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Spalluto LB, Lewis JA, Stolldorf D, Yeh VM, Callaway-Lane C, Wiener RS, Slatore CG, Yankelevitz DF, Henschke CI, Vogus TJ, Massion PP, Moghanaki D, Roumie CL. Organizational Readiness for Lung Cancer Screening: A Cross-Sectional Evaluation at a Veterans Affairs Medical Center. J Am Coll Radiol 2021; 18:809-819. [PMID: 33421372 PMCID: PMC8180484 DOI: 10.1016/j.jacr.2020.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Lung cancer has the highest cancer-related mortality in the United States and among Veterans. Screening of high-risk individuals with low-dose CT (LDCT) can improve survival through detection of early-stage lung cancer. Organizational factors that aid or impede implementation of this evidence-based practice in diverse populations are not well described. We evaluated organizational readiness for change and change valence (belief that change is beneficial and valuable) for implementation of LDCT screening. METHODS We performed a cross-sectional survey of providers, staff, and administrators in radiology and primary care at a single Veterans Affairs Medical Center. Survey measures included Shea's validated Organizational Readiness for Implementing Change (ORIC) scale and Shea's 10 items to assess change valence. ORIC and change valence were scored on a scale from 1 to 7 (higher scores representing higher readiness for change or valence). Multivariable linear regressions were conducted to determine predictors of ORIC and change valence. RESULTS Of 523 employees contacted, 282 completed survey items (53.9% overall response rate). Higher ORIC scores were associated with radiology versus primary care (mean 5.48, SD 1.42 versus 5.07, SD 1.22, β = 0.37, P = .039). Self-identified leaders in lung cancer screening had both higher ORIC (5.56, SD 1.39 versus 5.11, SD 1.26, β = 0.43, P = .050) and change valence scores (5.89, SD 1.21 versus 5.36, SD 1.19, β = 0.51, P = .012). DISCUSSION Radiology health professionals have higher levels of readiness for change for implementation of LDCT screening than those in primary care. Understanding health professionals' behavioral determinants for change can inform future lung cancer screening implementation strategies.
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Affiliation(s)
- Lucy B Spalluto
- Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee; Vice Chair of Health Equity, Associate Director, Diversity and Inclusion Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee.
| | - Jennifer A Lewis
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Co-Director, Veterans Administration Tennessee Valley Healthcare System Lung Cancer Screening Program, Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee
| | - Deonni Stolldorf
- Chair, Vanderbilt University School of Nursing PhD Program Evaluation Committee, Chair, Vanderbilt University Competency Exam Committee, School of Nursing, Vanderbilt University, Nashville, Tennessee
| | - Vivian M Yeh
- Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee
| | - Carol Callaway-Lane
- Co-Director, Veterans Administration Tennessee Valley Healthcare System Lung Cancer Screening Program, Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee; Associate Director, Tennessee Valley Healthcare System Veterans Administration Quality Scholars Program, Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee
| | - Renda Soylemez Wiener
- Associate Director, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, Co-Chair, VISN1 Lung Cancer Screening Council, Deputy Chair, Pulmonary Field Advisory Committee, Veterans Health Administration, Boston Massachusetts; The Pulmonary Center, Boston University Medical Center, Boston, Massachusetts
| | - Christopher G Slatore
- Medical Director, Portland VA Medical Center Unsuspected Radiologic Findings System, Health Services Research and Development, Portland Veterans Affairs Medical Center, Portland, Oregon; Co-Director, Portland VA Medical Center Lung Cancer Screening Program, Section of Pulmonary and Critical Care Medicine, Portland Veterans Affairs Medical Center, Portland, Oregon; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - David F Yankelevitz
- Director, Lung Biopsy Service, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Claudia I Henschke
- Phoenix Veterans Health Care System, Phoenix, Arizona; Director of the Early Lung and Cardiac Action Program, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Timothy J Vogus
- Deputy Director of Business Innovation, Frist Center for Autism and Innovation, Vanderbilt University, Faculty Director, Leadership Development, Owen Graduate School of Management, Vanderbilt University, Nashville, Tennessee
| | - Pierre P Massion
- Director, Cancer Early Detection and Prevention Initiative at Vanderbilt-Ingram Cancer Center, Co-Leader, Cancer Health Outcomes and Control Program, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Department of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Veterans Health Administration-Tennessee Valley Healthcare System, Medical Service, Nashville, Tennessee
| | - Drew Moghanaki
- Section Chief, Department of Radiation Oncology, Atlanta VA Medical Center, Atlanta, Georgia; Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Christianne L Roumie
- Deputy Director, VA Tennessee Valley Healthcare System VA Quality Scholars Program, Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee; Director, Vanderbilt Master of Public Health Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Koelmeyer L, Gaitatzis K, Ridner SH, Boyages J, Nelms J, Hughes TM, Elder E, French J, Ngui N, Hsu J, Stolldorf D. Implementing a prospective surveillance and early intervention model of care for breast cancer-related lymphedema into clinical practice: application of the RE-AIM framework. Support Care Cancer 2021; 29:1081-1089. [PMID: 32613370 PMCID: PMC10979505 DOI: 10.1007/s00520-020-05597-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/23/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Chronic lymphedema following breast cancer (BC) affects individuals physically, functionally, psychologically, and financially. Despite national guidelines and evidence-based research supporting a prospective surveillance and early intervention model of care (PSM), bridging the gap between research and clinical practice has been difficult. METHOD As part of an international randomized controlled trial (RCT), Australian women with BC from four hospitals were recruited, monitored for lymphedema at regular intervals over a 3-year period, and were provided a compression garment if intervention was triggered. The reach, effectiveness, adoption, implementation and maintenance (RE-AIM) evaluation framework was used retrospectively to assess a PSM at the individual and organizational level for those who had completed at least 2-year follow-up (N = 219) in the RCT. RESULTS The application of the RE-AIM framework retrospectively demonstrated an extensive reach to patients across public and private settings; the effectiveness of prospective surveillance and early intervention was achieved through low progression rates to clinical lymphedema (1.8%), and all hospital sites initially approached adopted the research study. Key implementation strategies necessary for effectiveness of this model of care included education to health professionals and patients, staff acceptability, and development of a referral and care pathway. Maintenance dimensions were evaluated both at the individual level with 92-100% adherence rates for all nonoptional study appointments over the 2-year period, and at the organizational-level, PSM was sustained after recruitment ceased for the research study. CONCLUSION The PSM for lymphedema in BC can be successfully implemented using the RE-AIM framework applied retrospectively. The implementation of the PSM used in the RCT has assisted in changing clinical practices and improving the quality and effectiveness of the health care system.
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Affiliation(s)
- Louise Koelmeyer
- Australian Lymphoedema Education, Research and Treatment (ALERT) Program, Department of Clinical Medicine, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, Australia.
| | - Katrina Gaitatzis
- Australian Lymphoedema Education, Research and Treatment (ALERT) Program, Department of Clinical Medicine, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, Australia
| | | | - John Boyages
- Australian Lymphoedema Education, Research and Treatment (ALERT) Program, Department of Clinical Medicine, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, Australia
- Icon Cancer Centre, Sydney, NSW, Australia
| | - Jerrod Nelms
- TTi Health Research and Economics, Westminster, MD, USA
| | - T Michael Hughes
- Northern Surgical Oncology, Sydney Adventist Hospital, Sydney, NSW, Australia
- Sydney Adventist Hospital Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Elisabeth Elder
- Westmead Breast Cancer Institute and University of Sydney, Sydney, NSW, Australia
| | - James French
- Westmead Breast Cancer Institute and University of Sydney, Sydney, NSW, Australia
| | - Nicholas Ngui
- Northern Surgical Oncology, Sydney Adventist Hospital, Sydney, NSW, Australia
- Sydney Adventist Hospital Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Jeremy Hsu
- Westmead Breast Cancer Institute and University of Sydney, Sydney, NSW, Australia
- Macquarie University Hospital, Macquarie University, Sydney, Australia
