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Chao CR, Xu L, Cannizzaro N, Bronstein D, Choi Y, Riewerts R, Mittman B, Zimmerman RK, Gilkey M, Glenn B, Shen E, Hsu C, Hahn EE. Trends in HPV vaccine administration and HPV vaccine coverage in children by race/ethnicity and socioeconomic status during the COVID-19 pandemic in an integrated health care system in California. Vaccine 2022; 40:6575-6580. [PMID: 36243591 PMCID: PMC9527222 DOI: 10.1016/j.vaccine.2022.09.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 06/17/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND We sought to evaluate the trends of HPV vaccination between 03/2019-09/2021 and whether the impact of the COVID pandemic on HPV vaccination varied by race/ethnicity and neighborhood deprivation index (NDI). METHODS Electronic medical records at Kaiser Permanente Southern California were used to assess monthly volume of HPV vaccine doses administered among children aged 9-12.9yrs, and up-to-date coverage (% vaccinated) by age 13 between 03/2019-09/2021. Modified Poisson models were used to evaluate the interactions between race/ethnicity, NDI and the pandemic periods on HPV vaccine coverage. RESULTS HPV vaccine doses administered in 2020/2021 have returned to the 2019 level after the initial drop. The average up-to-date coverage in 05/2021-09/2021 (54.8%) remained lower than the pre-pandemic level (58.5%). The associations between race/ethnicity, NDI and HPV vaccine coverage did not vary due to the pandemic. CONCLUSION HPV vaccine promotion efforts are needed to address COVID-19 pandemic's lasting impact on HPV vaccination coverage.
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Affiliation(s)
- Chun R. Chao
- Department of Research and Evaluation, Kaiser Permanente, Pasadena, CA, USA,Corresponding author at: Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Robles Ave, 2nd floor, Pasadena, CA 91101, USA
| | - Lanfang Xu
- Department of Research and Evaluation, Kaiser Permanente, Pasadena, CA, USA
| | - Nancy Cannizzaro
- Department of Research and Evaluation, Kaiser Permanente, Pasadena, CA, USA
| | - David Bronstein
- Department of Pediatrics, Kaiser Permanente, Palmdale, CA 93552, USA
| | - Yunsun Choi
- Department of Pediatrics, Kaiser Permanente, Los Angeles, CA 90034, USA
| | - Robert Riewerts
- Department of Pediatrics, Kaiser Permanente, Baldwin Park, CA 91706, USA
| | - Brian Mittman
- Department of Research and Evaluation, Kaiser Permanente, Pasadena, CA, USA
| | - Richard K. Zimmerman
- Department of Family Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA 15260, USA
| | - Melissa Gilkey
- Department of Health Behavior, University of North Carolina, Gillings School of Public Health, Chapel Hill, NC 27599, USA
| | - Beth Glenn
- Department Health Policy and Management, University of Los Angeles, Fielding School of Public Health, Los Angeles, CA 90095, USA
| | - Ernest Shen
- Department of Research and Evaluation, Kaiser Permanente, Pasadena, CA, USA
| | - Chunyi Hsu
- Department of Research and Evaluation, Kaiser Permanente, Pasadena, CA, USA
| | - Erin E. Hahn
- Department of Research and Evaluation, Kaiser Permanente, Pasadena, CA, USA
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Gropen TI, Ivankova NV, Beasley M, Hess EP, Mittman B, Gazi M, Minor M, Crawford W, Floyd AB, Varner GL, Lyerly MJ, Shoemaker CC, Owens J, Wilson K, Gray J, Kamal S. Trauma Communications Center Coordinated Severity-Based Stroke Triage: Protocol of a Hybrid Type 1 Effectiveness-Implementation Study. Front Neurol 2021; 12:788273. [PMID: 34938265 PMCID: PMC8686821 DOI: 10.3389/fneur.2021.788273] [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: 10/01/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Mechanical thrombectomy (MT) can improve the outcomes of patients with large vessel occlusion (LVO), but a minority of patients with LVO are treated and there are disparities in timely access to MT. In part, this is because in most regions, including Alabama, the emergency medical service (EMS) transports all patients with suspected stroke, regardless of severity, to the nearest stroke center. Consequently, patients with LVO may experience delayed arrival at stroke centers with MT capability and worse outcomes. Alabama's trauma communications center (TCC) coordinates EMS transport of trauma patients by trauma severity and regional hospital capability. Our aims are to develop a severity-based stroke triage (SBST) care model based on Alabama's trauma system, compare the effectiveness of this care pathway to current stroke triage in Alabama for improving broad, equitable, and timely access to MT, and explore stakeholder perceptions of the intervention's feasibility, appropriateness, and acceptability. Methods: This is a hybrid type 1 effectiveness-implementation study with a multi-phase mixed methods sequential design and an embedded observational stepped wedge cluster trial. We will extend TCC guided stroke severity assessment to all EMS regions in Alabama; conduct stakeholder interviews and focus groups to aid in development of region and hospital specific prehospital and inter-facility stroke triage plans for patients with suspected LVO; implement a phased rollout of TCC Coordinated SBST across Alabama's six EMS regions; and conduct stakeholder surveys and interviews to assess context-specific perceptions of the intervention. The primary outcome is the change in proportion of prehospital stroke system patients with suspected LVO who are treated with MT before and after implementation of TCC Coordinated SBST. Secondary outcomes include change in broad public health impact before and after implementation and stakeholder perceptions of the intervention's feasibility, appropriateness, and acceptability using a mixed methods approach. With 1200 to 1300 total observations over 36 months, we have 80% power to detect a 15% improvement in the primary endpoint. Discussion: This project, if successful, can demonstrate how the trauma system infrastructure can serve as the basis for a more integrated and effective system of emergency stroke care.
