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Nayahangan LJ, Konge L, Park C, Dubrowski A, Yudkowsky R. Development of a Rubric to Evaluate Implementation Quality of Simulation-Based Courses: A Consensus Study. Simul Healthc 2023; 18:351-358. [PMID: 36111989 DOI: 10.1097/sih.0000000000000684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Simulation-based education is a recognized way of developing medical competencies, and there is overwhelming scientific evidence to support its efficacy. However, it is still underused, which can often be related to poor implementation process. In addition, best practices for implementation of simulation-based courses based on implementation science are not widely known nor applied. The purpose of this study was to develop a rubric, the Implementation Quality Rubric for Simulation (IQR-SIM), to evaluate the implementation quality of simulation-based courses. METHODS A 3-round, modified Delphi process involving international simulation and implementation experts was initiated to gather and converge opinions regarding criteria for evaluating the implementation quality of simulation-based courses. Candidate items for Round 1 were developed based on the Adapted Implementation Model for Simulation. Items were revised and expanded to include descriptive anchors for evaluation in Round 2. Criterion for inclusion was 70% of respondents selecting an importance rating of 4 or 5/5. Round 3 provided refinement and final approval of items and anchors. RESULTS Thirty-three experts from 9 countries participated. The initial rubric of 32 items was reduced to 18 items after 3 Delphi rounds, resulting in the IQR-SIM: a 3-point rating scale, with nonscored options "Don't know/can't assess" and "Not applicable," and a comments section. CONCLUSIONS The IQR-SIM is an operational tool that can be used to evaluate the implementation quality of simulation-based courses and aid in the implementation process to identify gaps, monitor the process, and promote the achievement of desired implementation and learning outcomes.
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Affiliation(s)
- Leizl Joy Nayahangan
- From the Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, Copenhagen, Denmark (L.J.N., L.K.); Department of Medical Education, College of Medicine, University of Illinois at Chicago, IL (L.J.N., C.P., R.Y.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (L.K.); and maxSIMhealth Laboratory, Faculty of Health Sciences, Ontario Tech Health Sciences, Oshawa, Ontario Canada (A.D.)
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Candon M, Williams N, Zentgraf K, Buttenheim A, Bewtra M, Beidas RS, Stewart RE. Variation in Stakeholder Preferences for Implementing Evidence-Based Practices in Behavioral Health Care. Psychiatr Serv 2022; 73:1270-1273. [PMID: 35319915 PMCID: PMC9500117 DOI: 10.1176/appi.ps.202100453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective The authors examined whether stakeholders in behavioral health care differ in their preferences for strategies that support the implementation of evidence-based practices (EBPs). Methods Using data collected in March and April 2019 in a survey of stakeholders in Philadelphia Medicaid’s behavioral health care system, the authors compared empirical Bayes preference weights for implementation strategies across clinicians, supervisors, agency executives, and payers. Results Preferences for implementation strategies overlapped among the stakeholders (N=357 survey respondents). Financial incentives were consistently ranked as most useful and performance feedback as the least useful for implementing EBPs. However, areas of divergence were identified. For example, payers preferred compensation for EBP delivery, whereas clinicians considered compensation for time spent on preparing for EBPs as equally useful. Conclusions The observed variation in stakeholder preferences for strategies to implement EBPs may shed light on why the ongoing shift from volume to value in behavioral health care has had mixed results.
