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Chukwu OA, Nadigel J, Kasaai B, Boateng R, Glazier RH, McMahon M. Understanding the training, mentorship, and professional development priorities of early career embedded researchers. Int J Health Plann Manage 2024. [PMID: 38527109 DOI: 10.1002/hpm.3800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/02/2024] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
INTRODUCTION Health systems are constantly evolving in response to existing and emerging health challenges and are increasingly adopting the Quintuple Aim to guide transformation and improvement efforts. Addressing health challenges and achieving the Quintuple Aim (enhancing patient experience, improving healthcare provider experience, promoting population health, optimising the value of healthcare services, and advancing health equity) may be enhanced with the use of a Learning Health Systems approach that fosters the real-time use of data and evidence to inform improvement efforts and harnesses embedded researchers to co-produce timely, relevant evidence to address priorities. Training programs have emerged to build embedded research capacity within health system organisations and have focused predominantly on the postdoctoral career stage, with little attention paid to the early career researcher (ECR) stage. The objective of this study was to understand ECR training and mentorship needs in the embedded research context to inform the creation new or adaptation of existing programs to build embedded ECR capacity. METHODS This study used a qualitative approach to garner insight from embedded and applied scholars and health systems leaders in Canada from various professional backgrounds and at various career stages using a combination of focus group discussions, key informant interviews, and an online survey. Thematic content analysis was used to examine the responses of study participants within the interview themes. RESULTS Twenty-six (26) participants were included in the study. Results were organised according to four key themes: (1) key competencies and skills needed by embedded ECRs; (2) additional training and capacity development needs; (3) training delivery approaches; and (4) enablers and challenges faced by embedded ECRs. Results highlight the importance of supporting ECRs to develop their leadership and organisational management capabilities; their knowledge of and ability to use research approaches that are well-suited to real-world, complex, evolving environments; and their opportunities to learn with and from each other and mentors. Results underscore the perceived importance of context, including being embedded in a supportive environment that values research and evidence and of academic incentives that recognise and value real-world research impact. The challenges of responding to shifting organisational and system priorities were identified. Additional insights from health systems leaders were also highlighted. CONCLUSION This study identified the multifaceted needs of embedded ECRs and the challenges they face within healthcare systems. Designing new programs or tailoring existing ones to address these needs would build their capacity, foster career progression, and ensure their impact as leaders of evidence-informed health system improvement which is crucial for achieving the Quintuple Aim.
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Affiliation(s)
- Otuto Amarauche Chukwu
- CIHR Institute of Health Services and Policy Research, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jessica Nadigel
- CIHR Institute of Health Services and Policy Research, Toronto, Ontario, Canada
| | - Bahar Kasaai
- CIHR Institute of Health Services and Policy Research, Toronto, Ontario, Canada
| | - Rhonda Boateng
- CIHR Institute of Health Services and Policy Research, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Richard H Glazier
- CIHR Institute of Health Services and Policy Research, Toronto, Ontario, Canada
- ICES (Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Meghan McMahon
- CIHR Institute of Health Services and Policy Research, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, 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. Front Health Serv 2023; 3:1162762. [PMID: 37484830 PMCID: PMC10361069 DOI: 10.3389/frhs.2023.1162762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [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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Wyatt R, Tucker L, Mate K, Cerise F, Fernandez A, Jain S, Bau I, Wolfson D. A matter of trust: Commitment to act for health equity. Healthc (Amst) 2023; 11:100675. [PMID: 36693301 DOI: 10.1016/j.hjdsi.2023.100675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/23/2023]
Abstract
We believe these recommendations constitute "minimum requirements" for health care organizations to move toward greater health equity. As health systems, standards-setting organizations, national and private purchaser organizations, and thought leaders, we represent organizations in the health care ecosystem that can both advise on strategies for adopting the recommendations and have the power and leverage to cause their implementation. We commit individually and collectively to use our leverage to propel their implementation at our own institutions and across the county. We very much hope others will join us.
