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Designing and conducting initial application of a performance assessment model for in-hospital trauma care. BMC Health Serv Res 2022; 22:273. [PMID: 35232439 PMCID: PMC8887084 DOI: 10.1186/s12913-022-07578-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 02/01/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Trauma is a major cause of death worldwide, especially in Low and Middle-Income Countries (LMIC). The increase in health care costs and the differences in the quality of provided services indicates the need for trauma care evaluation. This study was done to develop and use a performance assessment model for in-hospital trauma care focusing on traffic injures. METHODS This multi-method study was conducted in three main phases of determining indicators, model development, and model application. Trauma care performance indicators were extracted through literature review and confirmed using a two-round Delphi survey and experts' perspectives. Two focus group discussions and 16 semi-structured interviews were conducted to design the prototype. In the next step, components and the final form of the model were confirmed following pre-determined factors, including importance and necessity, simplicity, clarity, and relevance. Finally, the model was tested by applying it in a trauma center. RESULTS A total of 50 trauma care indicators were approved after reviewing the literature and obtaining the experts' views. The final model consisted of six components of assessment level, teams, methods, scheduling, frequency, and data source. The model application revealed problems of a selected trauma center in terms of information recording, patient deposition, some clinical services, waiting time for deposit, recording medical errors and complications, patient follow-up, and patient satisfaction. CONCLUSION Performance assessment with an appropriate model can identify deficiencies and failures of services provided in trauma centers. Understanding the current situation is one of the main requirements for designing any quality improvement programs.
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Archambault P, Turcotte S, Smith PY, Said Abasse K, Paquet C, Côté A, Gomez D, Khechine H, Gagnon MP, Tremblay M, Elazhary N, Légaré F. Intention to Use Wiki-Based Knowledge Tools: Survey of Quebec Emergency Health Professionals. JMIR Med Inform 2021; 9:e24649. [PMID: 34142977 PMCID: PMC8277401 DOI: 10.2196/24649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/16/2021] [Accepted: 05/07/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Clinical decision support systems are information technologies that assist clinicians in making better decisions. Their adoption has been limited because their content is difficult to adapt to local contexts and slow to adapt to emerging evidence. Collaborative writing applications such as wikis have the potential to increase access to existing and emerging evidence-based knowledge at the point of care, standardize emergency clinical decision making, and quickly adapt this knowledge to local contexts. However, little is known about the factors influencing health professionals' use of wiki-based knowledge tools. OBJECTIVE This study aims to measure emergency physicians' (EPs) and other acute care health professionals' (ACHPs) intentions to use wiki-based knowledge tools in trauma care and identify determinants of this intention that can be used in future theory-based interventions for promoting the use of wiki-based knowledge tools in trauma care. METHODS In total, 266 EPs and 907 ACHPs (nurses, respiratory therapists, and pharmacists) from 12 Quebec trauma centers were asked to answer a survey based on the theory of planned behavior (TPB). The TPB constructs were measured using a 7-point Likert scale. Descriptive statistics and Pearson correlations between the TPB constructs and intention were calculated. Multiple linear regression analysis was conducted to identify the salient beliefs. RESULTS Among the eligible participants, 57.1% (152/266) of EPs and 31.9% (290/907) of ACHPs completed the questionnaire. For EPs, we found that attitude, perceived behavioral control (PBC), and subjective norm (SN) were significant determinants of the intention to use wiki-based knowledge tools and explained 62% of its variance. None of the sociodemographic variables were related to EPs' intentions to use wiki-based knowledge tools. The regression model identified two normative beliefs ("approval by physicians" and "approval by patients") and two behavioral beliefs ("refreshes my memory" and "reduces errors"). For ACHPs, attitude, PBC, SN, and two sociodemographic variables (profession and the previous personal use of a wiki) were significantly related to the intention to use wiki-based knowledge tools and explained 60% of the variance in behavioral intention. The final regression model for ACHPs included two normative beliefs ("approval by the hospital trauma team" and "people less comfortable with information technology"), one control belief ("time constraints"), and one behavioral belief ("access to evidence"). CONCLUSIONS The intentions of EPs and ACHPs to use wiki-based knowledge tools to promote best practices in trauma care can be predicted in part by attitude, SN, and PBC. We also identified salient beliefs that future theory-based interventions should promote for the use of wiki-based knowledge tools in trauma care. These interventions will address the barriers to using wiki-based knowledge tools, find ways to ensure the quality of their content, foster contributions, and support the exploration of wiki-based knowledge tools as potential effective knowledge translation tools in trauma care.