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Affiliation(s)
- Molly Candon
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | | | - Kelly Zentgraf
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Alison Buttenheim
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Family and Community Health, School of Nursing, University of Pennsylvania
| | - Meenakshi Bewtra
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rinad S. Beidas
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Penn Implementation Science Center (PISCE@LDI), Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Rebecca E. Stewart
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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Implementing Anti-Racism Interventions in Healthcare Settings: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062993. [PMID: 33803942 PMCID: PMC8000324 DOI: 10.3390/ijerph18062993] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 11/21/2022]
Abstract
Racism towards Black, Indigenous and people of colour continues to exist in the healthcare system. This leads to profound harm for people who use and work within these settings. This is a scoping review to identify anti-racism interventions in outpatient healthcare settings. Searching the peer-reviewed and grey literature, articles were screened for inclusion by at least two independent reviewers. Synthesizing the socio-ecological levels of interventions with inductively identifying themes, a conceptual model for implementing anti-racism interventions in healthcare settings is presented. In total, 37 peer-reviewed articles were included in the review, with 12 empirical studies and 25 theoretical or conceptual papers. Six grey literature documents were also included. Healthcare institutions need to incorporate an explicit, shared language of anti-racism. Anti-racism action should incorporate leadership buy-in and commitment with dedicated resources, support and funding; a multi-level approach beginning with policy and organizational interventions; transparent accountability mechanisms for sustainable change; long-term meaningful partnerships with Black, Indigenous, and people of colour (i.e., racialized communities); and ongoing, mandatory, tailored staff education and training. Decision-makers and staff in healthcare settings have a responsibility to take anti-racism action and may improve the success and sustainability of their efforts by incorporating the foundational principles and strategies identified in this paper.
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Hong YD, Goto D, Mullins CD. Querying stakeholders to inform comparative effectiveness research. J Comp Eff Res 2017; 6:10.2217/cer-2016-0082. [PMID: 28485177 PMCID: PMC5680160 DOI: 10.2217/cer-2016-0082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Despite the growing recognition of the value of stakeholder engagement in research, there is limited guidance on effectively eliciting stakeholder views during the comparative effectiveness research (CER) process. This article outlines the potential role of each stakeholder (patient, provider, policymaker and payer) throughout the CER process and provides examples of practical questions that researchers can ask the four primary stakeholder groups at each step of the CER process. This guide aims to assist in the development of meaningful stakeholder-researcher shared decision-making to incorporate stakeholder views in the design, conduct and dissemination of patient-centered CER.
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Affiliation(s)
- Yoon Duk Hong
- Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Daisuke Goto
- Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - C. Daniel Mullins
- Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, Baltimore, MD, USA
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Solomon MZ, Gusmano MK, Maschke KJ. The Ethical Imperative And Moral Challenges Of Engaging Patients And The Public With Evidence. Health Aff (Millwood) 2016; 35:583-9. [DOI: 10.1377/hlthaff.2015.1392] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Mildred Z. Solomon
- Mildred Z. Solomon is president of the Hastings Center, in Garrison, New York, and a professor of medical ethics in the Department of Anaesthesia and the Center for Bioethics at Harvard Medical School, in Boston, Massachusetts
| | - Michael K. Gusmano
- Michael K. Gusmano is a research scholar at the Hastings Center and an associate professor of health policy at Rutgers University, in New Brunswick, New Jersey
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Carney PA, Crites GE, Miller KH, Haight M, Stefanidis D, Cichoskikelly E, Price DW, Akinola MO, Scott VC, Kalishman S. Building and executing a research agenda toward conducting implementation science in medical education. MEDICAL EDUCATION ONLINE 2016; 21:32405. [PMID: 27565131 PMCID: PMC5002033 DOI: 10.3402/meo.v21.32405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/25/2016] [Accepted: 07/25/2016] [Indexed: 05/05/2023]
Abstract
BACKGROUND Implementation science (IS) is the study of methods that successfully integrate best evidence into practice. Although typically applied in healthcare settings to improve patient care and subsequent outcomes, IS also has immediate and practical applications to medical education toward improving physician training and educational outcomes. The objective of this article is to illustrate how to build a research agenda that focuses on applying IS principles in medical education. APPROACH We examined the literature to construct a rationale for using IS to improve medical education. We then used a generalizable scenario to step through a process for applying IS to improve team-based care. PERSPECTIVES IS provides a valuable approach to medical educators and researchers for making improvements in medical education and overcoming institution-based challenges. It encourages medical educators to systematically build upon the research outcomes of others to guide decision-making while evaluating the successes of best practices in individual environments and generate additional research questions and findings. CONCLUSIONS IS can act as both a driver and a model for educational research to ensure that best educational practices are easier and faster to implement widely.
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Affiliation(s)
- Patricia A Carney
- Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, OR, USA
- Department of Public Health & Preventive Medicine, Oregon Health & Science University School of Medicine, Portland, OR, USA;
| | - Gerald E Crites
- Department of Medicine, Augusta University/University of Georgia Medical Partnership, Athens, GA, USA
| | - Karen H Miller
- School of Medicine, University of Louisville, Louisville, KY, USA
| | - Michelle Haight
- Department of Pediatrics, Oregon Health & Science University School of Medicine, Portland, OR, USA
| | | | - Eileen Cichoskikelly
- Department of Family Medicine, College of Medicine, University of Vermont, Burlington, VT, USA
| | - David W Price
- American Board of Medical Specialties Research and Education Foundation, Chicago, IL, USA
- Department of Family Medicine, University of Colorado School of Medicine, Denver, CO, USA
| | - Modupeola O Akinola
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Victoria C Scott
- Department of Psychology, University of North Carolina, Charlotte, NC, USA
| | - Summers Kalishman
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA
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McGaghie WC, Barsuk JH, Cohen ER, Kristopaitis T, Wayne DB. Dissemination of an innovative mastery learning curriculum grounded in implementation science principles: a case study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:1487-1494. [PMID: 26352761 DOI: 10.1097/acm.0000000000000907] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Dissemination of a medical education innovation, such as mastery learning, from a setting where it has been used successfully to a new and different medical education environment is not easy. This article describes the uneven yet successful dissemination of a simulation-based mastery learning (SBML) curriculum on central venous catheter (CVC) insertion for internal medicine and emergency medicine residents across medical education settings. The dissemination program was grounded in implementation science principles. The article begins by describing implementation science which addresses the mechanisms of medical education and health care delivery. The authors then present a mastery learning case study in two phases: (1) the development, implementation, and evaluation of the SBML CVC curriculum at a tertiary care academic medical center; and (2) the dissemination of the SBML CVC curriculum to an academic community hospital setting. Contextual information about the drivers and barriers that affected the SBML CVC curriculum dissemination is presented. This work demonstrates that dissemination of mastery learning curricula, like all other medical education innovations, will fail without active educational leadership, personal contacts, dedication, hard work, rigorous measurement, and attention to implementation science principles. The article concludes by presenting a set of lessons learned about disseminating an SBML CVC curriculum across different medical education settings.
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Affiliation(s)
- William C McGaghie
- W.C. McGaghie is professor of medical education, Northwestern University Feinberg School of Medicine, Chicago, Illinois. J.H. Barsuk is associate professor of medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. E.R. Cohen is a research associate, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. T. Kristopaitis is associate professor of medicine and pathology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois. D.B. Wayne is vice dean of education and Dr. John Sherman Appleman Professor of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Tchetchik A, Grinstein A, Manes E, Shapira D, Durst R. From Research to Practice: Which Research Strategy Contributes More to Clinical Excellence? Comparing High-Volume versus High-Quality Biomedical Research. PLoS One 2015; 10:e0129259. [PMID: 26107296 PMCID: PMC4480880 DOI: 10.1371/journal.pone.0129259] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 05/06/2015] [Indexed: 11/18/2022] Open
Abstract
The question when and to what extent academic research can benefit society is of great interest to policy-makers and the academic community. Physicians in university hospitals represent a highly relevant test-group for studying the link between research and practice because they engage in biomedical academic research while also providing medical care of measurable quality. Physicians' research contribution to medical practice can be driven by either high-volume or high-quality research productivity, as often pursuing one productivity strategy excludes the other. To empirically examine the differential contribution to medical practice of the two strategies, we collected secondary data on departments across three specializations (Cardiology, Oncology and Orthopedics) in 50 U.S.-based university hospitals served by 4,330 physicians. Data on volume and quality of biomedical research at each department was correlated with publicly available ratings of departments' quality of care, demonstrating that high-quality research has significantly greater contribution to quality of care than high-volume research.
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Affiliation(s)
- Anat Tchetchik
- Department of Business and Management, Guilford Glazer Faculty of Management, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Amir Grinstein
- Department of Business and Management, Guilford Glazer Faculty of Management, Ben Gurion University of the Negev, Beer Sheva, Israel
- Faculty of Economics and Business Administration, VU University Amsterdam, Amsterdam, The Netherlands
- D’Amore-McKim School of Business, Northeastern University, Boston, Massachusetts, United States of America
| | - Eran Manes
- Department of Business and Management, Guilford Glazer Faculty of Management, Ben Gurion University of the Negev, Beer Sheva, Israel
- The School of Industrial Management, Jerusalem College of Technology, Jerusalem, Israel
| | - Daniel Shapira
- Department of Business and Management, Guilford Glazer Faculty of Management, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Ronen Durst
- Cardiology Division, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Glasgow RE, Rabin BA. Implementation science and comparative effectiveness research: a partnership capable of improving population health. J Comp Eff Res 2015; 3:237-40. [PMID: 24969150 DOI: 10.2217/cer.14.9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Russell E Glasgow
- Department of Family Medicine & Colorado Health Outcomes Program, School of Medicine, University of Colorado Denver, 13199 E Montview Boulevard, Suite 300, MS F443, Room 323, Aurora, CO 80045, USA
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Spallek H, Johnson L, Kerr J, Rankin D. Costs of Health IT: Beginning to Understand the Financial Impact of a Dental School EHR. J Dent Educ 2014. [DOI: 10.1002/j.0022-0337.2014.78.11.tb05830.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Heiko Spallek
- Dental Public Health; Center for Informatics in Oral Health Translational Research and Associate Dean; Office of Faculty Affairs; School of Dental Medicine; University of Pittsburgh
| | - Lynn Johnson
- School of Dentistry; Associate Dean for Faculty Affairs and Institutional Effectiveness; Clinical Professor; School of Information; University of Michigan
| | - Joseph Kerr
- School of Dental Medicine; University at Buffalo
| | - David Rankin
- Office of Computing and Information Systems; School of Dentistry; University of North Carolina at Chapel Hill
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Lenert L, Dunlea R, Del Fiol G, Hall LK. A model to support shared decision making in electronic health records systems. Med Decis Making 2014; 34:987-95. [PMID: 25224366 DOI: 10.1177/0272989x14550102] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Shared decision making (SDM) is an approach to medical care based on collaboration between provider and patient, with both sharing in medical decisions. When patients' values and preferences are incorporated in decision making, care is more appropriate, ethically sound, and often lower in cost. However, SDM is difficult to implement in routine practice because of the time required for SDM methods, the lack of integration of SDM approaches into electronic health record (EHR) systems, and absence of explanatory mechanisms for providers on the results of patients' use of decision aids. This article discusses potential solutions, including the concept of a "personalize button" for EHRs. Leveraging a 4-phase clinical model for SDM, this article describes how computer decision support (CDS) technologies integrated into EHRs can help ensure that health care is delivered in a way that is respectful of those preferences. The architecture described herein, called CDS for SDM, is built on recognized standards that are currently integrated into certification requirements for EHRs as part of meaningful use regulations. While additional work is needed on modeling of preferences and on techniques for rapid communication models of preferences to clinicians, unless EHRs are redesigned to support SDM around and during clinical encounters, they are likely to continue to be an unintended barrier to SDM. With appropriate development, EHRs could be a powerful tool to promote SDM by reminding providers of situations for SDM and monitoring ongoing care to ensure treatments are consistent with patients' preferences.
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Affiliation(s)
- Leslie Lenert
- Department of Internal Medicine, Medical University of South Carolina, Charleston (LL)
| | - Robert Dunlea
- Department of Biomedical Informatics, University of Utah, School of Medicine, Salt Lake City (RD, GDF)
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, School of Medicine, Salt Lake City (RD, GDF)
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King ML, Aden A, Tapa S, Jumah R, Khan S. Evidence-based stillbirth prevention strategies: combining empirical and theoretical paradigms to inform health planning and decision-making. Worldviews Evid Based Nurs 2014; 11:258-65. [PMID: 25040460 DOI: 10.1111/wvn.12048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A global health project undertaken in Qatar on the Arabian Peninsula immersed undergraduate nursing students in hands-on learning to address the question: What strategies are effective in preventing stillbirth? Worldwide stillbirth estimates of 2.6 million per year and the high rate in the Eastern Mediterranean Region of 27 per 1,000 total live births provided the stimulus for this inquiry. METHODS We used a dual empirical and theoretical approach that combined the principles of evidence-based practice and population health planning. Students were assisted to translate pre-appraised literature based on the 6S hierarchical pyramid of evidence. The PRECEDE-PROCEED (P-P) model served as an organizing template to assemble data extracted from the appraisal of 21 systematic literature reviews ± meta-analyses, 2 synopses of synthesized reports, and 9 individual studies summarizing stillbirth prevention strategies in low, middle, and high income countries. Consistent with elements of the P-P model, stillbirth prevention strategies were classified as social, epidemiological, educational, ecological, administrative, or policy. RESULTS Ten recommendations with clear evidence of effectiveness in preventing stillbirth in low, middle, or high income countries were identified. Several other promising interventions were identified with weak, uncertain, or inconclusive evidence. These require further rigorous testing. LINKING EVIDENCE TO ACTION Two complementary paradigms--evidence-based practice and an ecological population health program planning model--helped baccalaureate nursing students transfer research evidence into useable knowledge for practice. They learned the importance of comprehensive assessments and evidence-informed interventions. The multidimensional elements of the P-P model sensitized students to the complex interrelated factors influencing stillbirth and its prevention.
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Affiliation(s)
- Mary Lou King
- Assistant Professor, University of Calgary-Qatar, Doha, Qatar
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Morrato EH, Concannon TW, Meissner P, Shah ND, Turner BJ. Dissemination and implementation of comparative effectiveness evidence: key informant interviews with Clinical and Translational Science Award institutions. J Comp Eff Res 2014; 2:185-94. [PMID: 24236560 DOI: 10.2217/cer.13.10] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To identify ongoing practices and opportunities for improving national comparative effectiveness research (CER) translation through dissemination and implementation (D&I) via NIH-funded Clinical and Translational Science Award (CTSA) institutions. MATERIALS & METHODS Key informant interviews were conducted with 18 CTSA grantees sampled to represent a range of D&I efforts. RESULTS & CONCLUSIONS The institutional representatives endorsed fostering CER translation nationally via the CTSA Consortium. However, five themes emerged from the interviews as barriers to CER D&I: lack of institutional awareness, insufficient capacity, lack of established D&I methods, confusion among stakeholders about what CER actually is and limited funding opportunities. Interviewees offered two key recommendations to improve CER translation: development of a centralized clearing house to facilitate the diffusion of CER D&I resources and methods across CTSA institutions; and formalization of the national CTSA network to leverage existing community engagement relationships and resources for the purpose of adapting and disseminating robust CER evidence locally with providers, patients and healthcare systems.
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Affiliation(s)
- Elaine H Morrato
- Health Systems, Management & Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, CO, USA.
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Day H, Eckstrom E, Lee S, Wald H, Counsell S, Rich E. Optimizing health for complex adults in primary care: current challenges and a way forward. J Gen Intern Med 2014; 29:911-4. [PMID: 24557512 PMCID: PMC4026488 DOI: 10.1007/s11606-013-2749-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
As the population ages, the quantity and complexity of comorbidities only increases in the primary care setting. Health systems strive to improve quality of care and enhance cost savings, but current administrative and payment systems do not easily support the implementation of existing evidence and best practices for multimorbid adults in most primary care offices. This perspectives piece sets forth a research agenda in the area of implementation science at the intersection of geriatrics and general internal medicine. We challenge academic medical centers, medical societies, journals, and funders to actively value and support investigation in this area as much as traditional research pathways.
