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Wound characteristics and infiltration with immune globulin for rabies postexposure prophylaxis in the emergency department. Am J Emerg Med 2022; 62:55-61. [DOI: 10.1016/j.ajem.2022.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
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Mathur S, Dewan N, Janaudis-Ferreira T, Antonio P, Surins H, Deliva R, Patterson C, So S. Disseminating education to solid organ transplant recipients to promote engagement in physical activity. PEC INNOVATION 2022; 1:100024. [PMID: 37213783 PMCID: PMC10194172 DOI: 10.1016/j.pecinn.2022.100024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/28/2022] [Accepted: 02/13/2022] [Indexed: 05/23/2023]
Abstract
Objective To evaluate the dissemination of education through a workshop to promote engagement in physical activity (PA) among solid organ transplant (SOT) recipients. Methods The in-person workshop consisted of expert-led lectures on topics related to physical activity (day 1) and sports and fitness training with volunteer coaches (day 2). There were separate streams for children/adolescents and adults. RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) framework was used to evaluate the impact of the workshop. Presenters and participants completed evaluations of the workshop using a 5-point Likert scale. A subgroup of adults completed a self-reported PA questionnaire at baseline and 4-weeks after the workshop. Results 103 individuals (71 SOT recipients, 32 caregivers) attended the workshop (ages 4 to 71+ years). Sessions were highly rated (median = 5) for both quality and content on both days. There was no significant change (p = 0.16) in PA. However, 56% of SOT recipients reported changing their level of PA. Conclusion An educational-workshop with hands-on training was an efficient and well-received method for disseminating awareness about the benefits of PA in SOT recipients. Innovation Dissemination of evidence-based knowledge through a novel educational-workshop in a real-world setting has the potential to inform the decisions about PA behavior among SOT recipients.
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Affiliation(s)
- Sunita Mathur
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
| | - Neha Dewan
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Tania Janaudis-Ferreira
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montreal, Canada
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Patrick Antonio
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Holly Surins
- Department of Occupational Therapy and Occupational Science, University of Toronto, Toronto, Canada
| | - Robin Deliva
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Department of Rehabilitation Services, Hospital for Sick Children (SickKids), Toronto, Canada
| | - Catherine Patterson
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Department of Rehabilitation Services, Hospital for Sick Children (SickKids), Toronto, Canada
| | - Stephanie So
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Department of Rehabilitation Services, Hospital for Sick Children (SickKids), Toronto, Canada
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Using the RE-AIM framework to evaluate the implementation of scaling-up the Friendship Bench in Zimbabwe - a quantitative observational study. BMC Health Serv Res 2022; 22:1392. [PMID: 36419089 PMCID: PMC9682765 DOI: 10.1186/s12913-022-08767-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/30/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the real-world implementation of the Friendship Bench (FB) - an evidence-based brief psychological intervention delivered by community health workers (CHWs) - three years after its implementation in three city health departments in Zimbabwe. Implementation sites were evaluated according to their current performance using the RE-AIM framework making this one of the first evaluations of a scaled-up evidence-based psychological intervention in sub-Saharan Africa (SSA). METHODS Using the RE-AIM guide ( www.re-aim.org ), the authors designed quantitative indicators based on existing FB implementation data. Thirty-six primary health care clinics (PHC) in Harare (n=28), Chitungwiza (n=4) and Gweru (n=4) were included. Among these clinics 20 were large comprehensive health care centers, 7 medium (mostly maternal and child healthcare) and 9 small clinics (basic medical care and acting as referral clinic). Existing data from these clinics, added to additionally collected data through interviews and field observations were used to investigate and compare the performance of the FB across clinics. The focus was on the RE-AIM domains of Reach, Adoption, and Implementation. RESULTS Small clinics achieved 34% reach, compared to large (15%) and medium clinics (9%). Adoption was high in all clinic types, ranging from 59% to 71%. Small clinics led the implementation domain with 53%, followed by medium sized clinics 43% and large clinics 40%. Small clinics performed better in all indicators and differences in performance between small and large clinics were significant. Program activity and data quality depends on ongoing support for delivering agents and buy-in from health authorities. CONCLUSION The Friendship Bench program was implemented over three years transitioning from a research-based implementation program to one led locally. The Reach domain showed the largest gap across clinics where larger clinics performed poorly relative to smaller clinics and should be a target for future implementation improvements. Program data needs to be integrated into existing health information systems. Future studies should seek to optimize scale-up and sustainment strategies to maintain effective task-shared psychological interventions in SSA.
