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Kolanowski A, Heid AR, Behrens L, Riley K, Madrigal C, Boltz M, Van Haitsma K, Resnick B, Galik E, Ellis J, Eshraghi K. Community Goal Setting and Attainment: Organizational Characteristics and Indicators of Staff Adoption. J Gerontol Nurs 2022; 48:5-12. [PMID: 35511062 DOI: 10.3928/00989134-20220404-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In residential care communities (CCs), implementation strategies can improve the use of person-centered approaches for residents' behavioral symptoms of distress. We examined staff perceptions of how well their organizational goals for achieving person-centered care (PCC) were met following implementation of the strategy, Evidence Integration Triangle for Behavioral and Psychological Symptoms of Distress. We also identified organizational characteristics and indicators of staff adoption associated with perceived goal attainment. Goal attainment was evaluated by staff using goal attainment scaling (GAS) at the completion of the implementation trial in 26 CCs. Correlations, t tests, and linear regression were used to determine which factors were associated with goal attainment. Total time spent with the research facilitator, stable staff group membership, and presence of a survey deficiency during the study period explained 63% of the variance in goal attainment. Staff can set achievable organizational goals to improve PCC for residents' behavioral symptoms of distress. [Journal of Gerontological Nursing, 48(5), 5-12.].
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Meeker D, Fu P, Garcia G, Dyer IE, Yadav K, Fleishman R, Yee HF. Establishing a research informatics program in a public healthcare system: a case report with model documents. J Am Med Inform Assoc 2022; 29:694-700. [PMID: 35289368 PMCID: PMC8922175 DOI: 10.1093/jamia/ocab226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/25/2021] [Accepted: 10/19/2021] [Indexed: 09/20/2023] Open
Abstract
While much is known about governance models for research informatics programs in academic medical centers and similarly situated cancer centers, community and public health systems have been less well-characterized. As part of implementing an enterprise research governance framework, leaders in the Los Angeles County Department of Health Services established a research informatics program, including research data warehousing. The strategy is focused on high-priority, patient-centered research that leverages the investment in health IT and an efficient, sustained contribution from 2 affiliated Clinical Translational Sciences Institutes. This case study describes the foundational governance framework and policies that were developed. We share the results of several years of planning, implementation, and operations of an academically funded research informatics service core embedded in a large, multicenter county health system. We include herein a Supplementary Appendix of governance documents that may serve as pragmatic models for similar initiatives.
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Affiliation(s)
- Daniella Meeker
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Paul Fu
- Department of Pediatrics, City of Hope, Duarte, California, USA
| | - Gary Garcia
- Department of Health Services, Los Angeles County, Los Angeles, California, USA
| | - Irene E Dyer
- Department of Health Services, Los Angeles County, Los Angeles, California, USA
| | - Kabir Yadav
- Department of Health Services, Los Angeles County, Los Angeles, California, USA
| | - Ross Fleishman
- Department of Health Services, Los Angeles County, Los Angeles, California, USA
| | - Hal F Yee
- Department of Health Services, Los Angeles County, Los Angeles, California, USA
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Resnick B, Kolanowski A, Van Haitsma K, Galik E, Boltz M, Ellis J, Behrens L, Flanagan NM, Eshraghi KJ, Zhu S. Testing the evidence integration triangle for implementation of interventions to manage behavioral and psychological symptoms associated with dementia: Protocol for a pragmatic trial. Res Nurs Health 2018; 41:228-242. [PMID: 29485197 DOI: 10.1002/nur.21866] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/27/2017] [Indexed: 01/30/2023]
Abstract
Behavioral and psychological symptoms of dementia (BPSD) include aggression, agitation, resistiveness to care, depression, anxiety, apathy, and hallucinations. BPSD are common in nursing home residents and can be ameliorated using person-centered approaches. Despite regulatory requirements, less than 2% of nursing homes consistently implement person-centered behavioral approaches. In a National Institute of Nursing Research-funded research protocol, we are implementing a pragmatic cluster randomized clinical trial designed to enable staff in nursing homes to reduce BPSD using behavioral approaches while optimizing function, preventing adverse events, and improving quality of life of residents. The implementation is based on use of the Evidence Integration Triangle (EIT), a parsimonious, community-engaged participatory framework that is well suited to the complexity and variability in the nursing home environment. A total of 50 nursing home communities will be randomized to EIT-4-BPSD or education only. Primary Aim 1 is to determine if communities exposed to EIT-4-BPSD demonstrate evidence of implementation evaluated by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) criteria. Primary Aim 2 is to evaluate the feasibility, utility, and cost of the EIT approach in EIT-4-BPSD communities.
