1
|
MacKenzie NE, Chambers CT, Cassidy CE, Corkum PV, McGrady ME, Parker JA, Birnie KA. Understanding the unique and common perspectives of partners engaged in knowledge mobilization activities within pediatric pain management: a mixed methods study. BMC Health Serv Res 2024; 24:337. [PMID: 38486223 PMCID: PMC10938714 DOI: 10.1186/s12913-024-10782-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/25/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Knowledge mobilization (KM) is essential to close the longstanding evidence to practice gap in pediatric pain management. Engaging various partners (i.e., those with expertise in a given topic area) in KM is best practice; however, little is known about how different partners engage and collaborate on KM activities. This mixed-methods study aimed to understand what different KM partner groups (i.e., health professionals, researchers, and patient/caregiver partners) perceive as supporting KM activities within pediatric pain management. METHODS This study used a convergent mixed-methods design. Ten partners from each of the three groups participated in interviews informed by the Consolidated Framework for Implementation Research, where they discussed what impacted KM activities within pediatric pain. Participants then rated and ranked select factors discussed in the interview. Transcripts were analyzed within each group using reflexive thematic analysis. Group-specific themes were then triangulated to identify convergence and divergence among groups. A matrix analysis was then conducted to generate meta-themes to describe overarching concepts. Quantitative data were analyzed using descriptive statistics. RESULTS Unique themes were developed within each partner group and further analysis generated four meta-themes: (1) team dynamics; (2) role of leadership; (3) policy influence; (4) social influence. There was full agreement among groups on the meaning of team dynamics. While there was partial agreement on the role of leadership, groups differed on who they described as taking on leadership positions. There was also partial agreement on policy influence, where health professionals and researchers described different institutions as being responsible for providing funding support. Finally, there was partial agreement on social influence, where the role of networks was seen as serving distinct purposes to support KM. Quantitative analyses indicated that partner groups shared similar priorities (e.g., team relationships, communication quality) when it came to supporting KM in pediatric pain. CONCLUSIONS While partners share many needs in common, there is also nuance in how they wish to be engaged in KM activities as well as the contexts in which they work. Strategies must be introduced to address these nuances to promote effective engagement in KM to increase the impact of evidence in pediatric pain.
Collapse
Affiliation(s)
- Nicole E MacKenzie
- Department of Psychology and Neuroscience, Dalhousie University, Life Sciences Centre, 1355 Oxford Street, Halifax, NS, B3H4J1, Canada.
- Centre for Pediatric Pain Research, IWK Health, Halifax, NS, Canada.
| | - Christine T Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Life Sciences Centre, 1355 Oxford Street, Halifax, NS, B3H4J1, Canada
- Centre for Pediatric Pain Research, IWK Health, Halifax, NS, Canada
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
- Solutions for Kids in Pain, Halifax, NS, Canada
| | | | - Penny V Corkum
- Department of Psychology and Neuroscience, Dalhousie University, Life Sciences Centre, 1355 Oxford Street, Halifax, NS, B3H4J1, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Pediatrics, IWK Health, Halifax, NS, Canada
| | - Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Kathryn A Birnie
- Department of Psychology and Neuroscience, Dalhousie University, Life Sciences Centre, 1355 Oxford Street, Halifax, NS, B3H4J1, Canada
- Solutions for Kids in Pain, Halifax, NS, Canada
- Department of Anesthesiology, Perioperative, and Pain Medicine, and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
2
|
Cassidy CE, Flynn R, Campbell A, Dobson L, Langley J, McNeil D, Milne E, Zanoni P, Churchill M, Benzies KM. Knowledge translation strategies used for sustainability of an evidence-based intervention in child health: a multimethod qualitative study. BMC Nurs 2024; 23:125. [PMID: 38368328 PMCID: PMC10874067 DOI: 10.1186/s12912-024-01777-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/30/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Sustainability of evidence-based interventions (EBIs) is suboptimal in healthcare. Evidence on how knowledge translation (KT) strategies are used for the sustainability of EBIs in practice is lacking. This study examined what and how KT strategies were used to facilitate the sustainability of Alberta Family Integrated Care (FICare)™, a psychoeducational model of care scaled and spread across 14 neonatal intensive care units, in Alberta, Canada. METHODS First, we conducted an environmental scan of relevant documents to determine the use of KT strategies to support the sustainability of Alberta FICare™. Second, we conducted semi-structured interviews with decision makers and operational leaders to explore what and how KT strategies were used for the sustainability of Alberta FICare™, as well as barriers and facilitators to using the KT strategies for sustainability. We used the Expert Recommendations for Implementation Change (ERIC) taxonomy to code the strategies. Lastly, we facilitated consultation meetings with the Alberta FICare™ leads to share and gain insights and clarification on our findings. RESULTS We identified nine KT strategies to facilitate the sustainability of Alberta FICare™: Conduct ongoing training; Identify and prepare local champions; Research co-production; Remind clinicians; Audit and provide feedback; Change record systems; Promote adaptability; Access new funding; and Involve patients/consumers and family members. A significant barrier to the sustainability of Alberta FICare™ was a lack of clarity on who was responsible for the ongoing maintenance of the intervention. A key facilitator to sustainability of Alberta FICare was its alignment with the Maternal, Newborn, Child & Youth Strategic Clinical Network (MNCY SCN) priorities. Co-production between researchers and health system partners in the design, implementation, and scale and spread of Alberta FICare™ was critical to sustainability. CONCLUSION This research highlights the importance of clearly articulating who is responsible for continued championing for the sustainability of EBIs. Additionally, our research demonstrates that the adaptation of interventions must be considered from the onset of implementation so interventions can be tailored to align with contextual barriers for sustainability. Clear guidance is needed to continually support researchers and health system leaders in co-producing strategies that facilitate the long-term sustainability of effective EBIs in practice.