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A decision-making model to optimize the impact of community-based health programs. Prev Med 2021; 149:106619. [PMID: 33992658 PMCID: PMC8207482 DOI: 10.1016/j.ypmed.2021.106619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/22/2022]
Abstract
Hospitals and clinics are increasingly interested in building partnerships with community-based organizations to address the social determinants of health. Choosing among community-based health programs can be complex given that programs may have different effectiveness levels and implementation costs. This study develops a decision-making model that can be used to evaluate multiple key factors that would be relevant in resource allocation decisions related to a set of community-based health programs. The decision-making model compares community-based health programs by considering funding limitations, program duration, and participant retention until program completion. Specifically, the model allows decision makers to select the optimal mix of community-based health programs based on the profiles of the population given the above constraints. The model can be used to improve resource allocation in communities, ultimately contributing to the long-term goal of strengthening cross-sector partnerships and the integration of services to improve health outcomes.
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Czosnek L, Rankin N, Zopf E, Richards J, Rosenbaum S, Cormie P. Implementing Exercise in Healthcare Settings: The Potential of Implementation Science. Sports Med 2020; 50:1-14. [PMID: 31749112 DOI: 10.1007/s40279-019-01228-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Exercise is an efficacious therapy for many chronic diseases. Integrating efficacious evidence-based interventions (EBIs), such as exercise, into daily healthcare practice is a slow and complex pursuit. Implementation science seeks to understand and address this phenomenon by conducting studies about the methods used to promote the routine uptake of EBIs. The purpose of this article is to explore implementation science and a common conceptual framework in the discipline, the Consolidated Framework for Implementation Research (CFIR), as it applies to exercise EBI. We conclude by offering recommendations for future research that leverage implementation science priorities to highlight the potential of this research field for advancing the implementation of exercise EBI.
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Affiliation(s)
- Louise Czosnek
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia.
| | - Nicole Rankin
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Eva Zopf
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - Justin Richards
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand.,School of Public Health and Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Simon Rosenbaum
- School of Psychiatry, University of New South Wales, Sydney, Australia.,Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Prue Cormie
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia
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das Nair R, de Groot V, Freeman J. Beyond current research practice: Methodological considerations in MS rehabilitation research (is designing the perfect rehabilitation trial the Holy Grail or a Gordian knot?). Mult Scler 2020; 25:1337-1347. [PMID: 31469355 DOI: 10.1177/1352458519858271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Rehabilitation is an essential aspect of symptomatic and supportive treatment for people with multiple sclerosis (MS). The number of randomised controlled trials (RCTs) for rehabilitation interventions in MS has increased over the last two decades. The design, conduct and reporting quality of some of these trials could be improved. There are, however, some specific challenges that researchers face in conducting RCTs of rehabilitation interventions, which are often 'complex interventions'. This paper explores some of the challenges of undertaking robust clinical trials in rehabilitation. We focus on issues related to (1) participant selection and sample size, (2) interventions - the 'dose', content, active ingredients, targeting, fidelity of delivery and treatment adherence, (3) control groups and (4) outcomes - choosing the right type, number, timing of outcomes, and the importance of defining a primary outcome and clinically important difference between groups. We believe that by following internationally accepted RCT guidelines, by developing a critical mass of MS rehabilitation 'trialists' through international collaboration and by continuing to critique, challenge, and develop RCT designs, we can exploit the potential of RCTs to answer important questions related to the effectiveness of rehabilitation interventions.