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Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland, Baltimore, Maryland
| | - Ann Kolanowski
- Pennsylvania State University, University Park, Pennsylvania
| | | | - Elizabeth Galik
- School of Nursing, University of Maryland, Baltimore, Maryland
| | - Marie Boltz
- Pennsylvania State University, University Park, Pennsylvania
| | - Jeanette Ellis
- School of Nursing, University of Maryland, Baltimore, Maryland
| | - Liza Behrens
- Pennsylvania State University, University Park, Pennsylvania
| | - Nina M Flanagan
- Decker School of Nursing, Binghamton University, Binghamton, New York
| | | | - Shijun Zhu
- School of Nursing, University of Maryland, Baltimore, Maryland
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Pyykkő I, Manchaiah V, Kentala E, Levo H, Juhola M. Internet-Based Self-Help for Ménière's Disease: Details and Outcome of a Single-Group Open Trial. Am J Audiol 2017; 26:496-506. [PMID: 29049634 DOI: 10.1044/2017_aja-16-0068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 05/16/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE In this article, we present the details and the pilot outcome of an Internet-based self-help program for Ménière's disease (MD). METHOD The Norton-Kaplan model is applied to construct a strategic, person-focused approach in the enablement process. The program assesses the disorder profile and diagnosis. In the therapeutic component of the program, the participant defines vision and time frame, inspects confounding factors, determines goals, establishes a strategy, and starts to work on the important problems caused by the disorder. The program works interactively, utilizes collaboration with significant others, and enhances positive thinking. Participants took part in an Internet-based self-help program. Data were collected interactively using open-ended and structured questionnaires on various disease-specific and general health aspects. The pilot outcome of 41 patients with MD was evaluated. RESULTS The analysis of the pilot data showed statistically significant improvement in their general health-related quality of life (p < .001). Also, the outcome of the Posttraumatic Growth Inventory (Cann et al., 2010) showed small to moderate change as a result of the intervention. CONCLUSIONS The Internet-based self-help program can be helpful in the rehabilitation of patients with MD to supplement medical therapy.
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Affiliation(s)
- Ilmari Pyykkő
- Hearing and Balance Research Unit, Department of Otolaryngology, University of Tampere, Finland
| | - Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX
- Swedish Institute for Disability Research, Department of Behavioral Sciences and Learning, Linköping University, Sweden
- Audiology India, Karnataka, Mysore
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Karnataka, India
| | - Erna Kentala
- Department of Otolaryngology, University of Helsinki, Finland
| | - Hilla Levo
- Department of Otolaryngology, University of Helsinki, Finland
| | - Martti Juhola
- School of Information Sciences, University of Tampere, Finland
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Poggenburg S, Reinisch M, Höfler R, Stigler F, Avian A, Siebenhofer A. General practitioners in Styria - who is willing to take part in research projects and why? : A survey by the Institute of General Practice and Health Services Research. Wien Klin Wochenschr 2017; 129:823-834. [PMID: 28795257 PMCID: PMC5676841 DOI: 10.1007/s00508-017-1244-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/14/2017] [Indexed: 11/25/2022]
Abstract
Increasing recognition of general practice is reflected in the growing number of university institutes devoted to the subject and Health Services Research (HSR) is flourishing as a result. In May 2015 the Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, initiated a survey of Styrian GPs. The aim of the survey was to determine the willingness to take part in HSR projects, to collect sociodemographic data from GPs who were interested and to identify factors affecting participation in research projects. Of the 1015 GPs who received the questionnaire, 142 (14%) responded and 135 (13%) were included in the analysis. Overall 106 (10%) GPs indicated their willingness to take part in research projects. Factors inhibiting participation were lack of time, administrative workload, and lack of assistance. Overall, 10% of Styrian GPs were willing to participate in research projects. Knowledge about the circumstances under which family doctors are prepared to participate in HSR projects will help in the planning of future projects.
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Affiliation(s)
- Stephanie Poggenburg
- Institute of General Practice and Health Services Research, Medical University of Graz, Auenbruggerplatz 20/III, 8036, Graz, Austria.
| | - Manuel Reinisch
- Institute of General Practice and Health Services Research, Medical University of Graz, Auenbruggerplatz 20/III, 8036, Graz, Austria
| | - Reinhild Höfler
- Institute of General Practice and Health Services Research, Medical University of Graz, Auenbruggerplatz 20/III, 8036, Graz, Austria
| | - Florian Stigler
- Institute of General Practice and Health Services Research, Medical University of Graz, Auenbruggerplatz 20/III, 8036, Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Andrea Siebenhofer
- Institute of General Practice and Health Services Research, Medical University of Graz, Auenbruggerplatz 20/III, 8036, Graz, Austria
- Institute of General Practice, Goethe University, Frankfurt am Main, Germany
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Podolak I, Kisia C, Omosa-Manyonyi G, Cosby J. Using a multimethod approach to develop implementation strategies for a cervical self-sampling program in Kenya. BMC Health Serv Res 2017; 17:222. [PMID: 28320374 PMCID: PMC5360082 DOI: 10.1186/s12913-017-2160-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 03/11/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Numerous health policy makers/researchers are concerned about the limitations of research being applied to support informed decision/policy making and the implementation of practical solutions. The aim of the Chaguo Letu project (which means our choice in Swahili) was to determine how local decision makers could apply a multimethod approach to make strategic decisions to effectively implement a Cervical Self-Sampling Program in Kenya. METHODS A multimethod approach, involving participatory action research, scenario based planning, and phenomenology, was applied in conjunction with two tools to identify relevant factors (negative or positive) that could impact Cervical Self-Sampling Program implementation. A total of 107 stakeholders participated in interviews, focus groups, workshops, and informal interactions. Content analysis, an affinity exercise, and impact analysis were used to analyze data and develop robust strategic directions and supporting implementation strategies. RESULTS A total of 57 factors thought to impact the implementation of the Cervical Self-Sampling Program were identified and grouped into 13 thematic categories. These themes were instrumental in developing 10 strategic directions and 22 implementation strategies deemed necessary to implement a technically viable, politically supported, affordable, logistically feasible, socially acceptable, and transformative Program. CONCLUSIONS This study made three conclusions: 1) there is political will and a desire to improve cervical screening across Kenya, but in a period of dynamic change resources are constrained; 2) implementing the Program in urban/rural settings is logistically feasible, but the majority of Kenyan women could not afford screening without some form of a subsidy, and 3) self-sampling is perceived to be much more socially acceptable than the current Pap screening process. The Chaguo Letu study went beyond the traditional strategy development process of determining "what" needs to do done by describing in detail "how" the Program should be implemented to be relevant and accessible to all Kenyan women at risk of cervical cancer. This work could potentially facilitate communities of practice and knowledge sharing when addressing other types of health decisions in other low resource settings beyond Kenya.
