open
Abstract
Background Cancer is now viewed as a chronic disease, presenting challenges to follow-up and survivorship care. Models to shift from haphazard, suboptimal and fragmented episodes of care to an integrated cancer care continuum must be developed, tested and implemented. Numerous studies demonstrate improved care when follow-up is assured by both oncology and primary care providers rather than either group alone. However, there is little data on the roles assumed by specialized oncology teams and primary care providers and the extent to which they work together. This study aims to develop, pilot test and measure outcomes of an innovative risk-based coordinated cancer care model for patients transitioning from specialized oncology teams to primary care providers. Methods/design This multiple case study using a sequential mixed-methods design rests on a theory-driven realist evaluation approach to understand how transitions might be improved. The cases are two health regions in Quebec, Canada, defined by their geographic territory. Each case includes a Cancer Centre and three Family Medicine Groups selected based on differences in their determining characteristics. Qualitative data will be collected from document review (scientific journal, grey literature, local documentation), semi-directed interviews with key informants, and observation of care coordination practices. Qualitative data will be supplemented with a survey to measure the outcome of the coordinated model among providers (scope of practice, collaboration, relational coordination, leadership) and patients diagnosed with breast, colorectal or prostate cancer (access to care, patient-centredness, communication, self-care, survivorship profile, quality of life). Results from descriptive and regression analyses will be triangulated with thematic analysis of qualitative data. Qualitative, quantitative, and mixed methods data will be interpreted within and across cases in order to identify context-mechanism associations that explain outcomes. Discussion The study will provide empirical data on a risk-based coordinated model of cancer care to guide actions at different levels in the health system. This in-depth multiple case study using a realist approach considers both the need for context-specific intervention research and the imperative to address research gaps regarding coordinated models of cancer care. Electronic supplementary material The online version of this article (10.1186/s12913-017-2785-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dominique Tremblay
- Centre de recherche - Hôpital Charles-Le Moyne, Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, Longueuil, Québec, (J4K 0A8), Canada. .,Campus de Longueuil - Université de Sherbrooke - Faculté de médecine et des sciences de la santé, 150 Place Charles-Le Moyne, Longueuil, Québec, (J4K 0A8), Canada.
| | - Catherine Prady
- Centre de recherche - Hôpital Charles-Le Moyne, Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, Longueuil, Québec, (J4K 0A8), Canada.,Campus de Longueuil - Université de Sherbrooke - Faculté de médecine et des sciences de la santé, 150 Place Charles-Le Moyne, Longueuil, Québec, (J4K 0A8), Canada.,Centre intégré de santé et de services sociaux de la Montérégie-Centre, 3120 Boulevard Taschereau, Greenfield Park, Québec, (J4V 2H1), Canada
| | - Karine Bilodeau
- Université de Montréal - Faculté des sciences infirmières et Centre d'innovation en formation infirmière, 2375 Chemin Côte-Ste-Catherine, Montréal, Québec, (H3T 1A8), Canada
| | - Nassera Touati
- École Nationale d'Administration Publique, 4750 Avenue Henri-Julien, 5è étage, Montréal, Québec, (H2T 3E5), Canada
| | - Maud-Christine Chouinard
- Centre de recherche - Hôpital Charles-Le Moyne, Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, Longueuil, Québec, (J4K 0A8), Canada.,Université du Québec à Chicoutimi - Département des sciences de la santé, 555 Boulevard de l'Université, Chicoutimi, Québec, (G7H 2B1), Canada.,Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Hôpital de Chicoutimi, 305 St-Vallier, Chicoutimi, Québec, (G7H 5H6), Canada
| | - Martin Fortin
- Centre de recherche - Hôpital Charles-Le Moyne, Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, Longueuil, Québec, (J4K 0A8), Canada.,Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Hôpital de Chicoutimi, 305 St-Vallier, Chicoutimi, Québec, (G7H 5H6), Canada.,Université de Sherbrooke - Département de médecine de famille et de médecine d'urgence, 3001 12e Avenue Nord, Sherbrooke, Québec, (J1H 5N4), Canada
| | - Isabelle Gaboury
- Centre de recherche - Hôpital Charles-Le Moyne, Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, Longueuil, Québec, (J4K 0A8), Canada.,Campus de Longueuil - Université de Sherbrooke - Faculté de médecine et des sciences de la santé, 150 Place Charles-Le Moyne, Longueuil, Québec, (J4K 0A8), Canada
| | - Jean Rodrigue
- Centre intégré de santé et de services sociaux de la Montérégie-Centre, 3120 Boulevard Taschereau, Greenfield Park, Québec, (J4V 2H1), Canada
| | - Marie-France L'Italien
- Centre de recherche - Hôpital Charles-Le Moyne, Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, Longueuil, Québec, (J4K 0A8), Canada.,Campus de Longueuil - Université de Sherbrooke - Faculté de médecine et des sciences de la santé, 150 Place Charles-Le Moyne, Longueuil, Québec, (J4K 0A8), Canada
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16
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Gupta A, Thorpe C, Bhattacharyya O, Zwarenstein M. Promoting development and uptake of health innovations: The Nose to Tail Tool. F1000Res 2016; 5:361. [PMID: 27239275 PMCID: PMC4863676 DOI: 10.12688/f1000research.8145.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction Health sector management is increasingly complex as new health technologies, treatments, and innovative service delivery strategies are developed. Many of these innovations are implemented prematurely, or fail to be implemented at scale, resulting in substantial wasted resources. Methods A scoping review was conducted to identify articles that described the scale up process conceptually or that described an instance in which a healthcare innovation was scaled up. We define scale up as the expansion and extension of delivery or access to an innovation for all end users in a jurisdiction who will benefit from it. Results Sixty nine articles were eligible for review. Frequently described stages in the innovation process and contextual issues that influence progress through each stage were mapped. 16 stages were identified: 12 deliberation and 4 action stages. Included papers suggest that innovations progress through stages of maturity and the uptake of innovation depends on the innovation aligning with the interests of 3 critical stakeholder groups (innovators, end users and the decision makers) and is also influenced by 3 broader contexts (social and physical environment, the health system, and the regulatory, political and economic environment). The 16 stages form the rows of the Nose to Tail Tool (NTT) grid and the 6 contingency factors form columns. The resulting stage-by-issue grid consists of 72 cells, each populated with cell-specific questions, prompts and considerations from the reviewed literature. Conclusion We offer a tool that helps stakeholders identify the stage of maturity of their innovation, helps facilitate deliberative discussions on the key considerations for each major stakeholder group and the major contextual barriers that the innovation faces. We believe the NTT will help to identify potential problems that the innovation will face and facilitates early modification, before large investments are made in a potentially flawed solution.
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Affiliation(s)
- Archna Gupta
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, London, ON, Canada
| | - Cathy Thorpe
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, London, ON, Canada
| | | | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, London, ON, Canada
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