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Affiliation(s)
- Hollis Day
- Division of General Internal Medicine, University of Pittsburgh Medical Center, 3550 Terrace Street, M211 Scaife Hall, Pittsburgh, PA, 15261, USA,
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McGaghie WC, Issenberg SB, Barsuk JH, Wayne DB. A critical review of simulation-based mastery learning with translational outcomes. MEDICAL EDUCATION 2014; 48:375-85. [PMID: 24606621 DOI: 10.1111/medu.12391] [Citation(s) in RCA: 341] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 07/02/2013] [Accepted: 09/30/2013] [Indexed: 05/07/2023]
Abstract
OBJECTIVES This article has two objectives. Firstly, we critically review simulation-based mastery learning (SBML) research in medical education, evaluate its implementation and immediate results, and document measured downstream translational outcomes in terms of improved patient care practices, better patient outcomes and collateral effects. Secondly, we briefly address implementation science and its importance in the dissemination of innovations in medical education and health care. METHODS This is a qualitative synthesis of SBML with translational (T) science research reports spanning a period of 7 years (2006-2013). We use the 'critical review' approach proposed by Norman and Eva to synthesise findings from 23 medical education studies that employ the mastery learning model and measure downstream translational outcomes. RESULTS Research in SBML in medical education has addressed a range of interpersonal and technical skills. Measured outcomes have been achieved in educational laboratories (T1), and as improved patient care practices (T2), patient outcomes (T3) and collateral effects (T4). CONCLUSIONS Simulation-based mastery learning in medical education can produce downstream results. Such results derive from integrated education and health services research programmes that are thematic, sustained and cumulative. The new discipline of implementation science holds promise to explain why medical education innovations are adopted slowly and how to accelerate innovation dissemination.
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Affiliation(s)
- William C McGaghie
- Ralph P Leischner Jr, MD Institute for Medical Education, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois, USA
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Williams MV. Where's the beef? Progress on reducing readmissions. J Hosp Med 2014; 9:266-8. [PMID: 24523005 DOI: 10.1002/jhm.2165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 01/14/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Mark V Williams
- Center for Health Services Research, University of Kentucky, Lexington, Kentucky
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Kauffman KS, dosReis S, Ross M, Barnet B, Onukwugha E, Mullins CD. Engaging hard-to-reach patients in patient-centered outcomes research. J Comp Eff Res 2013; 2:313-24. [DOI: 10.2217/cer.13.11] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: This study aimed to identify methods to engage hard-to-reach patients in the research process. Materials & methods: With funding from the Patient-Centered Outcomes Research Institute (Washington, DC, USA), the University of Maryland (MD, USA) conducted 20 focus groups and one individual interview. The sample consisted of six groups of hard-to-reach patients, two groups of healthcare providers who work with hard-to-reach patients and two groups of surrogates of hard-to-reach patients. Results & conclusion: In order to make patient-centered outcomes research more meaningful to patients and their caregivers, patient-centered outcomes research should be conducted with a focus on building and maintaining trust, which is achieved via pre-engagement with communities and continuous engagement of study participants and their communities.
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Affiliation(s)
- Karen S Kauffman
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, USA
| | - Susan dosReis
- University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD 21201, USA
| | - Melissa Ross
- University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD 21201, USA
| | - Beth Barnet
- University of Maryland School of Medicine, 29 South Paca Street, Baltimore, MD 21201, USA
| | - Eberechukwu Onukwugha
- University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD 21201, USA
| | - C Daniel Mullins
- University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD 21201, USA.
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Lara M, Ramos-Valencia G, González-Gavillán JA, López-Malpica F, Morales-Reyes B, Marín H, Rodríguez-Sánchez MH, Mitchell H. Reducing quality-of-care disparities in childhood asthma: La Red de Asma Infantil intervention in San Juan, Puerto Rico. Pediatrics 2013; 131 Suppl 1:S26-37. [PMID: 23457147 DOI: 10.1542/peds.2012-1427d] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Although children living in Puerto Rico have the highest asthma prevalence of all US children, little is known regarding the quality-of-care disparities they experience nor the adaptability of existing asthma evidence-based interventions to reduce these disparities. The objective of this study was to describe our experience in reducing quality-of-care disparities among Puerto Rican children with asthma by adapting 2 existing evidence-based asthma interventions. METHODS We describe our experience in adapting and implementing 2 previously tested asthma evidence-based interventions: the Yes We Can program and the Inner-City Asthma Study intervention. We assessed the feasibility of combining key components of the 2 interventions to reduce asthma symptoms and estimated the potential cost savings associated with reductions in asthma-related hospitalizations and emergency department visits. A total of 117 children with moderate and severe asthma participated in the 12-month intervention in 2 housing projects in San Juan, Puerto Rico. A community-academic team with the necessary technical and cultural competences adapted and implemented the intervention. RESULTS Our case study revealed the feasibility of implementing the combined intervention, henceforth referred to as La Red intervention, in the selected Puerto Rican communities experiencing a disproportionately high level of asthma burden. After 1-year follow-up, La Red intervention significantly reduced asthma symptoms and exceeded reductions of the original interventions. Asthma-related hospitalizations and emergency department use, and their associated high costs, were also significantly reduced. CONCLUSIONS Asthma evidence-based interventions can be adapted to improve quality of care for children with asthma in a different cultural community setting.