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Stolldorf D, Germack HD, Harrison J, Riman K, Brom H, Cary M, Gilmartin H, Jones T, Norful A, Squires A. Health Equity Research in Nursing and Midwifery: Time to Expand Our Work. J Nurs Regul 2020; 11:51-61. [PMID: 32834909 PMCID: PMC7363434 DOI: 10.1016/s2155-8256(20)30110-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Stolldorf D, Koelmeyer L, Boyages J, Nelms J, Gaitatzis K, Ridner SH. Role of technology in a prospective surveillance and early intervention model for preventing lymphedema: The RE-AIM framework. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e14005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14005 Background: Translation of research derived technology into busy clinical practice can be difficult. The effectiveness of technology translation can be assessed by applying the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) evaluation framework. Methods: The RE-AIM evaluation framework was applied to the use of bioimpedance spectroscopy (BIS) in the prospective surveillance and early intervention model of care for breast cancer survivors at risk of arm lymphedema. Data was obtained during an interim analysis from four hospital sites (public and private settings) in Australia who were participating in the PREVENT international study. Women with breast cancer were monitored for lymphedema from a pre-treatment baseline and at regular intervals for a minimum of 12-months. Results: Each of the RE-AIM framework components were evaluated at patient, practitioner and institutional levels. Patients in both public (n = 50) and private settings (n = 61) were Reached with BIS technology which demonstrated Effectiveness of early surveillance with 16 participants being identified for an early prevention intervention. Each of the four sites Adopted the use of BIS technology using various Implemented strategies like education of all stakeholders and development of referral and care pathways. Adherence rates for mandatory study visits was 88. 48% for the prospective surveillance and the early intervention model of care group and were Maintained for a minimum 12 months following completion of the recruitment phase of the study. Conclusions: The effectiveness of using a technology such as BIS in a prospective surveillance and early intervention model of care in breast cancer in both public and private settings has been demonstrated using the RE-AIM framework. The translation of research into clinical practice has been successfully achieved with the PREVENT study. Clinical trial information: NCT02167659.
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Affiliation(s)
| | | | - John Boyages
- Macquarie University Hospital, Macquarie University, NSW, Australia
| | - Jerrod Nelms
- TTi Health Research and Economics, Westminster, MD
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Spalluto L, Lewis J, Callaway-Lane C, Stolldorf D, Prusaczyk B, Limper H, Audet C, Vogus T, Wiener R, Slatore C, Yankelevitz D, Henschke C, Dittus R, Massion P, Lindsell C, Kripalani S, Moghanaki D, Roumie C. P2.11-33 Organizational Readiness for Implementation of Lung Cancer Screening in a Veterans Affairs Healthcare System. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mixon AS, Smith GR, Mallouk M, Nieva HR, Kripalani S, Rennke S, Chu E, Sridharan A, Dalal A, Mueller S, Williams M, Wetterneck T, Stein JM, Stolldorf D, Howell E, Orav J, Labonville S, Levin B, Yoon C, Gresham M, Goldstein J, Platt S, Nyenpan C, Schnipper JL. Design of MARQUIS2: study protocol for a mentored implementation study of an evidence-based toolkit to improve patient safety through medication reconciliation. BMC Health Serv Res 2019; 19:659. [PMID: 31511070 PMCID: PMC6737715 DOI: 10.1186/s12913-019-4491-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 11/27/2018] [Accepted: 08/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The first Multi-center Medication Reconciliation Quality Improvement Study (MARQUIS1) demonstrated that implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in five hospitals. We sought to implement the MARQUIS toolkit in more diverse hospitals, incorporating lessons learned from MARQUIS1. METHODS MARQUIS2 is a pragmatic, mentored implementation QI study which collected clinical and implementation outcomes. Sites implemented a revised toolkit, which included interventions from these domains: 1) best possible medication history (BPMH)-taking; 2) discharge medication reconciliation and patient/caregiver counseling; 3) identifying and defining clinician roles and responsibilities; 4) risk stratification; 5) health information technology improvements; 6) improved access to medication sources; 7) identification and correction of real-time discrepancies; and, 8) stakeholder engagement. Eight hospitalists mentored the sites via one site visit and monthly phone calls over the 18-month intervention period. Each site's local QI team assessed opportunities to improve, implemented at least one of the 17 toolkit components, and accessed a variety of resources (e.g. implementation manual, webinars, and workshops). Outcomes to be assessed will include unintentional medication discrepancies per patient. DISCUSSION A mentored multi-center medication reconciliation QI initiative using a best practices toolkit was successfully implemented across 18 medical centers. The 18 participating sites varied in size, teaching status, location, and electronic health record (EHR) platform. We introduce barriers to implementation and lessons learned from MARQUIS1, such as the importance of utilizing dedicated, trained medication history takers, simple EHR solutions, clarifying roles and responsibilities, and the input of patients and families when improving medication reconciliation.