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Affiliation(s)
- Toby I Gropen
- Division of Cerebrovascular Disease, The University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Mark Beasley
- The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Erik P Hess
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Brian Mittman
- Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Melissa Gazi
- The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Michael Minor
- The University of Alabama at Birmingham, Birmingham, AL, United States
| | - William Crawford
- The Office of Emergency Medical Services, Alabama Department of Public Health, Montgomery, AL, United States
| | - Alice B Floyd
- The Office of Emergency Medical Services, Alabama Department of Public Health, Prattville, AL, United States
| | - Gary L Varner
- The Office of Emergency Medical Services, Alabama Department of Public Health, Montgomery, AL, United States
| | - Michael J Lyerly
- The University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Jackie Owens
- Mobile Infirmary Medical Center, Mobile, AL, United States
| | - Kent Wilson
- The Office of Emergency Medical Services, Alabama Department of Public Health, Prattville, AL, United States
| | - Jamie Gray
- The Office of Emergency Medical Services, Alabama Department of Public Health, Montgomery, AL, United States
| | - Shaila Kamal
- The University of Alabama at Birmingham, Birmingham, AL, United States
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Mularski RA, Mittman B, Haupt E, Wang S, Scholle S, McMullen C, Henry M, Shen E, Nguyen HQ. Performance of Patient-Reported Outcome Measures in a Large Pragmatic Trial of Home-Based Palliative Care (HomePal): Methodological and Practical Considerations for Embedded Patient-Centered Design. J Palliat Med 2021; 25:620-627. [PMID: 34735285 DOI: 10.1089/jpm.2021.0164] [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] [Indexed: 11/12/2022] Open
Abstract
Background: The research enterprise has embraced patient centeredness in embedded efficient pragmatic trials, but limited data exist on using patient-reported outcomes (PROs) collected as part of usual clinical care for research. Objectives: We sought to assess the performance of different assessment methods for obtaining PROs in a pragmatic cluster randomized trial (HomePal study) designed to compare two models of home-based palliative care (HBPC). Design: Descriptive analytics, comparative trends, and psychometric performance of PROs collected in the HomePal study; measures included Edmonton Symptom Assessment System (ESAS), PROMIS-10, and others administered at baseline, 1, and 6 months. Setting/Subjects: HomePal was conducted in the Southern California and Northwest Kaiser Permanente regions in the United States; subjects were patients receiving HBPC and their caregivers. Measurements: We specifically compared ESAS obtained by research staff with those obtained by clinical HBPC nurses at the time of HBPC enrollment. We also compared ESAS completed by patients versus if done or assisted by a caregiver (proxy). Results: We enrolled 3533 patients and had 2205 ESAS measurements that met the criteria for analysis at baseline and 1447 at the one-month follow-up assessment. Research staff-obtained ESAS at admission to HBPC was higher overall (indicating more symptoms) than the clinically collected measure whether symptoms were reported by patients (31.7 ± 15.4 vs. 26.0 ± 13.4) or by proxies (36.9 ± 15.6 vs. 26.5 ± 13.5). These differences persisted with follow-up ESAS measures. Conclusions: We identified significant variability in PRO responses between different surveyors and whether proxy interaction was needed suggesting complex issues around PRO measure performance for pragmatic embedded trials. ClinicalTrials.gov Identifier: NCT03694431.
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Affiliation(s)
- Richard A Mularski
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Brian Mittman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Portland, Oregon, USA
| | - Eric Haupt
- Department of Research and Evaluation, Kaiser Permanente Southern California, Portland, Oregon, USA
| | - Susan Wang
- West Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles, California, USA
| | - Sarah Scholle
- National Committee for Quality Assurance (NCQA), Washington, DC, USA
| | - Carmit McMullen
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | | | - Ernest Shen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Portland, Oregon, USA
| | - Huong Q Nguyen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Portland, Oregon, USA
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Li J, Clouser JM, Brock J, Davis T, Jack B, Levine C, Mays GP, Mittman B, Nguyen H, Sorra J, Stromberg A, Du G, Dai C, Adu A, Vundi N, Williams MV. