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Ritchie MJ, Smith JL, Kim B, Woodward EN, Kirchner JE. Building a sharable literature collection to advance the science and practice of implementation facilitation. FRONTIERS IN HEALTH SERVICES 2024; 4:1304694. [PMID: 38784706 PMCID: PMC11111980 DOI: 10.3389/frhs.2024.1304694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 04/30/2024] [Indexed: 05/25/2024]
Abstract
Background Implementation science seeks to produce generalizable knowledge on strategies that promote the adoption and sustained use of evidence-based innovations. Literature reviews on specific implementation strategies can help us understand how they are conceptualized and applied, synthesize findings, and identify knowledge gaps. Although rigorous literature reviews can advance scientific knowledge and facilitate theory development, they are time-consuming and costly to produce. Improving the efficiency of literature review processes and reducing redundancy of effort is especially important for this rapidly developing field. We sought to amass relevant literature on one increasingly used evidence-based strategy, implementation facilitation (IF), as a publicly available resource. Methods We conducted a rigorous systematic search of PubMed, CINAHL, and Web of Science citation databases for peer-reviewed, English-language articles with "facilitation" and a combination of other terms published from January 1996 to December 2021. We searched bibliographies of articles published from 1996 to 2015 and identified articles during the full text review that reported on the same study. Two authors screened 3,168 abstracts. After establishing inter-rater reliability, they individually conducted full-text review of 786 relevant articles. A multidisciplinary team of investigators provided recommendations for preparing and disseminating the literature collection. Findings The literature collection is comprised of 510 articles. It includes 277 empirical studies of IF and 77 other articles, including conceptual/theoretical articles, literature reviews, debate papers and descriptions of large-scale clinical initiatives. Over half of the articles were published between 2017 and 2021. The collection is publicly available as an Excel file and as an xml file that can be imported into reference management software. Conclusion We created a publicly accessible collection of literature about the application of IF to implement evidence-based innovations in healthcare. The comprehensiveness of this collection has the potential to maximize efficiency and minimize redundancy in scientific inquiry about this strategy. Scientists and practitioners can use the collection to more rapidly identify developments in the application of IF and to investigate a wide range of compelling questions on its use within and across different healthcare disciplines/settings, countries, and payer systems. We offer several examples of how this collection has already been used.
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Affiliation(s)
- Mona J. Ritchie
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Jeffrey L. Smith
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Eva N. Woodward
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- VA Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - JoAnn E. Kirchner
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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Crook R, Lennox C, Awenat Y, Edge D, Knowles S, Honeywell D, Gooding P, Haddock G, Brooks H, Pratt D. Development of the Prevention of Suicide Behaviour in Prisons: Enhancing Access to Therapy (PROSPECT) logic model and implementation strategies. BJPsych Bull 2024:1-9. [PMID: 38708568 DOI: 10.1192/bjb.2024.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
AIMS AND METHOD This study aimed to develop and articulate a logic model and programme theories for implementing a new cognitive-behavioural suicide prevention intervention for men in prison who are perceived to be at risk of death by suicide. Semi-structured one-to-one interviews with key stakeholders and a combination of qualitative analysis techniques were used to develop programme theories. RESULTS Interviews with 28 stakeholders resulted in five programme theories, focusing on: trust, willingness and engagement; readiness and ability; assessment and formulation; practitioner delivering the 'change work' stage of the intervention face-to-face in a prison environment; and practitioner training, integrating the intervention and onward care. Each theory provides details of what contextual factors need to be considered at each stage, and what activities can facilitate achieving the intended outcomes of the intervention, both intermediate and long term. CLINICAL IMPLICATIONS The PROSPECT implementation strategy developed from the five theories can be adapted to different situations and environments.
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Affiliation(s)
- Rebecca Crook
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester NHS Foundation Trust, Manchester, UK
| | - Charlotte Lennox
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Yvonne Awenat
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester NHS Foundation Trust, Manchester, UK
| | - Dawn Edge
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | | | | | - Patricia Gooding
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester NHS Foundation Trust, Manchester, UK
| | - Gillian Haddock
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester NHS Foundation Trust, Manchester, UK
| | | | - Daniel Pratt
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester NHS Foundation Trust, Manchester, UK
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Wang W, Fu Q, Shen W, Xu Y, Wang L, Chun X, Shi Y, Lin J, Zhao Y, Gu Y. Using the i-PARIHS theoretical framework to develop evidence implementation strategies for central venous catheter maintenance: a multi-site quality improvement project. JBI Evid Implement 2024; 22:195-204. [PMID: 38557993 PMCID: PMC11107888 DOI: 10.1097/xeb.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Evidence-based nursing practice can reduce complications associated with central venous catheters (CVCs). In this project, the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework was considered an ideal theoretical instrument to identify facilitators and barriers to implementing evidence-based practice. METHODS The project was conducted in pediatric intensive care units in six Chinese tertiary children's hospitals. Twenty-two audit criteria were obtained from best practice recommendations, and a baseline audit was conducted to assess current practice against best practice. Next, the i-PARIHS framework was used to identify facilitators and barriers to best practice and develop improvement strategies. A follow-up audit was then conducted to measure changes in compliance with best practices. RESULTS Facilitators and barriers were identified at the innovation, recipient, and context levels. A comprehensive CVC maintenance strategy was then developed to apply the best evidence to nurses' clinical work. Of the 22 audit criteria, 17 showed significant improvement compared with the baseline audit. CONCLUSIONS The i-PARIHS framework is an effective tool for developing targeted, evidence-based improvement strategies and applying these to the clinical setting. The quality of the nurses' clinical practice improved during CVC maintenance. However, there is no certainty that these positive results can be maintained, and long-term data are needed to verify this. SPANISH ABSTRACT http://links.lww.com/IJEBH/A185.
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Affiliation(s)
- Wenchao Wang
- Emergency Department, Children's Hospital of Fudan University, Shanghai, China
| | - Qin Fu
- Nursing Department, ShenZhen Children's Hospital, Guangdong, China
| | - Weijie Shen
- Pediatric Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Yulu Xu
- Cardiac Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Linjuan Wang
- Pediatric Intensive Care Unit, Shenzhen Children's Hospital, Guangdong, China
| | - Xiao Chun
- Pediatric Intensive Care Unit, Guangzhou Woman and Children's Medical Center, Guangdong, China
| | - Yuyun Shi
- Pediatric Intensive Care Unit, Children's Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Jianping Lin
- Pediatric Intensive Care Unit, Xiamen Children's Hospital, Fujian, China
| | - Yaxun Zhao
- Pediatric Intensive Care Unit, Anhui Children's Hospital, Anhui, China
| | - Ying Gu
- Nursing Department, Children's Hospital of Fudan University, Shanghai, China
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Ruest M, Guay M. [Orientations de facilitation pour soutenir l'application de l'Algo dans les services de soutien à domicile des personnes aînées]. Can J Aging 2024; 43:167-175. [PMID: 37902413 DOI: 10.1017/s0714980823000600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Comment soutenir le déploiement de connaissances coconstruites par des personnes cliniciennes, gestionnaires ou chercheures? Ce thème est abordé à partir de l'étude de l'application de l'Algo, un algorithme clinique décisionnel conçu pour la sélection des aides techniques visant à faciliter l'hygiène corporelle des personnes aînées vivant à domicile. L'objectif de cette note sur les politiques et les pratiques est de présenter les orientations de facilitation dégagées à la suite d'un devis mixte multiphases (2015-2019) mis en œuvre dans les services de soutien à domicile au Québec (Canada). Les orientations de facilitation centrée sur la tâche et holistique sont présentées en fonction des stades d'utilisation de l'Algo, afin de soutenir les personnes cliniciennes, gestionnaires et chercheures dans la poursuite de son application auprès des personnes aînées. De plus, cette note illustre l'apport des devis mixtes à la conduite et à la compréhension de l'application des connaissances coconstruites.
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Affiliation(s)
- Mélanie Ruest
- Faculté de médecine et des sciences de la santé de l'Université de Sherbrooke et Centre de recherche sur le vieillissement 3001, 12e Avenue Nord, Sherbrooke (Québec) CanadaJ1H 5N4
| | - Manon Guay
- Faculté de médecine et des sciences de la santé de l'Université de Sherbrooke et Centre de recherche sur le vieillissement 3001, 12e Avenue Nord, Sherbrooke (Québec) CanadaJ1H 5N4
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Nyholm L, Gunningberg L, Jangland E. Is this to be another project that fizzles out? Using the i-PARIHS framework to evaluate implementation of a mentoring programme. J Adv Nurs 2024. [PMID: 38174632 DOI: 10.1111/jan.16041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/13/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024]
Abstract
It is well-known that the implementation of evidence into clinical practice is complex and challenging. The integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework conceptualizes successful implementation of evidence into practice. As the implementation of the mentoring programme proved to be a challenge, it seemed valuable to retrospectively study the implementation process using a framework like the i-PARIHS. AIM The aim of this study was to evaluate implementation of a multifaceted mentoring programme for bedside nurses using the i-PARIHS framework, to identify factors that influenced the implementation. DESIGN A secondary analysis of qualitative data using the i-PARIHS framework as the theoretical lens. METHOD A directed content analysis was performed, driven theoretically by the i-PARIHS framework. The analysis focused separately on (a) characteristics of the innovation and (b) successful and hindering factors in the implementation process. RESULTS The results showed that successful factors influencing implementation of the mentoring programme included supportive and actively involved formal leaders and supervisors at the unit level. A major hindering factor was lack of resources in the form of personnel, time and money. A lack of facilitators, particularly experienced facilitators, throughout the organization hindered implementation. The i-PARIHS framework offered a structured how-to guide to identify factors that influenced the implementation process. CONCLUSION Implementation of the mentoring programme was a challenge for the organization. Investment into implementation should continue, with a more structured facilitation process. A structured and prioritized management system, including supportive leadership at the unit level, should be established by the hospital board. IMPLICATIONS FOR THE PROFESSION There is a need for experienced facilitators throughout the organization. This is crucial to achieve sustainability in the mentoring programme and ensure that the large investments of staff resources and money do not fizzle out. IMPACT What problem did the study address? Implementing a mentoring programme for nurses in a large university hospital proved to be a challenge. Therefore, it seemed valuable to retrospectively study the implementation process using a framework like the i-PARIHS. What were the main findings? A lack of facilitators, particularly experienced facilitators, throughout the organization hindered the implementation. The i-PARIHS framework offered a structured how-to guide to identify factors that influenced the implementation process. Where and on whom will the research have an impact? Our findings are important for leaders on all levels in a hospital setting, including the hospital board, heads of departments and nurse managers. REPORTING METHOD Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups is used. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Lena Nyholm
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
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Block H, Bellon M, Hunter SC, George S. Barriers and enablers to managing challenging behaviours after traumatic brain injury in the acute hospital setting: a qualitative study. BMC Health Serv Res 2023; 23:1266. [PMID: 37974214 PMCID: PMC10655469 DOI: 10.1186/s12913-023-10279-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Challenging behaviours after traumatic brain injury (TBI) in the acute setting are associated with risk of harm to the patient and staff, delays in commencing rehabilitation and increased length of hospital stay. Few guidelines exist to inform practice in acute settings, and specialist services providing multi-disciplinary expertise for TBI behaviour management are predominantly based in subacute inpatient services. This study aims to investigate acute and subacute staff perspectives of barriers and enablers to effectively managing challenging behaviours after TBI in acute hospital settings. METHODS Qualitative focus groups were conducted with 28 staff (17 from acute setting, 11 from subacute setting) across two sites who had experience working with patients with TBI. Data were analysed using inductive-deductive reflexive thematic analysis. Data were applied to the constructs of the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to generate themes representing barriers and enablers to managing challenging behaviours after TBI in the acute hospital setting. RESULTS Four barriers and three enablers were identified. Barriers include (1) Difficulties with clinical decision making; (2) Concerns for risks to staff and patients; (3) Hospital environment; (4) Intensive resources are required. Enablers were (1) Experienced staff with practical skills; (2) Incorporating person-centred care; and (3) Supportive teams. CONCLUSION These findings can inform pre-implementation planning for future improvements to TBI behaviour management in acute hospital settings. Difficulties with clinical decision making, concerns for risks of injury, the hospital environment and lack of resources are major challenges. Implementation strategies developed to address barriers will need to be trialled, with multi-disciplinary team approaches, and tailored to the acute setting.