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Ramanathan S. Retrospective Impact Evaluation Continuing to Prove Challenging Irrespective of Setting: A Study of Research Impact Enablers and Challenges Cloaked as an Impact Evaluation? Comment on "'We're Not Providing the Best Care If We Are Not on the Cutting Edge of Research': A Research Impact Evaluation at a Regional Australian Hospital and Health Service". Int J Health Policy Manag 2023; 12:7742. [PMID: 37579477 PMCID: PMC10241435 DOI: 10.34172/ijhpm.2022.7742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/18/2022] [Indexed: 08/16/2023] Open
Abstract
The original article provides a detailed and insightful presentation of enablers and detractors for research participation, translation, and impact, at a regional Australian hospital and health service. This information builds on existing knowledge, from the perspective of a non-metropolitan healthcare organisation. It stands to inform all healthcare organisations keen to embed research into their institutions. However, what the article fails to do is present the results of the research impact evaluation in a systematic and useful way for the reader to assess the benefits of research investment by a healthcare organisation including delivery of better quality care and improved patient outcomes. This commentary suggests why such information is critical to justify continued research investment by healthcare organisations and to showcase the potential benefits of the embedded research model. It also discusses the limitations of undertaking impact evaluation retrospectively and suggests that a prospective approach coupled with proper data collection systems and processes upfront could help future reporting of organisational research impact.
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Affiliation(s)
- Shanthi Ramanathan
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
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Trinkley KE, Ho PM, Glasgow RE, Huebschmann AG. How Dissemination and Implementation Science Can Contribute to the Advancement of Learning Health Systems. Acad Med 2022; 97:1447-1458. [PMID: 35796045 PMCID: PMC9547828 DOI: 10.1097/acm.0000000000004801] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Many health systems are working to become learning health systems (LHSs), which aim to improve the value of health care by rapidly, continuously generating evidence to apply to practice. However, challenges remain to advance toward the aspirational goal of becoming a fully mature LHS. While some important challenges have been well described (i.e., building system-level supporting infrastructure and the accessibility of inclusive, integrated, and actionable data), other key challenges are underrecognized, including balancing evaluation rapidity with rigor, applying principles of health equity and classic ethics, focusing on external validity and reproducibility (generalizability), and designing for sustainability. Many LHSs focus on continuous learning cycles, but with limited consideration of issues related to the rapidity of these learning cycles, as well as the sustainability or generalizability of solutions. Some types of data have been consistently underrepresented, including patient-reported outcomes and preferences, social determinants, and behavioral and environmental data, the absence of which can exacerbate health disparities. A promising approach to addressing many challenges that LHSs face may be found in dissemination and implementation (D&I) science. With an emphasis on multilevel dynamic contextual factors, representation of implementation partner engagement, pragmatic research, sustainability, and generalizability, D&I science methods can assist in overcoming many of the challenges facing LHSs. In this article, the authors describe the current state of LHSs and challenges to becoming a mature LHS, propose solutions to current challenges, focusing on the contributions of D&I science with other methods, and propose key components and characteristics of a mature LHS model that others can use to plan and develop their LHSs.
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Affiliation(s)
- Katy E Trinkley
- K.E. Trinkley is associate professor, Departments of Clinical Pharmacy and Medicine and Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Center, and clinical informaticist, Department of Clinical Informatics, UCHealth, Aurora, Colorado; ORCID: http://orcid.org/0000-0003-2041-7404
| | - P Michael Ho
- P.M. Ho is professor, Department of Medicine, University of Colorado Anschutz Medical Campus, and professor, VA Eastern Colorado Health Care System, Aurora, Colorado; ORCID: http://orcid.org/0000-0002-7775-6266
| | - Russell E Glasgow
- R.E. Glasgow is research professor, Department of Family Medicine, and director, Dissemination and Implementation Science Program, ACCORDS, University of Colorado Anschutz Medical Center, Aurora, Colorado; ORCID: http://orcid.org/0000-0003-4218-3231
| | - Amy G Huebschmann
- A.G. Huebschmann is associate professor, Division of General Internal Medicine, ACCORDS and Ludeman Family Center for Women's Health Research, University of Colorado Anschutz Medical Center, Aurora, Colorado; ORCID: http://orcid.org/0000-0002-9329-3142