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Affiliation(s)
- Roshan das Nair
- Clinical Psychology and Neuropsychology, Institute of Mental Health, University of Nottingham, Jubilee Campus, Nottingham, UK
| | - Vincent de Groot
- Department of Rehabilitation Medicine, MS Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jennifer Freeman
- Physiotherapy and Rehabilitation, School of Health Professions, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
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Cattaneo D, Gervasoni E, Pupillo E, Bianchi E, Aprile I, Imbimbo I, Russo R, Cruciani A, Turolla A, Jonsdottir J, Agostini M, Beghi E. Educational and Exercise Intervention to Prevent Falls and Improve Participation in Subjects With Neurological Conditions: The NEUROFALL Randomized Controlled Trial. Front Neurol 2019; 10:865. [PMID: 31572282 PMCID: PMC6754067 DOI: 10.3389/fneur.2019.00865] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/26/2019] [Indexed: 11/27/2022] Open
Abstract
Background: Falls, mobility impairments and lack of social support lead to participation restrictions in people with neurological conditions. The aim of this multicenter, single blinded randomized controlled trial was to test whether an educational program focusing on fall prevention and safe mobility reduces falls and increases social participation among people with neurological conditions. Methods: Ninety people with Stroke (n = 25), multiple sclerosis (n = 33) and Parkinson disease (n = 32), median age 63 (31-89), were randomized. A permuted block algorithm stratified by field center was used to allocate participants to an education group (EG, n = 42) consisting of an educational program focused on fall prevention and tailored balance exercises and a control group (CG, n = 48) receiving usual treatments. After baseline assessment, each participants was followed for 6 months with telephone contacts by blinded interviewers. Being fallers (>1 fall) and time to become a faller were used as primary outcomes. Community Integration Questionnaire (CIQ) and Instrumental Activities of Daily Living (IADL) scales assessed treatment effects on social integration and daily living activities. Results: Over a median (Interquartile Range) follow-up of 189 (182-205) days, [EG = 188 (182-202), CG = 189 (182-209)] fallers were 10 in the CG and 11 in the EG (hazard ratio 0.95, 95% confidence interval (CI) 0.45 to 2.5; P = 0.94). At follow-up the EG scored significantly better than CG on the CIQ (+1.7 points, CI: 0.1 to 3.3) and IADL (+2.2 points, CI: 0.4 to 4.0). Conclusions: This educational program did not reduce the risk of falls but it improved the ability to carry out activities of daily living and decreased participation restrictions in people with neurological conditions.
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Affiliation(s)
| | | | | | - Elisa Bianchi
- Istituto Di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Irene Aprile
- Fondazione Don Carlo Gnocchi Onlus (IRCCS), Milan, Italy
| | | | - Rita Russo
- San Carlo Borromeo Hospital, Milan, Italy
| | | | | | | | | | - Ettore Beghi
- Istituto Di Ricerche Farmacologiche Mario Negri, Milan, Italy
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Lai J, Klag M, Shikako‐Thomas K. Designing a program evaluation for a medical-dental service for adults with autism and intellectual disabilities using the RE-AIM framework. Learn Health Syst 2019; 3:e10192. [PMID: 31317073 PMCID: PMC6628980 DOI: 10.1002/lrh2.10192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/27/2018] [Accepted: 03/10/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Robust evaluation of service models can improve the quality and efficiency of care while articulating the models for potential replication. Even though it is an essential part of learning health systems, evaluations that benchmark and sustain models serving adults with developmental disabilities are lacking, impeding pilot programs from becoming official care pathways. Here, we describe the development of a program evaluation for a specialized medical-dental community clinic serving adults with autism and intellectual disabilities in Montreal, Canada. METHOD Using a Participatory Action-oriented approach, researchers and staff co-designed an evaluation for a primary care service for this population. We performed an evaluability assessment to identify the processes and outcomes that were feasible to capture and elicited perspectives at both clinical and health system levels. The RE-AIM framework was used to categorize and select tools to capture data elements that would inform practice at the clinic. RESULTS We detail the process of conceptualizing the evaluation framework and operationalizing the domains using a mixed-methods approach. Our experience demonstrated (1) the utility of a comprehensive framework that captures contextual factors in addition to clinical outcomes, (2) the need for validated measures that are not cumbersome for everyday practice, (3) the importance of understanding the functional needs of the organization and building a sustainable data infrastructure that addresses those needs, and (4) the need to commit to an evolving, "living" evaluation in a dynamic health system. CONCLUSIONS Evaluation employing rigorous patient-centered and systems-relevant metrics can help organizations effectively implement and continuously improve service models. Using an established framework and a collaborative approach provides an important blueprint for a program evaluation in a learning health system. This work provides insight into the process of integrating care for vulnerable populations with chronic conditions in health care systems and integrated knowledge generation processes between research and health systems.