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Affiliation(s)
- Patrick Archambault
- Département de médecine d'urgence, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
| | - Stéphane Turcotte
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Pascal Y Smith
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Kassim Said Abasse
- Département de management, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Catherine Paquet
- Département de marketing, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - André Côté
- Département de management, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Dario Gomez
- Département de systèmes d'information organisationnels, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Hager Khechine
- Département de systèmes d'information organisationnels, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Marie-Pierre Gagnon
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
- Faculté des sciences infirmières, Université Laval, Québec, QC, Canada
| | - Melissa Tremblay
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nicolas Elazhary
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
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Archambault PM, Rivard J, Smith PY, Sinha S, Morin M, LeBlanc A, Couturier Y, Pelletier I, Ghandour EK, Légaré F, Denis JL, Melady D, Paré D, Chouinard J, Kroon C, Huot-Lavoie M, Bert L, Witteman HO, Brousseau AA, Dallaire C, Sirois MJ, Émond M, Fleet R, Chandavong S. Learning Integrated Health System to Mobilize Context-Adapted Knowledge With a Wiki Platform to Improve the Transitions of Frail Seniors From Hospitals and Emergency Departments to the Community (LEARNING WISDOM): Protocol for a Mixed-Methods Implementation Study. JMIR Res Protoc 2020; 9:e17363. [PMID: 32755891 PMCID: PMC7439141 DOI: 10.2196/17363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/17/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Elderly patients discharged from hospital experience fragmented care, repeated and lengthy emergency department (ED) visits, relapse into their earlier condition, and rapid cognitive and functional decline. The Acute Care for Elders (ACE) program at Mount Sinai Hospital in Toronto, Canada uses innovative strategies, such as transition coaches, to improve the care transition experiences of frail elderly patients. The ACE program reduced the lengths of hospital stay and readmission for elderly patients, increased patient satisfaction, and saved the health care system over Can $4.2 million (US $2.6 million) in 2014. In 2016, a context-adapted ACE program was implemented at one hospital in the Centre intégré de santé et de services sociaux de Chaudière-Appalaches (CISSS-CA) with a focus on improving transitions between hospitals and the community. The quality improvement project used an intervention strategy based on iterative user-centered design prototyping and a "Wiki-suite" (free web-based database containing evidence-based knowledge tools) to engage multiple stakeholders. OBJECTIVE The objectives of this study are to (1) implement a context-adapted CISSS-CA ACE program in four hospitals in the CISSS-CA and measure its impact on patient-, caregiver-, clinical-, and hospital-level outcomes; (2) identify underlying mechanisms by which our context-adapted CISSS-CA ACE program improves care transitions for the elderly; and (3) identify underlying mechanisms by which the Wiki-suite contributes to context-adaptation and local uptake of knowledge tools. METHODS Objective 1 will involve staggered implementation of the context-adapted CISSS-CA ACE program across the four CISSS-CA sites and interrupted time series to measure the impact on hospital-, patient-, and caregiver-level outcomes. Objectives 2 and 3 will involve a parallel mixed-methods process evaluation study to understand the mechanisms by which our context-adapted CISSS-CA ACE program improves care transitions for the elderly and by which our Wiki-suite contributes to adaptation, implementation, and scaling up of geriatric knowledge tools. RESULTS Data collection started in January 2019. As of January 2020, we enrolled 1635 patients and 529 caregivers from the four participating hospitals. Data collection is projected to be completed in January 2022. Data analysis has not yet begun. Results are expected to be published in 2022. Expected results will be presented to different key internal stakeholders to better support the effort and resources deployed in the transition of seniors. Through key interventions focused on seniors, we are expecting to increase patient satisfaction and quality of care and reduce readmission and ED revisit. CONCLUSIONS This study will provide evidence on effective knowledge translation strategies to adapt best practices to the local context in the transition of care for elderly people. The knowledge generated through this project will support future scale-up of the ACE program and our wiki methodology in other settings in Canada. TRIAL REGISTRATION ClinicalTrials.gov NCT04093245; https://clinicaltrials.gov/ct2/show/NCT04093245. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/17363.
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Affiliation(s)
- Patrick Michel Archambault
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Josée Rivard
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
| | - Pascal Y Smith
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Samir Sinha
- Department of Medicine, Sinai Health System, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, QC, Canada
- Department of Medicine, University of Toronto, Toronto, QC, Canada
| | - Michèle Morin
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Annie LeBlanc
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
| | - Yves Couturier
- Department of Social Work, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Isabelle Pelletier
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - El Kebir Ghandour
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Institut national d'excellence en sante et en services sociaux, Québec, QC, Canada
| | - France Légaré
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Québec, QC, Canada
| | - Jean-Louis Denis
- Département de gestion, d'évaluation et de politique de santé, École de santé publique, Université de Montréal, Montreal, QC, Canada
| | - Don Melady
- Schwartz-Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel Paré
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
| | - Josée Chouinard
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
| | - Chantal Kroon
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
| | - Maxime Huot-Lavoie
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Laetitia Bert
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Faculty of Nursing, Université Laval, Québec, QC, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Office of Education and Professional Development, Faculty of Medicine, Université Laval, Québec, QC, Canada
- CHU de Québec-Université Laval, Québec, QC, Canada
| | - Audrey-Anne Brousseau
- Centre intégré universitaire de santé et de services sociaux de l'Estrie - CHUS, Sherbrooke, QC, Canada
| | - Clémence Dallaire
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Faculty of Nursing, Université Laval, Québec, QC, Canada
| | - Marie-Josée Sirois
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre d'excellence sur le vieillissement du Québec, Hôpital du Saint-Sacrement, Québec, QC, Canada
- Département de réadaptation, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Marcel Émond
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- CHU de Québec-Université Laval, Québec, QC, Canada
| | - Richard Fleet
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Sam Chandavong
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
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Cheng A, Nadkarni VM, Mancini MB, Hunt EA, Sinz EH, Merchant RM, Donoghue A, Duff JP, Eppich W, Auerbach M, Bigham BL, Blewer AL, Chan PS, Bhanji F. Resuscitation Education Science: Educational Strategies to Improve Outcomes From Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation 2019; 138:e82-e122. [PMID: 29930020 DOI: 10.1161/cir.0000000000000583] [Citation(s) in RCA: 186] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The formula for survival in resuscitation describes educational efficiency and local implementation as key determinants in survival after cardiac arrest. Current educational offerings in the form of standardized online and face-to-face courses are falling short, with providers demonstrating a decay of skills over time. This translates to suboptimal clinical care and poor survival outcomes from cardiac arrest. In many institutions, guidelines taught in courses are not thoughtfully implemented in the clinical environment. A current synthesis of the evidence supporting best educational and knowledge translation strategies in resuscitation is lacking. In this American Heart Association scientific statement, we provide a review of the literature describing key elements of educational efficiency and local implementation, including mastery learning and deliberate practice, spaced practice, contextual learning, feedback and debriefing, assessment, innovative educational strategies, faculty development, and knowledge translation and implementation. For each topic, we provide suggestions for improving provider performance that may ultimately optimize patient outcomes from cardiac arrest.
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Abu-Laban RB, Drebit S, Svendson B, Chan N, Ho K, Khazei A, Lindstrom RR, Lund A, Marsden J, Christenson J. Process and findings informing the development of a provincial emergency medicine network. Healthc Manage Forum 2019; 32:253-258. [PMID: 31180243 DOI: 10.1177/0840470419844276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe the process undertaken to inform the development of the recently launched British Columbia (BC) Emergency Medicine Network (EM Network). Five methods were undertaken: (1) a scoping literature review, (2) a survey of BC emergency practitioners and EM residents, (3) key informant interviews, (4) focus groups in sites across BC, and (5) establishment of a brand identity. There were 208 survey respondents: 84% reported consulting Internet resources once or more per emergency department shift; however, 26% reported feeling neutral, somewhat unsatisfied, or very unsatisfied with searching for information on the Internet to support their practice. Enthusiasm was expressed for envisioned EM Network resources, and the key informant interviews and focus group results helped identify and refine key desired components of the EM Network. In describing this, we provide guidance and lessons learned for health leaders and others who aspire to establish similar clinical networks, whether in EM or other medical disciplines.
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Affiliation(s)
- Riyad B Abu-Laban
- 1 Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
| | - Sharla Drebit
- 1 Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
| | - Brandy Svendson
- 2 Be the Change Group Inc., Vancouver, British Columbia, Canada
| | - Natalie Chan
- 2 Be the Change Group Inc., Vancouver, British Columbia, Canada
| | - Kendall Ho
- 1 Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
| | - Afshin Khazei
- 1 Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
| | - Ronald R Lindstrom
- 1 Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
| | - Adam Lund
- 1 Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
| | - Julian Marsden
- 1 Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
| | - Jim Christenson
- 1 Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada
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Abu-Laban RB, Drebit S, Lindstrom RR, Archibald C, Eggers K, Ho K, Khazei A, Lund A, MacKinnon C, Markham R, Marsden J, Martin E, Christenson J. The British Columbia Emergency Medicine Network: A Paradigm Shift in a Provincial System of Emergency Care. Cureus 2018. [PMID: 29531875 PMCID: PMC5837260 DOI: 10.7759/cureus.2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
As generalists, emergency practitioners face challenges in providing state-of-the-art care owing to the broad spectrum of practice and the rapid rate of new knowledge generation. Networks have become increasingly prevalent in health care, and it was in this backdrop, and the resulting opportunity to advance evidence-informed emergency care in the Canadian province of British Columbia (BC), that a new “Emergency Medicine Network” (EM Network) was launched in 2017. The EM Network consists of four programs, each led by a physician with expertise and a track record in the domain: (1) Clinical Resources; (2) Innovation; (3) Continuing Professional Development; and (4) Real-time Support. This paper provides an overview of the EM Network, including its background, purpose, programs, anticipated evolution, and impact on the BC health care system.
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Affiliation(s)
| | - Sharla Drebit
- Department of Emergency Medicine, University of British Columbia
| | | | | | | | - Kendall Ho
- Department of Emergency Medicine, University of British Columbia
| | - Afshin Khazei
- Department of Emergency Medicine, University of British Columbia
| | - Adam Lund
- Deparment of Emergency Medicine, University of British Columbia
| | | | - Ray Markham
- Department of Family Practice, University of British Columbia
| | - Julian Marsden
- Department of Emergency Medicine, University of British Columbia
| | | | - Jim Christenson
- Department of Emergency Medicine, University of British Columbia
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Archambault PM, van de Belt TH, Kuziemsky C, Plaisance A, Dupuis A, McGinn CA, Francois R, Gagnon M, Turgeon AF, Horsley T, Witteman W, Poitras J, Lapointe J, Brand K, Lachaine J, Légaré F. Collaborative writing applications in healthcare: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2017; 5:CD011388. [PMID: 28489282 PMCID: PMC6481880 DOI: 10.1002/14651858.cd011388.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Collaborative writing applications (CWAs), such as wikis and Google Documents, hold the potential to improve the use of evidence in both public health and healthcare. Although a growing body of literature indicates that CWAs could have positive effects on healthcare, such as improved collaboration, behavioural change, learning, knowledge management, and adaptation of knowledge to local context, this has never been assessed systematically. Moreover, several questions regarding safety, reliability, and legal aspects exist. OBJECTIVES The objectives of this review were to (1) assess the effects of the use of CWAs on process (including the behaviour of healthcare professionals) and patient outcomes, (2) critically appraise and summarise current evidence on the use of resources, costs, and cost-effectiveness associated with CWAs to improve professional practices and patient outcomes, and (3) explore the effects of different CWA features (e.g. open versus closed) and different implementation factors (e.g. the presence of a moderator) on process and patient outcomes. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and 11 other electronic databases. We searched the grey literature, two trial registries, CWA websites, individual journals, and conference proceedings. We also contacted authors and experts in the field. We did not apply date or language limits. We searched for published literature to August 2016, and grey literature to September 2015. SELECTION CRITERIA We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-and-after (CBA) studies, interrupted time series (ITS) studies, and repeated measures studies (RMS), in which CWAs were used as an intervention to improve the process of care, patient outcomes, or healthcare costs. DATA COLLECTION AND ANALYSIS Teams of two review authors independently assessed the eligibility of studies. Disagreements were resolved by discussion, and when consensus was not reached, a third review author was consulted. MAIN RESULTS We screened 11,993 studies identified from the electronic database searches and 346 studies from grey literature sources. We analysed the full text of 99 studies. None of the studies met the eligibility criteria; two potentially relevant studies are ongoing. AUTHORS' CONCLUSIONS While there is a high number of published studies about CWAs, indicating that this is an active field of research, additional studies using rigorous experimental designs are needed to assess their impact and cost-effectiveness on process and patient outcomes.