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Affiliation(s)
- Irene Podolak
- Brock University, 213-2300 Upper Middle Road W., Oakville, ON L6M 0T4 Canada
| | - Caroline Kisia
- Action Africa Help International, Fawe House, Ground floor, Chania Avenue, P.O. Box 76598-00508, Nairobi, Kenya
| | | | - Jarold Cosby
- Brock University, 500 Glenridge Ave, St. Catharines, ON L2S 3A1 Canada
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Keith RE, Crosson JC, O'Malley AS, Cromp D, Taylor EF. Using the Consolidated Framework for Implementation Research (CFIR) to produce actionable findings: a rapid-cycle evaluation approach to improving implementation. Implement Sci 2017; 12:15. [PMID: 28187747 PMCID: PMC5303301 DOI: 10.1186/s13012-017-0550-7] [Citation(s) in RCA: 352] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 02/04/2017] [Indexed: 12/03/2022] Open
Abstract
Background Much research does not address the practical needs of stakeholders responsible for introducing health care delivery interventions into organizations working to achieve better outcomes. In this article, we present an approach to using the Consolidated Framework for Implementation Research (CFIR) to guide systematic research that supports rapid-cycle evaluation of the implementation of health care delivery interventions and produces actionable evaluation findings intended to improve implementation in a timely manner. Methods To present our approach, we describe a formative cross-case qualitative investigation of 21 primary care practices participating in the Comprehensive Primary Care (CPC) initiative, a multi-payer supported primary care practice transformation intervention led by the Centers for Medicare and Medicaid Services. Qualitative data include observational field notes and semi-structured interviews with primary care practice leadership, clinicians, and administrative and medical support staff. We use intervention-specific codes, and CFIR constructs to reduce and organize the data to support cross-case analysis of patterns of barriers and facilitators relating to different CPC components. Results Using the CFIR to guide data collection, coding, analysis, and reporting of findings supported a systematic, comprehensive, and timely understanding of barriers and facilitators to practice transformation. Our approach to using the CFIR produced actionable findings for improving implementation effectiveness during this initiative and for identifying improvements to implementation strategies for future practice transformation efforts. Conclusions The CFIR is a useful tool for guiding rapid-cycle evaluation of the implementation of practice transformation initiatives. Using the approach described here, we systematically identified where adjustments and refinements to the intervention could be made in the second year of the 4-year intervention. We think the approach we describe has broad application and encourage others to use the CFIR, along with intervention-specific codes, to guide the efficient and rigorous analysis of rich qualitative data. Trial registration NCT02318108 Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0550-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rosalind E Keith
- Mathematica Policy Research, PO Box 2393, Princeton, NJ, 08543, USA.
| | - Jesse C Crosson
- Mathematica Policy Research, PO Box 2393, Princeton, NJ, 08543, USA
| | - Ann S O'Malley
- Mathematica Policy Research, 1100 1st Street, NE, 12th Floor, Washington, DC, 20002, USA
| | - DeAnn Cromp
- Group Health Research Institute, 1730 Minor Ave. Ste. 1600, Seattle, WA, 98101, USA
| | - Erin Fries Taylor
- Mathematica Policy Research, 1100 1st Street, NE, 12th Floor, Washington, DC, 20002, USA
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Magee M, Bardsley JK, Wallia A, Smith KM. Transitioning the Adult with Type 2 Diabetes From the Acute to Chronic Care Setting: Strategies to Support Pragmatic Implementation Success. Curr Diab Rep 2017; 17:6. [PMID: 28138821 DOI: 10.1007/s11892-017-0830-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Scientific evidence is available to guide the how to of medications management when patients with diabetes are hospitalized or present to the Emergency Department. However, few clinical trials in the diabetes field have addressed the execution, coupled with established implementation effectiveness evaluation frameworks to help inform and assess implementation practices to support the transition in care. These deficiencies may be overcome by (1) applying the principles of implementation and delivery systems science; (2) engaging the principles of human factors (HF) throughout the design, development, and evaluation planning activities; and (3) utilizing mixed methods to design the intervention, workflow processes, and evaluate the intervention for sustainability within existing care delivery models. This article provides a discussion of implementation science and human factors science including an overview of commonly used frameworks which can be applied to structure design and implementation of sustainable and generalizable interventions.