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Affiliation(s)
- Jonathan Lai
- Centre for Innovation in Autism and Intellectual DisabilitiesMiriam FoundationMontrealCanada
- School of Physical and Occupational TherapyMcGill UniversityMontrealCanada
| | - Malvina Klag
- Centre for Innovation in Autism and Intellectual DisabilitiesMiriam FoundationMontrealCanada
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Green BB, Vollmer WM, Keast E, Petrik AF, Coronado GD. Challenges in assessing population reach in a pragmatic trial. Prev Med Rep 2019; 15:100910. [PMID: 31198661 PMCID: PMC6558213 DOI: 10.1016/j.pmedr.2019.100910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 05/20/2019] [Accepted: 05/26/2019] [Indexed: 11/19/2022] Open
Abstract
Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC) was a pragmatic cluster-randomized trial conducted at federally qualified health centers and designed to “Reach” as many unscreened patients as possible by directly mailing them fecal screening tests. STOP CRC used an electronic health record registry to identify individuals' needing CRC screening and mail interventions to them. The registry was updated daily removing individuals completing CRC screening or those who no longer were clinic patients. Reach, a component RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance), is defined as the absolute number, percent, and representativeness of individuals “willing to participate in” or “exposed to” an initiative. We describe the complexities of measuring Reach in a pragmatic trial. Overall 21,134 patients were on the registry list for at least one day, with 18,226 remaining after removing patients completing screening before any mailings. Observed Reached (the percent of individuals exposed to the intervention) using each denominator was 30.7% and 35.6% respectively. Reach improved only modestly after accounting for factors that made it impossible for clinics to send mailings. Few differences were observed in demographic and health care utilization factors among individuals Reached versus not Reached, suggesting that health center Implementation was more influential than patients' willingness or ability to participate. A pragmatic definition of Reach that accounted for dynamic changes the absolute number eligible and the proportion exposed was more useful than traditional definitions of Reach. Actual Reach was dependent on Implementation and not patient level characteristics. Clinical Trials Registration Number: ClincalTrials.gov (NCT01742065).
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Affiliation(s)
- Beverly B. Green
- Kaiser Permanente Washington Health Research Institute, United States of America
- Corresponding author at: Kaiser Permanente Washington Health Research Institute and Kaiser Permanente Washington Medical Group, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, United States of America.
| | - William M. Vollmer
- Kaiser Permanente Northwest Center for Health Research, United States of America
| | - Erin Keast
- Kaiser Permanente Northwest Center for Health Research, United States of America
| | - Amanda F. Petrik
- Kaiser Permanente Northwest Center for Health Research, United States of America
| | - Gloria D. Coronado
- Kaiser Permanente Northwest Center for Health Research, United States of America
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Rice LA, Peterson EW, Backus D, Sung J, Yarnot R, Abou L, Van Denend T, Shen S, Sosnoff JJ. Validation of an individualized reduction of falls intervention program among wheelchair and scooter users with multiple sclerosis. Medicine (Baltimore) 2019; 98:e15418. [PMID: 31083170 PMCID: PMC6531239 DOI: 10.1097/md.0000000000015418] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/04/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Falls are a serious concern for wheelchair and scooter users with multiple sclerosis (MS). Approximately, 75% of the population reports at least one fall in a 6-month period and nearly half report frequent falls. Falls can result in physical injuries and contribute to activity curtailment. Despite the negative consequences, limited evidenced-based fall prevention programs designed specifically for wheelchair and scooter users with MS exist. PURPOSE Recognizing the threat falls pose to health and well-being and the dearth of fall prevention programs, the purpose of this study is to perform a structured process evaluation and examine the feasibility and efficacy of a community-based intervention specifically designed to reduce fall incidence among wheelchair and scooter users with MS. Secondary aims of the intervention are to improve functional mobility skills associated with fall risk (e.g., transfer and wheelchair skills, balance), increase knowledge of fall risk factors, decrease fear of falling, and enhance quality of life and community participation. METHODS To evaluate our specific aims, a clinical trial will be performed with 160 wheelchair and scooter users with MS. (ClinicalTrials.gov Identifier: NCT03705364). Participants will be recruited to participate in a small group-style community-based program. The content of the program will be based on factors found to be associated with falls among wheelchair and scooter users with MS. These factors include but are not limited to, wheelchair/scooter related characteristics, transfer activities, impaired seated balance, and environmental factors. A physical or occupational therapist, will implement the intervention, which is comprised of 6 sessions that occur once weekly. The incidence of falls, along with an examination of wheelchair/scooter and transfer skills, seated postural control and knowledge of fall related risk factors will be compared between intervention and control participants, with assessment periods occurring prior to the intervention, 1 to 2 weeks after completion of the 6-week intervention session, and 12 weeks after the intervention period is complete. CONCLUSION Results from this study will guide the refinement of the intervention program and inform future research among a large and diverse group of wheelchair and scooter users living with MS.