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Affiliation(s)
- Patrick M Archambault
- Université LavalDepartment of Family Medicine and Emergency MedicineQuébec CityQCCanada
- Centre hospitalier affilié universitaire Hôtel‐Dieu de LévisCentre intégré de santé et de services sociaux de Chaudière‐AppalachesLévisQCCanada
- Université LavalPopulation Health and Optimal Health Practice Research Unit, CHU de Québec ‐ Université Laval Research Center, CHU de Québec ‐ Université LavalQuébec CityQCCanada
- Université LavalDepartment of Anesthesiology and Critical Care Medicine, Division of Critical Care MedicineQuébec CityQCCanada
| | - Tom H van de Belt
- Radboud University Medical CenterRadboud REshape Innovation CenterPostbus 91016500 HB NijmegenNijmegenNetherlands
| | - Craig Kuziemsky
- University of OttawaTelfer School of Management55 Laurier Avenue EastOttawaONCanadaK1N 6N5
| | - Ariane Plaisance
- Centre hospitalier affilié universitaire Hôtel‐Dieu de LévisCentre intégré de santé et de services sociaux de Chaudière‐AppalachesLévisQCCanada
| | - Audrey Dupuis
- Centre hospitalier affilié universitaire Hôtel‐Dieu de LévisCentre intégré de santé et de services sociaux de Chaudière‐AppalachesLévisQCCanada
- Université LavalDepartment of Information and Communication1055, avenue du SéminaireQuébec CityQCCanadaG1V0A6
| | - Carrie A McGinn
- Centre hospitalier affilié universitaire Hôtel‐Dieu de LévisCentre intégré de santé et de services sociaux de Chaudière‐AppalachesLévisQCCanada
| | - Rebecca Francois
- Centre hospitalier affilié universitaire Hôtel‐Dieu de LévisCentre intégré de santé et de services sociaux de Chaudière‐AppalachesLévisQCCanada
| | - Marie‐Pierre Gagnon
- Université LavalPopulation Health and Optimal Health Practice Research Unit, CHU de Québec ‐ Université Laval Research Center, CHU de Québec ‐ Université LavalQuébec CityQCCanada
- Université LavalFaculty of NursingQuébec CityQCCanada
| | - Alexis F Turgeon
- Université LavalPopulation Health and Optimal Health Practice Research Unit, CHU de Québec ‐ Université Laval Research Center, CHU de Québec ‐ Université LavalQuébec CityQCCanada
- Université LavalDepartment of Anesthesiology and Critical Care Medicine, Division of Critical Care MedicineQuébec CityQCCanada
| | - Tanya Horsley
- Royal College of Physicians and Surgeons of CanadaResearch Unit774 Echo DriveOttawaONCanadaK1S 5N8
| | - William Witteman
- Université LavalClinical and Evaluative Research Unit, CHU de Québec Research Center45 Leclerc ‐ Room D6‐729Québec CityQCCanadaG1L 3L5
| | - Julien Poitras
- Université LavalDepartment of Family Medicine and Emergency MedicineQuébec CityQCCanada
- Centre hospitalier affilié universitaire Hôtel‐Dieu de LévisCentre intégré de santé et de services sociaux de Chaudière‐AppalachesLévisQCCanada
- Université LavalPopulation Health and Optimal Health Practice Research Unit, CHU de Québec ‐ Université Laval Research Center, CHU de Québec ‐ Université LavalQuébec CityQCCanada
| | - Jean Lapointe
- Université LavalDepartment of Family Medicine and Emergency MedicineQuébec CityQCCanada
- Centre hospitalier affilié universitaire Hôtel‐Dieu de LévisCentre intégré de santé et de services sociaux de Chaudière‐AppalachesLévisQCCanada
| | - Kevin Brand
- University of OttawaTelfer School of Management55 Laurier Avenue EastOttawaONCanadaK1N 6N5
| | - Jean Lachaine
- Université de MontréalFaculty of PharmacyC.P. 6128, Succursale Centre‐villeMontréalQCCanadaH3C 3J7
| | - France Légaré
- Université LavalDepartment of Family Medicine and Emergency MedicineQuébec CityQCCanada
- Université LavalPopulation Health and Optimal Health Practice Research Unit, CHU de Québec ‐ Université Laval Research Center, CHU de Québec ‐ Université LavalQuébec CityQCCanada
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Medicare Imaging Demonstration: Assessing Attributes of Appropriate Use Criteria and Their Influence on Ordering Behavior. AJR Am J Roentgenol 2017; 208:1051-1057. [PMID: 28267371 DOI: 10.2214/ajr.16.17169] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Persistent concern exists about the variable and possibly inappropriate utilization of high-cost imaging tests. The purpose of this study is to assess the influence of appropriate use criteria attributes on altering ambulatory imaging orders deemed inappropriate. MATERIALS AND METHODS This secondary analysis included Medicare Imaging Demonstration data collected from three health care systems in 2011-2013 via the use of clinical decision support (CDS) during ambulatory imaging order entry. The CDS system captured whether orders were inappropriate per the appropriate use criteria of professional societies and provided advice during the intervention period. For orders deemed inappropriate, we assessed the impact of the availability of alternative test recommendations, conflicts with local best practices, and the strength of evidence for appropriate use criteria on the primary outcome of cancellation or modification of inappropriate orders. Expert review determined conflicts with local best practices for 250 recommendations for abdominal and thoracic CT orders. Strength of evidence was assessed for the 15 most commonly triggered recommendations that were deemed inappropriate. A chi-square test was used for univariate analysis. RESULTS A total of 1691 of 63,222 imaging test orders (2.7%) were deemed inappropriate during the intervention period; this amount decreased from 364 of 11,675 test orders (3.1%) in the baseline period (p < 0.00001). Of 270 inappropriate recommendations with alternative test recommendations, 28 (10.4%) were modified, compared with four of 1024 inappropriate recommendations without alternatives (0.4%) (p < 0.0001). Seventy-eight of 250 recommendations (31%) conflicted with local best practices, but only six of 69 inappropriate recommendations (9%) conflicted (p < 0.001). No inappropriate recommendations that conflicted with local best practices were modified. All 15 commonly triggered recommendations had an Oxford Centre for Evidence-Based Medicine level of evidence of 5 (i.e., expert opinion). CONCLUSION Orders for imaging tests that were deemed inappropriate were modified infrequently, more often with alternative recommendations present and only for appropriate use criteria consistent with local best practices.