Collapse
Affiliation(s)
- Christine E Cassidy
- School of Nursing, Faculty of Health, Dalhousie University, 5869 University Avenue, B3H 4R2, Halifax, NS, PO Box 15000, Canada.
| | - Rachel Flynn
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College of Cork, College Road, T12 AK54, Cork, Ireland
| | - Alyson Campbell
- Faculty of Nursing, University of Prince Edward Island, 550 University Avenue, HSB Room 116, C1A 4P3, Charlottetown, PE, Canada
| | - Lauren Dobson
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Level 3, 11405 87 Avenue, T6G 1C9, Edmonton, AB, Canada
| | - Jodi Langley
- Faculty of Health, Dalhousie University, 5790 University Avenue, B3H 1V7, Halifax, NS, Canada
| | - Deborah McNeil
- Strategic Clinical Networks, Alberta Health Services, 10101 Southport Road SW, T2W 3N2, Calgary, AB, Canada
- Faculty of Nursing, Departments of Pediatrics and Community Health Science, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, T2N 1N4, Calgary, AB, Canada
| | - Ella Milne
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Level 3, 11405 87 Avenue, T6G 1C9, Edmonton, AB, Canada
| | - Pilar Zanoni
- Faculty of Nursing , University of Calgary, 2500 University Drive NW, T2N 1N4, Calgary, AB, Canada
| | - Megan Churchill
- Department of Pediatrics, IWK Health, 5980 University Ave #5850, B3K 6R8, Halifax, NS, Canada
| | - Karen M Benzies
- Faculty of Nursing, Departments of Pediatrics and Community Health Science, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, T2N 1N4, Calgary, AB, Canada
| |
Collapse
|
3
|
Cassidy CE, Boulos L, McConnell E, Barber B, Delahunty-Pike A, Bishop A, Fatima N, Higgins A, Churchill M, Lively A, MacPhee SP, Misener RM, Sarty R, Wells R, Curran JA. E-prescribing and medication safety in community settings: A rapid scoping review. Explor Res Clin Soc Pharm 2023; 12:100365. [PMID: 38023632 PMCID: PMC10679534 DOI: 10.1016/j.rcsop.2023.100365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Background Medication prescribing is essential for the treatment, curing, maintenance, and/or prevention of an illness and disease, however, medication errors remain common. Common errors including prescribing and administration, pose significant risk to patients. Electronic prescribing (e-prescribing) is one intervention used to enhance the safety and quality of prescribing by decreasing medication errors and reducing harm. E-prescribing in community-based settings has not been extensively examined. Objective To map and characterize the current evidence on e-prescribing and medication safety in community pharmacy settings. Methods We conducted a rapid scoping review of quantitative, qualitative, and mixed methods studies reporting on e-prescribing and medication safety. MEDLINE All (OVID), Embase (Elsevier), CINAHL Full Text (EBSCOHost), and Scopus (Elsevier) databases were searched December 2022 using keywords and MeSH terms related to e-prescribing, medication safety, efficiency, and uptake. Articles were imported to Covidence and screened by two reviewers. Data were extracted by a single reviewer and verified by a second reviewer using a standardized data extraction form. Findings are reported in accordance with JBI Manual for Evidence Synthesis following thematic analysis to narratively describe results. Results Thirty-five studies were included in this review. Most studies were quantitative (n = 22), non-experimental study designs (n = 16) and were conducted in the United States (n = 18). Half of included studies reported physicians as the prescriber (n = 18), while the remaining reported a mix of nurse practitioners, pharmacists, and physician assistants (n = 6). Studies reported on types of errors, including prescription errors (n = 20), medication safety errors (n = 9), dispensing errors (n = 2), and administration errors (n = 1). Few studies examined patient health outcomes, such as adverse drug events (n = 5). Conclusions Findings indicate that most research is descriptive in nature and focused primarily on rates of prescription errors. Further research, such as experimental, implementation, and evaluation mixed-methods research, is needed to investigate the effects of e-prescribing on reducing error rates and improving patient and health system outcomes.
Collapse
Affiliation(s)
- Christine E. Cassidy
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health, Halifax, Nova Scotia, Canada
| | - Leah Boulos
- Maritime SPOR SUPPORT Unit, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | | | | | | | - Andrea Bishop
- Nova Scotia College of Pharmacists, Halifax, Nova Scotia, Canada
| | - Nawal Fatima
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | - Rowan Sarty
- Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | | | - Janet A. Curran
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health, Halifax, Nova Scotia, Canada
| |
Collapse
|
4
|
Reszel J, Daub O, Leese J, Augustsson H, Bellows DM, Cassidy CE, Crowner BE, Dunn SI, Goodwin LB, Hoens AM, Hunter SC, Lynch EA, Moore JL, Rafferty MR, Romney W, Stacey D, Graham ID. Essential content for teaching implementation practice in healthcare: a mixed-methods study of teams offering capacity-building initiatives. Implement Sci Commun 2023; 4:151. [PMID: 38012798 PMCID: PMC10680357 DOI: 10.1186/s43058-023-00525-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Applying the knowledge gained through implementation science can support the uptake of research evidence into practice; however, those doing and supporting implementation (implementation practitioners) may face barriers to applying implementation science in their work. One strategy to enhance individuals' and teams' ability to apply implementation science in practice is through training and professional development opportunities (capacity-building initiatives). Although there is an increasing demand for and offerings of implementation practice capacity-building initiatives, there is no universal agreement on what content should be included. In this study we aimed to explore what capacity-building developers and deliverers identify as essential training content for teaching implementation practice. METHODS We conducted a convergent mixed-methods study with participants who had developed and/or delivered a capacity-building initiative focused on teaching implementation practice. Participants completed an online questionnaire to provide details on their capacity-building initiatives; took part in an interview or focus group to explore their questionnaire responses in depth; and offered course materials for review. We analyzed a subset of data that focused on the capacity-building initiatives' content and curriculum. We used descriptive statistics for quantitative data and conventional content analysis for qualitative data, with the data sets merged during the analytic phase. We presented frequency counts for each category to highlight commonalities and differences across capacity-building initiatives. RESULTS Thirty-three individuals representing 20 capacity-building initiatives participated. Study participants identified several core content areas included in their capacity-building initiatives: (1) taking a process approach to implementation; (2) identifying and applying implementation theories, models, frameworks, and approaches; (3) learning implementation steps and skills; (4) developing relational skills. In addition, study participants described offering applied and pragmatic content (e.g., tools and resources), and tailoring and evolving the capacity-building initiative content to address emerging trends in implementation science. Study participants highlighted some challenges learners face when acquiring and applying implementation practice knowledge and skills. CONCLUSIONS This study synthesized what experienced capacity-building initiative developers and deliverers identify as essential content for teaching implementation practice. These findings can inform the development, refinement, and delivery of capacity-building initiatives, as well as future research directions, to enhance the translation of implementation science into practice.
Collapse
Affiliation(s)
- Jessica Reszel
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada.
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada.
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Canada.
| | - Olivia Daub
- School of Communication Sciences and Disorders, Western University, London, Canada
| | - Jenny Leese
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Hanna Augustsson
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm, Sweden
| | - Danielle Moeske Bellows
- School of Physical Therapy, Massachusetts College of Pharmacy and Health Sciences, Worcester, USA
| | - Christine E Cassidy
- School of Nursing, Dalhousie University, Halifax, Canada
- IWK Health Centre, Halifax, Canada
| | | | - Sandra I Dunn
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Canada
| | - Lisa B Goodwin
- Inpatient Rehabilitation, University of Vermont Medical Center, Colchester, USA
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Sarah C Hunter
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Elizabeth A Lynch
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Jennifer L Moore
- Regional Rehabilitation Knowledge Center, Sunnaas Hospital, Oslo, Norway
- Institute for Knowledge Translation, Carmel, Indiana, USA
| | - Miriam R Rafferty
- Shirley Ryan AbilityLab and Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, USA
| | - Wendy Romney
- Physical Therapy, Sacred Heart University, Fairfield, USA
| | - Dawn Stacey
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Ian D Graham
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| |
Collapse
|
5
|
Reszel J, Daub O, Dunn SI, Cassidy CE, Hafizi K, Lightfoot M, Pervez D, Quosdorf A, Wood A, Graham ID. Planning and implementing practice changes in Ontario maternal-newborn hospital units: a secondary qualitative analysis. BMC Pregnancy Childbirth 2023; 23:735. [PMID: 37848826 PMCID: PMC10583424 DOI: 10.1186/s12884-023-06042-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Moving evidence into practice is complex, and pregnant and birthing people and their infants do not always receive care that aligns with the best available evidence. Implementation science can inform how to effectively move evidence into practice. While there are a growing number of examples of implementation science being studied in maternal-newborn care settings, it remains unknown how real-world teams of healthcare providers and leaders approach the overall implementation process when making practice changes. The purpose of this study was to describe maternal-newborn hospital teams' approaches to implementing practice changes. We aimed to identify what implementation steps teams take (or not) and identify strengths and potential areas for improvement based on best practices in implementation science. METHODS We conducted a supplementary qualitative secondary analysis of 22 interviews completed in 2014-2015 with maternal-newborn nursing leaders in Ontario, Canada. We used directed content analysis to code the data to seven steps in an implementation framework (Implementation Roadmap): identify the problem and potential best practice; assemble local evidence; select and customize best practice; discover barriers and drivers; tailor implementation strategies; field-test, plan evaluation, prepare to launch; launch, evaluate, and sustain. Frequency counts are presented for each step. RESULTS Participants reported completing a median of 4.5 of 7 Implementation Roadmap steps (range = 3-7), with the most common being identifying a practice problem. Other steps were described less frequently (e.g., selecting and adapting evidence, field-testing, outcome evaluation) or discussed frequently but not optimally (e.g., barriers assessment). Participants provided examples of how they engaged point-of-care staff throughout the implementation process, but provided fewer examples of engaging pregnant and birthing people and their families. Some participants stated they used a formal framework or process to guide their implementation process, with the most common being quality improvement approaches and tools. CONCLUSIONS We identified variability across the 22 hospitals in the implementation steps taken. While we observed many strengths, we also identified areas where further support may be needed. Future work is needed to create opportunities and resources to support maternal-newborn healthcare providers and leaders to apply principles and tools from implementation science to their practice change initiatives.
Collapse
Affiliation(s)
- Jessica Reszel
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
| | - Olivia Daub
- School of Communication Sciences and Disorders, Western University, 1201 Western Road, London, ON, N6G 1H1, Canada
| | - Sandra I Dunn
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Christine E Cassidy
- School of Nursing, Dalhousie University, 5869 University Avenue, Halifax, NS, B3H 4R2, Canada
- IWK Health Centre, 5980 University Avenue, Halifax, NS, B3K 6R8, Canada
| | - Kaamel Hafizi
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Marnie Lightfoot
- Women and Children's Health Network, Orillia Soldiers' Memorial Hospital, 170 Colborne St W, Orillia, ON, L3V 2Z3, Canada
| | | | - Ashley Quosdorf
- Neonatal Intensive Care Unit, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Allison Wood
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Ian D Graham
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| |
Collapse
|
6
|
McLean RKD, Carden F, Aiken AB, Armstrong R, Bray J, Cassidy CE, Daub O, Di Ruggiero E, Fierro LA, Gagnon M, Hutchinson AM, Kislov R, Kothari A, Kreindler S, McCutcheon C, Reszel J, Scarrow G, Graham ID. Evaluating the quality of research co-production: Research Quality Plus for Co-Production (RQ + 4 Co-Pro). Health Res Policy Syst 2023; 21:51. [PMID: 37312190 DOI: 10.1186/s12961-023-00990-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/05/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Co-production is an umbrella term used to describe the process of generating knowledge through partnerships between researchers and those who will use or benefit from research. Multiple advantages of research co-production have been hypothesized, and in some cases documented, in both the academic and practice record. However, there are significant gaps in understanding how to evaluate the quality of co-production. This gap in rigorous evaluation undermines the potential of both co-production and co-producers. METHODS This research tests the relevance and utility of a novel evaluation framework: Research Quality Plus for Co-Production (RQ + 4 Co-Pro). Following a co-production approach ourselves, our team collaborated to develop study objectives, questions, analysis, and results sharing strategies. We used a dyadic field-test design to execute RQ + 4 Co-Pro evaluations amongst 18 independently recruited subject matter experts. We used standardized reporting templates and qualitative interviews to collect data from field-test participants, and thematic assessment and deliberative dialogue for analysis. Main limitations include that field-test participation included only health research projects and health researchers and this will limit perspective included in the study, and, that our own co-production team does not include all potential perspectives that may add value to this work. RESULTS The field test surfaced strong support for the relevance and utility of RQ + 4 Co-Pro as an evaluation approach and framework. Research participants shared opportunities for fine-tuning language and criteria within the prototype version, but also, for alternative uses and users of RQ + 4 Co-Pro. All research participants suggested RQ + 4 Co-Pro offered an opportunity for improving how co-production is evaluated and advanced. This facilitated our revision and publication herein of a field-tested RQ + 4 Co-Pro Framework and Assessment Instrument. CONCLUSION Evaluation is necessary for understanding and improving co-production, and, for ensuring co-production delivers on its promise of better health.. RQ + 4 Co-Pro provides a practical evaluation approach and framework that we invite co-producers and stewards of co-production-including the funders, publishers, and universities who increasingly encourage socially relevant research-to study, adapt, and apply.
