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Silverstein WK, Kerssens M, Vaassen S, Valencia V, van Mook WNKA, Noben CYG, Moriates C, Wong BM, Born KB. How Medical Students Benefit from Participating in a Longitudinal Resource Stewardship Medical Education Program (STARS): An International Descriptive Evaluation. J Gen Intern Med 2024:10.1007/s11606-024-08971-9. [PMID: 39085581 DOI: 10.1007/s11606-024-08971-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND STARS (Students and Trainees Advocating for Resource Stewardship) is a medical student leadership program that promotes integration of resource stewardship (RS) into medical education in at least seven countries. Little is known about how participation affects student leaders. AIM To understand how partaking in STARS impacted participants' knowledge, skills, and influenced career plans, and aspirations. SETTING AND PARTICIPANTS We conducted qualitative semi-structured interviews with STARS participants (n = 27) from seven countries. PROGRAM DESCRIPTION STARS was designed to facilitate grassroots efforts that embed RS principles into medical education. STARS programs globally share common features: participation from several medical schools, centralized organizing hubs and leadership summits, and support from faculty mentors. Students take lessons learnt from centralized programming to implement changes that advance RS initiatives at their schools. PROGRAM EVALUATION Students finished STARS with better RS knowledge, enhanced change management skills (leadership, advocacy, collaboration), and a commitment to incorporate RS into future practice. Nearly all respondents hoped to pursue leadership activities in medicine, but most were unclear if they would focus efforts to advance RS. DISCUSSION STARS participants gained knowledge as it relates to RS, change management skills, and catalyzed a commitment to incorporate high-value care into future practice. Medical education initiatives should be leveraged as a key strategic approach to build RS capacity.
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Affiliation(s)
- William K Silverstein
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
- Choosing Wisely Canada, Toronto, ON, Canada.
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - Marlou Kerssens
- Choosing Wisely Canada, Toronto, ON, Canada
- TwynstraGudde, Amersfoort, Netherlands
| | - Sanne Vaassen
- Maastrict University Medical Centre, Maastricht, Netherlands
| | | | | | - Cindy Y G Noben
- Maastrict University Medical Centre, Maastricht, Netherlands
| | - Christopher Moriates
- Costs of Care, Boston, MA, USA
- Division of Hospital Medicine, Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Brian M Wong
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Choosing Wisely Canada, Toronto, ON, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, ON, Canada
| | - Karen B Born
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
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Rycroft-Malone J, D. Graham I, Kothari A, McCutcheon C. Research Coproduction: An Underused Pathway to Impact. Int J Health Policy Manag 2024; 13:8461. [PMID: 39099499 PMCID: PMC11270607 DOI: 10.34172/ijhpm.2024.8461] [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: 08/02/2023] [Accepted: 04/23/2024] [Indexed: 08/06/2024] Open
Abstract
Knowledge translation and implementation science have made many advances in the last two decades. However, research is still not making expedient differences to practice, policy, and service delivery. It is time to evolve our approach to knowledge production and implementation. In this editorial we advance research coproduction as a neglected pathway to impact. Our starting point is that research impact is a function of how research is done and who is involved, arguing that researchers and non-researchers have an equal voice and role to play. We outline principles of coproduction including sharing power, valuing different sources of knowledge and viewpoints, equality, open communication, inclusivity, and mutuality. We consider implications at micro, meso, and macro system levels. In calling for this shift in the way knowledge is produced and applied, we anticipate it leading to inclusive research that more rapidly translates to better, more equitable health and care for all.
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Quinn AE, Chew DS, Faris P, Au F, James MT, Tonelli M, Manns BJ. Physician Variation and the Impact of Payment Model in Cardiac Imaging. J Am Heart Assoc 2023; 12:e029149. [PMID: 38084753 PMCID: PMC10863764 DOI: 10.1161/jaha.122.029149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 10/30/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND The influence of fee-for-service reimbursement on cardiac imaging has not been compared with other payment models. Furthermore, variation in ordering practices is not well understood. METHODS AND RESULTS This retrospective, population-based cohort study using linked administrative data from Alberta, Canada included adults with chronic heart disease (atrial fibrillation, coronary artery disease, and heart failure) seen by cardiac specialists for a new outpatient consultation April 2012 to December 2018. Generalized linear mixed-effects models estimated the association of payment model (including the ability to bill to interpret imaging tests) and the use of cardiac imaging and quantified variation in cardiac imaging. Among 31 685 adults seen by 308 physicians at 136 sites, patients received an observed mean of 0.67 (95% CI, 0.67-0.68) imaging tests per consultation. After adjustment, patients seeing fee-for-service physicians had 2.07 (95% CI, 1.68-2.54) and fee-for-service physicians with ability to interpret had 2.87 (95% CI, 2.16-3.81) times the rate of receiving a test than those seeing salaried physicians. Measured patient, physician, and site effects accounted for 31% of imaging variation and, following adjustment, reduced unexplained site-level variation 40% and physician-level variation 29%. CONCLUSIONS We identified substantial variation in the use of outpatient cardiac imaging related to physician and site factors. Physician payment models have a significant association with imaging use. Our results raise concern that payment models may influence cardiac imaging practice. Similar methods could be applied to identify the source and magnitude of variation in other health care processes and outcomes.
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Affiliation(s)
- Amity E. Quinn
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryAlbertaCanada
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryAlbertaCanada
| | - Derek S. Chew
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryAlbertaCanada
- Libin Cardiovascular Institute, Cumming School of MedicineUniversity of CalgaryAlbertaCanada
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryAlbertaCanada
| | - Peter Faris
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryAlbertaCanada
- Data and Analytics, Alberta Health ServicesAlbertaCanada
| | - Flora Au
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryAlbertaCanada
| | - Matthew T. James
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryAlbertaCanada
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryAlbertaCanada
| | - Marcello Tonelli
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryAlbertaCanada
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryAlbertaCanada
| | - Braden J. Manns
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryAlbertaCanada
- Libin Cardiovascular Institute, Cumming School of MedicineUniversity of CalgaryAlbertaCanada
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryAlbertaCanada
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Flynn R, Cassidy C, Dobson L, Al-Rassi J, Langley J, Swindle J, Graham ID, Scott SD. Knowledge translation strategies to support the sustainability of evidence-based interventions in healthcare: a scoping review. Implement Sci 2023; 18:69. [PMID: 38049900 PMCID: PMC10694920 DOI: 10.1186/s13012-023-01320-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 11/13/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Knowledge translation (KT) strategies are widely used to facilitate the implementation of EBIs into healthcare practices. However, it is unknown what and how KT strategies are used to facilitate the sustainability of EBIs in institutional healthcare settings. OBJECTIVES This scoping review aimed to consolidate the current evidence on (i) what and how KT strategies are being used for the sustainability of EBIs in institutional healthcare settings; (ii) the reported KT strategy outcomes (e.g., acceptability) for EBI sustainability, and (iii) the reported EBI sustainability outcomes (e.g., EBI activities or component of the intervention continue). METHODS We conducted a scoping review of five electronic databases. We included studies describing the use of specific KT strategies to facilitate the sustainability of EBIs (more than 1-year post-implementation). We coded KT strategies using the clustered ERIC taxonomy and AIMD framework, we coded KT strategy outcomes using Tierney et al.'s measures, and EBI sustainability outcomes using Scheirer and Dearing's and Lennox's taxonomy. We conducted descriptive numerical summaries and a narrative synthesis to analyze the results. RESULTS The search identified 3776 studies for review. Following the screening, 25 studies (reported in 27 papers due to two companion reports) met the final inclusion criteria. Most studies used multi-component KT strategies for EBI sustainability (n = 24). The most common ERIC KT strategy clusters were to train and educate stakeholders (n = 38) and develop stakeholder interrelationships (n = 34). Education was the most widely used KT strategy (n = 17). Many studies (n = 11) did not clearly report whether they used different or the same KT strategies between EBI implementation and sustainability. Seven studies adapted KT strategies from implementation to sustainability efforts. Only two studies reported using a new KT strategy for EBI sustainability. The most reported KT strategy outcomes were acceptability (n = 10), sustainability (n = 5); and adoption (n = 4). The most commonly measured EBI sustainability outcome was the continuation of EBI activities or components (n = 23), followed by continued benefits for patients, staff, and stakeholders (n = 22). CONCLUSIONS Our review provides insight into a conceptual problem where initial EBI implementation and sustainability are considered as two discrete time periods. Our findings show we need to consider EBI implementation and sustainability as a continuum and design and select KT strategies with this in mind. Our review has emphasized areas that require further research (e.g., KT strategy adaptation for EBI sustainability). To advance understanding of how to employ KT strategies for EBI sustainability, we recommend clearly reporting the dose, frequency, adaptations, fidelity, and cost of KT strategies. Advancing our understanding in this area would facilitate better design, selection, tailored, and adapted use of KT strategies for EBI sustainability, thereby contributing to improved patient, provider, and health system outcomes.