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Affiliation(s)
- Michelle Magee
- MedStar Diabetes Institute, 100 Irving St, NW, #4114, Washington, DC, USA.
- MedStar Health Research Institute, 6525 Belcrest Rd., Ste. 700, Hyattsville, MD, 20782, USA.
- Georgetown University School of Medicine and Healthcare Sciences, Washington, DC, USA.
| | - Joan K Bardsley
- MedStar Health Research Institute, 6525 Belcrest Rd., Ste. 700, Hyattsville, MD, 20782, USA
- MedStar Health Corporate Nursing, 6525 Belcrest Rd., Ste. 700, Hyattsville, MD, 20782, USA
| | - Amisha Wallia
- Northwestern University Feinberg School of Medicine, Suite 530 645N, Michigan Avenue, Chicago, IL, 60611, USA
| | - Kelly M Smith
- MedStar Health Research Institute, 6525 Belcrest Rd., Ste. 700, Hyattsville, MD, 20782, USA
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Buchbinder R, Maher C, Harris IA. Setting the research agenda for improving health care in musculoskeletal disorders. Nat Rev Rheumatol 2015; 11:597-605. [DOI: 10.1038/nrrheum.2015.81] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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10
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Smith S, Ward V. The role of boundary maintenance and blurring in a UK collaborative research project: How researchers and health service managers made sense of new ways of working. Soc Sci Med 2015; 130:225-33. [DOI: 10.1016/j.socscimed.2015.02.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Peek CJ, Glasgow RE, Stange KC, Klesges LM, Purcell EP, Kessler RS. The 5 R's: an emerging bold standard for conducting relevant research in a changing world. Ann Fam Med 2014; 12:447-55. [PMID: 25354409 PMCID: PMC4157982 DOI: 10.1370/afm.1688] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 05/13/2014] [Accepted: 06/02/2014] [Indexed: 11/09/2022] Open
Abstract
Research often fails to find its way into practice or policy in a timely way, if at all. Given the current pressure and pace of health care change, many authors have recommended different approaches to make health care research more relevant and rapid. An emerging standard for research, the "5 R's" is a synthesis of recommendations for care delivery research that (1) is relevant to stakeholders; (2) is rapid and recursive in application; (3) redefines rigor; (4) reports on resources required; and (5) is replicable. Relevance flows from substantive ongoing participation by stakeholders. Rapidity and recursiveness occur through accelerated design and peer reviews followed by short learning/implementation cycles through which questions and answers evolve over time. Rigor is the disciplined conduct of shared learning within the specific changing situations in diverse settings. Resource reporting includes costs of interventions. Replicability involves designing for the factors that may affect subsequent implementation of an intervention or program in different contexts. These R's of the research process are mutually reinforcing and can be supported by training that fosters collaborative and reciprocal relationships among researchers, implementers, and other stakeholders. In sum, a standard is emerging for research that is both rigorous and relevant. Consistent and bold application will increase the value, timeliness, and applicability of the research enterprise.
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Affiliation(s)
- C J Peek
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Russell E Glasgow
- Department of Family Medicine and Colorado Health Outcomes Program, University of Colorado, Denver, Colorado
| | - Kurt C Stange
- Department of Family Medicine & Community Health, Department of Epidemiology & Biostatistics, and Department of Sociology, Case Comprehensive Cancer Center, Cleveland Clinical & Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio
| | - Lisa M Klesges
- School of Public Health, University of Memphis, Memphis, Tennessee
| | - E Peyton Purcell
- Clinical Research Directorate/CMRP, SAIC-Frederick, Inc, Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Rodger S Kessler
- Department of Family Medicine and the Center for Clinical and Translational Science, University of Vermont College of Medicine, Burlington, Vermont
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Green LW, Ottoson JM, García C, Hiatt RA, Roditis ML. Diffusion theory and knowledge dissemination, utilization and integration. FRONTIERS IN PUBLIC HEALTH SERVICES & SYSTEMS RESEARCH 2014; 3:3. [PMID: 26251771 PMCID: PMC4524659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Part of the Community Health and Preventive Medicine Commons, Health and Medical Administration Commons, Health Policy Commons, Health Services Administration Commons, Health Services Research Commons, and the Public Health Education and Promotion Commons. Many accomplishments of public health have been distributed unevenly among populations. This article reviews the concepts of applying evidence-based practice in public health in the face of the varied cultures and circumstances of practice in these varied populations. Key components of EBPH include: making decisions based on the best available scientific evidence, using data and information systems systematically, applying program planning frameworks, engaging the community and practitioners in decision making, conducting sound evaluation, and disseminating what is learned. The usual application of these principles has overemphasized the scientific evidence as the starting point, whereas this review suggests engaging the community and practitioners as an equally important starting point to assess their needs, assets and circumstances, which can be facilitated with program planning frameworks and use of local assessment and surveillance data.