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Vilendrer S, Saliba‐Gustafsson EA, Asch SM, Brown‐Johnson CG, Kling SM, Shaw JG, Winget M, Larson DB. Evaluating clinician‐led quality improvement initiatives: A system‐wide embedded research partnership at Stanford Medicine. Learn Health Syst 2022; 6:e10335. [PMID: 36263267 PMCID: PMC9576232 DOI: 10.1002/lrh2.10335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Many healthcare delivery systems have developed clinician‐led quality improvement (QI) initiatives but fewer have also developed in‐house evaluation units. Engagement between the two entities creates unique opportunities. Stanford Medicine funded a collaboration between their Improvement Capability Development Program (ICDP), which coordinates and incentivizes clinician‐led QI efforts, and the Evaluation Sciences Unit (ESU), a multidisciplinary group of embedded researchers with expertise in implementation and evaluation sciences. Aim To describe the ICDP‐ESU partnership and report key learnings from the first 2 y of operation September 2019 to August 2021. Methods Department‐level physician and operational QI leaders were offered an ESU consultation to workshop design, methods, and overall scope of their annual QI projects. A steering committee of high‐level stakeholders from operational, clinical, and research perspectives subsequently selected three projects for in‐depth partnered evaluation with the ESU based on evaluability, importance to the health system, and broader relevance. Selected project teams met regularly with the ESU to develop mixed methods evaluations informed by relevant implementation science frameworks, while aligning the evaluation approach with the clinical teams' QI goals. Results Sixty and 62 ICDP projects were initiated during the 2 cycles, respectively, across 18 departments, of which ESU consulted with 15 (83%). Within each annual cycle, evaluators made actionable, summative findings rapidly available to partners to inform ongoing improvement. Other reported benefits of the partnership included rapid adaptation to COVID‐19 needs, expanded clinician evaluation skills, external knowledge dissemination through scholarship, and health system‐wide knowledge exchange. Ongoing considerations for improving the collaboration included the need for multi‐year support to enable nimble response to dynamic health system needs and timely data access. Conclusion Presence of embedded evaluation partners in the enterprise‐wide QI program supported identification of analogous endeavors (eg, telemedicine adoption) and cross‐cutting lessons across QI efforts, clinician capacity building, and knowledge dissemination through scholarship.
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Affiliation(s)
- Stacie Vilendrer
- Department of Medicine, Division of Primary Care and Population Health Stanford University School of Medicine California USA
| | - Erika A. Saliba‐Gustafsson
- Department of Medicine, Division of Primary Care and Population Health Stanford University School of Medicine California USA
| | - Steven M. Asch
- Department of Medicine, Division of Primary Care and Population Health Stanford University School of Medicine California USA
| | - Cati G. Brown‐Johnson
- Department of Medicine, Division of Primary Care and Population Health Stanford University School of Medicine California USA
| | - Samantha M.R. Kling
- Department of Medicine, Division of Primary Care and Population Health Stanford University School of Medicine California USA
| | - Jonathan G. Shaw
- Department of Medicine, Division of Primary Care and Population Health Stanford University School of Medicine California USA
| | - Marcy Winget
- Department of Medicine, Division of Primary Care and Population Health Stanford University School of Medicine California USA
| | - David B. Larson
- Department of Radiology Stanford University School of Medicine California USA
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Kilbourne AM, Schmidt J, Edmunds M, Vega R, Bowersox N, Atkins D. How the VA is training the Next‐Generation workforce for learning health systems. Learn Health Syst 2022; 6:e10333. [PMID: 36263263 PMCID: PMC9576233 DOI: 10.1002/lrh2.10333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/15/2022] [Accepted: 08/01/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives Methods Results Conclusions
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Affiliation(s)
- Amy M. Kilbourne
- Health Services Research and Development, Office of Research and Development, Veterans Health Administration U.S. Department of Veterans Affairs Washington District of Columbia USA
- Department of Learning Health Sciences University of Michigan Medical School Ann Arbor Michigan USA
| | - Joel Schmidt
- Advanced Fellowships Section, Office of Academic Affiliations, Veterans Health Administration U.S. Department of Veterans Affairs Washington District of Columbia USA
| | - Margo Edmunds
- Fellowship Programs AcademyHealth Washington District of Columbia USA
| | - Ryan Vega
- Health Innovation and Learning, Veterans Health Administration U.S. Department of Veterans Affairs Washington District of Columbia USA
| | - Nicholas Bowersox
- Health Services Research and Development, Office of Research and Development, Veterans Health Administration U.S. Department of Veterans Affairs Washington District of Columbia USA