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Affiliation(s)
- Rachel Flynn
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College of Cork, College Road Cork, Cork, T12 AK54, Ireland.
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
| | - Christine Cassidy
- School of Nursing, Faculty of Health, Dalhousie University, Room N21, Forrest Bldg., PO Box 15000 5869 University Avenue Halifax, Nova Scotia, B3H 4R2, Canada.
| | - Lauren Dobson
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Joyce Al-Rassi
- School of Nursing, Faculty of Health, Dalhousie University, Room N21, Forrest Bldg., PO Box 15000 5869 University Avenue Halifax, Nova Scotia, B3H 4R2, Canada
| | - Jodi Langley
- School of Nursing, Faculty of Health, Dalhousie University, Room N21, Forrest Bldg., PO Box 15000 5869 University Avenue Halifax, Nova Scotia, B3H 4R2, Canada
| | - Jennifer Swindle
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
- The Centre for Implementation Research, Ottawa Hospital Research Institute, 501 Smyth Road, Box 241, Ottawa, Ontario, K1H 8L6, Canada
| | - Shannon D Scott
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
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Gartner JB, Côté A. Optimization of Care Pathways Through Technological, Clinical, Organizational and Social Innovations: A Qualitative Study. Health Serv Insights 2023; 16:11786329231211096. [PMID: 37953914 PMCID: PMC10637140 DOI: 10.1177/11786329231211096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
Numerous calls at national and international level are leading some countries to seek to redesign the provision of healthcare and services. Care pathways have the potential to improve outcomes by providing a mechanism to coordinate care and reduce fragmentation and ultimately costs. However, their implementation still shows variable results, resulting in them being considered as complex interventions in complex systems. By mobilizing an emerging approach combining action research and grounded theory methodology, we conducted a pilot project on care pathways. We used a strongly inductive process, to mobilize comparison and continuous theoretical sampling to produce theories. Forty-two interviews were conducted, and participant observations were made throughout the project, including 60 participant observations at meetings, workshops and field observations. The investigators kept logbooks and recorded field notes. Thematic analysis was used with an inductive approach. The present model explains the factors that positively or negatively influence the implementation of innovations in care pathways. The model represents interactions between facilitating factors, favourable conditions for the emergence of innovation adoption, implementation process enablers and challenges or barriers including those related specifically to the local context. What seems to be totally new is the embodiment of the mobilizing shared objective of active patient-partner participation in decision-making, data collection and analysis and solution building. This allows, in our opinion, to transcend professional perspectives for the benefit of patient-oriented results. Finally, the pilot project has created expectations in terms of spread and scaling. Future research on care pathway implementation should go further in the evaluation of the multifactorial impacts and develop a methodological framework of care pathway implementation, as the only existing proposition seems limited. Furthermore, from a social science perspective, it would be interesting to analyse the modes of social valuation of the different actors to understand what allows the transformation of collective action.
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Affiliation(s)
- Jean-Baptiste Gartner
- Département de management, Faculté des sciences de l’administration, Université Laval, Québec, QC, Canada
- Centre de recherche en gestion des services de santé, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
- Centre de recherche du CISSS de Chaudière-Appalaches, Québec, QC, Canada
- VITAM, Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
- Centre de recherche de l’Institut Universitaire de Cardio-Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - André Côté
- Département de management, Faculté des sciences de l’administration, Université Laval, Québec, QC, Canada
- Centre de recherche en gestion des services de santé, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
- Centre de recherche du CISSS de Chaudière-Appalaches, Québec, QC, Canada
- VITAM, Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
- Centre de recherche de l’Institut Universitaire de Cardio-Pneumologie de Québec, Université Laval, Québec, QC, Canada
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Gartner JB, Benharbit B, Layani G, Sasseville M, Lemaire C, Bergeron F, Wilhelmy C, Menear M, Côté A. Implementation model for a national learning health system (IMPLEMENT-National LHS): a concept analysis and systematic review protocol. BMJ Open 2023; 13:e073767. [PMID: 37907296 PMCID: PMC10619008 DOI: 10.1136/bmjopen-2023-073767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Despite efforts and repeated calls to improve the organisation and quality of healthcare and services, and in view of the many challenges facing health systems, the results and capacity to adapt and integrate innovations and new knowledge remain suboptimal. Learning health systems (LHS) may be an effective model to accelerate the application of research for real quality improvement in healthcare. However, while recognising the enormous potential of LHS, the literature suggests the model remains more of an aspiration than a reality. METHODS AND ANALYSIS To reach a fine understanding of the implementation of the concepts involved in LHS, we will use a hybrid method which combines concept analyses with systematic review methodology. We will use a two-step analysis, a content analysis to analyse the definitions, uses and attributes of the concept and a systematic review to analyse the concept's implementation mechanisms. We will search eight databases and grey literature and present a broad synthesis of the available evidence regarding design, implementation and evaluation of LHS in a multilevel perspective. We will follow the latest Preferred Reporting Items for Systematic Review and Meta-Analysis statement for conducting and reporting a systematic review. Two reviewers will independently screen the titles and abstracts against the eligibility criteria followed by full-text screening of potentially relevant articles for final inclusion decision. Conflicts will be resolved with a senior author. We will include published primary studies that use qualitative, quantitative or mixed methods. The assessment of risk of bias will be made using the Mixed-Methods Appraisal Tool. ETHICS AND DISSEMINATION This systematic review is exempt from ethics approval. The results formulated will highlight evidence-based interventions that support the implementation of a national LHS. They will be of particular interest to decision makers, researchers, managers, clinicians and patients allowing finally to implement the promising proposal of LHSs at national scale. PROSPERO REGISTRATION NUMBER CRD42023393565.