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Janssen A, Robinson TE, Provan P, Shaw T. The Sydney West Knowledge Portal: Evaluating the Growth of a Knowledge Portal to Support Translational Research. J Med Internet Res 2016; 18:e170. [PMID: 27357641 PMCID: PMC4945823 DOI: 10.2196/jmir.5786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/09/2016] [Accepted: 05/27/2016] [Indexed: 11/13/2022] Open
Abstract
Background The Sydney West Translational Cancer Research Centre is an organization funded to build capacity for translational research in cancer. Translational research is essential for ensuring the integration of best available evidence into practice and for improving patient outcomes. However, there is a low level of awareness regarding what it is and how to conduct it optimally. One solution to addressing this gap is the design and deployment of web-based knowledge portals to disseminate new knowledge and engage with and connect dispersed networks of researchers. A knowledge portal is an web-based platform for increasing knowledge dissemination and management in a specialized area. Objective To measure the design and growth of an web-based knowledge portal for increasing individual awareness of translational research and to build organizational capacity for the delivery of translational research projects in cancer. Methods An adaptive methodology was used to capture the design and growth of an web-based knowledge portal in cancer. This involved stakeholder consultations to inform initial design of the portal. Once the portal was live, site analytics were reviewed to evaluate member usage of the portal and to measure growth in membership. Results Knowledge portal membership grew consistently for the first 18 months after deployment, before leveling out. Analysis of site metrics revealed members were most likely to visit portal pages with community-generated content, particularly pages with a focus on translational research. This was closely followed by pages that disseminated educational material about translational research. Conclusions Preliminary data from this study suggest that knowledge portals may be beneficial tools for translating new evidence and fostering an environment of communication and collaboration.
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Affiliation(s)
- Anna Janssen
- Research in Implementation Science and eHealth, Faculty of Health Sciences, The University of Sydney, Sydney University, Australia.
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10
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Archambault PM, Beaupré P, Bégin L, Dupuis A, Côté M, Légaré F. Impact of Implementing a Wiki to Develop Structured Electronic Order Sets on Physicians' Intention to Use Wiki-Based Order Sets. JMIR Med Inform 2016; 4:e18. [PMID: 27189046 PMCID: PMC4909394 DOI: 10.2196/medinform.4852] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 03/12/2016] [Accepted: 04/03/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Wikis have the potential to promote best practices in health systems by sharing order sets with a broad community of stakeholders. However, little is known about the impact of using a wiki on clinicians' intention to use wiki-based order sets. OBJECTIVE The aims of this study were: (1) to describe the use of a wiki to create structured order sets for a single emergency department; (2) to evaluate whether the use of this wiki changed emergency physicians' future intention to use wiki-based order sets; and (3) to understand the impact of using the wiki on the behavioral determinants for using wiki-based order sets. METHODS This was a pre/post-intervention mixed-methods study conducted in one hospital in Lévis, Quebec. The intervention was comprised of receiving access to and being motivated by the department head to use a wiki for 6 months to create electronic order sets designed to be used in a computer physician order entry system. Before and after our intervention, we asked participants to complete a previously validated questionnaire based on the Theory of Planned Behavior. Our primary outcome was the intention to use wiki-based order sets in clinical practice. We also assessed participants' attitude, perceived behavioral control, and subjective norm to use wiki-based order sets. Paired pre- and post-Likert scores were compared using Wilcoxon signed-rank tests. The post-questionnaire also included open-ended questions concerning participants' comments about the wiki, which were then classified into themes using an existing taxonomy. RESULTS Twenty-eight emergency physicians were enrolled in the study (response rate: 100%). Physicians' mean intention to use a wiki-based reminder was 5.42 (SD 1.04) before the intervention, and increased to 5.81 (SD 1.25) on a 7-point Likert scale (P =.03) after the intervention. Participants' attitude towards using a wiki-based order set also increased from 5.07 (SD 0.90) to 5.57 (SD 0.88) (P =.003). Perceived behavioral control and subjective norm did not change. Easier information sharing was the most frequently positive impact raised. In order of frequency, the three most important facilitators reported were: ease of use, support from colleagues, and promotion by the departmental head. Although participants did not mention any perceived negative impacts, they raised the following barriers in order of frequency: poor organization of information, slow computers, and difficult wiki access. CONCLUSIONS Emergency physicians' intention and attitude to use wiki-based order sets increased after having access to and being motivated to use a wiki for 6 months. Future studies need to explore if this increased intention will translate into sustained actual use and improve patient care. Certain barriers need to be addressed before implementing a wiki for use on a larger scale.