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Kottke TE, Courneya PT. Optimizing the health of mothers, infants, and communities through research. Mayo Clin Proc 2013; 88:1350-2. [PMID: 24290106 DOI: 10.1016/j.mayocp.2013.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 10/21/2013] [Indexed: 10/26/2022]
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Emmons KM, Puleo E, Sprunck-Harrild K, Ford J, Ostroff JS, Hodgson D, Greenberg M, Diller L, de Moor J, Tyc V. Partnership for health-2, a web-based versus print smoking cessation intervention for childhood and young adult cancer survivors: randomized comparative effectiveness study. J Med Internet Res 2013; 15:e218. [PMID: 24195867 PMCID: PMC3841363 DOI: 10.2196/jmir.2533] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 05/21/2013] [Accepted: 07/04/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Smoking among cancer survivors increases the risk of late effects and second cancers. This article reports on Partnership for Health-2 (PFH-2)-an effort to develop an effective and scalable version of Partnership for Health (PFH), which was a previously tested peer-delivered telephone counseling program that doubled smoking cessation rates among childhood cancer survivors who smoke. OBJECTIVE This paper presents results from a randomized controlled trial evaluating the effectiveness of PFH-2 in targeted and tailored Web-based versus print formats. The overall goal was to determine whether the intervention outcomes in these self-guided scalable formats approximate what was found in a more intensive telephone counseling program. METHODS This study was a randomized controlled trial with a 15-month follow-up that included 374 smokers who were survivors of childhood or young adult cancers, recruited from five survivorship clinics. Participants were randomly assigned to a Web-based or print format of the PFH intervention; all had access to free pharmacotherapy. The website was designed to provide new content at each log-on, and a peer counselor moderated a forum/chat feature. The primary outcome was smoking status at 15 months post randomization. RESULTS In total, 58.3% (77/132) of Web participants logged on at least once (mean visits 3.25). Using multiple imputation methods for missing data, there were similar rates of cessation in the two arms (print: 20/128, 15.6%; Web: 33/201, 6.4%), and no differences in quit attempts or readiness to quit. The quit rates were equivalent to those found in our previous telephone counseling intervention. There were high rates of satisfaction with both of the PFH-2 interventions. CONCLUSIONS The print and Web formats yielded equivalent levels of success to those found with our telephone-delivered intervention and are comparable to other Internet treatment studies. This study provides important options for survivorship programs that may not have resources for interpersonal forms of cessation counseling. Efforts to increase patient use of the interventions may result in higher cessation rates.
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Affiliation(s)
- Karen M Emmons
- Dana-Farber Cancer Institute, Boston, MA, United States.
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Kairys S, Wasserman R, Pace W. Practice-based quality improvement/research networks: full speed forward. Acad Pediatr 2013; 13:S12-3. [PMID: 24268077 DOI: 10.1016/j.acap.2013.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 02/03/2013] [Indexed: 11/24/2022]
Affiliation(s)
- Steven Kairys
- Department of Pediatrics, Jersey Shore University Medical Center, Neptune, NJ.
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16
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Tomoaia-Cotisel A, Scammon DL, Waitzman NJ, Cronholm PF, Halladay JR, Driscoll DL, Solberg LI, Hsu C, Tai-Seale M, Hiratsuka V, Shih SC, Fetters MD, Wise CG, Alexander JA, Hauser D, McMullen CK, Scholle SH, Tirodkar MA, Schmidt L, Donahue KE, Parchman ML, Stange KC. Context matters: the experience of 14 research teams in systematically reporting contextual factors important for practice change. Ann Fam Med 2013; 11 Suppl 1:S115-23. [PMID: 23690380 PMCID: PMC3707255 DOI: 10.1370/afm.1549] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We aimed to advance the internal and external validity of research by sharing our empirical experience and recommendations for systematically reporting contextual factors. METHODS Fourteen teams conducting research on primary care practice transformation retrospectively considered contextual factors important to interpreting their findings (internal validity) and transporting or reinventing their findings in other settings/situations (external validity). Each team provided a table or list of important contextual factors and interpretive text included as appendices to the articles in this supplement. Team members identified the most important contextual factors for their studies. We grouped the findings thematically and developed recommendations for reporting context. RESULTS The most important contextual factors sorted into 5 domains: (1) the practice setting, (2) the larger organization, (3) the external environment, (4) implementation pathway, and (5) the motivation for implementation. To understand context, investigators recommend (1) engaging diverse perspectives and data sources, (2) considering multiple levels, (3) evaluating history and evolution over time, (4) looking at formal and informal systems and culture, and (5) assessing the (often nonlinear) interactions between contextual factors and both the process and outcome of studies. We include a template with tabular and interpretive elements to help study teams engage research participants in reporting relevant context. CONCLUSIONS These findings demonstrate the feasibility and potential utility of identifying and reporting contextual factors. Involving diverse stakeholders in assessing context at multiple stages of the research process, examining their association with outcomes, and consistently reporting critical contextual factors are important challenges for a field interested in improving the internal and external validity and impact of health care research.