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Affiliation(s)
- Laura A. Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign
| | - Elizabeth W. Peterson
- Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago
| | - Deborah Backus
- Crawford Research Institute, Shepherd Center, Atlanta, Georgia
| | - JongHun Sung
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign
| | - Rebecca Yarnot
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign
| | - Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign
| | - Toni Van Denend
- Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago
| | - Sa Shen
- Center for Health, Aging and Disability, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Illinois
| | - Jacob J. Sosnoff
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign
- Center for Health, Aging and Disability, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Illinois
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Masterson Creber RM, Dayan PS, Kuppermann N, Ballard DW, Tzimenatos L, Alessandrini E, Mistry RD, Hoffman J, Vinson DR, Bakken S. Applying the RE-AIM Framework for the Evaluation of a Clinical Decision Support Tool for Pediatric Head Trauma: A Mixed-Methods Study. Appl Clin Inform 2018; 9:693-703. [PMID: 30184559 PMCID: PMC6125135 DOI: 10.1055/s-0038-1669460] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The overuse of cranial computed tomography (CT) to diagnose potential traumatic brain injuries (TBIs) exposes children with minor blunt head trauma to unnecessary ionizing radiation. The Pediatric Emergency Care Applied Research Network and the Clinical Research on Emergency Services and Treatments Network implemented TBI prediction rules via electronic health record (EHR) clinical decision support (CDS) to decrease use of CTs in children with minor blunt head trauma. OBJECTIVE This article aims to facilitate implementation and dissemination of a CDS alert into emergency departments around the country. METHODS We evaluated the EHR CT CDS tool through a mixed-methods analysis of 38 audio-recorded interviews with health care stakeholders and quantitative data sources, using the Reach, Efficacy, Adoption, Implementation, and Maintenance framework. RESULTS Reach -: The demographics of participants enrolled in the clinical trial were consistent with national estimates of TBI prevalence. Efficacy-There was a variable and modest reduction in CT rates for the 8,067 children with minor head trauma whose clinicians received CDS. Adoption -: The EHR CT CDS tool was well matched with the organizational mission, values, and priorities of the implementation sites. Implementation- The most important predisposing factors for successful implementation were the presence of an approachable clinical champion at each site and belief that the tool was a relevant, reusable knowledge asset. Enabling factors included an effective integration within the clinical workflow, organizational investment in user training, and ease of use. Maintenance -: Reinforcing factors for the EHR CT CDS tool included a close fit with the institutional culture, belief that it was useful for providers and families, and a good educational and informational tool. As such, the EHR CT CDS tool was maintained in clinical practice long after study completion. CONCLUSION Data from this mixed-methods study complement findings from the efficacy trial and provide critical components for consideration prior to integration and subsequent dissemination of the EHR CT CDS tool. TRIAL REGISTRATION NCT01453621, Registered September 27, 2011.
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Affiliation(s)
- Ruth M. Masterson Creber
- Division of Health Informatics, Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York, United States
| | - Peter S. Dayan
- Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, United States
| | - Nathan Kuppermann
- Davis School of Medicine, University of California, Sacramento, California, United States
| | - Dustin W. Ballard
- Kaiser Permanente, San Rafael Medical Center, San Rafael, California, United States
- Kaiser Permanente Division of Research, Oakland, California, United States
| | - Leah Tzimenatos
- Davis School of Medicine, University of California, Sacramento, California, United States
| | - Evaline Alessandrini
- Department of Pediatrics, James M. Anderson Center for Health Systems Excellence and Emergency Medicine, Cincinnati Children's Hospital and Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Rakesh D. Mistry
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado Denver, Aurora, Colorado, United States
| | - Jeffrey Hoffman
- Division of Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - David R. Vinson
- Kaiser Permanente Division of Research, Oakland, California, United States
- Kaiser Permanente, Roseville Medical Center, Roseville, California, United States
| | - Suzanne Bakken
- School of Nursing, Columbia University, New York, New York, United States
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
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Glasgow RE, Estabrooks PE. Pragmatic Applications of RE-AIM for Health Care Initiatives in Community and Clinical Settings. Prev Chronic Dis 2018; 15:E02. [PMID: 29300695 PMCID: PMC5757385 DOI: 10.5888/pcd15.170271] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) planning and evaluation framework has been applied broadly, but users often have difficulty in applying the model because of data collection needs across multiple domains and sources. Questions in the more common "who, what, where, how, when, and why" format may be an effective guide to ensure that individual participants, organization staff, and the perspectives of the setting are considered in planning and evaluation. Such a format can also help users in typical community and clinical settings to identify which outcomes are most valued and to focus limited measurement resources. Translations of RE-AIM that are easy to understand and apply are needed for application in real-world community and clinical settings where research and evaluation resources are limited. The purpose of this article is to provide simplified, pragmatic, user-centered and stakeholder-centered recommendations to increase the use of RE-AIM in community and clinical settings and in translational research.