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Affiliation(s)
- Heather Block
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, Australia.
- Division of Allied Health, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia.
| | - Michelle Bellon
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, Australia
| | - Sarah C Hunter
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, Australia
| | - Stacey George
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, Australia
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Bosak J, Drainoni M, Bryer C, Goodman D, Messersmith L, Declercq E. 'It opened my eyes, my ears, and my heart': Codesigning a substance use disorder treatment programme. Health Expect 2023; 27:e13908. [PMID: 37920874 PMCID: PMC10726284 DOI: 10.1111/hex.13908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Pregnant and parenting women have low engagement and poor retention in substance use disorder (SUD) treatment. The aim of this study was to analyse the implementation of an adapted experience-based codesign (EBCD) process involving SUD treatment staff and pregnant or parenting women with lived experience (WWLE) of SUD to launch a residential treatment service where women could coreside with their children and receive long term comprehensive treatment for dual diagnosis of SUD and mental illness. METHODS A process evaluation was conducted utilising five data sources: two sets of semistructured interviews with WWLE and SUD treatment staff, ethnographic observation and transcripts from group events, and meeting minutes. Based on the Integrated Promoting Action on Research in Health Services framework constructs (context, recipients, facilitation, innovation) researchers applied thematic analysis to determine main themes within each construct. RESULTS The full sample across the implementation totalled 34 individuals (WWLE = 13 and SUD staff = 21). The EBCD process engaged both cohorts and supported group cohesion and collaborative brainstorming. WWLE felt respected, emotionally safe to share, and empowered by participation. A cohesive, multidisciplinary codesign planning group, inclusive of WWLE, supported a more equitable codesign process. The need for a virtual platform due to the COVID-19 pandemic impeded human connection and relationship building. The complex environment of residential regulations and uncertainties during start-up phase of an organisation presented implementation challenges. CONCLUSION These results highlight the feasibility of, and challenges to, effectively engaging WWLE in a codesign process. The findings also demonstrated a positive influence on WWLE's feelings of empowerment. Identified themes reinforce the purposeful components within EBCD that enhance participation, along with new insights to inform successful codesign with a vulnerable population. The author's team included a WWLE who collaborated throughout the full scope of the research process, enriching the overall research and ensuring the authenticity of the presentation of women in recovery's perspective. Utilising the codesign approach to design and implement new services should improve health equity by enhancing patient engagement and retention in care. PATIENT CONTRIBUTION Parenting WWLE of residential SUD treatment were involved in the full scope of the research process and the implementation being evaluated. For the actual codesign work WWLE were key members of the codesign planning team that met weekly throughout the implementation to plan, implement, problem solve and adapt the process over an 18 month timeframe. As is appropriate for codesign the actual ongoing workgroup participants had average 50% WWLE participation. For the research team, this research is a culmination of the lead author's doctoral dissertation. One member of the five-person dissertation committee was a recovery coach and a WWLE. She was an active participant across the entire research process overseeing and influencing the research design, conduct of the study, analysis, interpretation of findings and approval of the final manuscript. The findings were member checked with the larger codesign planning group that had additional WWLE members.
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Affiliation(s)
- Julie Bosak
- Community Health ServicesBoston University School of Public HealthBostonMassachusettsUSA
- Dartmouth Hitchcock Medical CenterLebanonNew HampshireUSA
- Dartmouth Geisel School of MedicineLebanonNew HampshireUSA
| | - Mari‐Lynn Drainoni
- Department of Medicine, Section of Infectious DiseasesBoston University Aram V. Chobanian & Edward Avedisian School of MedicineBostonMassachusettsUSA
- Department of Health Law Policy and ManagementBoston University School of Public HealthBostonMassachusettsUSA
| | - Cheri Bryer
- Dartmouth Hitchcock Medical CenterLebanonNew HampshireUSA
- Dartmouth Geisel School of MedicineLebanonNew HampshireUSA
| | - Daisy Goodman
- Dartmouth Hitchcock Medical CenterLebanonNew HampshireUSA
- Department of Health Law Policy and ManagementBoston University School of Public HealthBostonMassachusettsUSA
| | - Lisa Messersmith
- Department of Global HealthBoston University School of Public HealthBostonMassachusettsUSA
| | - Eugene Declercq
- Community Health ServicesBoston University School of Public HealthBostonMassachusettsUSA
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Harvey G, Collyer S, McRae P, Barrimore SE, Demmitt C, Lee-Steere K, Nolan B, Mudge AM. Navigating the facilitation journey: a qualitative, longitudinal evaluation of 'Eat Walk Engage' novice and experienced facilitators. BMC Health Serv Res 2023; 23:1132. [PMID: 37864161 PMCID: PMC10588033 DOI: 10.1186/s12913-023-10116-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/04/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The Promoting Action on Research Implementation in Health Services (PARIHS) and integrated-PARIHS (i-PARIHS) frameworks position facilitation as an overarching strategy to enable implementation. In the revised i-PARIHS framework, facilitation is operationalised through a multi-level model with novice, experienced and expert facilitators working together in a network structure to build facilitation knowledge and skills along a continuum. To date, there has been limited evaluation of this facilitation model in practice, which is the aim of the study reported here. METHODS A descriptive, qualitative longitudinal study was undertaken to track a team of four novice and two experienced facilitators involved in facilitating the implementation of an intervention known as 'Eat Walk Engage' to improve multidisciplinary team delivery of age-friendly care principles in hospital. Over an 18-month period, repeat interviews were conducted to explore the learning, development, and evolving roles of novice facilitators and the roles of the experienced facilitators in providing support and mentoring. Interview data were analysed using a descriptive qualitative approach and findings were interpreted in collaboration with the participating facilitators. RESULTS The findings demonstrated experiential learning in both the novice and experienced facilitator groups as they enacted their roles in practice. The novice facilitators progressively transitioned to becoming more experienced facilitators and the experienced facilitators became increasingly expert, in line with the i-PARIHS concept of a facilitation journey from novice to expert. Strategies to support this development included a staggered approach to learning, regular meetings between the experienced and novice facilitators, reflective writing and informal peer support and networking. However, the roles were not without challenge and these challenges changed over time, from a more specific focus on the demands of the facilitator role to concerns about embedding and sustaining improvements in practice. CONCLUSIONS Within a network of peers and a mentored relationship with more experienced facilitators, individuals who are new to an implementation facilitator role can transition along a continuum to become experienced facilitators. Building implementation facilitation capability in this way takes time and requires tailored support and mentorship using a mix of structured and flexible approaches incorporating opportunities for reflection to support individual and group learning.
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Affiliation(s)
- Gillian Harvey
- Caring Futures Institute, Flinders University, Adelaide, Australia.
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia.
| | - Sarah Collyer
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Prue McRae
- Royal Brisbane and Women's Hospital Department of Internal Medicine and Aged Care, Brisbane, Australia
- Queensland University of Technology Institute of Health and Biomedical Innovation, Brisbane, Australia
| | | | - Camey Demmitt
- Caboolture Hospital, Caboolture, Queensland, Australia
| | - Karen Lee-Steere
- Royal Brisbane and Women's Hospital Department of Internal Medicine and Aged Care, Brisbane, Australia
- University of Queensland Faculty of Health and Behavioural Sciences, Brisbane, Australia
| | | | - Alison M Mudge
- Royal Brisbane and Women's Hospital Department of Internal Medicine and Aged Care, Brisbane, Australia
- University of Queensland Faculty of Medicine, Brisbane, Australia
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Tham S, Koh FH, Ladlad J, Chue KM, Lin CL, Teo EK, Foo FJ. The imitation game: a review of the use of artificial intelligence in colonoscopy, and endoscopists' perceptions thereof. Ann Coloproctol 2023; 39:385-394. [PMID: 36907170 PMCID: PMC10626328 DOI: 10.3393/ac.2022.00878.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/22/2022] [Accepted: 01/09/2023] [Indexed: 03/14/2023] Open
Abstract
The development of deep learning systems in artificial intelligence (AI) has enabled advances in endoscopy, and AI-aided colonoscopy has recently been ushered into clinical practice as a clinical decision-support tool. This has enabled real-time AI-aided detection of polyps with a higher sensitivity than the average endoscopist, and evidence to support its use has been promising thus far. This review article provides a summary of currently published data relating to AI-aided colonoscopy, discusses current clinical applications, and introduces ongoing research directions. We also explore endoscopists' perceptions and attitudes toward the use of this technology, and discuss factors influencing its uptake in clinical practice.
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Affiliation(s)
- Sarah Tham
- Department of General Surgery, Sengkang General Hospital, SingHealth Services, Singapore
| | - Frederick H. Koh
- Colorectal Service, Department of General Surgery, Sengkang General Hospital, SingHealth Services, Singapore
- SKH Endoscopy Centre, Division of Hyperacute Care, Sengkang General Hospital, SingHealth Services, Singapore
| | - Jasmine Ladlad
- Colorectal Service, Department of General Surgery, Sengkang General Hospital, SingHealth Services, Singapore
- SKH Endoscopy Centre, Division of Hyperacute Care, Sengkang General Hospital, SingHealth Services, Singapore
| | - Koy-Min Chue
- Department of General Surgery, Sengkang General Hospital, SingHealth Services, Singapore
- SKH Endoscopy Centre, Division of Hyperacute Care, Sengkang General Hospital, SingHealth Services, Singapore
| | - SKH Endoscopy Centre
- SKH Endoscopy Centre, Division of Hyperacute Care, Sengkang General Hospital, SingHealth Services, Singapore
| | - Cui-Li Lin
- SKH Endoscopy Centre, Division of Hyperacute Care, Sengkang General Hospital, SingHealth Services, Singapore
- Department of Gastroenterology and Hepatology, Sengkang General Hospital, SingHealth Services, Singapore
| | - Eng-Kiong Teo
- SKH Endoscopy Centre, Division of Hyperacute Care, Sengkang General Hospital, SingHealth Services, Singapore
- Department of Gastroenterology and Hepatology, Sengkang General Hospital, SingHealth Services, Singapore
| | - Fung-Joon Foo
- Colorectal Service, Department of General Surgery, Sengkang General Hospital, SingHealth Services, Singapore
- SKH Endoscopy Centre, Division of Hyperacute Care, Sengkang General Hospital, SingHealth Services, Singapore
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Tham S, Koh FH, Teo EK, Lin CL, Foo FJ. Knowledge, perceptions and behaviours of endoscopists towards the use of artificial intelligence-aided colonoscopy. Surg Endosc 2023; 37:7395-7400. [PMID: 37670191 DOI: 10.1007/s00464-023-10412-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/14/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Recent developments in artificial intelligence (AI) systems have enabled advancements in endoscopy. Deep learning systems, using convolutional neural networks, have allowed for real-time AI-aided detection of polyps with higher sensitivity than the average endoscopist. However, not all endoscopists welcome the advent of AI systems. METHODS We conducted a survey on the knowledge of AI, perceptions of AI in medicine, and behaviours regarding use of AI-aided colonoscopy, in a single centre 2 months after the implementation of Medtronic's GI Genius in colonoscopy. We obtained a response rate of 66.7% (16/24) amongst consultant-grade endoscopists. Fisher's exact test was used to calculate the significance of correlations. RESULTS Knowledge of AI varied widely amongst endoscopists. Most endoscopists were optimistic about AI's capabilities in performing objective administrative and clinical tasks, but reserved about AI providing personalised, empathetic care. 68.8% (n = 11) of endoscopists agreed or strongly agreed that GI Genius should be used as an adjunct in colonoscopy. In analysing the 31.3% (n = 5) of endoscopists who disagreed or were ambivalent about its use, there was no significant correlation with their knowledge or perceptions of AI, but a significant number did not enjoy using the programme (p-value = 0.0128) and did not think it improved the quality of colonoscopy (p-value = 0.033). CONCLUSIONS Acceptance of AI-aided colonoscopy systems is more related to the endoscopist's experience with using the programme, rather than general knowledge or perceptions towards AI. Uptake of such systems will rely greatly on how the device is delivered to the end user.
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Affiliation(s)
- Sarah Tham
- Department of General Surgery, Sengkang General Hospital, SingHealth Services, Singapore, Singapore
| | - Frederick H Koh
- Colorectal Service, Department of General Surgery, Sengkang General Hospital, SingHealth Services, 110 Sengkang East Way, Singapore, 544886, Singapore.
| | - Eng-Kiong Teo
- Department of Gastroenterology and Hepatology, Sengkang General Hospital, SingHealth Services, Singapore, Singapore
| | - Cui-Li Lin
- Department of Gastroenterology and Hepatology, Sengkang General Hospital, SingHealth Services, Singapore, Singapore
| | - Fung-Joon Foo
- Colorectal Service, Department of General Surgery, Sengkang General Hospital, SingHealth Services, 110 Sengkang East Way, Singapore, 544886, Singapore
- Endoscopy Centre, Division of Hyperacute Care, Sengkang General Hospital, Singapore, Singapore
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Sandvin Olsson AB, Stenberg U, Haaland-Øverby M, Slettebø T, Strøm A. Enabling primary healthcare service development with patient participation: a qualitative study of the internal facilitator role in Norway. Prim Health Care Res Dev 2023; 24:e57. [PMID: 37753659 PMCID: PMC10539736 DOI: 10.1017/s1463423623000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/22/2022] [Accepted: 08/05/2023] [Indexed: 09/28/2023] Open
Abstract
AIM To explore how primary healthcare professionals (HCPs) tasked with facilitating primary healthcare service development with patient participation perceived their role. INTRODUCTION Patient participation in health service development is a recognized means of ensuring that health services fit the public's needs. However, HCPs are often uncertain about how to involve patient representatives (PRs), and patient participation is poorly implemented. Inspired by the Promoting Action on Research Implementation in Health Services framework, we address the innovation (patient participation), its recipients (PRs, HCPs, supervisors, and senior managers), and its context (primary healthcare at a local and organizational level). METHODS We conducted semi-structured individual interviews with six HCPs working as internal facilitators in primary healthcare in four Norwegian municipalities. The data were analyzed by applying Braun and Clarke's reflexive thematic analysis. FINDINGS The themes show that to develop primary healthcare services with patient participation, facilitators must establish a network of PRs with relevant skills, promote involvement within their organization, engage HCPs favorable toward patient participation, and demonstrate to supervisors and senior managers its usefulness to win their support. Implementing patient participation must be a shared, collective responsibility of facilitators, supervisors, and senior management. However, supervisors and senior management appear not to fully understand the potential of involvement or how to support the facilitators. The facilitator role requires continuous and systematic work on multiple organizational levels to enable the development of health services with patient participation. It entails maintaining a network of persons with experiential knowledge, engaging HCPs, and having senior management's understanding and support.
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Affiliation(s)
- Ann Britt Sandvin Olsson
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
- VID Specialized University, Center of Diaconia and Professional Practice, Oslo, Norway
| | - Una Stenberg
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
- Frambu Resource Center for Rare Disorders, Siggerud, Norway
| | - Mette Haaland-Øverby
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
- Oslo Metropolitan University, Faculty of Health Sciences, Oslo, Norway
| | - Tor Slettebø
- VID Specialized University, Faculty of Social Studies, Oslo, Norway
| | - Anita Strøm
- VID Specialized University, Faculty of Health Sciences, Oslo, Norway
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Mudge AM, McRae P, Young A, Blackberry I, Lee-Steere K, Barrimore S, Quirke T, Harvey G. Implementing a ward-based programme to improve care for older inpatients: process evaluation of the cluster randomised CHERISH trial. BMC Health Serv Res 2023; 23:668. [PMID: 37344776 DOI: 10.1186/s12913-023-09659-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 06/06/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Older inpatients are at high risk of hospital-associated complications, particularly delirium and functional decline. These can be mitigated by consistent attention to age-friendly care practices such as early mobility, adequate nutrition and hydration, and meaningful cognitive and social activities. Eat Walk Engage is a ward-based improvement programme theoretically informed by the i-PARIHS framework which significantly reduced delirium in a four-hospital cluster trial. The objective of this process evaluation was to understand how Eat Walk Engage worked across trial sites. METHODS Prospective multi-method implementation evaluation on medical and surgical wards in four hospitals implementing Eat Walk Engage January 2016-May 2017. Using UK Medical Research Council guidance, this process evaluation assessed context, implementation (core components, implementation strategies and improvements) and mechanisms of impact (practice changes measured through older person interviews, structured mealtime observations and activity mapping) at each site. RESULTS The four wards had varied contextual barriers which altered dynamically with time. One ward with complex outer organisational barriers showed poorer implementation and fewer practice changes. Two experienced facilitators supported four novice site facilitators through interactive training and structured reflection as well as data management, networking and organisational influence. Novice site facilitators used many implementation strategies to facilitate 45 discrete improvements at individual, team and system level. Patient interviews (42 before and 38 after implementation) showed better communication about program goals in three sites. Observations of 283 meals before and 297 after implementation showed improvements in mealtime positioning and assistance in all sites. Activity mapping in 85 patients before and 111 patients after implementation showed improvements in cognitive and social engagement in three sites, but inconsistent changes in mobility. The improvements in mealtime care and cognitive and social engagement are plausible mediators of reduced delirium observed in the trial. The lack of consistent mobility improvements may explain why the trial did not show reduction in functional decline. CONCLUSIONS A multi-level enabling facilitation approach supported adaptive implementation to varied contexts to support mechanisms of impact which partly achieved the programme goals. Contexts changed over time, suggesting the need for adequate time and continued facilitation to embed, enhance and sustain age-friendly practices on acute care wards and optimise outcomes. TRIAL REGISTRATION The CHERISH trial was prospectively registered with the ANZCTR ( http://www.anzctr.org.au ): ACTRN12615000879561.
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Affiliation(s)
- Alison M Mudge
- Royal Brisbane and Women's Hospital Department of Internal Medicine and Aged Care, Herston, Australia.
- Queensland University of Technology Institute of Health and Biomedical Innovation, Kelvin Grove, Australia.
- University of Queensland Faculty of Medicine, Brisbane, Australia.
| | - Prue McRae
- Royal Brisbane and Women's Hospital Department of Internal Medicine and Aged Care, Herston, Australia
- Queensland University of Technology Institute of Health and Biomedical Innovation, Kelvin Grove, Australia
| | - Adrienne Young
- University of Queensland Faculty of Medicine, Brisbane, Australia
- Royal Brisbane and Women's Hospital Department of Nutrition and Dietetics, Herston, Australia
| | - Irene Blackberry
- LaTrobe University John Richards Centre for Rural Ageing Research, Wodonga, Australia
| | - Karen Lee-Steere
- Royal Brisbane and Women's Hospital Department of Internal Medicine and Aged Care, Herston, Australia
- University of Queensland Faculty of Health and Behavioural Sciences, Brisbane, Australia
| | | | - Tara Quirke
- Consumer Advocate Dementia Training Australia, Brisbane, Australia
| | - Gillian Harvey
- Queensland University of Technology Institute of Health and Biomedical Innovation, Kelvin Grove, Australia
- Flinders University College of Nursing and Health Sciences, Bedford Park, Australia
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Basger BJ, Moles RJ, Chen TF. Uptake of pharmacist recommendations by patients after discharge: Implementation study of a patient-centered medicines review service. BMC Geriatr 2023; 23:183. [PMID: 36991378 PMCID: PMC10061906 DOI: 10.1186/s12877-023-03921-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 03/22/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Polypharmacy and potentially inappropriate medicine use is common in older people, resulting in harm increased by lack of patient-centred care. Hospital clinical pharmacy services may reduce such harm, particularly prevalent at transitions of care. An implementation program to achieve such services can be a complex long-term process. OBJECTIVES To describe an implementation program and discuss its application in the development of a patient-centred discharge medicine review service; to assess service impact on older patients and their caregivers. METHOD An implementation program was begun in 2006. To assess program effectiveness, 100 patients were recruited for follow-up after discharge from a private hospital between July 2019 and March 2020. There were no exclusion criteria other than age less than 65 years. Medicine review and education were provided for each patient/caregiver by a clinical pharmacist, including recommendations for future management, written in lay language. Patients were asked to consult their general practitioner to discuss those recommendations important to them. Patients were followed-up after discharge. RESULTS Of 368 recommendations made, 351 (95%) were actioned by patients, resulting in 284 (77% of those actioned) being implemented, and 206 regularly taken medicines (19.7 % of all regular medicines) deprescribed. CONCLUSION Implementation of a patient-centred medicine review discharge service resulted in patient-reported reduction in potentially inappropriate medicine use and hospital funding of this service. This study was registered retrospectively on 12th July 2022 with the ISRCTN registry, ISRCTN21156862, https://www.isrctn.com/ISRCTN21156862 .
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Affiliation(s)
- Benjamin Joseph Basger
- Discipline of Pharmacy Practice, Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Room N517, A15 Science Road, Camperdown, Sydney, NSW, 2006, Australia.
- Wolper Jewish Hospital, 8 Trelawney Street, Woollahra, Sydney, NSW, 2025, Australia.
| | - Rebekah Jane Moles
- Discipline of Pharmacy Practice, Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Room N517, A15 Science Road, Camperdown, Sydney, NSW, 2006, Australia
| | - Timothy Frank Chen
- Discipline of Pharmacy Practice, Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Room N517, A15 Science Road, Camperdown, Sydney, NSW, 2006, Australia
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Cahill M, Neill S, Treleaven E, Lee-Steere K, Carter A, McCormack L, Mudge A. Eat Walk Engage: Enabling acute care teams to deliver consistent fundamentals of care for older people. J Adv Nurs 2023; 79:961-969. [PMID: 35864082 DOI: 10.1111/jan.15363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 05/29/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022]
Abstract
AIMS Fundamentals of care are particularly important for older people in acute inpatient settings, who are at increased risk of serious hospital-associated complications like delirium and functional decline. These complications occur due to interactions between clinical complexity and the complex processes and context of hospital care and can be reduced by consistent attention to the fundamentals of care. This paper aims to illustrate of how multi-level nursing leadership of fundamentals of care can be supported to emerge within complex multidisciplinary delivery systems in acute care. DESIGN Discussion paper informed by clinical and organizational experience of a multidisciplinary leadership team and complexity leadership theory. DATA SOURCES We provide a series of vignettes as practical illustrations of a successful multidisciplinary improvement program called Eat Walk Engage which supports the delivery of better care for older inpatients, significantly reducing delirium. We argue that taking a broader complexity-based approach including collaborative multidisciplinary engagement, iterative and integrated interventions and appropriate knowledge translation frameworks can enable emergent leadership by nurses at all levels. IMPLICATIONS FOR NURSING This promising approach to improving care for older patients requires organizational support for facilitation and reflective practice, and for meaningful data to support change. Our discussion challenges nursing leaders to support the time, agency and connections their nursing staff need in order to emerge as local leaders in fundamental care. CONCLUSION The debate around scope and responsibilities for fundamentals of care in hospital care has important practical implications for conceptualizing leadership and accountability for improvement. IMPACT Our discussion illustrates how a structured multidisciplinary approach that acknowledges and navigates complexity can empower nurses to lead and improve outcomes of older patients in acute care.
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Affiliation(s)
- Margaret Cahill
- Eat Walk Engage program, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Sharne Neill
- Eat Walk Engage program, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Medicine Service Line, Redcliffe Hospital, Brisbane, Queensland, Australia
| | - Elise Treleaven
- Eat Walk Engage program, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Department of Nutrition & Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Karen Lee-Steere
- Eat Walk Engage program, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Andy Carter
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Linda McCormack
- Healthcare Improvement Unit, Clinical Excellence Division, Queensland Health, Queensland, Australia
| | - Alison Mudge
- Eat Walk Engage program, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Clinical Medicine, The University of Queensland, Herston, Queensland, Australia
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Bashir AZ, Dinkel DM, Pipinos II, Estabrooks PA, Johanning JM, Myers SA. Long-term use of an ankle-foot orthosis intervention in patients with peripheral artery disease using the integrated promoting action on research implementation in health services (i-PARIHS) framework. Int J Cardiol 2023; 372:23-32. [PMID: 36455699 PMCID: PMC9836764 DOI: 10.1016/j.ijcard.2022.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/05/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Peripheral artery disease (PAD) is a cardiovascular disease that limits patients' walking ability. Persistent ankle-foot orthosis (AFO) use may increase the distance patients can walk as well as physical activity. PURPOSE The purpose of the study was to determine the implementation and patients' perspectives related to the use or disuse of the AFO intervention six months post-intervention. This study was guided by a semi-structured interview and survey based on the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) constructs. DESIGN A convergent mixed methods design was used to evaluate participants' perceptions six months following a three-month AFO intervention. A survey and semi-structured questionnaire based on the i-PARIHS constructs were administered and analyzed. SETTING Vascular surgery clinic and biomechanics research laboratory. PARTICIPANTS Patients (N = 7; male, 100%; age, 71.9 ± 0.6.7y; body mass index, 29.0 ± 0.5.5; ankle brachial index 0.50 ± 0.17) with claudication completed the study. INTERVENTIONS A certified orthotist fit participants with an AFO that was worn for 3 months. MAIN OUTCOME MEASURES Qualitative analysis of semi-structured interviews and quantitative analysis of the survey. RESULTS The highest positive ratings were seen in the dimensions of usability and cost-effectiveness. The patients found the AFO device and instructions to wear, easy when starting the intervention and there were no out-of-pocket costs. The lower scores and challenges faced with observability and relative advantage domains indicated issues related to motivation for sustained use of the AFO. CONCLUSIONS Barriers associated with AFO function that prevent common activities and poor health seem to be the biggest issue for not wanting to wear the AFO after the 3-month intervention. Addressing patients' perceptions and challenges to wearing the AFO is essential to increasing compliance and physical activity. Future research should concentrate on understanding the compatibility of orthotic device interventions with the subject's lifestyle. CLINICAL TRIAL REGISTRATION NO NCT02902211.
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Affiliation(s)
- Ayisha Z Bashir
- Department of Biomechanics, College of Education, Biomechanics Research Building 6160 University Drive South Omaha, University of Nebraska at Omaha, Omaha, NE, USA.
| | - Danae M Dinkel
- Department of Health and Kinesiology, the University of Nebraska at Omaha, Omaha, NE, USA
| | - Iraklis I Pipinos
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA; Department of Surgery and Research Service, Omaha VA Medical Center, Omaha, NE, USA
| | - Paul A Estabrooks
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, USA
| | - Jason M Johanning
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA; Department of Surgery and Research Service, Omaha VA Medical Center, Omaha, NE, USA
| | - Sara A Myers
- Department of Biomechanics, the University of Nebraska at Omaha, Omaha, NE, USA; Department of Surgery and Research Service, Omaha VA Medical Center, Omaha, NE, USA
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16
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Hunter SC, Kim B, Kitson AL. Mobilising Implementation of i-PARIHS (Mi-PARIHS): development of a facilitation planning tool to accompany the Integrated Promoting Action on Research Implementation in Health Services framework. Implement Sci Commun 2023; 4:2. [PMID: 36624543 PMCID: PMC9830739 DOI: 10.1186/s43058-022-00379-y] [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: 07/14/2022] [Accepted: 11/17/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Facilitation makes the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework a popular framework in the field of implementation science. Facilitation allows for flexible application of the i-PARIHS framework by encouraging the iterative tailoring of implementation strategies to a dynamic context. However, successfully harnessing this flexibility can be challenging to navigate, particularly for novice facilitators. Therefore, to support and promote more widespread use of the i-PARIHS framework, and to make it easier for people who are already using i-PARIHS, we have undertaken the Mi-PARIHS Project-Mobilising Implementation of i-PARIHS, focused on developing a suite of practical and pragmatic i-PARIHS resources. METHODS Through a co-design approach drawing on end-users' experiences, we developed the Mi-PARIHS Facilitation Planning Tool, and this article reports on the final end-user feedback via an online survey. RESULTS A total of 58 participants completed the online survey. The survey focused on participants' previous experiences with i-PARIHS, their feedback on the background information provided with the Mi-PARIHS Tool, and their feedback on the tool itself (e.g. clarity, use, satisfaction, improvements). This feedback resulted in the development of a comprehensive 34-item Mi-PARIHS Facilitation Planning Tool that supports i-PARIHS users in their (1) assessment of the i-PARIHS framework's innovation, context, and recipient constructs; (2) development of a tailored facilitation plan; and (3) repeated use over time to evaluate the effectiveness of facilitation strategies. CONCLUSIONS The Mi-PARIHS Facilitation Planning Tool makes framework-guided implementation more accessible and reliable to a wider range of systems and stakeholders, thereby contributing to more consistent implementation of evidence-based practices and other innovations. It addresses the challenge of systematically assessing core constructs of the i-PARIHS framework to develop tailored facilitation strategies. The Mi-PARIHS Facilitation Planning Tool is freely available for use at the website https://www.flinders.edu.au/caring-futures-institute/Mi-PARIHS-tool .
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Affiliation(s)
- Sarah C. Hunter
- grid.1014.40000 0004 0367 2697Caring Futures Institute, Flinders University, Sturt Road, Bedford Park, South Australia 5042 Australia ,grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, South Australia 5042 Australia
| | - Bo Kim
- grid.410370.10000 0004 4657 1992Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130 USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Alison L. Kitson
- grid.1014.40000 0004 0367 2697Caring Futures Institute, Flinders University, Sturt Road, Bedford Park, South Australia 5042 Australia ,grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, South Australia 5042 Australia
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Lyons PG, Chen V, Sekhar TC, McEvoy CA, Kollef MH, Govindan R, Westervelt P, Vranas KC, Maddox TM, Geng EH, Payne PRO, Politi MC. Clinician Perspectives on Barriers and Enablers to Implementing an Inpatient Oncology Early Warning System: A Mixed-Methods Study. JCO Clin Cancer Inform 2023; 7:e2200104. [PMID: 36706345 DOI: 10.1200/cci.22.00104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To elicit end-user and stakeholder perceptions regarding design and implementation of an inpatient clinical deterioration early warning system (EWS) for oncology patients to better fit routine clinical practices and enhance clinical impact. METHODS In an explanatory-sequential mixed-methods study, we evaluated a stakeholder-informed oncology early warning system (OncEWS) using surveys and semistructured interviews. Stakeholders were physicians, advanced practice providers (APPs), and nurses. For qualitative data, we used grounded theory and thematic content analysis via the constant comparative method to identify determinants of OncEWS implementation. RESULTS Survey respondents generally agreed that an oncology-focused EWS could add value beyond clinical judgment, with nurses endorsing this notion significantly more strongly than other clinicians (nurse: median 5 on a 6-point scale [6 = strongly agree], interquartile range 4-5; doctors/advanced practice providers: 4 [4-5]; P = .005). However, some respondents would not trust an EWS to identify risk accurately (n = 36 [42%] somewhat or very concerned), while others were concerned that institutional culture would not embrace such an EWS (n = 17 [28%]).Interviews highlighted important aspects of the EWS and the local context that might facilitate implementation, including (1) a model tailored to the subtleties of oncology patients, (2) transparent model information, and (3) nursing-centric workflows. Interviewees raised the importance of sepsis as a common and high-risk deterioration syndrome. CONCLUSION Stakeholders prioritized maximizing the degree to which the OncEWS is understandable, informative, actionable, and workflow-complementary, and perceived these factors to be key for translation into clinical benefit.
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Affiliation(s)
- Patrick G Lyons
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St Louis, MO.,Healthcare Innovation Lab, BJC HealthCare, St Louis, MO.,Siteman Cancer Center, St Louis, MO
| | - Vanessa Chen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Tejas C Sekhar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Colleen A McEvoy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Marin H Kollef
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Ramaswamy Govindan
- Siteman Cancer Center, St Louis, MO.,Division of Hematology and Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Peter Westervelt
- Siteman Cancer Center, St Louis, MO.,Division of Hematology and Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Kelly C Vranas
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR.,Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR
| | - Thomas M Maddox
- Healthcare Innovation Lab, BJC HealthCare, St Louis, MO.,Division of Cardiology, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Elvin H Geng
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO.,Center for Dissemination and Implementation in the Institute for Public Health, Washington University School of Medicine, St Louis, MO
| | - Philip R O Payne
- Institute for Informatics, Washington University School of Medicine, St Louis, MO
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO.,Center for Collaborative Care Decisions, Department of Surgery, Washington University School of Medicine, St Louis, MO
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Jaworski BK, Webb Hooper M, Aklin WM, Jean-Francois B, Elwood WN, Belis D, Riley WT, Hunter CM. Advancing digital health Equity: Directions for behavioral and social science research. Transl Behav Med 2022; 13:132-139. [PMID: 36318232 DOI: 10.1093/tbm/ibac088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract
The field of digital health is evolving rapidly and encompasses a wide range of complex and changing technologies used to support individual and population health. The COVID-19 pandemic has augmented digital health expansion and significantly changed how digital health technologies are used. To ensure that these technologies do not create or exacerbate existing health disparities, a multi-pronged and comprehensive research approach is needed. In this commentary, we outline five recommendations for behavioral and social science researchers that are critical to promoting digital health equity. These recommendations include: (i) centering equity in research teams and theoretical approaches, (ii) focusing on issues of digital health literacy and engagement, (iii) using methods that elevate perspectives and needs of underserved populations, (iv) ensuring ethical approaches for collecting and using digital health data, and (v) developing strategies for integrating digital health tools within and across systems and settings. Taken together, these recommendations can help advance the science of digital health equity and justice.
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Affiliation(s)
- Beth K Jaworski
- Office of Behavioral and Social Sciences Research, National Institutes of Health , Bethesda, MD , USA
| | - Monica Webb Hooper
- National Institute on Minority Health and Health Disparities, National Institutes of Health , Bethesda, MD , USA
| | - Will M Aklin
- National Institute on Drug Abuse, National Institutes of Health , Bethesda, MD , USA
| | - Beda Jean-Francois
- National Center for Complementary and Integrative Health, National Institutes of Health , Bethesda, MD , USA
| | - William N Elwood
- Office of Behavioral and Social Sciences Research, National Institutes of Health , Bethesda, MD , USA
| | - Deshirée Belis
- Office of Behavioral and Social Sciences Research, National Institutes of Health , Bethesda, MD , USA
| | - William T Riley
- Office of Behavioral and Social Sciences Research, National Institutes of Health , Bethesda, MD , USA
| | - Christine M Hunter
- Office of Behavioral and Social Sciences Research, National Institutes of Health , Bethesda, MD , USA
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Söling S, Pfaff H, Karbach U, Ansmann L, Köberlein-Neu J, Kellermann-Mühlhoff P, Düvel L, Beckmann T, Hammerschmidt R, Jachmich J, Leicher E, Brandt B, Richard J, Meyer F, Flume M, Müller T, Gerlach FM, Muth C, Gonzalez-Gonzalez AI, Chapidi K, Brünn R, Ihle P, Meyer I, Timmesfeld N, Trampisch HJ, Klaaßen-Mielke R, Basten J, Greiner W, Suhrmann B, Piotrowski A, Beifuß K, Meyer S, Grandt D, Grandt S. How is leadership behavior associated with organization-related variables? Translation and psychometric evaluation of the implementation leadership scale in German primary healthcare. BMC Health Serv Res 2022; 22:1065. [PMID: 35986273 PMCID: PMC9391066 DOI: 10.1186/s12913-022-08434-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Implementation Leadership Scale (ILS) was developed to assess leadership behavior with regard to being proactive, knowledgeable, supportive, or perseverant in implementing evidence-based practices (EBPs). As part of a study on the implementation of a digitally supported polypharmacy management application in primary care, the original ILS was translated and validated for use in the German language. Rationale This study aimed to translate the original ILS into German and evaluate its psychometric properties. Methods The validation sample consisted of 198 primary care physicians in a cluster-randomized controlled trial in which the intervention group implemented a digitally supported clinical decision support system for polypharmacy management. The ILS was assessed using a 12-item scale. The study included a process evaluation with two evaluation waves between 2019 and 2021. The ILS was used within this process evaluation study to assess the leadership support with regard to the implementation of the polypharmacy management. The ILS was translated in a multi-step process, including pre-testing of the instrument and triple, back-and-forth translation of the instrument. We tested the reliability (Cronbach’s alpha) and validity (construct and criterion-related validity) of the scale. Results The four-dimensional structure of the instrument was confirmed (comparative fit index = .97; root mean square error of approximation = .06). Convergent validity was demonstrated by correlations with organizational innovation climate, social capital, and workload, which was consistent with the proposed hypothesis. Criterion-related validity of the ILS was demonstrated by predicting the organizational readiness for change scores using structural equation modeling. The reliability of the scale was good (α = .875). Conclusion The German version of the ILS created in this study is a reliable and valid measure. The original four-dimensional structure of the ILS was confirmed in a primary care setting. Further psychometric testing is needed to establish the validity and reliability of the ILS and to transfer it to other health care settings. It is a useful tool for identifying the areas for implementation leadership development. Further research is needed on how, why, and when distinct types of leadership behaviors have different effects on healthcare organizations in implementation processes.
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Kitson A. How and Why Context Matters: A Personal Reflection Comment on "Stakeholder Perspectives of Attributes and Features of Context Relevant to Knowledge Translation in Health Settings: A Multi-Country Analysis". Int J Health Policy Manag 2022; 11:1590-1591. [PMID: 35490256 PMCID: PMC9808323 DOI: 10.34172/ijhpm.2022.6782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/28/2022] [Indexed: 01/12/2023] Open
Abstract
This commentary acknowledges that the evidence-based practice (EBP) movement did not automatically or initially understand the impact of context on successful implementation (SI). The subsequent work of research teams, such as the PARIHS (Promoting Action on Research in Health Services) team, and the Ottawa team led by Squires, have contributed to the ongoing refinement of the concept. However, still under discussion is whether having a more comprehensive set of contextual attributes will necessarily lead to more implementation success. Just as the strength of the evidence does not automatically lead to implementation success, so having a comprehensive understanding of contextual factors will not necessarily improve implementation uptake.
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Affiliation(s)
- Alison Kitson
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
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21
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Xiao L, Yu Y, Ratcliffe J, Milte R, Meyer C, Chapman M, Chen L, Ullah S, Kitson A, De Andrade AQ, Beattie E, Brodaty H, McKechnie S, Low LF, Nguyen TA, Whitehead C, Brijnath B, Sinclair R, Voss D. Creating 'Partnership in iSupport program' to optimise family carers' impact on dementia care: a randomised controlled trial protocol. BMC Health Serv Res 2022; 22:762. [PMID: 35689281 PMCID: PMC9185883 DOI: 10.1186/s12913-022-08148-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/01/2022] [Indexed: 12/03/2022] Open
Abstract
Background The majority of people with dementia are cared for by their family members. However, family carers are often unprepared for their caring roles, receiving less education and support compared with professional carers. The consequences are their reduced mental and physical health and wellbeing, and that of care recipients. This study protocol introduces the ‘Partnership in iSupport program’ that includes five interventional components: managing transitions, managing dementia progression, psychoeducation, carer support group and feedback on services. This health services research is built on family carer and dementia care service provider partnerships. The aims of the study are to evaluate the effectiveness, cost-effectiveness and family carers’ experiences in the program. Methods A multicentre randomised controlled trial will be conducted with family carers of people living with dementia from two tertiary hospitals and two community aged care providers across three Australian states. The estimated sample size is 185 family carers. They will be randomly assigned to either the intervention group or the usual care group. Outcomes are measurable improvements in quality of life for carers and people with dementia, caregiving self-efficacy, social support, dementia related symptoms, and health service use for carers and their care recipients. Data will be collected at three time points: baseline, 6 months and 12 months post-initiation of the intervention. Discussion This is the first large randomised controlled trial of a complex intervention on health and social care services with carers of people living with dementia in real-world practice across hospital and community aged care settings in three Australian states to ascertain the effectiveness, cost-effectiveness and carers’ experiences of the innovative program. We expect that this study will address gaps in supporting dementia carers in health and social care systems while generating new knowledge of the mechanisms of change in the systems. Findings will strengthen proactive health management for both people living with dementia and their carers by embedding, scaling up and sustaining the ‘Partnership in iSupport program’ in the health and social care systems. Trial registration The Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12622000199718. Registered February 4th, 2022. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08148-2.
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Affiliation(s)
- Lily Xiao
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia.
| | - Ying Yu
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Julie Ratcliffe
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Rachel Milte
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Claudia Meyer
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia.,Bolton Clarke Research Institute, Melbourne, VIC, Australia.,Adjunct Research Fellow; Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Australia.,Honorary Associate, Centre for Health Communication and Participation, La Trobe University, Melbourne, Australia
| | | | - Langduo Chen
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia.,Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Andre Queiroz De Andrade
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Elizabeth Beattie
- Queensland Dementia Training Study Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Sue McKechnie
- Community Services, Resthaven Incorporated, Wayville, South Australia, Australia
| | - Lee-Fay Low
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Tuan Anh Nguyen
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Australia
| | - Craig Whitehead
- Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Bianca Brijnath
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Australia.,School of Allied Health, Curtin University, Bentley, West Australia, Australia
| | - Ronald Sinclair
- Faculty of Sciences, University of Adelaide, Adelaide, Australia
| | - Diana Voss
- Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
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22
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Wallis M, Craswell A, Marsden E, Taylor A. Establishing the Geriatric Emergency Department Intervention in Queensland emergency departments: a qualitative implementation study using the i-PARIHS model. BMC Health Serv Res 2022; 22:692. [PMID: 35606808 PMCID: PMC9128293 DOI: 10.1186/s12913-022-08081-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 05/13/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Frail older adults require specific, targeted care and expedited shared decision making in the emergency department (ED) to prevent poor outcomes and minimise time spent in this chaotic environment. The Geriatric Emergency Department Intervention (GEDI) model was developed to help limit these undesirable consequences. This qualitative study aimed to explore the ways in which two hospital implementation sites implemented the structures and processes of the GEDI model and to examine the ways in which the i-PARIHS (innovation-Promoting Action on Research Implementation in Health Services) framework influenced the implementation. METHODS Using the i-PARIHS approach to implementation, the GEDI model was disseminated into two hospitals using a detailed implementation toolkit, external and internal facilitators and a structured program of support. Following implementation, interviews were conducted with a range of staff involved in the implementation at both sites to explore the implementation process used. Transcribed interviews were analysed for themes and sub-themes. RESULTS There were 31 interviews with clinicians involved in the implementation, conducted across two hospitals, including interviews with the two external facilitators. Major themes identified included: (i) elements of the GEDI model adopted or (ii) adapted by implementation sites and (iii) factors that affected the implementation of the GEDI model. Both sites adopted the model of care and there was general support for the GEDI approach to the management of frail older people in the ED. Both sites adapted the structure of the GEDI team and the expertise of the team members to suit their needs and resources. Elements such as service focus, funding, staff development and service evaluation were initially adopted but adaptation occurred over time. Resourcing and cost shifting issues at the implementation sites and at the site providing the external facilitators negatively impacted the facilitation process. CONCLUSIONS The i-PARIHS framework provided a pragmatic approach to the implementation of the evidenced-based GEDI model. Passionate, driven clinicians ensured that successful implementation occurred despite unanticipated changes in context at both the implementation and host facilitator sites as well as the absence of sustained facilitation support.
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Affiliation(s)
- Marianne Wallis
- Faculty of Health, Southern Cross University, Southern Cross Drive, Bilinga, Queensland Australia
- Sunshine Coast Health Institute, Birtinya, Queensland Australia
| | - Alison Craswell
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sippy Downs, Queensland Australia
| | - Elizabeth Marsden
- Sunshine Coast Health Institute, Birtinya, Queensland Australia
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sippy Downs, Queensland Australia
| | - Andrea Taylor
- Sunshine Coast Health Institute, Birtinya, Queensland Australia
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sippy Downs, Queensland Australia
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23
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Parmar J, Sacrey LA, Anderson S, Charles L, Dobbs B, McGhan G, Shapkin K, Tian P, Triscott J. Facilitators, barriers and considerations for the implementation of healthcare innovation: A qualitative rapid systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:856-868. [PMID: 34558143 DOI: 10.1111/hsc.13578] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 06/13/2023]
Abstract
Family caregiving scholars recommend that health providers receive competency-based education to partner with and support family caregivers to care and to maintain their own health. While it may be relatively easy to develop competency-based education for healthcare providers, ensuring widespread uptake and spread and scale of healthcare education is critical to ensuring consistent person-centered support for all family caregivers (FCGs) throughout the care trajectory. The development of novel healthcare innovations requires implementation strategies for uptake and spread, with implementation involving the use of strategies to integrate a novel innovation into healthcare. Research suggests that there are many factors involved in successful implementation and a synthesis of potential factors is warranted. The purpose of this review is to provide an in-depth examination of facilitators, barriers and considerations for implementation of a novel healthcare innovation that will be used to develop an implementation plan for spread and scale of our competency-based education for health providers to learn about person-centered care for FCGs. A systematic review of published and grey literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA [Moher et al., 2015]) guidelines. The systematic review involved searching four databases for original research articles that described barriers, facilitators and/or other considerations when implementing innovations. Twenty-eight articles were included in the qualitative thematic analyses and described three areas of implementation research: barriers, facilitators and recommendations. There were major and parallel themes that emerged under facilitators and barriers. There were a wide variety of strategies that were identified as recommendations. The findings were synthesised into five considerations for implementation: Research and information sharing, intentional implementation planning, organisational underpinnings, creating the clinical context and facilitative training. This review provides an integrative overview of identified facilitators, barriers and recommendations for implementation that may aid in developing implementation strategies that can be tailored to the local context or innovation being implemented.
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Affiliation(s)
- Jasneet Parmar
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
- Edmonton Zone Home Living, Alberta Health Services, Edmonton, Alberta, Canada
| | - Lori Ann Sacrey
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Sharon Anderson
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Lesley Charles
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Bonnie Dobbs
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Gwen McGhan
- Faculty of Nursing, University of Calgary, Alberta, Canada
| | | | - Peter Tian
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jean Triscott
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
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24
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Lim HC, Austin JA, van der Vegt AH, Rahimi AK, Canfell OJ, Mifsud J, Pole JD, Barras MA, Hodgson T, Shrapnel S, Sullivan CM. Toward a Learning Health Care System: A Systematic Review and Evidence-Based Conceptual Framework for Implementation of Clinical Analytics in a Digital Hospital. Appl Clin Inform 2022; 13:339-354. [PMID: 35388447 PMCID: PMC8986462 DOI: 10.1055/s-0042-1743243] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective
A learning health care system (LHS) uses routinely collected data to continuously monitor and improve health care outcomes. Little is reported on the challenges and methods used to implement the analytics underpinning an LHS. Our aim was to systematically review the literature for reports of real-time clinical analytics implementation in digital hospitals and to use these findings to synthesize a conceptual framework for LHS implementation.
Methods
Embase, PubMed, and Web of Science databases were searched for clinical analytics derived from electronic health records in adult inpatient and emergency department settings between 2015 and 2021. Evidence was coded from the final study selection that related to (1) dashboard implementation challenges, (2) methods to overcome implementation challenges, and (3) dashboard assessment and impact. The evidences obtained, together with evidence extracted from relevant prior reviews, were mapped to an existing digital health transformation model to derive a conceptual framework for LHS analytics implementation.
Results
A total of 238 candidate articles were reviewed and 14 met inclusion criteria. From the selected studies, we extracted 37 implementation challenges and 64 methods employed to overcome such challenges. We identified common approaches for evaluating the implementation of clinical dashboards. Six studies assessed clinical process outcomes and only four studies evaluated patient health outcomes. A conceptual framework for implementing the analytics of an LHS was developed.
Conclusion
Health care organizations face diverse challenges when trying to implement real-time data analytics. These challenges have shifted over the past decade. While prior reviews identified fundamental information problems, such as data size and complexity, our review uncovered more postpilot challenges, such as supporting diverse users, workflows, and user-interface screens. Our review identified practical methods to overcome these challenges which have been incorporated into a conceptual framework. It is hoped this framework will support health care organizations deploying near-real-time clinical dashboards and progress toward an LHS.
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Affiliation(s)
- Han Chang Lim
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Brisbane, Australia.,Department of Health, eHealth Queensland, Queensland Government, Brisbane, Australia
| | - Jodie A Austin
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Brisbane, Australia.,Department of Health, eHealth Queensland, Queensland Government, Brisbane, Australia
| | - Anton H van der Vegt
- Information Engineering Lab, School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Brisbane, Australia
| | - Amir Kamel Rahimi
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Brisbane, Australia.,Digital Health Cooperative Research Centre, Australian Government, Sydney, New South Wales, Australia
| | - Oliver J Canfell
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Brisbane, Australia.,Digital Health Cooperative Research Centre, Australian Government, Sydney, New South Wales, Australia.,UQ Business School, Faculty of Business, Economics and Law, The University of Queensland, St. Lucia, Brisbane, Australia
| | - Jayden Mifsud
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Brisbane, Australia
| | - Jason D Pole
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Brisbane, Australia
| | - Michael A Barras
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, PACE Precinct, Woolloongabba, Brisbane, Australia.,Pharmacy Department, Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia
| | - Tobias Hodgson
- UQ Business School, Faculty of Business, Economics and Law, The University of Queensland, St. Lucia, Brisbane, Australia
| | - Sally Shrapnel
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Brisbane, Australia.,School of Mathematics and Physics, Faculty of Science, The University of Queensland, St Lucia, Brisbane, Australia
| | - Clair M Sullivan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Brisbane, Australia.,Department of Health, Metro North Hospital and Health Service, Queensland Government, Herston QLD, Australia
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25
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Kim B, Miller CJ, Ritchie MJ, Smith JL, Kirchner JE, Stolzmann K, Connolly SL, Drummond KL, Bauer MS. Time–motion analysis of external facilitation for implementing the Collaborative Chronic Care Model in general mental health clinics: Use of an interval-based data collection approach. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221086275. [PMID: 37091094 PMCID: PMC9924237 DOI: 10.1177/26334895221086275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Facilitation is an effective strategy to implement evidence-based practices, often involving external facilitators (EFs) bringing content expertise to implementation sites. Estimating time spent on multifaceted EF activities is complex. Furthermore, collecting continuous time–motion data for facilitation tasks is challenging. However, organizations need this information to allocate implementation resources to sites. Thus, our objectives were to conduct a time–motion analysis of external facilitation, and compare continuous versus noncontinuous approaches to collecting time–motion data. Methods: We analyzed EF time–motion data from six VA mental health clinics implementing the evidence-based Collaborative Chronic Care Model (CCM). We documented EF activities during pre-implementation (4–6 weeks) and implementation (12 months) phases. We collected continuous data during the pre-implementation phase, followed by data collection over a 2-week period (henceforth, “a two-week interval”) at each of three time points (beginning/middle/end) during the implementation phase. As a validity check, we assessed how closely interval data represented continuous data collected throughout implementation for two of the sites. Results: EFs spent 21.8 ± 4.5 h/site during pre-implementation off-site, then 27.5 ± 4.6 h/site site-visiting to initiate implementation. Based on the 2-week interval data, EFs spent 2.5 ± 0.8, 1.4 ± 0.6, and 1.2 ± 0.6 h/week toward the implementation’s beginning, middle, and end, respectively. Prevalent activities were preparation/planning, process monitoring, program adaptation, problem identification, and problem-solving. Across all activities, 73.6% of EF time involved email, phone, or video communication. For the two continuous data sites, computed weekly time averages toward the implementation’s beginning, middle, and end differed from the interval data’s averages by 1.0, 0.1, and 0.2 h, respectively. Activities inconsistently captured in the interval data included irregular assessment, stakeholder engagement, and network development. Conclusions: Time–motion analysis of CCM implementation showed initial higher-intensity EF involvement that tapered. The 2-week interval data collection approach, if accounting for its potential underestimation of irregular activities, may be promising/efficient for implementation studies collecting time–motion data.