- Department of Psychiatry University of Michigan Medical School Ann Arbor Michigan USA
| | - David Atkins
- Health Services Research and Development, Office of Research and Development, Veterans Health Administration U.S. Department of Veterans Affairs Washington District of Columbia USA
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Beidas RS, Dorsey S, Lewis CC, Lyon AR, Powell BJ, Purtle J, Saldana L, Shelton RC, Stirman SW, Lane-Fall MB. Promises and pitfalls in implementation science from the perspective of US-based researchers: learning from a pre-mortem. Implement Sci 2022; 17:55. [PMID: 35964095 PMCID: PMC9375077 DOI: 10.1186/s13012-022-01226-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 07/20/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Implementation science is at a sufficiently advanced stage that it is appropriate for the field to reflect on progress thus far in achieving its vision, with a goal of charting a path forward. In this debate, we offer such reflections and report on potential threats that might stymie progress, as well as opportunities to enhance the success and impact of the field, from the perspective of a group of US-based researchers. MAIN BODY Ten mid-career extramurally funded US-based researchers completed a "pre-mortem" or a group brainstorming exercise that leverages prospective hindsight to imagine that an event has already occurred and to generate an explanation for it - to reduce the likelihood of a poor outcome. We came to consensus on six key themes related to threats and opportunities for the field: (1) insufficient impact, (2) too much emphasis on being a "legitimate science," (3) re-creation of the evidence-to-practice gap, (4) difficulty balancing accessibility and field coherence, (5) inability to align timelines and priorities with partners, and (6) overly complex implementation strategies and approaches. CONCLUSION We submit this debate piece to generate further discussion with other implementation partners as our field continues to develop and evolve. We hope the key opportunities identified will enhance the future of implementation research in the USA and spark discussion across international groups. We will continue to learn with humility about how best to implement with the goal of achieving equitable population health impact at scale.
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Thompson HM, Clement AM, Ortiz R, Preston TM, Quantrell ALW, Enfield M, King AJ, Klosinski L, Reback CJ, Hamilton A, Milburn N. Community engagement to improve access to healthcare: a comparative case study to advance implementation science for transgender health equity. Int J Equity Health 2022; 21:104. [PMID: 35907962 PMCID: PMC9339189 DOI: 10.1186/s12939-022-01702-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent calls to action have been made for Implementation Science to attend to health inequities at the intersections of race, gender, and social injustice in the United States. Transgender people, particularly Black and Latina transgender women, experience a range of health inequities and social injustices. In this study, we compared two processes of transgender community engagement in Los Angeles and in Chicago as an implementation strategy to address inequitable access to care; we adapted and extended the Exploration Planning Implementation and Sustainment (EPIS) framework for transgender health equity. METHODS A comparative case method and the EPIS framework were used to examine parallel implementation strategies of transgender community engagement to expand access to care. To foster conceptual development and adaptation of EPIS for trans health equity, the comparative case method required detailed description, exploration, and analyses of the community-engagement processes that led to different interventions to expand access. In both cities, the unit of analysis was a steering committee made up of local transgender and cisgender stakeholders. RESULTS Both steering committees initiated their exploration processes with World Café-style, transgender community-engaged events in order to assess community needs and structural barriers to healthcare. The steering committees curated activities that amplified the voices of transgender community members among stakeholders, encouraging more effective and collaborative ways to advance transgender health equity. Based on analysis and findings from the Los Angeles town hall, the steering committee worked with a local medical school, extending the transgender medicine curriculum, and incorporating elements of transgender community-engagement. The Chicago steering committee determined from their findings that the most impactful intervention on structural racism and barriers to healthcare access would be to design and pilot an employment program for Black and Latina transgender women. CONCLUSION In Los Angeles and Chicago, transgender community engagement guided implementation processes and led to critical insights regarding specific, local barriers to healthcare. The steering committee itself represented an important vehicle for individual-, organizational-, and community-level relationship and capacity building. This comparative case study highlights key adaptations of EPIS toward the formation of an implementation science framework for transgender health equity.