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Affiliation(s)
- Russell E Glasgow
- University of Colorado School of Medicine, Department of Family Medicine, AO1, Mail Stop F496, P.O. Box 6511, Aurora, CO 80045.
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Hugos CL, Frankel D, Tompkins SA, Cameron M. Community Delivery of a Comprehensive Fall-Prevention Program in People with Multiple Sclerosis: A Retrospective Observational Study. Int J MS Care 2016; 18:42-8. [PMID: 26917997 DOI: 10.7224/1537-2073.2014-086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND People with multiple sclerosis (MS) fall frequently. In 2011, the National Multiple Sclerosis Society launched a multifactorial fall-prevention group exercise and education program, Free From Falls (FFF), to prevent falls in MS. The objective of this study was to assess the impact of participation in the FFF program on balance, mobility, and falls in people with MS. METHODS This was a retrospective evaluation of assessments from community delivery of FFF. Changes in Activities-specific Balance Confidence scale scores, Berg Balance Scale scores, 8-foot Timed Up and Go performance, and falls were assessed. RESULTS A total of 134 participants completed the measures at the first and last FFF sessions, and 109 completed a 6-month follow-up assessment. Group mean scores on the Activities-specific Balance Confidence scale (F1,66 = 17.14, P < .05, η(2) = 0.21), Berg Balance Scale (F1,68 = 23.39, P < .05, η(2) = 0.26), and 8-foot Timed Up and Go (F1,79 = 4.83, P < .05, η(2) = 0.06) all improved significantly from the first to the last session. At the 6-month follow-up, fewer falls were reported (χ(2) [4, N = 239] = 10.56, P < .05, Phi = 0.21). CONCLUSIONS These observational data suggest that the FFF group education and exercise program improves balance confidence, balance performance, and functional mobility and reduces falls in people with MS.
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Affiliation(s)
- Cinda L Hugos
- Portland VA Medical Center, Portland, OR, USA (CLH, MC); Departments of Neurology (CLH, MC) and Rehabilitation (CLH), Oregon Health & Science University, Portland, OR, USA; Department of Advocacy, Services, and Research, National Multiple Sclerosis Society, New York, NY, USA (DF); and Madipen, LLC, Program Planning and Evaluation Consulting, Fort Collins, CO, USA (SAT)
| | - Debra Frankel
- Portland VA Medical Center, Portland, OR, USA (CLH, MC); Departments of Neurology (CLH, MC) and Rehabilitation (CLH), Oregon Health & Science University, Portland, OR, USA; Department of Advocacy, Services, and Research, National Multiple Sclerosis Society, New York, NY, USA (DF); and Madipen, LLC, Program Planning and Evaluation Consulting, Fort Collins, CO, USA (SAT)
| | - Sara A Tompkins
- Portland VA Medical Center, Portland, OR, USA (CLH, MC); Departments of Neurology (CLH, MC) and Rehabilitation (CLH), Oregon Health & Science University, Portland, OR, USA; Department of Advocacy, Services, and Research, National Multiple Sclerosis Society, New York, NY, USA (DF); and Madipen, LLC, Program Planning and Evaluation Consulting, Fort Collins, CO, USA (SAT)
| | - Michelle Cameron
- Portland VA Medical Center, Portland, OR, USA (CLH, MC); Departments of Neurology (CLH, MC) and Rehabilitation (CLH), Oregon Health & Science University, Portland, OR, USA; Department of Advocacy, Services, and Research, National Multiple Sclerosis Society, New York, NY, USA (DF); and Madipen, LLC, Program Planning and Evaluation Consulting, Fort Collins, CO, USA (SAT)
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