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Affiliation(s)
- Andrada Tomoaia-Cotisel
- Department of Family & Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
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A masterclass to teach public health professionals to conduct practice-based research to promote evidence-based practice: a case study from The Netherlands. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2012; 19:83-92. [PMID: 23169408 DOI: 10.1097/phh.0b013e318225158a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Public health professionals have a pivotal position in efforts to obtain more practice-based evidence about what people need and what works in real circumstances. Close collaboration with researchers should enable public health professionals to design and conduct research in practical settings to address today's complex public health problems and increase the external validity of results. This requires expanding the research competencies of public health professionals. We developed and implemented a masterclass for public health professionals, modeled on an existing scientific training course for general practitioners and rehabilitation physicians. METHOD The masterclass was evaluated using a multiple method design, involving quantitative and qualitative methods. Evaluation took place during, at the end of, and 9 months after the masterclass. RESULTS Twenty-one candidates (mean age, 41 y) started the program, 66% of whom completed it. Teaching materials, lectures, organization, and facilities were favorably evaluated. At the end of the masterclass, participants were able to design and implement a research proposal in their daily work setting, write a draft article, and critically appraise scientific research for practice and policy purposes. Participants had become more confident about their research competence. Management support from their employer proved crucial. Results obtained with the different methods were consistent. CONCLUSION The masterclass appeared to be an effective instrument to increase the practice-based research skills of public health professionals, provided the research is implemented in a supportive organization with management backing and supervision by senior university researchers. We recommend using masterclasses to contribute to the improvement of practice-based evidence for projects addressing current and future public health problems.
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Glasgow RE, Green LW, Taylor MV, Stange KC. An evidence integration triangle for aligning science with policy and practice. Am J Prev Med 2012; 42:646-54. [PMID: 22608384 PMCID: PMC4457385 DOI: 10.1016/j.amepre.2012.02.016] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 12/14/2011] [Accepted: 02/02/2012] [Indexed: 01/01/2023]
Abstract
Over-reliance on decontextualized, standardized implementation of efficacy evidence has contributed to slow integration of evidence-based interventions into health policy and practice. This article describes an "evidence integration triangle" (EIT) to guide translation, implementation, prevention efforts, comparative effectiveness research, funding, and policymaking. The EIT emphasizes interactions among three related components needed for effective evidence implementation: (1) practical evidence-based interventions; (2) pragmatic, longitudinal measures of progress; and (3) participatory implementation processes. At the center of the EIT is active engagement of key stakeholders and scientific evidence and attention to the context in which a program is implemented. The EIT model is a straightforward framework to guide practice, research, and policy toward greater effectiveness and is designed to be applicable across multiple levels-from individual-focused and patient-provider interventions, to health systems and policy-level change initiatives.
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Affiliation(s)
- Russell E Glasgow
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Rockville, MD 20852, USA.
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Pollack LA, Hawkins NA, Peaker BL, Buchanan N, Risendal BC. Dissemination and translation: a frontier for cancer survivorship research. Cancer Epidemiol Biomarkers Prev 2012; 20:2093-8. [PMID: 21980017 DOI: 10.1158/1055-9965.epi-11-0652] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
As the field of survivorship research grows, the need for translation is imperative to expand new knowledge into arenas that directly impact survivors. This commentary seeks to encourage research focused on dissemination and translation of survivorship interventions and programs, including practice-based research. We overview diffusion, dissemination and translation in the context of cancer survivorship and present the RE-AIM and Knowledge to Action frameworks as approaches that can be used to expand research into communities. Many academic, governmental, and community-based organizations focus on cancer survivor. Future survivorship research should contribute to harmonizing these assets to identify effective interventions, maximize their reach and adoption, and integrate promising practices into routine care.
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Affiliation(s)
- Lori A Pollack
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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[Research in primary care as an area of knowledge. SESPAS Report 2012]. GACETA SANITARIA 2011; 26 Suppl 1:76-81. [PMID: 22047623 DOI: 10.1016/j.gaceta.2011.05.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 04/19/2011] [Accepted: 05/19/2011] [Indexed: 11/23/2022]
Abstract
Primary care offers huge potential for research. This setting is an area of knowledge that must expand to improve the quality of its services and patients' health. Population-based clinical studies with a focus on health promotion and primary, secondary and tertiary disease prevention offer unique research opportunities. Developing research in the biopsychosocial model of clinical practice and new models of integrated healthcare and community care is therefore a priority. The framework and activities carried out by the Research Network in Preventive Activities and Health Promotion have been instrumental in the development of research in primary care in Spain. Despite the efforts invested by various institutions, foundations, teaching and research departments in primary care research, the projected outputs in terms of volume, quality and impact have not been achieved. The involvement of primary care professionals in research platforms is insufficient, with scarce contribution toward investment in specific primary care research projects. To change the current status of research in primary care, a number of measures are required, namely, the consolidation of research organisms specific to primary care with adequate allocation of funding and staff, and the allocation of specific time for research to primary care professionals to enable them to produce significant projects and consolidate established research lines in their areas of expertise, with applications mainly in quality improvement and innovation of primary care services.