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Affiliation(s)
- Marielena Lara
- RAND Corporation, 1776 Main St, PO Box 2138, Santa Monica, CA 90407-2138, USA.
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McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Translational educational research: a necessity for effective health-care improvement. Chest 2013; 142:1097-1103. [PMID: 23138127 DOI: 10.1378/chest.12-0148] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Medical education research contributes to translational science (TS) when its outcomes not only impact educational settings, but also downstream results, including better patient-care practices and improved patient outcomes. Simulation-based medical education (SBME) has demonstrated its role in achieving such distal results. Effective TS also encompasses implementation science, the science of health-care delivery. Educational, clinical, quality, and safety goals can only be achieved by thematic, sustained, and cumulative research programs, not isolated studies. Components of an SBME TS research program include motivated learners, curriculum grounded in evidence-based learning theory, educational resources, evaluation of downstream results, a productive research team, rigorous research methods, research resources, and health-care system acceptance and implementation. National research priorities are served from translational educational research. National funding priorities should endorse the contribution and value of translational education research.
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Affiliation(s)
- William C McGaghie
- Center for Education in Medicine and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - S Barry Issenberg
- Michael S. Gordon Center for Research in Medical Education and Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Elaine R Cohen
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jeffrey H Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Diane B Wayne
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Hastings-Tolsma M, Matthews EE, Nelson JM, Schmiege S. Comparative effectiveness research: nursing science and health care delivery. West J Nurs Res 2013; 35:683-702. [PMID: 23363698 DOI: 10.1177/0193945912474501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Comparative effectiveness research (CER) is an important foundation in the development of scientific evidence that can assist patients, clinicians, and policy makers in making decisions that improve patient and system outcomes, including cost. CER is a part of what is now called dissemination and implementation science, which focuses on translating knowledge into practice by facilitating stakeholder access to more interpretable findings. CER has evolved from a rich history that aims to compare the effectiveness of select clinical treatments, approaches, or programs. This article describes the development of CER, approaches to designing and analyzing this research, and resources useful in generating such knowledge by nurse scientists.
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Affiliation(s)
- Marie Hastings-Tolsma
- University of Colorado College of Nursing, Division of Women, Children & Family Health, Denver, CO, USA.
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Wilson D, Redman RW, Talsma A, Aebersold M. Differences in Perceptions of Patient Safety Culture between Charge and Noncharge Nurses: Implications for Effectiveness Outcomes Research. Nurs Res Pract 2012; 2012:847626. [PMID: 22548163 PMCID: PMC3324150 DOI: 10.1155/2012/847626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 01/15/2012] [Accepted: 01/15/2012] [Indexed: 11/29/2022] Open
Abstract
The implementation of evidence-based practice guidelines can be influenced by nurses' perceptions of the organizational safety culture. Shift-by-shift management of each nursing unit is designated to a subset of staff nurses (charge nurses), whom are often recruited as champions for change. The findings indicate that compared to charge nurses, noncharge nurses were more positive about overall perceptions of safety (P = .05) and teamwork (P < .05). Among charge nurses, significant differences were observed based on the number of years' experience in charge: perception of teamwork within units [F(3, 365) = 3.52, P < .01]; overall perceptions of safety, [F(3, 365) = 4.20, P < .05]; safety grade for work area [F(3, 360) = 2.61, P < .05]; number of events reported within the last month [F(3, 362) = 3.49, P < .05]. These findings provide important insights to organizational contextual factors that may impact effectiveness outcomes research in the future.