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Affiliation(s)
- Hale M Thompson
- Rush University Medical Center, 1645 W. Jackson Blvd., Suite 302, Chicago, IL, 60612, USA.
| | - Allison M Clement
- University of California-Los Angeles, 760 Westwood Plaza A8-159A, Los Angeles, CA, 90095, USA
| | - Reyna Ortiz
- TaskForce Prevention & Community Services, 9 N. Cicero, Chicago, IL, 60644, USA
| | - Toni Marie Preston
- Howard Brown Health Center, 4025 N. Sheridan Road, Chicago, IL, 60613, USA
| | | | - Michelle Enfield
- AIDS Project Los Angeles, 5901 W. Olympic Blvd., Suite 310, Los Angeles, CA, 90036, USA
| | - A J King
- Center for AIDS Research, University of California-Los Angeles, 11075 Santa Monica Blvd, Suite 100, Los Angeles, CA, 90025, USA
| | - Lee Klosinski
- University of California-Los Angeles, 760 Westwood PlazaA8-159A, Los Angeles, CA, 90095, USA
| | - Cathy J Reback
- Friends Research Institute, 6910 Santa Monica Boulevard, Los Angeles, CA, 90038, USA
| | - Alison Hamilton
- University of California-Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Norweeta Milburn
- University of California-Los Angeles, 760 Westwood Plaza A8-159A, Los Angeles, CA, 90095, USA
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Damschroder LJ, Sussman JB, Pfeiffer PN, Kurlander JE, Freitag MB, Robinson CH, Spoutz P, Christopher MLD, Battar S, Dickerson K, Sedgwick C, Wallace-Lacey AG, Barnes GD, Linsky AM, Ulmer CS, Lowery JC. Maintaining Implementation through Dynamic Adaptations (MIDAS): protocol for a cluster-randomized trial of implementation strategies to optimize and sustain use of evidence-based practices in Veteran Health Administration (VHA) patients. Implement Sci Commun 2022; 3:53. [PMID: 35568903 PMCID: PMC9107220 DOI: 10.1186/s43058-022-00297-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/05/2022] [Indexed: 11/18/2022] Open
Abstract
Background The adoption and sustainment of evidence-based practices (EBPs) is a challenge within many healthcare systems, especially in settings that have already strived but failed to achieve longer-term goals. The Veterans Affairs (VA) Maintaining Implementation through Dynamic Adaptations (MIDAS) Quality Enhancement Research Initiative (QUERI) program was funded as a series of trials to test multi-component implementation strategies to sustain optimal use of three EBPs: (1) a deprescribing approach intended to reduce potentially inappropriate polypharmacy; (2) appropriate dosing and drug selection of direct oral anticoagulants (DOACs); and (3) use of cognitive behavioral therapy as first-line treatment for insomnia before pharmacologic treatment. We describe the design and methods for a harmonized series of cluster-randomized control trials comparing two implementation strategies. Methods For each trial, we will recruit 8–12 clinics (24–36 total). All will have access to relevant clinical data to identify patients who may benefit from the target EBP at that clinic and provider. For each trial, clinics will be randomized to one of two implementation strategies to improve the use of the EBPs: (1) individual-level academic detailing (AD) or (2) AD plus the team-based Learn. Engage. Act. Process. (LEAP) quality improvement (QI) learning program. The primary outcomes will be operationalized across the three trials as a patient-level dichotomous response (yes/no) indicating patients with potentially inappropriate medications (PIMs) among those who may benefit from the EBP. This outcome will be computed using month-by-month administrative data. Primary comparison between the two implementation strategies will be analyzed using generalized estimating equations (GEE) with clinic-level monthly (13 to 36 months) percent of PIMs as the dependent variable. Primary comparative endpoint will be at 18 months post-baseline. Each trial will also be analyzed independently. Discussion MIDAS QUERI trials will focus on fostering sustained use of EBPs that previously had targeted but incomplete implementation. Our implementation approaches are designed to engage frontline clinicians in a dynamic optimization process that integrates the use of actional clinical data and making incremental changes, designed to be feasible within busy clinical settings. Trial registration ClinicalTrials.gov: NCT05065502. Registered October 4, 2021—retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00297-z.