Collapse
Affiliation(s)
- Robert K D McLean
- Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
- Policy and Evaluation Division, International Development Research Centre, Ottawa, Canada.
- Integrated Knowledge Translation Research Network, Ottawa Hospital Research Institute, Ottawa, Canada.
| | | | - Alice B Aiken
- Vice-President Research and Innovation, Dalhousie University, Halifax, Canada
| | - Rebecca Armstrong
- Research and Evaluation Branch, National Disability Insurance Agency, Melbourne, Australia
| | - Judy Bray
- Vice-President Research, Canadian Cancer Society, Toronto, Canada
| | | | - Olivia Daub
- School of Communication Sciences & Disorders, University of Western Ontario, London, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Leslie A Fierro
- Max Bell School of Public Policy, McGill University, Montreal, Canada
| | | | - Alison M Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety in the Institute for Health Transformation, Deakin University, Geelong, Australia
- Barwon Health, Geelong, Australia
| | - Roman Kislov
- Faculty of Business and Law, Manchester Metropolitan University, Manchester, United Kingdom
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Anita Kothari
- School of Health Studies, Western University, London, Canada
| | - Sara Kreindler
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Chris McCutcheon
- Integrated Knowledge Translation Research Network, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jessica Reszel
- Ottawa Hospital Research Institute, Ottawa, Canada
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Gayle Scarrow
- Michael Smith Health Research B.C, Vancouver, Canada
| | - Ian D Graham
- Integrated Knowledge Translation Research Network, Ottawa Hospital Research Institute, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute & Schools of Epidemiology and Public Health & Nursing, University of Ottawa, Ottawa, Canada
| |
Collapse
|
7
|
McLean RKD, Carden F, Graham ID, Aiken AB, Armstrong R, Bray J, Cassidy CE, Daub O, Di Ruggiero E, Fierro LA, Gagnon M, Hutchinson AM, Kislov R, Kothari A, Kreindler S, McCutcheon C, Reszel J, Scarrow G. Evaluating research co-production: protocol for the Research Quality Plus for Co-Production (RQ+ 4 Co-Pro) framework. Implement Sci Commun 2022; 3:28. [PMID: 35287758 PMCID: PMC8919555 DOI: 10.1186/s43058-022-00265-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Research co-production is an umbrella term used to describe research users and researchers working together to generate knowledge. Research co-production is used to create knowledge that is relevant to current challenges and to increase uptake of that knowledge into practice, programs, products, and/or policy. Yet, rigorous theories and methods to assess the quality of co-production are limited. Here we describe a framework for assessing the quality of research co-production—Research Quality Plus for Co-Production (RQ+ 4 Co-Pro)—and outline our field test of this approach.
Methods
Using a co-production approach, we aim to field test the relevance and utility of the RQ+ 4 Co-Pro framework. To do so, we will recruit participants who have led research co-production projects from the international Integrated Knowledge Translation Research Network. We aim to sample 16 to 20 co-production project leads, assign these participants to dyadic groups (8 to 10 dyads), train each participant in the RQ+ 4 Co-Pro framework using deliberative workshops and oversee a simulation assessment exercise using RQ+ 4 Co-Pro within dyadic groups. To study this experience, we use a qualitative design to collect participant demographic information and project demographic information and will use in-depth semi-structured interviews to collect data related to the experience each participant has using the RQ+ 4 Co-Pro framework.
Discussion
This study will yield knowledge about a new way to assess research co-production. Specifically, it will address the relevance and utility of using RQ+ 4 Co-Pro, a framework that includes context as an inseparable component of research, identifies dimensions of quality matched to the aims of co-production, and applies a systematic and transferable evaluative method for reaching conclusions. This is a needed area of innovation for research co-production to reach its full potential. The findings may benefit co-producers interested in understanding the quality of their work, but also other stewards of research co-production. Accordingly, we undertake this study as a co-production team representing multiple perspectives from across the research enterprise, such as funders, journal editors, university administrators, and government and health organization leaders.