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Perl HI. Addicted to discovery: Does the quest for new knowledge hinder practice improvement? Addict Behav 2011; 36:590-596. [PMID: 21349648 DOI: 10.1016/j.addbeh.2011.01.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 01/17/2011] [Indexed: 11/19/2022]
Abstract
Despite the billions of dollars spent on health-focused research and the hundreds of billions spent on delivering health services each year, relatively little money and effort are directed toward investigating how best to connect the two. This results in missed opportunities to assure that research findings inform and improve quality across healthcare in general and for addiction prevention and treatment in particular. There is an asymmetrical focus that favors the identification of new interventions and neglects the implementation of science-based knowledge in actual practice. The consequences of that neglect are severe: significantly diminished progress in research on how to implement treatments that could improve the lives of persons with addiction problems, their families, and the rest of society. While the advancement of knowledge regarding effective implementation is lagging, it is clear that existing systemic incentives in the conduct of science inhibit rather than facilitate widespread adoption of evidence-based practices. This commentary proposes three interrelated strategies for improving the implementation process. First, develop scientific tools to understand implementation better, by expanding investigations on the science of implementation and broadening approaches to the design and execution of research. Second, nurture and support a collaborative implementation workforce comprised of scientists and on-the-ground practitioners, with an explicit focus on enhancing appropriate incentives for both. Third, pay closer attention to crafting research that seeks answers that are most relevant to clinicians' actual needs, primarily by ensuring that the anticipated users of the evidence-based practice are full partners in developing the questions right from the start.
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Partnership research: a practical trial design for evaluation of a natural experiment to improve depression care. Med Care 2010; 48:576-82. [PMID: 20508531 DOI: 10.1097/mlr.0b013e3181dbea62] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Translational research is increasingly important as academic health centers transform themselves to meet new requirements of National Institutes of Health funding. Most attention has focused on T1 translation studies (bench to bedside) with considerable uncertainty about how to enhance T2 (effectiveness trials) and especially T3 (implementation studies). OBJECTIVE To describe an innovative example of a T3 study, conducted as partnership research with the leaders of a major natural experiment in Minnesota to improve the primary care of depression. METHODS All health plans in the state have agreed on a new payment model to support clinics that implement the well-evidenced collaborative care model for depression in the Depression Improvement Across Minnesota: Offering a New Direction initiative. The Depression Improvement Across Minnesota: Offering a New Direction study was developed in an ongoing partnership with the Initiative leaders from 7 health plans, 85 clinics, and a regional quality improvement collaborative to evaluate the implementation and its impacts on patients and other stakeholders. We agreed on a staggered implementation, multiple baseline research design, using the concepts of practical clinical trials and engaged scholarship and have collaborated on all aspects of conducting the study, including joint identification of patient and clinic survey recipients. RESULTS Complex study methods have worked well through 20 months because of the commitment of all stakeholders to both the Initiative and the Study. Over 1500 subjects have been recruited from health plan information delivered weekly, and 99.7% of 316 physicians and administrators from all participating clinical organizations have completed the Study surveys. CONCLUSIONS Partnership research can greatly facilitate translational research studies.
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Hummers-Pradier E, Beyer M, Chevallier P, Eilat-Tsanani S, Lionis C, Peremans L, Petek D, Rurik I, Soler JK, Stoffers HE, Topsever P, Ungan M, Royen PV. The Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe. Part 1. Background and methodology1. Eur J Gen Pract 2010; 15:243-50. [DOI: 10.3109/13814780903452184] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Green LW, Ottoson JM, García C, Hiatt RA. Diffusion theory and knowledge dissemination, utilization, and integration in public health. Annu Rev Public Health 2009; 30:151-74. [PMID: 19705558 DOI: 10.1146/annurev.publhealth.031308.100049] [Citation(s) in RCA: 508] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Legislators and their scientific beneficiaries express growing concerns that the fruits of their investment in health research are not reaching the public, policy makers, and practitioners with evidence-based practices. Practitioners and the public lament the lack of relevance and fit of evidence that reaches them and barriers to their implementation of it. Much has been written about this gap in medicine, much less in public health. We review the concepts that have guided or misguided public health in their attempts to bridge science and practice through dissemination and implementation. Beginning with diffusion theory, which inspired much of public health's work on dissemination, we compare diffusion, dissemination, and implementation with related notions that have served other fields in bridging science and practice. Finally, we suggest ways to blend diffusion with other theory and evidence in guiding a more decentralized approach to dissemination and implementation in public health, including changes in the ways we produce the science itself.
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Affiliation(s)
- Lawrence W Green
- Helen Diller Comprehensive Cancer Center, and Department of Epidemiology and Biostatistics, School of Medicine University of California, San Francisco, California 94143-0981, USA.
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McDonald PW, Viehbeck S, Robinson SJ, Leatherdale ST, Nykiforuk CI, Jolin MA. Building research capacity for evidence-informed tobacco control in Canada: a case description. Tob Induc Dis 2009; 5:12. [PMID: 19664224 PMCID: PMC2746799 DOI: 10.1186/1617-9625-5-12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 08/07/2009] [Indexed: 11/10/2022] Open
Abstract
Tobacco use remains the leading cause of death and disability in Canada. Insufficient research capacity can inhibit evidence-informed decision making for tobacco control. This paper outlines a Canadian project to build research capacity, defined as a community's ability to produce research that adequately informs practice, policy, and future research in a timely, practical manner. A key component is that individuals and teams within the community must mutually engage around common, collectively negotiated goals to address specific practices, policies or programs of research. An organizing framework, a set of activities to build strategic recruitment, productivity tools, and procedures for enhancing social capital are described. Actions are intended to facilitate better alignment between research and the priorities of policy developers and service providers, enhance the external validity of the work performed, and reduce the time required to inform policy and practice.
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Affiliation(s)
- Paul W McDonald
- Department of Health Studies and Gerontology, University of Waterloo Waterloo, Ontario, Canada.