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Affiliation(s)
- Deleise Wilson
- University of Michigan School of Nursing, Ann Arbor, 48109 MI, USA
| | | | - AkkeNeel Talsma
- University of Michigan School of Nursing, Ann Arbor, 48109 MI, USA
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Holloway RG, Ringel SP. Getting to value in neurological care: a roadmap for academic neurology. Ann Neurol 2011; 69:909-18. [PMID: 21681794 DOI: 10.1002/ana.22439] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Academic neurology is undergoing transformational changes. The public investment in biomedical research and clinical care is enormous and there is a growing perception that the return on this huge investment is insufficient. Hospitals, departments, and individual neurologists should expect more scrutiny as information about their quality of care and financial relationships with industry are increasingly reported to the public. There are unprecedented changes occurring in the financing and delivery of health care and research that will have profound impact on the mission and operation of academic departments of neurology. With the passage of the Patient Protection and Affordable Care Act (PPACA) there will be increasing emphasis on research that demonstrates value and includes the patient's perspective. Here we review neurological investigations of our clinical and research enterprises that focus on quality of care and comparative effectiveness, including cost-effectiveness. By highlighting progress made and the challenges that lie ahead, we hope to create a clinical, educational, and research roadmap for academic departments of neurology to thrive in today's increasingly regulated environment.
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Affiliation(s)
- Robert G Holloway
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.
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Rich EC, Bonham AC, Kirch DG. The implications of comparative effectiveness research for academic medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:684-688. [PMID: 21512362 DOI: 10.1097/acm.0b013e318217e941] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
With growing constraints on government spending, policy makers are investing in comparative effectiveness research (CER) to attempt to bring the power of science to bear on the problems of suboptimal outcomes and high cost in the U.S. health care system. This commitment of resources to CER reflects confidence that better evidence can help clinicians and patients make better decisions, consistent with the long tradition of medical schools' and teaching hospitals' use of science to inform medical care. Thus, CER offers a great opportunity, albeit with some considerable challenges, for academic medicine to play a central role in comprehensive health care reform. Certainly, many scientists conducting CER will learn their methodological rigor in the training programs of academic health centers. Numerous new CER research teams will be needed, establishing effective partnerships far outside the walls of the traditional academic setting. And the clinicians interpreting the medical literature and applying the insights from CER to the unique problems of individual patients will need to learn this evidence-based, patient-centered care from the educators, mentors, and role models at U.S. medical and other health science schools and teaching hospitals. Achieving this will require investment in research infrastructure, adaptations of institutional culture, development of new disciplines and research methods, establishment of new collaborations, training of new faculty, and the expansion and refocusing of educational capacity. By successfully responding to this challenge, academic medicine can further strengthen its long-standing commitment to the scientific practice of medicine and the use of evidence in patient-centered, personalized care.
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Affiliation(s)
- Eugene C Rich
- Center on Health Care Effectiveness, Mathematica Policy Research, 600 Maryland Ave. SW, Washington, DC 20024, USA
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Haines SL, DeHart RM, Flynn AA, Hess KM, Marciniak MW, Mount J, Phillips BB, Saseen JJ, Whitney Zatzkin S. Academic pharmacy and patient-centered health care: A model to prepare the next generation of pharmacists. J Am Pharm Assoc (2003) 2011; 51:194-202. [DOI: 10.1331/japha.2011.10158] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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McGaghie WC. Implementation science: Addressing complexity in medical education. MEDICAL TEACHER 2011; 33:97-98. [PMID: 21275541 DOI: 10.3109/0142159x.2011.550971] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- William C McGaghie
- Center for Education in Medicine, Feinberg School of Medicine, Northwestern University, 1-003 Ward Building, 303 East Chicago Avenue, Chicago, IL 60611-3008, USA.
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