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Affiliation(s)
- Jean-Baptiste Gartner
- Département de management, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
- Centre de recherche en gestion des services de santé, Université Laval, Québec, QC, Canada
- Centre de recherche de l'Institut Universitaire de Cardio-Pneumologie de Québec, Université Laval, Québec, QC, Canada
- VITAM, Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
- Centre de recherche du CISSS de Chaudière-Appalaches, Université Laval, Québec, QC, Canada
| | - Boutheina Benharbit
- Centre de recherche en gestion des services de santé, Université Laval, Québec, QC, Canada
| | - Géraldine Layani
- Département de Médecine de famille et médecine d'urgence, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche du CHUM, Montreal, QC, Canada
| | - Maxime Sasseville
- VITAM, Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
- Faculté des sciences infirmières, Université Laval, Quebec, QC, Canada
| | - Célia Lemaire
- Département de management, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
- iaelyon, Université Jean Moulin Lyon 3 iaelyon School of Management, Lyon, France
| | - Frédéric Bergeron
- Bibliothèque-Direction des services-conseils, Université Laval, Québec, QC, Canada
| | - Catherine Wilhelmy
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Matthew Menear
- VITAM, Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
- Département de médecine familiale et de médecine d'urgence, Université Laval, Quebec, Quebec, Canada
| | - André Côté
- Département de management, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
- Centre de recherche en gestion des services de santé, Université Laval, Québec, QC, Canada
- Centre de recherche de l'Institut Universitaire de Cardio-Pneumologie de Québec, Université Laval, Québec, QC, Canada
- VITAM, Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
- Centre de recherche du CISSS de Chaudière-Appalaches, Université Laval, Québec, QC, Canada
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Reszel J, Daub O, Dunn SI, Cassidy CE, Hafizi K, Lightfoot M, Pervez D, Quosdorf A, Wood A, Graham ID. Planning and implementing practice changes in Ontario maternal-newborn hospital units: a secondary qualitative analysis. BMC Pregnancy Childbirth 2023; 23:735. [PMID: 37848826 PMCID: PMC10583424 DOI: 10.1186/s12884-023-06042-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Moving evidence into practice is complex, and pregnant and birthing people and their infants do not always receive care that aligns with the best available evidence. Implementation science can inform how to effectively move evidence into practice. While there are a growing number of examples of implementation science being studied in maternal-newborn care settings, it remains unknown how real-world teams of healthcare providers and leaders approach the overall implementation process when making practice changes. The purpose of this study was to describe maternal-newborn hospital teams' approaches to implementing practice changes. We aimed to identify what implementation steps teams take (or not) and identify strengths and potential areas for improvement based on best practices in implementation science. METHODS We conducted a supplementary qualitative secondary analysis of 22 interviews completed in 2014-2015 with maternal-newborn nursing leaders in Ontario, Canada. We used directed content analysis to code the data to seven steps in an implementation framework (Implementation Roadmap): identify the problem and potential best practice; assemble local evidence; select and customize best practice; discover barriers and drivers; tailor implementation strategies; field-test, plan evaluation, prepare to launch; launch, evaluate, and sustain. Frequency counts are presented for each step. RESULTS Participants reported completing a median of 4.5 of 7 Implementation Roadmap steps (range = 3-7), with the most common being identifying a practice problem. Other steps were described less frequently (e.g., selecting and adapting evidence, field-testing, outcome evaluation) or discussed frequently but not optimally (e.g., barriers assessment). Participants provided examples of how they engaged point-of-care staff throughout the implementation process, but provided fewer examples of engaging pregnant and birthing people and their families. Some participants stated they used a formal framework or process to guide their implementation process, with the most common being quality improvement approaches and tools. CONCLUSIONS We identified variability across the 22 hospitals in the implementation steps taken. While we observed many strengths, we also identified areas where further support may be needed. Future work is needed to create opportunities and resources to support maternal-newborn healthcare providers and leaders to apply principles and tools from implementation science to their practice change initiatives.
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Affiliation(s)
- Jessica Reszel
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
| | - Olivia Daub
- School of Communication Sciences and Disorders, Western University, 1201 Western Road, London, ON, N6G 1H1, Canada
| | - Sandra I Dunn
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Christine E Cassidy
- School of Nursing, Dalhousie University, 5869 University Avenue, Halifax, NS, B3H 4R2, Canada
- IWK Health Centre, 5980 University Avenue, Halifax, NS, B3K 6R8, Canada
| | - Kaamel Hafizi
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Marnie Lightfoot
- Women and Children's Health Network, Orillia Soldiers' Memorial Hospital, 170 Colborne St W, Orillia, ON, L3V 2Z3, Canada
| | | | - Ashley Quosdorf
- Neonatal Intensive Care Unit, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Allison Wood
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Ian D Graham
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
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Aloisio LD, Graham N, Grinspun D, Naik S, Coughlin M, Medeiros C, McConnell H, Sales A, McNeill S, Santos WJ, Squires JE. Indicators to measure implementation and sustainability of nursing best practice guidelines: A mixed methods analysis. Heliyon 2023; 9:e19983. [PMID: 37809679 PMCID: PMC10559663 DOI: 10.1016/j.heliyon.2023.e19983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Background The use of best practice guidelines (BPGs) has the potential to decrease the gap between best evidence and nursing and healthcare practices. We conducted an exploratory mixed method study to identify strategies, processes, and indicators relevant to the implementation and sustainability of two Registered Nurses' Association of Ontario (RNAO) BPGs at Best Practice Spotlight Organizations® (BPSOs). Methods Our study had four phases. In Phase 1, we triangulated two qualitative studies: a) secondary analysis of 126 narrative reports detailing implementation progress from 21 BPSOs spanning four sectors to identify strategies and processes used to support the implementation and sustainability of BPGs and b) interviews with 25 guideline implementers to identify additional strategies and processes. In Phase 2, we evaluated correlations between strategies and processes identified from the narrative reports and one process and one outcome indicator for each of the guideline. In Phase 3, the results from Phases 1 and 2 informed indicator development, led by an expert panel. In Phase 4, the indicators were assessed internally by RNAO staff and externally by Ontario Health Teams. A survey was used to validate proposed indicators to determine relevance, feasibility, readability, and usability with knowledge users and BPSO leaders. Results Triangulation of the two qualitative studies revealed 46 codes of implementation and sustainability of BPGs, classified into eight overarching themes: Stakeholder Engagement, Practice Interventions, Capacity Building, Evidence-Based Culture, Leadership, Evaluation & Monitoring, Communication, and Governance. A total of 28 structure, process, or outcome indicators were developed. End users and BPSO leaders were agreeable with the indicators according to the validation survey. Conclusions Many processes and strategies can influence the implementation and sustainability of BPGs at BPSOs. We have developed indicators that can help BPSOs promote evidence-informed practice implementation of BPGs.
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Affiliation(s)
- Laura D. Aloisio
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Nicole Graham
- University of Ottawa, Faculty of Health Sciences, School of Nursing, Ottawa, ON, Canada
| | - Doris Grinspun
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Shanoja Naik
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Mary Coughlin
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Christina Medeiros
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | | | - Anne Sales
- Sinclair School of Nursing and Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Susan McNeill
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Wilmer J. Santos
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Janet E. Squires
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- University of Ottawa, Faculty of Health Sciences, School of Nursing, Ottawa, ON, Canada
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Harvey G, Rycroft-Malone J, Seers K, Wilson P, Cassidy C, Embrett M, Hu J, Pearson M, Semenic S, Zhao J, Graham ID. Connecting the science and practice of implementation - applying the lens of context to inform study design in implementation research. FRONTIERS IN HEALTH SERVICES 2023; 3:1162762. [PMID: 37484830 PMCID: PMC10361069 DOI: 10.3389/frhs.2023.1162762] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023]
Abstract
The saying "horses for courses" refers to the idea that different people and things possess different skills or qualities that are appropriate in different situations. In this paper, we apply the analogy of "horses for courses" to stimulate a debate about how and why we need to get better at selecting appropriate implementation research methods that take account of the context in which implementation occurs. To ensure that implementation research achieves its intended purpose of enhancing the uptake of research-informed evidence in policy and practice, we start from a position that implementation research should be explicitly connected to implementation practice. Building on our collective experience as implementation researchers, implementation practitioners (users of implementation research), implementation facilitators and implementation educators and subsequent deliberations with an international, inter-disciplinary group involved in practising and studying implementation, we present a discussion paper with practical suggestions that aim to inform more practice-relevant implementation research.
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Affiliation(s)
- Gillian Harvey
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Jo Rycroft-Malone
- Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Kate Seers
- Warwick Medical School, Faculty of Science, University of Warwick, Coventry, United Kingdom
| | - Paul Wilson
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
| | - Christine Cassidy
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Mark Embrett
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Jiale Hu
- College of Health Professions, Virginia Commonwealth University, Richmond, VA, United States
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, United Kingdom
| | - Sonia Semenic
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Junqiang Zhao
- Centre for Research on Health and Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Ian D. Graham
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Hamel C, Margau R, Pageau P, Venturi M, Esmaeilisaraji L, Avard B, Campbell S, Corser N, Dea N, Kwok E, MacLean C, Sarrazin E, Yong-Hing CJ, Zaki-Metias K. Canadian Association of Radiologists Diagnostic Imaging Referral Guidelines: a guideline development protocol. CMAJ Open 2023; 11:E248-E254. [PMID: 36918208 PMCID: PMC10019324 DOI: 10.9778/cmajo.20220098] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Comprehensive diagnostic imaging referral guidelines are an important tool to assist referring clinicians and radiologists in determining the safest and best-clinical-value diagnostic imaging study for their patients; the Canadian Association of Radiologists (CAR) last produced its diagnostic imaging referral guidelines in 2012. In partnership with several national organizations, referring clinicians, radiologists, and patient and family advisors from across Canada, the association is redoing its referral guidelines using a new methodology for guideline development, and these guideline recommendations will be suited for integration into clinical decision support systems. METHODS Expert panels of radiologists, referring clinicians and a patient advisor will work with epidemiologists at the CAR to create guidelines across 13 clinical sections. The expert panel for each section will first create a comprehensive list of clinical and diagnostic scenarios to include in the guidelines. Canadian Association of Radiologists epidemiologists will then conduct a systematic rapid scoping review to identify systematically produced guidelines from other guideline groups. The corresponding expert panel will develop diagnostic imaging recommendations for each clinical and diagnostic scenario using the recommendations identified from the scoping review and contextualize them to the Canadian health care systems. The expert panels will accomplish this using an adapted Grading of Recommendations Assessment, Development and Evaluation framework, which reflects the benefits and harms, values and preferences, equity, accessibility, resources and cost. INTERPRETATION Freely available, up-to-date, comprehensive Canadian-specific diagnostic imaging referral guidelines are needed. A transparent and structured guideline-development approach will aid the CAR and its partners in producing guidelines across its 13 sections.
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Affiliation(s)
- Candyce Hamel
- Canadian Association of Radiologists (Hamel, Venturi, Esmaeilisaraji), Ottawa, Ont.; Department of Medical Imaging (Margau, Avard), North York General Hospital, Toronto, Ont.; Department of Emergency Medicine (Pageau), University of Ottawa, and Emergency Medicine (Pageau), The Ottawa Hospital, Ottawa, Ont.; Charles V. Keating Emergency and Trauma Centre (Campbell), Queen Elizabeth II Health Sciences Centre; Department of Emergency Medicine (Campbell), Dalhousie University, Halifax, NS; Society of Rural Physicians of Canada (Corser), Shawville, Que.; Hinton Medical Clinic (Corser), Hinton, Alta.; Department of Surgery (Dea), Vancouver General Hospital; Division of Neurosurgery (Dea), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Emergency Medicine (Kwok), University of Ottawa; Ottawa Hospital Research Institute (Kwok), Ottawa, Ont.; Department of Academic Family Medicine (MacLean), University of Saskatchewan, Saskatoon, Sask.; Nurse Practitioner Association of Canada (Sarrazin); BC Cancer (Yong-Hing); Department of Radiology (Yong-Hing), University of British Columbia, Vancouver, BC; Trinity Health Oakland Hospital and Wayne State University School of Medicine (Zaki-Metias), Pontiac, Mich.
| | - Ryan Margau
- Canadian Association of Radiologists (Hamel, Venturi, Esmaeilisaraji), Ottawa, Ont.; Department of Medical Imaging (Margau, Avard), North York General Hospital, Toronto, Ont.; Department of Emergency Medicine (Pageau), University of Ottawa, and Emergency Medicine (Pageau), The Ottawa Hospital, Ottawa, Ont.; Charles V. Keating Emergency and Trauma Centre (Campbell), Queen Elizabeth II Health Sciences Centre; Department of Emergency Medicine (Campbell), Dalhousie University, Halifax, NS; Society of Rural Physicians of Canada (Corser), Shawville, Que.; Hinton Medical Clinic (Corser), Hinton, Alta.; Department of Surgery (Dea), Vancouver General Hospital; Division of Neurosurgery (Dea), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Emergency Medicine (Kwok), University of Ottawa; Ottawa Hospital Research Institute (Kwok), Ottawa, Ont.; Department of Academic Family Medicine (MacLean), University of Saskatchewan, Saskatoon, Sask.; Nurse Practitioner Association of Canada (Sarrazin); BC Cancer (Yong-Hing); Department of Radiology (Yong-Hing), University of British Columbia, Vancouver, BC; Trinity Health Oakland Hospital and Wayne State University School of Medicine (Zaki-Metias), Pontiac, Mich
| | - Paul Pageau
- Canadian Association of Radiologists (Hamel, Venturi, Esmaeilisaraji), Ottawa, Ont.; Department of Medical Imaging (Margau, Avard), North York General Hospital, Toronto, Ont.; Department of Emergency Medicine (Pageau), University of Ottawa, and Emergency Medicine (Pageau), The Ottawa Hospital, Ottawa, Ont.; Charles V. Keating Emergency and Trauma Centre (Campbell), Queen Elizabeth II Health Sciences Centre; Department of Emergency Medicine (Campbell), Dalhousie University, Halifax, NS; Society of Rural Physicians of Canada (Corser), Shawville, Que.; Hinton Medical Clinic (Corser), Hinton, Alta.; Department of Surgery (Dea), Vancouver General Hospital; Division of Neurosurgery (Dea), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Emergency Medicine (Kwok), University of Ottawa; Ottawa Hospital Research Institute (Kwok), Ottawa, Ont.; Department of Academic Family Medicine (MacLean), University of Saskatchewan, Saskatoon, Sask.; Nurse Practitioner Association of Canada (Sarrazin); BC Cancer (Yong-Hing); Department of Radiology (Yong-Hing), University of British Columbia, Vancouver, BC; Trinity Health Oakland Hospital and Wayne State University School of Medicine (Zaki-Metias), Pontiac, Mich
| | - Marc Venturi
- Canadian Association of Radiologists (Hamel, Venturi, Esmaeilisaraji), Ottawa, Ont.; Department of Medical Imaging (Margau, Avard), North York General Hospital, Toronto, Ont.; Department of Emergency Medicine (Pageau), University of Ottawa, and Emergency Medicine (Pageau), The Ottawa Hospital, Ottawa, Ont.; Charles V. Keating Emergency and Trauma Centre (Campbell), Queen Elizabeth II Health Sciences Centre; Department of Emergency Medicine (Campbell), Dalhousie University, Halifax, NS; Society of Rural Physicians of Canada (Corser), Shawville, Que.; Hinton Medical Clinic (Corser), Hinton, Alta.; Department of Surgery (Dea), Vancouver General Hospital; Division of Neurosurgery (Dea), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Emergency Medicine (Kwok), University of Ottawa; Ottawa Hospital Research Institute (Kwok), Ottawa, Ont.; Department of Academic Family Medicine (MacLean), University of Saskatchewan, Saskatoon, Sask.; Nurse Practitioner Association of Canada (Sarrazin); BC Cancer (Yong-Hing); Department of Radiology (Yong-Hing), University of British Columbia, Vancouver, BC; Trinity Health Oakland Hospital and Wayne State University School of Medicine (Zaki-Metias), Pontiac, Mich
| | - Leila Esmaeilisaraji
- Canadian Association of Radiologists (Hamel, Venturi, Esmaeilisaraji), Ottawa, Ont.; Department of Medical Imaging (Margau, Avard), North York General Hospital, Toronto, Ont.; Department of Emergency Medicine (Pageau), University of Ottawa, and Emergency Medicine (Pageau), The Ottawa Hospital, Ottawa, Ont.; Charles V. Keating Emergency and Trauma Centre (Campbell), Queen Elizabeth II Health Sciences Centre; Department of Emergency Medicine (Campbell), Dalhousie University, Halifax, NS; Society of Rural Physicians of Canada (Corser), Shawville, Que.; Hinton Medical Clinic (Corser), Hinton, Alta.; Department of Surgery (Dea), Vancouver General Hospital; Division of Neurosurgery (Dea), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Emergency Medicine (Kwok), University of Ottawa; Ottawa Hospital Research Institute (Kwok), Ottawa, Ont.; Department of Academic Family Medicine (MacLean), University of Saskatchewan, Saskatoon, Sask.; Nurse Practitioner Association of Canada (Sarrazin); BC Cancer (Yong-Hing); Department of Radiology (Yong-Hing), University of British Columbia, Vancouver, BC; Trinity Health Oakland Hospital and Wayne State University School of Medicine (Zaki-Metias), Pontiac, Mich
| | - Barb Avard
- Canadian Association of Radiologists (Hamel, Venturi, Esmaeilisaraji), Ottawa, Ont.; Department of Medical Imaging (Margau, Avard), North York General Hospital, Toronto, Ont.; Department of Emergency Medicine (Pageau), University of Ottawa, and Emergency Medicine (Pageau), The Ottawa Hospital, Ottawa, Ont.; Charles V. Keating Emergency and Trauma Centre (Campbell), Queen Elizabeth II Health Sciences Centre; Department of Emergency Medicine (Campbell), Dalhousie University, Halifax, NS; Society of Rural Physicians of Canada (Corser), Shawville, Que.; Hinton Medical Clinic (Corser), Hinton, Alta.; Department of Surgery (Dea), Vancouver General Hospital; Division of Neurosurgery (Dea), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Emergency Medicine (Kwok), University of Ottawa; Ottawa Hospital Research Institute (Kwok), Ottawa, Ont.; Department of Academic Family Medicine (MacLean), University of Saskatchewan, Saskatoon, Sask.; Nurse Practitioner Association of Canada (Sarrazin); BC Cancer (Yong-Hing); Department of Radiology (Yong-Hing), University of British Columbia, Vancouver, BC; Trinity Health Oakland Hospital and Wayne State University School of Medicine (Zaki-Metias), Pontiac, Mich
| | - Sam Campbell
- Canadian Association of Radiologists (Hamel, Venturi, Esmaeilisaraji), Ottawa, Ont.; Department of Medical Imaging (Margau, Avard), North York General Hospital, Toronto, Ont.; Department of Emergency Medicine (Pageau), University of Ottawa, and Emergency Medicine (Pageau), The Ottawa Hospital, Ottawa, Ont.; Charles V. Keating Emergency and Trauma Centre (Campbell), Queen Elizabeth II Health Sciences Centre; Department of Emergency Medicine (Campbell), Dalhousie University, Halifax, NS; Society of Rural Physicians of Canada (Corser), Shawville, Que.; Hinton Medical Clinic (Corser), Hinton, Alta.; Department of Surgery (Dea), Vancouver General Hospital; Division of Neurosurgery (Dea), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Emergency Medicine (Kwok), University of Ottawa; Ottawa Hospital Research Institute (Kwok), Ottawa, Ont.; Department of Academic Family Medicine (MacLean), University of Saskatchewan, Saskatoon, Sask.; Nurse Practitioner Association of Canada (Sarrazin); BC Cancer (Yong-Hing); Department of Radiology (Yong-Hing), University of British Columbia, Vancouver, BC; Trinity Health Oakland Hospital and Wayne State University School of Medicine (Zaki-Metias), Pontiac, Mich
| | - Noel Corser
- Canadian Association of Radiologists (Hamel, Venturi, Esmaeilisaraji), Ottawa, Ont.; Department of Medical Imaging (Margau, Avard), North York General Hospital, Toronto, Ont.; Department of Emergency Medicine (Pageau), University of Ottawa, and Emergency Medicine (Pageau), The Ottawa Hospital, Ottawa, Ont.; Charles V. Keating Emergency and Trauma Centre (Campbell), Queen Elizabeth II Health Sciences Centre; Department of Emergency Medicine (Campbell), Dalhousie University, Halifax, NS; Society of Rural Physicians of Canada (Corser), Shawville, Que.; Hinton Medical Clinic (Corser), Hinton, Alta.; Department of Surgery (Dea), Vancouver General Hospital; Division of Neurosurgery (Dea), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Emergency Medicine (Kwok), University of Ottawa; Ottawa Hospital Research Institute (Kwok), Ottawa, Ont.; Department of Academic Family Medicine (MacLean), University of Saskatchewan, Saskatoon, Sask.; Nurse Practitioner Association of Canada (Sarrazin); BC Cancer (Yong-Hing); Department of Radiology (Yong-Hing), University of British Columbia, Vancouver, BC; Trinity Health Oakland Hospital and Wayne State University School of Medicine (Zaki-Metias), Pontiac, Mich
| | - Nicolas Dea
- Canadian Association of Radiologists (Hamel, Venturi, Esmaeilisaraji), Ottawa, Ont.; Department of Medical Imaging (Margau, Avard), North York General Hospital, Toronto, Ont.; Department of Emergency Medicine (Pageau), University of Ottawa, and Emergency Medicine (Pageau), The Ottawa Hospital, Ottawa, Ont.; Charles V. Keating Emergency and Trauma Centre (Campbell), Queen Elizabeth II Health Sciences Centre; Department of Emergency Medicine (Campbell), Dalhousie University, Halifax, NS; Society of Rural Physicians of Canada (Corser), Shawville, Que.; Hinton Medical Clinic (Corser), Hinton, Alta.; Department of Surgery (Dea), Vancouver General Hospital; Division of Neurosurgery (Dea), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Emergency Medicine (Kwok), University of Ottawa; Ottawa Hospital Research Institute (Kwok), Ottawa, Ont.; Department of Academic Family Medicine (MacLean), University of Saskatchewan, Saskatoon, Sask.; Nurse Practitioner Association of Canada (Sarrazin); BC Cancer (Yong-Hing); Department of Radiology (Yong-Hing), University of British Columbia, Vancouver, BC; Trinity Health Oakland Hospital and Wayne State University School of Medicine (Zaki-Metias), Pontiac, Mich
| | - Edmund Kwok
- Canadian Association of Radiologists (Hamel, Venturi, Esmaeilisaraji), Ottawa, Ont.; Department of Medical Imaging (Margau, Avard), North York General Hospital, Toronto, Ont.; Department of Emergency Medicine (Pageau), University of Ottawa, and Emergency Medicine (Pageau), The Ottawa Hospital, Ottawa, Ont.; Charles V. Keating Emergency and Trauma Centre (Campbell), Queen Elizabeth II Health Sciences Centre; Department of Emergency Medicine (Campbell), Dalhousie University, Halifax, NS; Society of Rural Physicians of Canada (Corser), Shawville, Que.; Hinton Medical Clinic (Corser), Hinton, Alta.; Department of Surgery (Dea), Vancouver General Hospital; Division of Neurosurgery (Dea), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Emergency Medicine (Kwok), University of Ottawa; Ottawa Hospital Research Institute (Kwok), Ottawa, Ont.; Department of Academic Family Medicine (MacLean), University of Saskatchewan, Saskatoon, Sask.; Nurse Practitioner Association of Canada (Sarrazin); BC Cancer (Yong-Hing); Department of Radiology (Yong-Hing), University of British Columbia, Vancouver, BC; Trinity Health Oakland Hospital and Wayne State University School of Medicine (Zaki-Metias), Pontiac, Mich
| | - Cathy MacLean
- Canadian Association of Radiologists (Hamel, Venturi, Esmaeilisaraji), Ottawa, Ont.; Department of Medical Imaging (Margau, Avard), North York General Hospital, Toronto, Ont.; Department of Emergency Medicine (Pageau), University of Ottawa, and Emergency Medicine (Pageau), The Ottawa Hospital, Ottawa, Ont.; Charles V. Keating Emergency and Trauma Centre (Campbell), Queen Elizabeth II Health Sciences Centre; Department of Emergency Medicine (Campbell), Dalhousie University, Halifax, NS; Society of Rural Physicians of Canada (Corser), Shawville, Que.; Hinton Medical Clinic (Corser), Hinton, Alta.; Department of Surgery (Dea), Vancouver General Hospital; Division of Neurosurgery (Dea), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Emergency Medicine (Kwok), University of Ottawa; Ottawa Hospital Research Institute (Kwok), Ottawa, Ont.; Department of Academic Family Medicine (MacLean), University of Saskatchewan, Saskatoon, Sask.; Nurse Practitioner Association of Canada (Sarrazin); BC Cancer (Yong-Hing); Department of Radiology (Yong-Hing), University of British Columbia, Vancouver, BC; Trinity Health Oakland Hospital and Wayne State University School of Medicine (Zaki-Metias), Pontiac, Mich
| | - Erin Sarrazin
- Canadian Association of Radiologists (Hamel, Venturi, Esmaeilisaraji), Ottawa, Ont.; Department of Medical Imaging (Margau, Avard), North York General Hospital, Toronto, Ont.; Department of Emergency Medicine (Pageau), University of Ottawa, and Emergency Medicine (Pageau), The Ottawa Hospital, Ottawa, Ont.; Charles V. Keating Emergency and Trauma Centre (Campbell), Queen Elizabeth II Health Sciences Centre; Department of Emergency Medicine (Campbell), Dalhousie University, Halifax, NS; Society of Rural Physicians of Canada (Corser), Shawville, Que.; Hinton Medical Clinic (Corser), Hinton, Alta.; Department of Surgery (Dea), Vancouver General Hospital; Division of Neurosurgery (Dea), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Emergency Medicine (Kwok), University of Ottawa; Ottawa Hospital Research Institute (Kwok), Ottawa, Ont.; Department of Academic Family Medicine (MacLean), University of Saskatchewan, Saskatoon, Sask.; Nurse Practitioner Association of Canada (Sarrazin); BC Cancer (Yong-Hing); Department of Radiology (Yong-Hing), University of British Columbia, Vancouver, BC; Trinity Health Oakland Hospital and Wayne State University School of Medicine (Zaki-Metias), Pontiac, Mich
| | - Charlotte J Yong-Hing
- Canadian Association of Radiologists (Hamel, Venturi, Esmaeilisaraji), Ottawa, Ont.; Department of Medical Imaging (Margau, Avard), North York General Hospital, Toronto, Ont.; Department of Emergency Medicine (Pageau), University of Ottawa, and Emergency Medicine (Pageau), The Ottawa Hospital, Ottawa, Ont.; Charles V. Keating Emergency and Trauma Centre (Campbell), Queen Elizabeth II Health Sciences Centre; Department of Emergency Medicine (Campbell), Dalhousie University, Halifax, NS; Society of Rural Physicians of Canada (Corser), Shawville, Que.; Hinton Medical Clinic (Corser), Hinton, Alta.; Department of Surgery (Dea), Vancouver General Hospital; Division of Neurosurgery (Dea), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Emergency Medicine (Kwok), University of Ottawa; Ottawa Hospital Research Institute (Kwok), Ottawa, Ont.; Department of Academic Family Medicine (MacLean), University of Saskatchewan, Saskatoon, Sask.; Nurse Practitioner Association of Canada (Sarrazin); BC Cancer (Yong-Hing); Department of Radiology (Yong-Hing), University of British Columbia, Vancouver, BC; Trinity Health Oakland Hospital and Wayne State University School of Medicine (Zaki-Metias), Pontiac, Mich
| | - Kaitlin Zaki-Metias
- Canadian Association of Radiologists (Hamel, Venturi, Esmaeilisaraji), Ottawa, Ont.; Department of Medical Imaging (Margau, Avard), North York General Hospital, Toronto, Ont.; Department of Emergency Medicine (Pageau), University of Ottawa, and Emergency Medicine (Pageau), The Ottawa Hospital, Ottawa, Ont.; Charles V. Keating Emergency and Trauma Centre (Campbell), Queen Elizabeth II Health Sciences Centre; Department of Emergency Medicine (Campbell), Dalhousie University, Halifax, NS; Society of Rural Physicians of Canada (Corser), Shawville, Que.; Hinton Medical Clinic (Corser), Hinton, Alta.; Department of Surgery (Dea), Vancouver General Hospital; Division of Neurosurgery (Dea), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Emergency Medicine (Kwok), University of Ottawa; Ottawa Hospital Research Institute (Kwok), Ottawa, Ont.; Department of Academic Family Medicine (MacLean), University of Saskatchewan, Saskatoon, Sask.; Nurse Practitioner Association of Canada (Sarrazin); BC Cancer (Yong-Hing); Department of Radiology (Yong-Hing), University of British Columbia, Vancouver, BC; Trinity Health Oakland Hospital and Wayne State University School of Medicine (Zaki-Metias), Pontiac, Mich
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Cundiff GW. Does AUGS Still Have Quality Assurance Goals? UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:315-317. [PMID: 36374785 DOI: 10.1097/spv.0000000000001298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Geoffrey W Cundiff
- From the University of British Columbia School of Medicine, Vancouver, British Columbia, Canada
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12
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Zaccagnini M, Bussières A, Mak S, Boruff J, West A, Thomas A. Scholarly practice in healthcare professions: findings from a scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022:10.1007/s10459-022-10180-0. [PMID: 36456756 DOI: 10.1007/s10459-022-10180-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/16/2022] [Indexed: 06/17/2023]
Abstract
Scholarly practitioners are broadly defined as healthcare professionals that address critical practice problems using theory, scientific evidence, and practice-based knowledge. Though scholarly practice is included in most competency frameworks, it is unclear what scholarly practice is, how it develops and how it is operationalized in clinical practice. The aim of this review was to determine what is known about scholarly practice in healthcare professionals. We conducted a scoping review and searched MEDLINE, EMBASE, CINAHL from inception to May 2020. We included papers that explored, described, or defined scholarly practice, scholar or scholarly practitioner, and/or related concepts in healthcare professionals. We included a total of 90 papers. Thirty percent of papers contained an explicit definition of scholarly practice. Conceptualizations of scholarly practice were organized into three themes: the interdependent relationship between scholarship and practice; advancing the profession's field; and core to being a healthcare practitioner. Attributes of scholarly practitioners clustered around five themes: commitment to excellence in practice; collaborative nature; presence of virtuous characteristics; effective communication skills; and adaptive change ethos. No single unified definition of scholarly practice exists within the literature. The variability in terms used to describe scholarly practice suggests that it is an overarching concept rather than a definable entity. There are similarities between scholarly practitioners and knowledge brokers regarding attributes and how scholarly practice is operationalized. Individuals engaged in the teaching, research and/or assessment of scholarly practice should make explicit their definitions and expectations for healthcare professionals.
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Affiliation(s)
- Marco Zaccagnini
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montréal, QC, H3G 1Y5, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, QC, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montréal, QC, H3G 1Y5, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, QC, Canada
- Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Susanne Mak
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montréal, QC, H3G 1Y5, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, QC, Canada
- Institute of Health Sciences Education, McGill University, Montréal, QC, Canada
| | - Jill Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montréal, QC, Canada
| | - Andrew West
- The Canadian Society of Respiratory Therapists, Saint John, NB, Canada
| | - Aliki Thomas
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montréal, QC, H3G 1Y5, Canada.
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, QC, Canada.
- Institute of Health Sciences Education, McGill University, Montréal, QC, Canada.
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13
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Greenough M, Bucknall T, Jibb L, Lewis K, Lamontagne C, Squires JE. Attaining expert consensus on diagnostic expectations of primary chronic pain diagnoses for patients referred to interdisciplinary pediatric chronic pain programs: A delphi study with pediatric chronic pain physicians and advanced practice nurses. FRONTIERS IN PAIN RESEARCH 2022; 3:1001028. [PMID: 36341155 PMCID: PMC9632850 DOI: 10.3389/fpain.2022.1001028] [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: 07/22/2022] [Accepted: 08/24/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Pediatric primary chronic pain disorders come with diagnostic uncertainty, which may obscure diagnostic expectations for referring providers and the decision to accept or re-direct patients into interdisciplinary pediatric chronic pain programs based on diagnostic completeness. We aimed to attain expert consensus on diagnostic expectations for patients who are referred to interdisciplinary pediatric chronic pain programs with six common primary chronic pain diagnoses. Method We conducted a modified Delphi study with pediatric chronic pain physicians, nurse practitioners and clinical nurse specialists to determine degree of importance on significant clinical indicators and diagnostic items relevant to each of the six primary chronic pain diagnoses. Items were identified through point of care databases and complimentary literature and were rated by participants on a 5-point Likert scale. Our consensus threshold was set at 70%. Results Amongst 22 experts across 14 interdisciplinary programs in round one and 16 experts across 12 interdisciplinary programs in round two, consensus was reached on 84% of diagnostic items, where the highest degree of agreement was with Complex Regional Pain Syndrome (CRPS), Type 1 (100%) and the lowest with chronic pelvic pain (67%). Conclusion This study demonstrated a general agreement amongst pediatric chronic pain experts regarding diagnostic expectations of patients referred to interdisciplinary chronic pain programs with primary chronic pain diagnoses. Study findings may help to clarify referral expectations and the decision to accept or re-direct patients into such programs based on diagnostic completeness while reducing the occurrence of unnecessary diagnostic tests and subsequent delays in accessing specialized care.
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Affiliation(s)
- Megan Greenough
- School of Nursing, Chronic Pain Services, The Children’s Hospital of Eastern Ontario Chronic Pain Services at The Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
- Correspondence: Megan Greenough ,
| | - Tracey Bucknall
- School of Nursing, Deakin University, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Geelong, VIC, Australia
| | - Lindsay Jibb
- Bloomberg Faculty of Nursing, Pediatric Nursing Research, SickKids Hospital, University of Toronto, Toronto, ON, Canada
| | - Krystina Lewis
- School of Nursing, The University of Ottawa, Ottawa, ON, Canada
| | - Christine Lamontagne
- Department of Medicine, Chronic Pain Services, The Children’s Hospital of Eastern OntarioUniversity of Ottawa, Ottawa, ON, Canada
| | - Janet Elaine Squires
- School of Nursing, University Research Chair in Health Evidence Implementation, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Santos WJ, Graham ID, Lalonde M, Demery Varin M, Squires JE. The effectiveness of champions in implementing innovations in health care: a systematic review. Implement Sci Commun 2022; 3:80. [PMID: 35869516 PMCID: PMC9308185 DOI: 10.1186/s43058-022-00315-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/30/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Champions have been documented in the literature as an important strategy for implementation, yet their effectiveness has not been well synthesized in the health care literature. The aim of this systematic review was to determine whether champions, tested in isolation from other implementation strategies, are effective at improving innovation use or outcomes in health care. METHODS The JBI systematic review method guided this study. A peer-reviewed search strategy was applied to eight electronic databases to identify relevant articles. We included all published articles and unpublished theses and dissertations that used a quantitative study design to evaluate the effectiveness of champions in implementing innovations within health care settings. Two researchers independently completed study selection, data extraction, and quality appraisal. We used content analysis and vote counting to synthesize our data. RESULTS After screening 7566 records titles and abstracts and 2090 full text articles, we included 35 studies in our review. Most of the studies (71.4%) operationalized the champion strategy by the presence or absence of a champion. In a subset of seven studies, five studies found associations between exposure to champions and increased use of best practices, programs, or technological innovations at an organizational level. In other subsets, the evidence pertaining to use of champions and innovation use by patients or providers, or at improving outcomes was either mixed or scarce. CONCLUSIONS We identified a small body of literature reporting an association between use of champions and increased instrumental use of innovations by organizations. However, more research is needed to determine causal relationship between champions and innovation use and outcomes. Even though there are no reported adverse effects in using champions, opportunity costs may be associated with their use. Until more evidence becomes available about the effectiveness of champions at increasing innovation use and outcomes, the decision to deploy champions should consider the needs and resources of the organization and include an evaluation plan. To further our understanding of champions' effectiveness, future studies should (1) use experimental study designs in conjunction with process evaluations, (2) describe champions and their activities and (3) rigorously evaluate the effectiveness of champions' activities. REGISTRATION Open Science Framework ( https://osf.io/ba3d2 ). Registered on November 15, 2020.