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Affiliation(s)
- Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Christopher J. Miller
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mona J. Ritchie
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey L. Smith
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - JoAnn E. Kirchner
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kelly Stolzmann
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | - Samantha L. Connolly
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Karen L. Drummond
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mark S. Bauer
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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26
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Murray J, Hunter SC, Splawinski Z, Conroy T. Lessons Learned from the Preimplementation Phase of an Oral Health Care Project. JDR Clin Trans Res 2022:23800844221083966. [PMID: 35238233 DOI: 10.1177/23800844221083966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
KNOWLEDGE TRANSFER STATEMENT This commentary highlights that effective implementation of best-practice oral health care in acute geriatric units is built on the time and relationship building invested in the preimplementation phase.
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Affiliation(s)
- J Murray
- College of Nursing and Health Sciences and Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - S C Hunter
- College of Nursing and Health Sciences and Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Z Splawinski
- Speech Pathology, Southern Adelaide Local Health Network, Bedford Park, SA, Australia
| | - T Conroy
- College of Nursing and Health Sciences and Caring Futures Institute, Flinders University, Adelaide, SA, Australia
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27
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Lo B, Almilaji K, Jankowicz D, Sequeira L, Strudwick G, Tajirian T. Application of the i-PARIHS framework in the implementation of speech recognition technology as a way of addressing documentation burden within a mental health context. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2022; 2021:803-812. [PMID: 35308937 PMCID: PMC8861762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Documentation burden continues to be a critical issue in the adoption of comprehensive electronic health record systems. This case study demonstrates how the i-PARIHS framework can be applied to support the implementation of interventions in reducing documentation and EHR-related burden in a mental health context. As part of pre-adoption implementation activities for Speech Recognition Technology (SRT), a cross-sectional survey was conducted with physicians, residents, and fellows at an academic mental health hospital to explore their perceptions on SRT. Open-ended responses and follow-up interviews explored challenges and concerns on using SRT in practice. Through an analysis using the i-PARIHS framework, key considerations were mapped across the four components of the framework. This study demonstrates the value of applying well-established implementation frameworks, such as the i-PARIHS framework, in mitigating challenges related to documentation burden. Future studies should explore how implementation frameworks can be systematically embedded in addressing EHR-related burden.
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Affiliation(s)
- Brian Lo
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
| | - Khaled Almilaji
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Damian Jankowicz
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lydia Sequeira
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
| | - Gillian Strudwick
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
| | - Tania Tajirian
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
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28
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Shoobridge J, Schultz T, Harvey G, Kirby N. Using an implementation science approach to build leader facilitation capability in healthcare: a novel approach for enhancing action learning set facilitation. J Health Organ Manag 2021; ahead-of-print. [PMID: 34525300 DOI: 10.1108/jhom-12-2020-0510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The study describes the implementation of a novel strategy, entitled the Action Learning Set Facilitation Model, to develop internal facilitation capability to lead change. The Model incorporated the Novice-Experienced-Expert pathway, a facilitation development approach underpinning the integrated-Promoting Action on Research Implementation in Health Services Implementation Framework, with action learning methodology. DESIGN/METHODOLOGY/APPROACH A mixed-methods descriptive approach reports the results of 22 interviews, 182 Action Learning Sets and 159 post program survey data sets to explore facilitator experiences, strengths and potential application of the Model. FINDINGS At program completion, five novice (of 174) and one experienced (of 27) facilitator transitioned to the next facilitation level. The three groups of facilitators described positive change in confidence and facilitation skill, and experience of action learning sets. Inconsistencies between self-report competence and observed practice amongst novices was reported. Novices had decreasing exposure to the Model due to factors related to ongoing organisational change. Internal facilitators were considered trusted and credible facilitators. RESEARCH LIMITATIONS/IMPLICATIONS There are practical and resource implications in investing in internal facilitation capability, noting proposed and real benefits of similar development programs may be compromised during, or as a consequence of organisational change. Further research describing application of the facilitation model, strategies to enhance multisystemic support for programs and evaluation support are suggested. PRACTICAL IMPLICATIONS The Action Learning Set Facilitation Model offers promise in developing internal facilitation capability supporting change in organisations. Critical success factors include building broad scale internal capability, stable leadership and longitudinal support to embed practice. ORIGINALITY/VALUE This is the first application of the facilitation component of the integrated-Promoting Action on Research Implementation in Health Services implementation framework embedded to action learning sets as an implementation science strategy for leader development supporting organisational change.
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Affiliation(s)
- Jodie Shoobridge
- Faculty of Health and Medical Sciences, Adelaide Nursing School, The University of Adelaide, Adelaide, Australia.,Faculty of Health and Medical Sciences, School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Tim Schultz
- Faculty of Health and Medical Sciences, Flinders University, Adelaide, Australia
| | - Gill Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Neil Kirby
- Faculty of Health and Medical Sciences, School of Psychology, The University of Adelaide, Adelaide, Australia
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29
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Fluctuations in barriers to medication treatment for opioid use disorder prescribing over the course of a one-year external facilitation intervention. Addict Sci Clin Pract 2021; 16:51. [PMID: 34362445 PMCID: PMC8343892 DOI: 10.1186/s13722-021-00259-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background The Veterans Health Administration (VHA) is invested in expanding access to medication treatment for opioid use disorder (MOUD) to save lives. Access varies across VHA facilities and, thus, requires implementation strategies to promote system-wide adoption of MOUD. We conducted a 12-month study employing external facilitation that targeted MOUD treatment among low-adopting VHA facilities. In this study, we sought to evaluate the patterns of perceived barriers over 1 year of external implementation facilitation using the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Methods We randomly selected eight VHA facilities from the bottom quartile of the proportion of Veterans with an OUD diagnosis receiving MOUD (< 21%). The 1-year external implementation intervention included developmental evaluation to tailor the facilitation, an on-site visit, and monthly facilitation calls. Facilitators recorded detailed notes for each call on a structured template. Qualitative data was analyzed by coding and mapping barriers to the constructs in the i-PARIHS framework (Innovation, Recipients, Context). We identified emerging themes within each construct by month. Results Barriers related to the Innovation, such as provider perception of the need for MOUD in their setting, were minimal throughout the 12-month study. Barriers related to Recipients were predominant and fluctuated over time. Recipient barriers were common during the initial months when providers did not have the training and waivers necessary to prescribe MOUD. Once additional providers (Recipients) were trained and waivered to prescribe MOUD, Recipient barriers dropped and then resurfaced as the facilities worked to expand MOUD prescribing to other clinics. Context barriers, such as restrictions on which clinics could prescribe MOUD and fragmented communication across clinics regarding the management of patients receiving MOUD, emerged more prominently in the middle of the study. Conclusions VHA facilities participating in 12-month external facilitation interventions experienced fluctuations in barriers to MOUD prescribing with contextual barriers emerging after a facilitated reduction in recipient- level barriers. Adoption of MOUD prescribing in low-adopting VHA facilities requires continual reassessment, monitoring, and readjustment of implementation strategies over time to meet challenges. Although i-PARIHS was useful in categorizing most barriers, the lack of conceptual clarity was a concern for some constructs. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-021-00259-1.
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30
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Hartmann CW, Engle RL, Pimentel CB, Mills WL, Clark VA, Keleher VC, Nash P, Ott C, Roland T, Sloup S, Frank B, Brady C, Snow AL. Virtual external implementation facilitation: successful methods for remotely engaging groups in quality improvement. Implement Sci Commun 2021; 2:66. [PMID: 34158115 PMCID: PMC8218278 DOI: 10.1186/s43058-021-00168-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 06/07/2021] [Indexed: 11/21/2022] Open
Abstract
Background Relatively little guidance exists on how to use virtual implementation facilitation to successfully implement evidence-based practices and innovations into clinical programs. Yet virtual methods are increasingly common. They have potentially wider reach, emergent public health situations necessitate their use, and restrictions on resources can make them more attractive. We therefore outline a set of principles for virtual external implementation facilitation and a series of recommendations based on extensive experience successfully using virtual external implementation facilitation in a national program. Model and recommendations Success in virtual external implementation facilitation may be achieved by facilitators applying three overarching principles: pilot everything, incorporate a model, and prioritize metacognition. Five practical principles also help: plan in advance, communicate in real time, build relationships, engage participants, and construct a virtual room for participants. We present eight concrete suggestions for enacting the practical principles: (1) assign key facilitation roles to facilitation team members to ensure the program runs smoothly; (2) create small cohorts of participants so they can have meaningful interactions; (3) provide clarity and structure for all participant interactions; (4) structure program content to ensure key points are described, reinforced, and practiced; (5) use visuals to supplement audio content; (6) build activities into the agenda that enable participants to immediately apply knowledge at their own sites, separate from the virtual experience; (7) create backup plans whenever possible; and (8) engage all participants in the program. Summary These principles represent a novel conceptualization of virtual external implementation facilitation, giving structure to a process that has been, to date, inadequately described. The associated actions are demonstrably useful in supporting the principles and offer teams interested in virtual external implementation facilitation concrete methods by which to ensure success. Our examples stem from experiences in healthcare. But the principles can, in theory, be applied to virtual external implementation facilitation regardless of setting, as they and the associated actions are not setting specific. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00168-z.
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Affiliation(s)
- Christine W Hartmann
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA. .,Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, 01854, USA.
| | - Ryann L Engle
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, 02130, USA
| | - Camilla B Pimentel
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA.,New England Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, Bedford, MA, 01730, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, 01605, USA
| | - Whitney L Mills
- Center for Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, RI, 02908, USA.,Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, 02912, USA
| | - Valerie A Clark
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
| | | | - Princess Nash
- Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, 35404, USA
| | - Corilyn Ott
- Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, 35404, USA.,School of Nursing and School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 335294, USA
| | - Therasia Roland
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
| | - Sharon Sloup
- Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, 35404, USA
| | - Barbara Frank
- B&F Consulting, 69 Locust Terrace, Warren, RI, 02885, USA
| | - Cathie Brady
- B&F Consulting, 69 Locust Terrace, Warren, RI, 02885, USA
| | - A Lynn Snow
- Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, 35404, USA.,Alabama Research Institute on Aging and the Department of Psychology, University of Alabama, Tuscaloosa, AL, 35487, USA
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Porter GC, Schwab R, Hill JL, Bartee T, Heelan KA, Michaud TL, Estabrooks PA. Examining the feasibility and characteristics of realistic weight management support for patients: Focus groups with rural, micropolitan, and metropolitan primary care providers. Prev Med Rep 2021; 23:101390. [PMID: 34026468 PMCID: PMC8134728 DOI: 10.1016/j.pmedr.2021.101390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 11/18/2022] Open
Abstract
The purpose of this investigation was to understand perspectives of physicians, nurses, and staff regarding the feasibility of implementing an evidence-based weight management program to support primary care practice. An exploratory aim was to examine differences in responses based on the clinic location. Ten focus groups were conducted with primary care staff from rural, micropolitan, and metropolitan clinics. The Promoting Action on Research in Health Services (PARIHS) framework was used to inform the interview guide. Transcripts were reviewed to identify common themes among PARIHS constructs (evidence, context, and facilitation). Presence of comorbidities (e.g., diabetes, hypertension) were typical prompts for provider-led discussions about patient weight. Metropolitan clinics reported the availability of health coaching, diabetes education, or dietician consultation, but no clinic reported offering a comprehensive weight management program. Participants agreed it is possible to implement a weight management program through primary care, but cited potential facilitation challenges such as costs, clinic resources, and individual patient barriers. More enthusiasm arose for a referral program with patient tracking. Program characteristics such as proven efficacy, individual tailoring, program accessibility, and patient feedback to the providers were desired. Rural focus group participants reported unique barriers (lack of local resources) and facilitators (more flexibility in practice changes) to weight management when compared to metropolitan and micropolitan focus groups. Primary care staff are interested in weight management solutions for their patients and would prefer an evidence-based program to which they could refer patients, receive feedback on patient progress, and sustainably include as part of their regular services.