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Affiliation(s)
- Laura J Damschroder
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.
| | - Jeremy B Sussman
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Paul N Pfeiffer
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Jacob E Kurlander
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Michelle B Freitag
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | - Claire H Robinson
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | - Patrick Spoutz
- Veterans Health Affairs VISN 20 Pharmacy Benefits Management, Vancouver, WA, USA
| | - Melissa L D Christopher
- Pharmacy Benefits Management Services, Veterans Health Administration, 810 Vermont Ave NW, Washington DC, 20420, USA
| | - Saraswathy Battar
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
| | | | - Christopher Sedgwick
- Department of Veterans Affairs, VA Heartland Network (VISN 15), Kansas City, MO, USA
| | | | - Geoffrey D Barnes
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.,Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Amy M Linsky
- Section of General Medicine, VA Boston Healthcare System, Boston, MA, USA.,Center for Health Organizations and Implementation Research, VA Boston Healthcare System, Boston, MA, USA.,Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Christi S Ulmer
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Health Care System, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Julie C Lowery
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
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Caverly TJ, Skurla SE, Klamerus ML, Sparks JB, Kerr EA, Hofer TP, Reed D, Damschroder LJ. Applying User-Centered Design to Develop Practical Strategies that Address Overuse in Primary Care. J Gen Intern Med 2022; 37:57-63. [PMID: 34535845 DOI: 10.1007/s11606-021-07124-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Engaging patients and frontline clinicians in re-designing clinical care is essential for improving care delivery in a complex clinical environment. This study sought to assess an innovative user-centered design approach to improving clinical care quality, focusing on the use cases of de-intensifying non-beneficial care within the following areas: (1) de-intensifying diabetes treatment in high-risk patients; (2) stopping screening for carotid artery stenosis in asymptomatic patients; and (3) stopping colorectal cancer screening in average-risk, older adults. METHODS The user-centered design approach, consisting of patient and patient-clinician charrettes (defined as intensive workshops where key stakeholders collaborate to develop creative solutions to a specific problem) and participant surveys, has been described previously. Following the charrettes, we used inductive coding to identify and categorize themes emerging from the de-intensification ideas prioritized by participants as well as facilitator notes and audio recordings from the charrettes. RESULTS Thirty-five patients participated in the patient design charrettes, generating 134 unique de-intensification ideas and prioritizing 32, which were then distilled into six patient-generated principles of de-intensification by the study team. These principles provided a starting point for a subsequent patient-clinician charrette. In this follow-up charrette, 9 patients who had participated in an earlier patient design charrette collaborated with 7 clinicians to generate 63 potential de-intensification solutions. Six of these potential solutions were developed into multi-faceted, fully operationalized de-intensification strategies. DISCUSSION The de-intensification strategies that patients and clinicians prioritized and operationalized during the co-design charrette process were detailed and multi-faceted. Each component of a strategy had a rationale based on feasibility, practical considerations, and ways of overcoming barriers. The charrette-based process may be a useful way to engage clinicians and patients in developing the complex and multi-faceted strategies needed to improve care delivery.
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Kilbourne AM, Garrido MM, Brown A. Translating Research into Policy and Action. Health Serv Res 2022; 57 Suppl 1:5-8. [PMID: 35362119 PMCID: PMC9108221 DOI: 10.1111/1475-6773.13980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Amy M Kilbourne
- Quality Enhancement Research Initiative, U.S. Department of Veterans Affairs.,Department of Learning Health Sciences, University of Michigan
| | - Melissa M Garrido
- Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System.,Department of Health Law, Policy and Management, Boston University School of Public Health
| | - Arleen Brown
- Division of General Internal Medicine and Health Services Research, UCLA School of Medicine.,Olive View-UCLA Medical Center
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Damschroder LJ, Reardon CM, Opra Widerquist MA, Lowery J. Conceptualizing outcomes for use with the Consolidated Framework for Implementation Research (CFIR): the CFIR Outcomes Addendum. Implement Sci 2022; 17:7. [PMID: 35065675 PMCID: PMC8783408 DOI: 10.1186/s13012-021-01181-5] [Citation(s) in RCA: 135] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/14/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The challenges of implementing evidence-based innovations (EBIs) are widely recognized among practitioners and researchers. Context, broadly defined as everything outside the EBI, includes the dynamic and diverse array of forces working for or against implementation efforts. The Consolidated Framework for Implementation Research (CFIR) is one of the most widely used frameworks to guide assessment of contextual determinants of implementation. The original 2009 article invited critique in recognition for the need for the framework to evolve. As implementation science has matured, gaps in the CFIR have been identified and updates are needed. Our team is developing the CFIR 2.0 based on a literature review and follow-up survey with authors. We propose an Outcomes Addendum to the CFIR to address recommendations from these sources to include outcomes in the framework. MAIN TEXT We conducted a literature review and surveyed corresponding authors of included articles to identify recommendations for the CFIR. There were recommendations to add both implementation and innovation outcomes from these sources. Based on these recommendations, we make conceptual distinctions between (1) anticipated implementation outcomes and actual implementation outcomes, (2) implementation outcomes and innovation outcomes, and (3) CFIR-based implementation determinants and innovation determinants. CONCLUSION An Outcomes Addendum to the CFIR is proposed. Our goal is to offer clear conceptual distinctions between types of outcomes for use with the CFIR, and perhaps other determinant implementation frameworks as well. These distinctions can help bring clarity as researchers consider which outcomes are most appropriate to evaluate in their research. We hope that sharing this in advance will generate feedback and debate about the merits of our proposed addendum.
