Understanding the implementation of evidence-informed policies and practices from a policy perspective: a critical interpretive synthesis

The Role of Nurse Implementation Scientists in Leading Health System Transformation in Atlantic Canada and Beyond: A Discussion Paper

AIM

To discuss and provide examples of how nurse implementation scientists can support health system transformation.

DESIGN

Discussion paper.

METHODS

Using Prince Edward Island's health system strategic plan as a case exemplar, selected key priorities in the strategic plan were mapped with examples and discussion of how nurse implementation scientists can support health system transformation on Prince Edward Island and beyond.

CONCLUSION

Accelerating the development and delivery of evidence-informed services that support health system transformation is needed. Nurse implementation scientists are ideally positioned to lead these efforts. Appropriate resourcing and compensation are essential to fully embrace nurse implementation scientist roles, collaboration, and buy-in from health system leaders.

IMPLICATIONS FOR NURSING

Practical examples of how nurse implementation scientists can lead health system transformation in a rigorous, evidence-informed way are identified.

IMPACT

Literature providing examples of how nurse implementation scientists can make meaningful impacts within health systems, particularly in rural contexts, is limited. Nurse implementation scientists are ideally positioned to collaborate with and lead health system transformation by virtue of their knowledge, skills, qualifications and experience. Implications of this work extend beyond nursing to other health disciplines, health organisations, government leaders, researchers and populations. The discussion and examples provided may be applicable to similar contexts.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

A Mixed-Methods Exploration of the Implementation of Policies That Earmarked Taxes for Behavioral Health

Policy Points Earmarked tax policies for behavioral health are perceived as having positive impacts related to increasing flexible funding, suggesting benefits to expand this financing approach. Implementation challenges related to these earmarked taxes included tax base volatility that impedes long-term service delivery planning and inequities in the distribution of tax revenue. Recommendations for designing or revising earmarked tax policies include developing clear guidelines and support systems to manage the administrative aspects of earmarked tax programs, cocreating reporting and oversight structures with system and service delivery agents, and selecting revenue streams that are relatively stable across years.

CONTEXT

Over 200 cities and counties in the United States have implemented policies earmarking tax revenue for behavioral health services. This mixed-methods study was conducted with the aim of characterizing perceptions of the impacts of these earmarked tax policies, strengths and weaknesses of tax policy designs, and factors that influence decision making about how tax revenue is allocated for services.

METHODS

Study data came from surveys completed by 274 officials involved in behavioral health earmarked tax policy implementation and 37 interviews with officials in a sample of jurisdictions with these taxes-California (n = 16), Washington (n = 12), Colorado (n = 6), and Iowa (n = 3). Interviews primarily explored perceptions of the advantages and drawbacks of the earmarked tax, perceptions of tax policy design, and factors influencing decisions about revenue allocation.

FINDINGS

A total of 83% of respondents strongly agreed that it was better to have the tax than not, 73.2% strongly agreed that the tax increased flexibility to address complex behavioral health needs, and 65.1% strongly agreed that the tax increased the number of people served by evidence-based practices. Only 43.3%, however, strongly agreed that it was easy to satisfy tax-reporting requirements. Interviews revealed that the taxes enabled funding for services and implementation supports, such as training in the delivery of evidence-based practices, and supplemented mainstream funding sources (e.g., Medicaid). However, some interviewees also reported challenges related to volatility of funding, inequities in the distribution of tax revenue, and, in some cases, administratively burdensome tax reporting. Decisions about tax revenue allocation were influenced by goals such as reducing behavioral health care inequities, being responsive to community needs, addressing constraints of mainstream funding sources, and, to a lesser degree, supporting services considered to be evidence based.

CONCLUSIONS

Earmarked taxes are a promising financing strategy to improve access to, and quality of, behavioral health services by supplementing mainstream state and federal financing.

Strategies for implementing music-based interventions for people with dementia in long-term care facilities: A systematic review

OBJECTIVES

Research has found that music-based interventions can decrease behavioral and psychological symptoms of dementia or behaviors that challenge (BPSD/BtC). However, how to effectively implement these interventions is unclear. This study synthesizes available evidence regarding implementation strategies and outcomes of music-based interventions for people with dementia at residential long-term care facilities.

METHODS

Study registered with PROSPERO (registration number: CRD42020194354). We searched the following databases: PsychInfo, PubMed, MEDLINE, CINAHL, and The Cochrane Library. Inclusion criteria included articles targeting music-based interventions conducted for people with dementia, studies conducted in residential long-term care facilities, and articles that reported implementation strategies and outcomes of the intervention.

RESULTS

Of the included eight studies, half were studies of music therapy and the other half were on individualized music. 49 implementation strategies were reported. The most frequently reported category of strategies was planning (34.7%), followed by education (24.5%), quality management (24.5%), restructuring (12.2%), and finance (4.1%). No strategies under the category of attending to the policy context were reported. The most frequently reported implementation outcomes were appropriateness (27.3%), followed by adoption (22.7%), fidelity (22.7%), acceptability (9.1%), sustainability (9.1%), and cost (9.1%). No studies measured feasibility or penetration.

CONCLUSIONS

Although various effective implementation strategies were identified, we were unable to examine the effectiveness of individual implementation strategies due to the designs of the selected studies. Less attention has been paid to strategies that aim at structural changes of intervention delivery systems. Future studies should investigate facilitators and barriers of implementing music-based interventions especially focusing on structural aspects.