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Atkins D. QUERI and implementation research: emerging from adolescence into adulthood: QUERI Series. Implement Sci 2009; 4:12. [PMID: 19267919 PMCID: PMC2660900 DOI: 10.1186/1748-5908-4-12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Accepted: 03/06/2009] [Indexed: 11/29/2022] Open
Abstract
The Quality Enhancement Research Initiative (QUERI) program and implementation research have both come of age in the 10 years since QUERI was established. Looking forward, if QUERI and the field of implementation science are to mature successfully, we will need to address a series of challenges. First, we need to more clearly demonstrate how applying principles of implementation science leads to more effective implementation and communicate those lessons to our partners and funders. Second, we will need to engage in the ongoing debate over methodological standards in quality improvement and implementation research. Third, a program like QUERI needs to become more relevant to the daily decisions of key stakeholders. Fourth, if we hope to sustain interest in implementation science, we will need to demonstrate the business case for more effective implementation. Fifth, we need to think creatively about how to nurture the next generations of implementation researchers and front-line "connectors," who are critical for accelerating implementation. Finally, we need to strengthen the connections between implementation research and the other operational and research activities that influence change in healthcare systems. The excitement of entering adulthood is tempered by the challenge of new responsibilities and expectations. What is essential is that we continue to learn and move forward. For implementation science and for QUERI, the next decade looks to be one filled with exciting possibilities, new partnerships, increasing relevance, and real accomplishment.
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Solberg LI, Elward KS, Phillips WR, Gill JM, Swanson G, Main DS, Yawn BP, Mold JW, Phillips RL. How can primary care cross the quality chasm? Ann Fam Med 2009; 7:164-9. [PMID: 19273872 PMCID: PMC2653967 DOI: 10.1370/afm.951] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The chasm between knowledge and practice decried by the Institute of Medicine (IOM) is the result of other chasms that have not been addressed. They include the chasm between what we know and what we need to know to improve care; the chasm between those who provide primary care and those who do not fund, study, support, or publish practical primary care studies; and the chasm between research and quality improvement (QI). These chasms are a result of problematic concepts, attitudes, traditions, time frames, and financing approaches among the various participants. If we are to facilitate the production and use of the knowledge needed for primary care to cross IOM's chasm, major changes are needed. These changes include the following: (1) admission by all primary care professions that we have quality problems that require our unified attention and action; (2) conversion of the paradigm from "translate research into practice" to "optimizing health and health care through research and QI"; (3) development and facilitation of more partnerships among clinicians, researchers, and care delivery leaders for engaged scholarship in both research and QI; (4) modification of the agendas and methods of funders and researchers so they emphasize the problems of patients and patient care and support practical time frames and research designs; and (5) facilitation by funders and journals of the dissemination and implementation of lessons from QI and practical research.
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Affiliation(s)
- Leif I Solberg
- Health Partners, Minneapolis, Minnesota 55440-1524, USA.
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Solberg L. Lessons for non-VA care delivery systems from the U.S. Department of Veterans Affairs Quality Enhancement Research Initiative: QUERI Series. Implement Sci 2009; 4:9. [PMID: 19245709 PMCID: PMC2649893 DOI: 10.1186/1748-5908-4-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Accepted: 02/26/2009] [Indexed: 11/10/2022] Open
Abstract
The U.S. Veterans Health Administration (VHA) may have a very different structure and function from the organizations and practices that provide medical care to most Americans, but those organizations and practices could learn a lot from the VHA's Quality Enhancement Research Initiative (QUERI). There are at least six topics of increasing importance for implementation research where QUERI experience should be of value to other non-VHA organizations, both within and external to the United States: 1) Researcher-clinical leader partnerships for care improvement; 2) Attention to culture, capacity, leadership, and a supportive infrastructure; 3) Practical economic evaluation of quality implementation efforts; 4) Human subject protection problems; 5) Sustainability of improvements; and 6) Scale-up and spread of improvements. The articles in Implementation Science's QUERI Series provide the details of those lessons for others who are willing to invest the time to translate them into their different settings.
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Affiliation(s)
- Leif Solberg
- HealthPartners Medical Group and HealthPartners Research Foundation, Minneapolis MN, USA.
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Coleman LA, Kottke TE, Rank B, Reding DJ, Selna M, Isham GJ, Nelson AF, Greenlee RT. Partnering care delivery and research to optimize health. Clin Med Res 2008; 6:113-8. [PMID: 19325175 PMCID: PMC2670530 DOI: 10.3121/cmr.2008.843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A close partnership between care delivery and research organizations has the potential to provide essential elements needed to optimize health and health care. This clinical leadership panel, held during the 14th Annual Health Maintenance Organization Research Network (HMORN) Conference, identifies the value, opportunities and challenges of those close partnerships between three HMORN care delivery and research organizations. The objectives of this plenary session were: (1) identify the important facets of partnership that bring value to care delivery and research, (2) pinpoint the critical alignments of care delivery and research that are needed to fulfill the promised value between clinical and research organizations, and (3) recognize the challenges that clinical and research organizations need to address.
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Affiliation(s)
- Laura A Coleman
- Epidemiology Research Center, Marshfield Clinic Research Foundation, 1000 North Oak Avenue, Marshfield, WI 54449, USA.
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