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Affiliation(s)
- Laura J Damschroder
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.
| | - Caitlin M Reardon
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | - Marilla A Opra Widerquist
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | - Julie Lowery
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
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Jackson GL, Damschroder LJ, White BS, Henderson B, Vega RJ, Kilbourne AM, Cutrona SL. Balancing reality in embedded research and evaluation: Low vs high embeddedness. Learn Health Syst 2021; 6:e10294. [PMID: 35434356 PMCID: PMC9006533 DOI: 10.1002/lrh2.10294] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/30/2021] [Accepted: 10/07/2021] [Indexed: 11/09/2022] Open
Abstract
Embedding research and evaluation into organizations is one way to generate “practice‐based” evidence needed to accelerate implementation of evidence‐based innovations within learning health systems. Organizations and researchers/evaluators vary greatly in how they structure and operationalize these collaborations. One key aspect is the degree of embeddedness: from low embeddedness where researchers/evaluators are located outside organizations (eg, outside evaluation consultants) to high embeddedness where researchers/evaluators are employed by organizations and thus more deeply involved in program evolution and operations. Pros and cons related to the degree of embeddedness (low vs high) must be balanced when developing these relationships. We reflect on this process within the context of an embedded, mixed‐methods evaluation of the Veterans Health Administration (VHA) Diffusion of Excellence (DoE) program. Considerations that must be balanced include: (a) low vs high alignment of goals; (b) low vs high involvement in strategic planning; (c) observing what is happening vs being integrally involved with programmatic activities; (d) reporting findings at the project's end vs providing iterative findings and recommendations that contribute to program evolution; and (e) adhering to predetermined aims vs adapting aims in response to evolving partner needs.
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Affiliation(s)
- George L. Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health Care System Durham North Carolina USA
- Department of Population Health Sciences Duke University Durham North Carolina USA
- Division of General Internal Medicine, Department of Medicine Duke University Durham North Carolina USA
- Department of Family Medicine and Community Health Duke University Durham North Carolina USA
| | - Laura J. Damschroder
- Center for Clinical Management Research VA Ann Arbor Healthcare System Ann Arbor Michigan USA
| | - Brandolyn S. White
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health Care System Durham North Carolina USA
| | - Blake Henderson
- Office of Healthcare Innovation and Learning United States Veterans Health Administration Washington District of Columbia USA
| | - Ryan J. Vega
- Office of Healthcare Innovation and Learning United States Veterans Health Administration Washington District of Columbia USA
| | - Amy M. Kilbourne
- Quality Enhancement Research Initiative (QUERI) United States Veterans Health Administration Washington District of Columbia USA
- Department of Learning Health Sciences University of Michigan Ann Arbor Michigan USA
| | - Sarah L. Cutrona
- Center for Healthcare Organization & Implementation Research Bedford & Boston VA Medical Centers Bedford Massachusetts USA
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences University of Massachusetts Medical School Worcester Massachusetts USA
- Division of General Internal Medicine, Department of Medicine University of Massachusetts Medical School Worcester Massachusetts USA
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