Collapse
|
8
|
Cassidy CE, Kontak JC, Pidduck J, Higgins A, Anderson S, Best S, Grant A, Jeffers E, MacDonald S, MacKinnon L, Mireault A, Rowe L, Walls R, Curran J. Provider perspectives of barriers and facilitators to the transition from pediatric to adult care: a qualitative descriptive study using the COM-B model of behaviour. Journal of Transition Medicine 2022. [DOI: 10.1515/jtm-2022-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
Transition of care can be a complex process that involves multiple providers working together across the pediatric and adult health care system to support youth. The shift from a primarily family-centred approach to a patient-centred approach that emphasizes more personal responsibility for health care management can be challenging for youth, caregivers and providers to navigate. Despite the importance of transition, there is a lack of evidence about the best practices and types of interventions that support the transition of care process from the perspective of both pediatric and adult health care providers. An exploration of barriers and facilitators is a critical first step to identifying important behavioural determinants for designing and implementing evidence-based interventions. As such, the purpose of this study was to identify the barriers and facilitators to the transition of care from the perspective of pediatric and adult health care providers.
Methods
A qualitative descriptive design was used to conduct semi-structured interviews guided by the COM-B Model of Behaviour – a theoretical model that suggests that for any behaviour to occur there must be a change in one or more of the following domains: capability, opportunity and/or motivation. The study took place in the province of Nova Scotia, Canada and focused on three common conditions: Inflammatory Bowel Disease, Diabetes, and Juvenile Idiopathic Arthritis. Participants were recruited through stratified purposeful and convenience sampling and all interviews were conducted virtually on Zoom. Interviews were audio-recorded, transcribed verbatim and imported into NVivo Qualitative Data Software for analysis. Data were first analyzed using directed content analysis, guided by the COM-B model, then further examined using inductive thematic analysis to identify barriers and facilitators within the three domains.
Results
In total, 26 health care providers participated in this study (pediatric, n=13, adult n=13) including a mix of adult and pediatric physicians, nurses, and allied health care professionals. The participants identified primarily as female (n=19.73%) and had a range of years of experience (3–39, mean = 14.84). We identified a range of interconnected barriers and facilitators across each of the COM-B Model of Behaviour domains such as, degree of formalized training (capability), facilitation and coordination responsibilities (opportunity), collaboration across providers (opportunities), securing attachment to adult care system (motivation) and time (opportunity). Findings were categorized by three overarching themes: (1) Knowledge and Skills to Support Transition of Care; (2) Navigation Role for Youth and Caregivers; and (3) System Coordination.
Conclusions
By using the COM-B Model of Behaviour, we identified key barriers and facilitators that intersect to influence the transition of care process. These findings will be used to inform and adapt initiatives and interventions in Nova Scotia to improve the transition experience, as well as may be transferrable to other jurisdictions.
Collapse
Affiliation(s)
- Christine E. Cassidy
- School of Nursing , Dalhousie University and IWK Health Centre , Halifax , NS , Canada
| | - Julia C. Kontak
- Maritime SPOR SUPPORT Unit, Nova Scotia Health and Faculty of Health, Dalhousie University , Halifax , NS , Canada
| | | | | | - Scott Anderson
- Maritime SPOR SUPPORT Unit , Nova Scotia Health , Halifax , NS , Canada
| | | | - Amy Grant
- Maritime SPOR SUPPORT Unit , Nova Scotia Health , Halifax , NS , Canada
| | - Elizabeth Jeffers
- Maritime SPOR SUPPORT Unit , Nova Scotia Health , Halifax , NS , Canada
| | | | | | - Amy Mireault
- Maritime SPOR SUPPORT Unit , Nova Scotia Health , Halifax , NS , Canada
| | - Liam Rowe
- Maritime SPOR SUPPORT Unit , Nova Scotia Health , Halifax , NS , Canada
| | - Rose Walls
- Mental Health and Addictions, Nova Scotia Health , Halifax , NS , Canada
| | - Janet Curran
- School of Nursing , Dalhousie University and IWK Health Centre , Halifax , NS , Canada
| |
Collapse
|
9
|
Cassidy CE, Harrison MB, Godfrey C, Nincic V, Khan PA, Oakley P, Ross-White A, Grantmyre H, Graham ID. Use and effects of implementation strategies for practice guidelines in nursing: a systematic review. Implement Sci 2021; 16:102. [PMID: 34863220 PMCID: PMC8642950 DOI: 10.1186/s13012-021-01165-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Practice guidelines can reduce variations in nursing practice and improve patient care. However, implementation of guidelines is complex and inconsistent in practice. It is unclear which strategies are effective at implementing guidelines in nursing. This review aimed to describe the use and effects of implementation strategies to facilitate the uptake of guidelines focused on nursing care. METHODS We conducted a systematic review of five electronic databases in addition to the Cochrane Effective Practice and Organization of Care (EPOC) Group specialized registry. Studies were included if implementation of a practice guideline in nursing and process or outcome of care provided by nurses were reported. Two reviewers independently screened studies, assessed study quality, extracted data, and coded data using the EPOC taxonomy of implementation strategies. For those strategies not included in the EPOC taxonomy, we inductively categorized these strategies and generated additional categories. We conducted a narrative synthesis to analyze results. RESULTS The search identified 46 papers reporting on 41 studies. Thirty-six studies used a combination of educational materials and educational meetings. Review findings show that multicomponent implementation strategies that include educational meetings, in combination with other educational strategies, report positive effects on professional practice outcomes, professional knowledge outcomes, patient health status outcomes, and resource use/expenditures. Twenty-three of the 41 studies employed implementation strategies not listed within the EPOC taxonomy, including adaptation of practice guidelines to local context (n = 9), external facilitation (n = 14), and changes to organizational policy (n = 3). These implementation strategies also corresponded with positive trends in patient, provider, and health system outcomes. CONCLUSIONS Nursing guideline implementation may benefit from using the identified implementation strategies described in this review, including participatory approaches such as facilitation, adaptation of guidelines, and organizational policy changes. Further research is needed to understand how different implementation strategy components work in a nursing context and to what effect. As the field is still emerging, future reviews should also explore guideline implementation strategies in nursing in quasi or non-experimental research designs and qualitative research studies.
Collapse
Affiliation(s)
- Christine E. Cassidy
- School of Nursing, Dalhousie University, 5860 University Ave., Halifax, NS B3H 4R2 Canada
| | - Margaret B. Harrison
- School of Nursing, Queen’s University, 92 Barrie Street, Kingston, ON K7L 3J9 Canada
| | - Christina Godfrey
- School of Nursing, Queen’s University, 92 Barrie Street, Kingston, ON K7L 3J9 Canada
| | - Vera Nincic
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1W8 Canada
| | - Paul A. Khan
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1W8 Canada
| | - Patricia Oakley
- National Research Council Canada, Institute for Information Technology, 46 Dineen Drive, Fredericton, NB E3B 9W4 Canada
| | - Amanda Ross-White
- Queen’s University Library, Queen’s University, 18 Stuart Street, Kingston, ON K7L 3N6 Canada
| | - Hilary Grantmyre
- School of Nursing, Dalhousie University, 5860 University Ave., Halifax, NS B3H 4R2 Canada
| | - Ian D. Graham
- School of Epidemiology and Public HealthSchool of Nursing, University of Ottawa, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| |
Collapse
|
10
|
Cassidy CE, Shin HD, Ramage E, Conway A, Mrklas K, Laur C, Beck A, Varin MD, Steinwender S, Nguyen T, Langley J, Dorey R, Donnelly L, Ormel I. Trainee-led research using an integrated knowledge translation or other research partnership approaches: a scoping reviews. Health Res Policy Syst 2021; 19:135. [PMID: 34727926 PMCID: PMC8561363 DOI: 10.1186/s12961-021-00784-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/12/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There are increasing expectations for researchers and knowledge users in the health system to use a research partnership approach, such as integrated knowledge translation, to increase the relevance and use of research findings in health practice, programmes and policies. However, little is known about how health research trainees engage in research partnership approaches such as IKT. In response, the purpose of this scoping review was to map and characterize the evidence related to using an IKT or other research partnership approach from the perspective of health research trainees in thesis and/or postdoctoral work. METHODS We conducted this scoping review following the Joanna Briggs Institute methodology and Arksey and O'Malley's framework. We searched the following databases in June 2020: MEDLINE, Embase, CINAHL and PsycINFO. We also searched sources of unpublished studies and grey literature. We reported our findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. RESULTS We included 74 records that described trainees' experiences using an IKT or other research partnership approach to health research. The majority of studies involved collaboration with knowledge users in the research question development, recruitment and data collection stages of the research process. Intersecting barriers to IKT or other research partnerships at the individual, interpersonal and organizational levels were reported, including lack of skills in partnership research, competing priorities and trainees' "outsider" status. We also identified studies that evaluated their IKT approach and reported impacts on partnership formation, such as valuing different perspectives, and enhanced relevance of research. CONCLUSION Our review provides insights for trainees interested in IKT or other research partnership approaches and offers guidance on how to apply an IKT approach to their research. The review findings can serve as a basis for future reviews and primary research focused on IKT principles, strategies and evaluation. The findings can also inform IKT training efforts such as guideline development and academic programme development.
Collapse
Affiliation(s)
| | | | - Emily Ramage
- School of Health Sciences, University of Newcastle, Callaghan, Australia
| | - Aislinn Conway
- Better Outcomes and Registry Network (BORN), Ottawa, ON Canada
| | - Kelly Mrklas
- Alberta Health Services Foothills Medical Centre, Calgary, AB Canada
| | - Celia Laur
- Institute for Health System Solutions and Virtual Care, Women’s College Hospital, Toronto, Canada
| | - Amy Beck
- Faculty of Nursing, University of Calgary, Calgary, AB Canada
| | | | | | - Tram Nguyen
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON Canada
| | - Jodi Langley
- School of Health and Human Performance, Dalhousie University, Halifax, NS Canada
| | | | | | - Ilja Ormel
- Department of Family Medicine, McGill University, Montreal, QC Canada
| |
Collapse
|
11
|
Cassidy CE, Beck AJ, Conway A, Demery Varin M, Laur C, Lewis KB, Ramage ER, Nguyen T, Steinwender S, Ormel I, Stratton L, Shin HD. Using an integrated knowledge translation or other research partnership approach in trainee-led research: a scoping review protocol. BMJ Open 2021; 11:e043756. [PMID: 34035094 PMCID: PMC8154946 DOI: 10.1136/bmjopen-2020-043756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Collaborative research approaches, such as co-production, co-design, engaged scholarship and integrated knowledge translation (IKT), aim to bridge the evidence to practice and policy gap. There are multiple benefits of collaborative research approaches, but studies report many challenges with establishing and maintaining research partnerships. Researchers often do not have the opportunity to learn how to build collaborative relationships, and most graduate students do not receive formal training in research partnerships. We are unlikely to make meaningful progress in strengthening graduate and postgraduate training on working collaboratively with the health system until we have a better understanding of how students are currently engaging in research partnership approaches. In response, this scoping review aims to map and characterise the evidence related to using an IKT or other research partnership approach from the perspective of health research trainees. METHODS AND ANALYSIS We will employ methods described by the Joanna Briggs Institute and Arksey and O'Malley's framework for conducting scoping reviews. The reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews checklist. We will include both published and unpublished grey literature and search the following databases: MEDLINE, Embase, CINAHL, PsycINFO, ProQuest Dissertations & Theses Global databases, Google Scholar and websites from professional bodies and other organisations. Two reviewers will independently screen the articles and extract data using a standardised data collection form. We will narratively describe quantitative data and conduct a thematic analysis of qualitative data. We will map the IKT and other research partnership activities onto the Knowledge to Action cycle and IAP2 Levels of Engagement Framework. ETHICS AND DISSEMINATION No ethical approval is required for this study. We will share the results in a peer-reviewed, open access publication, conference presentation and stakeholder communications.