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Lacson R, Raja AS, Osterbur D, Ip I, Schneider L, Bain P, Mita C, Whelan J, Silveira P, Dement D, Khorasani R. Assessing Strength of Evidence of Appropriate Use Criteria for Diagnostic Imaging Examinations. J Am Med Inform Assoc 2016; 23:649-53. [PMID: 26911819 DOI: 10.1093/jamia/ocv194] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/09/2015] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE For health information technology tools to fully inform evidence-based decisions, recommendations must be reliably assessed for quality and strength of evidence. We aimed to create an annotation framework for grading recommendations regarding appropriate use of diagnostic imaging examinations. METHODS The annotation framework was created by an expert panel (clinicians in three medical specialties, medical librarians, and biomedical scientists) who developed a process for achieving consensus in assessing recommendations, and evaluated by measuring agreement in grading the strength of evidence for 120 empirically selected recommendations using the Oxford Levels of Evidence. RESULTS Eighty-two percent of recommendations were assigned to Level 5 (expert opinion). Inter-annotator agreement was 0.70 on initial grading (κ = 0.35, 95% CI, 0.23-0.48). After systematic discussion utilizing the annotation framework, agreement increased significantly to 0.97 (κ = 0.88, 95% CI, 0.77-0.99). CONCLUSIONS A novel annotation framework was effective for grading the strength of evidence supporting appropriate use criteria for diagnostic imaging exams.
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Affiliation(s)
- Ronilda Lacson
- Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA Harvard Medical School, Boston, MA 02115, USA
| | - Ali S Raja
- Harvard Medical School, Boston, MA 02115, USA Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - David Osterbur
- Harvard Medical School, Boston, MA 02115, USA Countway Library of Medicine, Boston, MA 02115, USA
| | - Ivan Ip
- Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA Harvard Medical School, Boston, MA 02115, USA Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Louise Schneider
- Harvard Medical School, Boston, MA 02115, USA Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Paul Bain
- Harvard Medical School, Boston, MA 02115, USA Countway Library of Medicine, Boston, MA 02115, USA
| | - Carol Mita
- Harvard Medical School, Boston, MA 02115, USA Countway Library of Medicine, Boston, MA 02115, USA
| | - Julia Whelan
- Harvard Medical School, Boston, MA 02115, USA Countway Library of Medicine, Boston, MA 02115, USA
| | - Patricia Silveira
- Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - David Dement
- Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Ramin Khorasani
- Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA Harvard Medical School, Boston, MA 02115, USA
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Bientzle M, Griewatz J, Kimmerle J, Küppers J, Cress U, Lammerding-Koeppel M. Impact of Scientific Versus Emotional Wording of Patient Questions on Doctor-Patient Communication in an Internet Forum: A Randomized Controlled Experiment with Medical Students. J Med Internet Res 2015; 17:e268. [PMID: 26607233 PMCID: PMC4704952 DOI: 10.2196/jmir.4597] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/21/2015] [Accepted: 11/02/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Medical expert forums on the Internet play an increasing role in patient counseling. Therefore, it is important to understand how doctor-patient communication is influenced in such forums both by features of the patients or advice seekers, as expressed in their forum queries, and by characteristics of the medical experts involved. OBJECTIVE In this experimental study, we aimed to examine in what way (1) the particular wording of patient queries and (2) medical experts' therapeutic health concepts (for example, beliefs around adhering to a distinctly scientific understanding of diagnosis and treatment and a clear focus on evidence-based medicine) impact communication behavior of the medical experts in an Internet forum. METHODS Advanced medical students (in their ninth semester of medical training) were recruited as participants. Participation in the online forum was part of a communication training embedded in a gynecology course. We first measured their biomedical therapeutic health concept (hereinafter called "biomedical concept"). Then they participated in an online forum where they answered fictitious patient queries about mammography screening that either included scientific or emotional wording in a between-group design. We analyzed participants' replies with regard to the following dimensions: their use of scientific or emotional wording, the amount of communicated information, and their attempt to build a positive doctor-patient relationship. RESULTS This study was carried out with 117 medical students (73 women, 41 men, 3 did not indicate their sex). We found evidence that both the wording of patient queries and the participants' biomedical concept influenced participants' response behavior. They answered emotional patient queries in a more emotional way (mean 0.92, SD 1.02) than scientific patient queries (mean 0.26, SD 0.55; t74=3.48, P<.001, d=0.81). We also found a significant interaction effect between participants' use of scientific or emotional wording and type of patient query (F2,74=10.29, P<.01, partial η(2)=0.12) indicating that participants used scientific wording independently of the type of patient query, whereas they used emotional wording particularly when replying to emotional patient queries. In addition, the more pronounced the medical experts' biomedical concept was, the more scientifically (adjusted β=.20; F1,75=2.95, P=.045) and the less emotionally (adjusted β=-.22; F1,74=3.66, P=.03) they replied to patient queries. Finally, we found that participants' biomedical concept predicted their engagement in relationship building (adjusted β=-.26): The more pronounced their biomedical concept was, the less they attempted to build a positive doctor-patient relationship (F1,74=5.39, P=.02). CONCLUSIONS Communication training for medical experts could aim to address this issue of recognizing patients' communication styles and needs in certain situations in order to teach medical experts how to take those aspects adequately into account. In addition, communication training should also make medical experts aware of their individual therapeutic health concepts and the consequential implications in communication situations.
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Affiliation(s)
- Martina Bientzle
- Leibniz-Institut für Wissensmedien / Knowledge Media Research Center, Knowledge Construction Lab, Tuebingen, Germany
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Fernandez A, Sturmberg J, Lukersmith S, Madden R, Torkfar G, Colagiuri R, Salvador-Carulla L. Evidence-based medicine: is it a bridge too far? Health Res Policy Syst 2015; 13:66. [PMID: 26546273 PMCID: PMC4636779 DOI: 10.1186/s12961-015-0057-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 10/29/2015] [Indexed: 01/28/2023] Open
Abstract
AIMS This paper aims to describe the contextual factors that gave rise to evidence-based medicine (EBM), as well as its controversies and limitations in the current health context. Our analysis utilizes two frameworks: (1) a complex adaptive view of health that sees both health and healthcare as non-linear phenomena emerging from their different components; and (2) the unified approach to the philosophy of science that provides a new background for understanding the differences between the phases of discovery, corroboration, and implementation in science. RESULTS The need for standardization, the development of clinical epidemiology, concerns about the economic sustainability of health systems and increasing numbers of clinical trials, together with the increase in the computer's ability to handle large amounts of data, have paved the way for the development of the EBM movement. It was quickly adopted on the basis of authoritative knowledge rather than evidence of its own capacity to improve the efficiency and equity of health systems. The main problem with the EBM approach is the restricted and simplistic approach to scientific knowledge, which prioritizes internal validity as the major quality of the studies to be included in clinical guidelines. As a corollary, the preferred method for generating evidence is the explanatory randomized controlled trial. This method can be useful in the phase of discovery but is inadequate in the field of implementation, which needs to incorporate additional information including expert knowledge, patients' values and the context. CONCLUSION EBM needs to move forward and perceive health and healthcare as a complex interaction, i.e. an interconnected, non-linear phenomenon that may be better analysed using a variety of complexity science techniques.
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Affiliation(s)
- Ana Fernandez
- Brain and Mind Centre, Faculty of Health Sciences, The University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
| | - Joachim Sturmberg
- Discipline of General Practice, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.
| | - Sue Lukersmith
- Centre for Disability Research and Policy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
| | - Rosamond Madden
- Centre for Disability Research and Policy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
| | - Ghazal Torkfar
- Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia.
| | - Ruth Colagiuri
- Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia.
| | - Luis Salvador-Carulla
- Centre for Disability Research and Policy-Brain and Mind Centre, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
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