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Affiliation(s)
- Gwenndolyn C. Porter
- Deaprtment of Health Promotion, College of Public Health, University of Nebraska Medical Center, United States
- Corresponding author.
| | - Robert Schwab
- Deaprtment of Health Promotion, College of Public Health, University of Nebraska Medical Center, United States
| | - Jennie L. Hill
- Deaprtment of Health Promotion, College of Public Health, University of Nebraska Medical Center, United States
| | - Todd Bartee
- Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney, United States
| | - Kate A. Heelan
- Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney, United States
| | - Tzeyu L. Michaud
- Deaprtment of Health Promotion, College of Public Health, University of Nebraska Medical Center, United States
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, United States
| | - Paul A. Estabrooks
- Deaprtment of Health Promotion, College of Public Health, University of Nebraska Medical Center, United States
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Bell JJ, Young AM, Hill JM, Banks MD, Comans TA, Barnes R, Keller HH. Systematised, Interdisciplinary Malnutrition Program for impLementation and Evaluation delivers improved hospital nutrition care processes and patient reported experiences - An implementation study. Nutr Diet 2021; 78:466-475. [PMID: 33817934 DOI: 10.1111/1747-0080.12663] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/29/2021] [Accepted: 02/09/2021] [Indexed: 01/01/2023]
Abstract
AIM Models of hospital malnutrition care reliant on dietitians can be inefficient and of limited effectiveness. This study evaluated whether implementing the Systematised, Interdisciplinary Malnutrition Program for impLementation and Evaluation (SIMPLE) improved hospital nutrition care processes and patientreported experiences compared with traditional practice. METHODS A multi-site (five hospitals) prospective, pre-post study evaluated the facilitated implementation of SIMPLE, a malnutrition care pathway promoting proactive nutrition support delivered from time of malnutrition screening by the interdisciplinary team, without need for prior dietetic assessment. Implementation was tailored to local site needs and resources. Nutrition care processes delivered to inpatients who were malnourished or at-risk of malnutrition were identified across diagnosis, intervention, and monitoring domains using standardised audits from medical records, foodservice systems and patient-reported nutrition experience measures. RESULTS Pre-implementation (n = 365) and post-implementation (n = 397) cohorts were similar for age (74 vs 73 years), gender (47.1% vs 48.6% female), and nutrition risk status (46.6% vs 45.3% at-risk). Post-implementation, at-risk participants were more likely to receive enhanced food and fluids (68.5% vs 83.9%; P < .01), nutrition information (30.9% vs 47.2%; P < .01), mealtime assistance where required (61.4% vs 77.9% P = .04), nutrition monitoring (25.2% vs 46.3%; P < .01) and care planning (17.8% vs 27.7%; P = .01). Patient-reported nutrition experience measures confirmed improved nutrition care. There was no difference in dietetic occasions of service per patient (1.51 vs 1.25; P = .83). CONCLUSIONS Tailored SIMPLE implementation improves nutrition care processes and patient reported nutrition experience measures for at-risk inpatients within existing dietetic resources.
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Affiliation(s)
- Jack J Bell
- Allied Health, The Prince Charles Hospital, Metro North HHS, Brisbane, Queensland, Australia.,School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Adrienne M Young
- Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jan M Hill
- Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Merrilyn D Banks
- Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Tracy A Comans
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Rhiannon Barnes
- Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Heather H Keller
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada.,Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Murphy J, Qureshi O, Endale T, Esponda GM, Pathare S, Eaton J, De Silva M, Ryan G. Barriers and drivers to stakeholder engagement in global mental health projects. Int J Ment Health Syst 2021; 15:30. [PMID: 33812375 PMCID: PMC8019163 DOI: 10.1186/s13033-021-00458-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background Engagement with diverse stakeholders, including policy makers, care providers and service users and communities, is essential for successful implementation of global mental health interventions. Despite being a fundamental factor in the implementation process, evidence about challenges and drivers to stakeholder engagement is limited in the global mental health literature. Methods We conducted semi-structured qualitative interviews with 29 recipients of Grand Challenges Canada Global Mental Health funding to assess barriers and drivers to global mental health implementation across a portfolio of projects. We used framework analysis to identify key themes related to implementation barriers and drivers. This paper reports on barriers and drivers to stakeholder engagement, with results related to capacity development and service delivery reported elsewhere in this journal. Results Barriers and drivers to stakeholder engagement were identified across four themes: (1) Contextual Considerations, (2) Resources, (3) Participation, Uptake and Empowerment, and (4) Stigma. While complex contextual challenges create barriers, mechanisms such as formative research can facilitate a deeper contextual understanding that supports effective implementation planning. Limited financial and human resources and competing priorities can lead to substantial challenges. Investing in and leveraging existing local resources and expertise can help to mitigate these barriers. The challenge of achieving active participation from stakeholders and diverging expectations about the nature of participation were identified as barriers, while providing opportunities for meaningful participation and empowerment acted as drivers. Stigma at the institutional, community and individual level was also identified as a substantial barrier to engagement. Conclusion The findings of this study are relevant to implementers in global mental health. They also have implications for global mental health funding agencies and policy organizations, who can support improved stakeholder engagement by investing in high-quality formative research, supporting capacity building for policy engagement, investing in longer-term funding schemes to support sustainable partnerships and scale-up, thus fostering successful engagement and supporting effective implementation of global mental health innovations.
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Affiliation(s)
- Jill Murphy
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, 2255 Westbrook Mall, Vancouver, BC, V6T 2A1, Canada.
| | - Onaiza Qureshi
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | - Tarik Endale
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Georgina Miguel Esponda
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, 411004, India
| | - Julian Eaton
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | - Mary De Silva
- Wellcome Trust, 215 Euston Road, London, NW1 2BE, UK
| | - Grace Ryan
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
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Tucker S, McNett M, Mazurek Melnyk B, Hanrahan K, Hunter SC, Kim B, Cullen L, Kitson A. Implementation Science: Application of Evidence-Based Practice Models to Improve Healthcare Quality. Worldviews Evid Based Nurs 2021; 18:76-84. [PMID: 33779042 DOI: 10.1111/wvn.12495] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Translating research into practice is complex for clinicians, yet essential for high quality patient care. The field of implementation science evolved to address this gap by developing theoretical approaches to guide adoption and sustained implementation of practice changes. Clinicians commonly lack knowledge, time, and resources of how evidence-based practice (EBP) models can guide implementation, contributing to the knowledge-to-practice gap. AIM This paper aimed to equip clinicians and other healthcare professionals with implementation science knowledge, confidence, and models to facilitate EBP change in their local setting and ultimately improve healthcare quality, safety, and population health outcomes. METHODS The field of implementation science is introduced, followed by application of three select models. Models are applied to a clinical scenario to emphasize contextual factors, process, implementation strategies, and outcome evaluation. Key attributes, strengths, opportunities, and utilities of each model are presented, along with general resources for selecting and using published criteria to best fit clinical needs. Partnerships between implementation scientists and clinicians are highlighted to facilitate the uptake of evidence into practice. LINKING EVIDENCE TO ACTION Knowledge of implementation science can help clinicians adopt high-quality evidence into their practices. Application-oriented approaches can guide clinicians through the EBP processes. Clinicians can partner with researchers in advancing implementation science to continue to accelerate the adoption of evidence and reduce the knowledge-to-action gap.
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Affiliation(s)
- Sharon Tucker
- Implementation Science Core, Helene Fuld Health Trust National Institute for EBP, College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Molly McNett
- Implementation Science, Helene Fuld Health Trust National Institute for EBP, College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Bernadette Mazurek Melnyk
- Implementation Science Core, Helene Fuld Health Trust National Institute for EBP, College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Kirsten Hanrahan
- Department of Nursing Services and Patient Care, University of Iowa Health Care, Iowa City, IA, USA
| | - Sarah C Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Bo Kim
- HSR&D Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Laura Cullen
- Department of Nursing Services and Patient Care, University of Iowa Health Care, Iowa City, IA, USA
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
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Kim B, Wilson SM, Mosher TM, Breland JY. Systematic Decision-Making for Using Technological Strategies to Implement Evidence-Based Interventions: An Illustrated Case Study. Front Psychiatry 2021; 12:640240. [PMID: 34079479 PMCID: PMC8166223 DOI: 10.3389/fpsyt.2021.640240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/14/2021] [Indexed: 12/24/2022] Open
Abstract
Technology can improve implementation strategies' efficiency, simplifying progress tracking and removing distance-related barriers. However, incorporating technology is meaningful only if the resulting strategy is usable and useful. Hence, we must systematically assess technological strategies' usability and usefulness before employing them. Our objective was therefore to adapt the effort-vs-impact assessment (commonly used in systems science and operations planning) to decision-making for technological implementation strategies. The approach includes three components - assessing the effort needed to make a technological implementation strategy usable, assessing its impact (i.e., usefulness regarding performance/efficiency/quality), and deciding whether/how to use it. The approach generates a two-by-two effort-vs-impact chart that categorizes the strategy by effort (little/much) and impact (small/large), which serves as a guide for deciding whether/how to use the strategy. We provide a case study of applying this approach to design a package of technological strategies for implementing a 5 A's tobacco cessation intervention at a Federally Qualified Health Center. The effort-vs-impact chart guides stakeholder-involved decision-making around considered technologies. Specification of less technological alternatives helps tailor each technological strategy within the package (minimizing the effort needed to make the strategy usable while maximizing its usefulness), aligning to organizational priorities and clinical tasks. Our three-component approach enables methodical and documentable assessments of whether/how to use a technological implementation strategy, building on stakeholder-involved perceptions of its usability and usefulness. As technology advances, results of effort-vs-impact assessments will likely also change. Thus, even for a single technological implementation strategy, the three-component approach can be repeatedly applied to guide implementation in dynamic contexts.
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Affiliation(s)
- Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Sarah M Wilson
- Center of Innovation for Accelerating Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, United States.,Duke University School of Medicine, Durham, NC, United States
| | | | - Jessica Y Breland
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, United States
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