Collapse
Affiliation(s)
| | - Amy Jane Beck
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | | | - Melissa Demery Varin
- School of Nursing, University of Ottawa Faculty of Health Sciences, Ottawa, Ontario, Canada
| | - Celia Laur
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Krystina B Lewis
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Emily R Ramage
- School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
| | - Tram Nguyen
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Sandy Steinwender
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Ilja Ormel
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Lillian Stratton
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | | |
Collapse
|
12
|
Cassidy CE, Flynn R, Shuman CJ. Preparing Nursing Contexts for Evidence-Based Practice Implementation: Where Should We Go From Here? Worldviews Evid Based Nurs 2021; 18:102-110. [PMID: 33493388 DOI: 10.1111/wvn.12487] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Context is important to the adoption and sustainability of evidence-based practices (EBPs). Currently, most published implementation efforts address context in relation to one specific EBP or a bundle of related EBPs. Since EBP and implementation are ongoing and dynamic, more discussion is needed on preparing nursing contexts to be more conducive to implementation generally. AIM To discuss the need to create contexts that are more adaptable to ongoing change due to the dynamic nature of EBPs and the ever-changing healthcare environment. METHODS This paper builds on a collection of our previous work, as nursing implementation scientists representing the Canadian and American healthcare contexts, and a literature review of the implementation science, knowledge translation, and sustainability literatures from 2006 to 2019. RESULTS We argue for a different way of thinking about the influence of context and implementation of EBPs. We contend that nursing contexts must be prepared to be more flexible and conducive to ongoing EBP implementation more generally. Contexts that embrace, facilitate, and have the capacity for change may be more likely to effectively de-implement ineffective interventions or implement and sustain new EBPs. We outline future directions to build a program of research on preparing the soil for implementation of EBPs, including building capacity among nurses, supporting organizations to embrace change, co-producing research evidence, and contributing to implementation science. LINKING EVIDENCE TO ACTION Supporting contexts to adopt and sustain evidence in nursing practice is essential for bridging the evidence to practice gap and improving outcomes for patients, clinicians, and the health system. Moving forward, we need to develop a better understanding of how to create contexts that embrace change prior to the implementation of EBPs in order sustain improvements to patient and health system outcomes.
Collapse
Affiliation(s)
| | - Rachel Flynn
- WCHRI, University of Alberta, Edmonton, AB, Canada.,Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.,Child Health Evaluative Sciences and Centre for Nursing Research, The Hospital for Sick Children, Toronto, ON, Canada
| | | |
Collapse
|
13
|
Yu Z, Gallant AJ, Cassidy CE, Boulos L, Macdonald M, Stevens S. Case Management Models and Continuing Care: A Literature Review across nations, settings, approaches, and assessments. Home Health Care Management & Practice 2020. [DOI: 10.1177/1084822320954394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Older adults accessing continuing care often have multiple chronic conditions. Research suggests that case management is a promising approach to reduce health care expenditure and improve patient outcomes. To optimize healthcare delivery, an examination of existing case management models and their effectiveness is essential. This literature review was conducted using Joanna Briggs Institute (JBI) methods to explore case management models for older adults accessing continuing care services. Searches were conducted in PubMed and CINAHL from 2010 to 2018. A total of 37 articles were included in this review. Approaches to case management are diverse with respect to composition of care providers, method of care provision, and location of care. Findings from 27 quantitative studies demonstrated that nurse-led and interdisciplinary team case management models that include home visits can effectively reduce hospital admission/readmission while lowering costs. Mixed results were found on the impact of case management on patient satisfaction, ED visits, quality of life, length of stay, self-efficacy, social integration and caregiver burden. Among 10 qualitative studies, 3 facilitators for quality case management were identified that include receiving care at home, building trusting relationships, and improving self-efficacy. Based on these findings, we conclude that nurse-led and interdisciplinary team case management can effectively reduce hospital admission of frail older adults while lowering costs, particularly within home care settings.
Collapse
Affiliation(s)
- Ziwa Yu
- Dalhousie University, Halifax, Canada
| | | | | | - Leah Boulos
- Maritime SPOR SUPPORT Unit, Halifax, NS, Canada
| | | | | |
Collapse
|
14
|
Cassidy CE, Bowen S, Fontaine G, Côté-Boileau É, Botting I. How to Work Collaboratively Within the Health System: Workshop Summary and Facilitator Reflection. Int J Health Policy Manag 2020; 9:233-239. [PMID: 32613791 PMCID: PMC7382904 DOI: 10.15171/ijhpm.2019.131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/27/2019] [Indexed: 11/09/2022] Open
Abstract
Effectiveness in health services research requires development of specific knowledge and skills for working in partnership with health system decision-makers. In an initial effort to frame capacity-building activities for researchers, we designed a workshop on working collaboratively within the health system. The workshop, based on recent research exploring health system experience and perspectives on research collaborations, was trialed at the annual Canadian Health Services and Policy Research (CAHSPR) conference in May 2019. Participants reported positive evaluations of the workshop. However, further efforts should target health services researchers that may not be as motivated to develop skills in collaborative research. Additional attention to equipping researchers with the skills needed to work in partnerships is recommended, including approaches and materials that avoid oversimplification of complex challenges.
Collapse
Affiliation(s)
- Christine E Cassidy
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Sarah Bowen
- Applied Research and Evaluation Consultant, Halifax, NS, Canada
| | - Guillaume Fontaine
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada.,Montreal Heart Institute Research Center, Montreal, QC, Canada
| | - Élizabeth Côté-Boileau
- Faculty of Medicine and Health Sciences Research, University of Sherbrooke, Sherbrooke, QC, Canada.,Charles-Le Moyne - Saguenay-Lac-Saint-Jean Research Center on Health Innovations, Longueuil, QC, Canada
| | - Ingrid Botting
- Health Services Integration, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| |
Collapse
|
15
|
Cassidy CE, Burgess S, Graham ID. It's All About the IKT Approach: Three Perspectives on an Embedded Research Fellowship Comment on "CIHR Health System Impact Fellows: Reflections on 'Driving Change' Within the Health System". Int J Health Policy Manag 2019; 8:455-458. [PMID: 31441283 PMCID: PMC6706976 DOI: 10.15171/ijhpm.2019.31] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/11/2019] [Indexed: 11/13/2022] Open
Abstract
As a group of Health System Impact (HSI) postdoctoral fellows, Sim and colleagues offer their reflections on ‘driving change’ within the health system and present a framework for understanding the HSI fellow as an embedded researcher. Our commentary offers a different perspective of the fellow’s role by highlighting the integrated knowledge translation (IKT) approach we consider to be foundational to the fellowship experience. Further, we provide several recommendations to enhance Sim and colleagues’ framework to ensure we capture the full value of the fellowship program to the HSI fellow, health system organization, and academic institution.