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Affiliation(s)
- Amanda S Mixon
- GRECC, VA Tennessee Valley Healthcare System and Section of Hospital Medicine, Vanderbilt University Medical Center, Suite 450, 2525 West End Avenue, Nashville, TN, 37203, USA.
| | - G Randy Smith
- Hospital Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Meghan Mallouk
- Center for Quality Improvement, Society of Hospital Medicine, Philadelphia, PA, USA
| | - Harry Reyes Nieva
- Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sunil Kripalani
- Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephanie Rennke
- Division of Hospital Medicine, University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Eugene Chu
- Division of Hospital Medicine, Parkland Health and Hospital System and Department of Internal Medicine, University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | | | - Anuj Dalal
- Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephanie Mueller
- Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark Williams
- Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Tosha Wetterneck
- Division of General Internal Medicine, University of Wisconsin, Madison, WI, USA
| | | | | | - Eric Howell
- Division of Collaborative Inpatient Medicine Service, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - John Orav
- Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephanie Labonville
- Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian Levin
- Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Catherine Yoon
- Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marcus Gresham
- Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jenna Goldstein
- Center for Hospital Innovation and Improvement, Society of Hospital Medicine, Philadelphia, PA, USA
| | - Sara Platt
- Center for Quality Improvement, Society of Hospital Medicine, Philadelphia, PA, USA
| | - Christopher Nyenpan
- Center for Quality Improvement, Society of Hospital Medicine, Philadelphia, PA, USA
| | - Jeffrey L Schnipper
- Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Squires A, Germack H, Muench U, Stolldorf D, Witkoski-Stimpfel A, Yakusheva O, Brom H, Harrison J, Patel E, Riman K, Martsolf G. The Interdisciplinary Research Group on Nursing Issues: Advancing Health Services Research, Policy, Regulation, and Practice. J Nurs Regul 2019; 10:55-59. [PMID: 36844480 PMCID: PMC9957562 DOI: 10.1016/s2155-8256(19)30116-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Allison Squires
- Rory Meyers College of Nursing, New York University, New York City
| | - Hayley Germack
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pennsylvania
| | - Ulrike Muench
- School of Nursing, University of California, San Francisco
| | | | | | | | - Heather Brom
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia
| | - Jordan Harrison
- Center for Health Outcomes and Policy Research, University of Pennsylvania
| | - Esita Patel
- School of Nursing, University of North Carolina-Chapel Hill
| | - Kathryn Riman
- Center for Health Outcomes and Policy Research, University of Pennsylvania
| | - Grant Martsolf
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, and a RAND Affiliated Adjunct Policy Researcher
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Abstract
Health care organizations are continually challenged with improving the safety of and the quality of care delivered to patients. Research studies often bring to the forefront interventions that health care organizations may choose to institute in an effort to provide evidence-based, quality care. Rapid response teams are one such intervention. Rapid response teams were introduced by the Institute for Healthcare Improvement as part of their "100,000 Lives" Campaign. Rapid response teams are one initiative health care organizations can implement in an effort to improve the quality of care delivered to patients. This article uses Donabedian's model of structure, process, and outcomes to discuss the United States health care systems, rapid response teams, and the outcomes of rapid response teams. National and organizational policy implications associated with rapid response teams are discussed and recommendations made for future research.
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Sandifer MG, Stolldorf D. Psychotropic drug prescribing in a family medicine residency program. J Fam Pract 1980; 11:1077-1080. [PMID: 7452166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The records of 201 patients in a family medicine training clinic were examined for frequency of prescription of psychotropic drugs. It was found that 11.5 percent (23/201 patients) had received a psychotropic drug over an average clinic visit time of 2 1/2 years. Patients were primarily female (2:1), with the socioeconomic status skewed towards the lower end, and with patient age ranging from 18 to 87 years. It was found that most psychotropic drugs were prescribed for short periods of time, with the prescriptions ranging from 1 month to 4 1/2 years. That only 11.5 percent of patients received a psychotropic drug was lower than expected. The clinic's conceptualization of the role of psychotropic drugs, the different approach utilized in data collection, or characteristics of the "training" setting, may account for these phenomena.
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