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Affiliation(s)
- Wilmer J. Santos
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON Canada
| | - Ian D. Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
- School of Epidemiology and Public Health, School of Nursing, University of Ottawa, Ottawa, ON Canada
| | - Michelle Lalonde
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON Canada
- Institut du Savoir Montfort, Hôpital Montfort, Ottawa, Canada
| | - Melissa Demery Varin
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON Canada
| | - Janet E. Squires
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
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Patey AM, Fontaine G, Francis JJ, McCleary N, Presseau J, Grimshaw JM. Healthcare professional behaviour: health impact, prevalence of evidence-based behaviours, correlates and interventions. Psychol Health 2022; 38:766-794. [PMID: 35839082 DOI: 10.1080/08870446.2022.2100887] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Healthcare professional (HCP) behaviours are actions performed by individuals and teams for varying and often complex patient needs. However, gaps exist between evidence-informed care behaviours and the care provided. Implementation science seeks to develop generalizable principles and approaches to investigate and address care gaps, supporting HCP behaviour change while building a cumulative science. We highlight theory-informed approaches for defining HCP behaviour and investigating the prevalence of evidence-based care and known correlates and interventions to change professional practice. Behavioural sciences can be applied to develop implementation strategies to support HCP behaviour change and provide valid, reliable tools to evaluate these strategies. There are thousands of different behaviours performed by different HCPs across many contexts, requiring different implementation approaches. HCP behaviours can include activities related to promoting health and preventing illness, assessing and diagnosing illnesses, providing treatments, managing health conditions, managing the healthcare system and building therapeutic alliances. The key challenge is optimising behaviour change interventions that address barriers to and enablers of recommended practice. HCP behaviours may be determined by, but not limited to, Knowledge, Social influences, Intention, Emotions and Goals. Understanding HCP behaviour change is a critical to ensuring advances in health psychology are applied to maximize population health.
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Affiliation(s)
- Andrea M. Patey
- Centre for Implementation Research, Ottawa Hospital Research Institute - General Campus, Ottawa, Ontario, Canada
| | - Guillaume Fontaine
- Centre for Implementation Research, Ottawa Hospital Research Institute - General Campus, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jillian J. Francis
- Centre for Implementation Research, Ottawa Hospital Research Institute - General Campus, Ottawa, Ontario, Canada
- School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Nicola McCleary
- Centre for Implementation Research, Ottawa Hospital Research Institute - General Campus, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Justin Presseau
- Centre for Implementation Research, Ottawa Hospital Research Institute - General Campus, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeremy M. Grimshaw
- Centre for Implementation Research, Ottawa Hospital Research Institute - General Campus, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Légaré F, Stacey D, Forest PG, Archambault P, Boland L, Coutu MF, Giguère AMC, LeBlanc A, Lewis KB, Witteman HO. Shared decision-making in Canada: Update on integration of evidence in health decisions and patient-centred care government mandates. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 171:22-29. [PMID: 35606312 DOI: 10.1016/j.zefq.2022.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
In Canada, government mandates for patient-centred care (PCC) vary across the 10 provinces and three territories. Although basic medical and hospital services are provided for all, health care options for patients also depend on having private insurance. Thus, the current design of the Canadian healthcare system has several implications for PCC and shared decision-making (SDM). Since 2007, this is our fourth update on SDM in Canada. The aim of this paper is to provide an update on the current state of SDM and patient and public involvement in Canada. Overall, we still observed the difficulty of implementing any sort of national strategy partly because of the decentralized nature of the healthcare system. Second, national professional education programs are complicated by licensure and scope of practice variations across jurisdictions. Third, there are variations in the availability of different options covered by universal healthcare. Canada has experienced some favorable development as PCC is now explicitly articulated in the policies of most provinces and territories and there are increased efforts to give patients more access to their electronic health records. However, patient and public engagement (PPE) reform in health programs and governance remains an exception, and continuing centralization of governance structures may reduce their responsiveness to patient priorities. In a 2018 survey, 47.2% of respondents reported that they were not told by their health professional that they had a choice about treatment. Nonetheless, decision aids and decision coaching are increasingly available for health-related decisions and the Ottawa Hospital Research Institute's decision aid inventory has ensured continued leadership in this area. Diverse jurisdictions are starting to embed decision aids into care pathways, with some decision aids being included in clinical practice guidelines. The COVID-19 pandemic may have had a negative impact on SDM by removing decision choices due to emergency public health mandates, but stimulated new research and decision aids. Canada continues to assign health research funding to SDM and PCC, and a program dedicated to patient-oriented research is central to this effort. Guides and frameworks are increasingly available for planning and evaluating PPE. Finally, various initiatives are attempting to involve and empower Indigenous peoples through PPE and SDM.
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Affiliation(s)
- France Légaré
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada; Research Centre of the Centre Hospitalier Universitaire de Québec, Quebec City, Canada.
| | - Dawn Stacey
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Patrick Archambault
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada; Research Centre of the Centre Hospitalier Universitaire de Québec, Quebec City, Canada; Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Canada; Department of Anesthesiology and Intensive Care Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
| | - Laura Boland
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marie-France Coutu
- Centre for Action in Work Disability Prevention and Rehabilitation affiliated with Hôpital Charles-Lemoyne Research Center, Rehabilitation School, Longueuil Campus - Université de Sherbrooke, Longueuil, Canada
| | - Anik M C Giguère
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada; Office of Education and Continuing Development, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
| | - Annie LeBlanc
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
| | - Krystina B Lewis
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; University of Ottawa Heart Institute, Ottawa, Canada
| | - Holly O Witteman
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada; Research Centre of the Centre Hospitalier Universitaire de Québec, Quebec City, Canada; Ottawa Hospital Research Institute, Ottawa, Canada; Office of Education and Continuing Development, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
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