Collapse
Affiliation(s)
- Christine E Cassidy
- IWK Health Centre, Halifax, NS, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Centre for Practice-Changing Research, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| |
Collapse
|
16
|
Cassidy CE, MacEachern L, Best S, Foley L, Rowe ME, Dugas K, Mills JLA. Barriers and Enablers to Implementing the Children's Hospital Early Warning Score: A Pre- and Post-Implementation Qualitative Descriptive Study. J Pediatr Nurs 2019; 46:39-47. [PMID: 30836203 DOI: 10.1016/j.pedn.2019.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/06/2019] [Accepted: 02/06/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study was to identify and compare barriers and enablers to the implementation of the Children's Hospital Early Warning Score (CHEWS) on a pediatric inpatient unit pre- and post-implementation. DESIGN AND METHODS A qualitative descriptive design, guided by the Theoretical Domains Framework, was used to conduct semi-structured focus groups and individual interviews with nurses on a pediatric inpatient unit to identify barriers and enablers in the pre- and post- CHEWS implementation phases. Data were analyzed using a directed content analysis approach followed by inductive thematic analysis. RESULTS Two pre-implementation focus groups (N = 15) and 8 post-implementation individual interviews with nurses were conducted. We identified pre- and post- CHEWS implementation barriers related to clinical decision making, interprofessional relationships, the unit context, and negative emotions, and enablers related to quality of care and patient safety. The identified barriers and enablers to implementation were categorized within 13 TDF domains. CONCLUSIONS Our findings illustrate a range of barriers and enablers to CHEWS implementation during the pre- and post-implementation phases. Tailored strategies are needed to overcome barriers related to nurses' perceptions of CHEWS impeding clinical decision-making and interprofessional collaboration. By addressing the identified barriers, we can leverage nurses' motivations for using CHEWS to improve the quality of patient care and enhance patient safety. PRACTICE IMPLICATIONS The barriers and enablers identified in this study can be used to select implementation strategies to support the use of early warning systems in pediatric nursing practice.
Collapse
Affiliation(s)
- Christine E Cassidy
- IWK Health Centre, Halifax, Nova Scotia, Canada; Dalhousie University School of Nursing, Halifax, Nova Scotia, Canada.
| | | | - Shauna Best
- IWK Health Centre, Halifax, Nova Scotia, Canada.
| | - Laura Foley
- IWK Health Centre, Halifax, Nova Scotia, Canada.
| | | | | | - Jessica L A Mills
- IWK Health Centre, Halifax, Nova Scotia, Canada; Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada.
| |
Collapse
|
17
|
Cassidy CE. Licensure by specialty. Fed Bull 1980; 67:263-7. [PMID: 10248313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
18
|
Cassidy CE. Commemorative tribute: Edwin B. Astwood, M.D., C.M., Ph.D. Endocrinology 1976; 99:1155-60. [PMID: 791637 DOI: 10.1210/endo-99-5-1155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
19
|
Abstract
Previous studies have shown that transketolase activity is decreased in the brains of thiamin deficient rats. This study assesses the effect of decreased transketolase levels on the activity of the pentose phosphate cycle in murine thiamin deficient cortex and brainstem. Thiamin deficiency was produced in newborn and adult rats by either pyrithiamin administration or by feeding a low thiamin diet. Newborn rats were killed at 22 days of age, and adults were killed at the onset of moderate to severe nurological signs. Cortices and brainstems from thiamin deficient and control rats were analyzed for activity of the two regulatory enzymes of the pentose phosphate cycle, glucose-6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase. Flux through the pathway was measured by the differentially labeled glucose technique in the brainstems of deficient and control adult rats. In both the brainstem and cortex of thiamin dificient rats, areas in which transketolase activity was decreased up to 65%, the activities of the two regulatory enzymes, glucose-6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase, were unaltered. Further, flux through the pentose phosphate cycle was not decreased as compared to pair-fed control rats. These data do not support the hypothesis that in thiamin dificient rats, a decrease in cerebral transketolase activity leads to a diminished pentose phosphate cycle activity.
Collapse
|
20
|
McCandless DW, Cassidy CE. Adenine nucleotides in thiamine deficient rat brain. Res Commun Chem Pathol Pharmacol 1976; 14:579-82. [PMID: 959658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The net levels and turnover of ATP, ADP, and AMP were measured in the cortex and brainstem of thiamine deficient and control rats. In spite of a 63% decrease in pyruvate decarboxylase activity in the brainstem of severely deficient rats, metabolism of the adenine nucleotides was unaffected. These data indicate a major reserve capacity for pyruvate decarboxylase and show that the adenylate pool is not significantly altered in thiamine deficient rat brain.
Collapse
|
21
|
Abstract
A new multi-bladed air-driven guillotine is described. This device removes newborn rat heads and slices them into several thin wafers, which facilitates freezing and permits easy regional dissection.
Collapse
|
22
|
|
23
|
|
24
|
|
25
|
|
26
|
Bray GA, Glennon JA, Rüedi B, Cheifetz P, Cassidy CE. Triiodothyronine and mercurial diuretics. Effects on excretion of a water load and on plasma free fatty acids in obese patients. Am J Clin Nutr 1969; 22:1420-2. [PMID: 5350757 DOI: 10.1093/ajcn/22.11.1420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
|
27
|
|
28
|
|
29
|
|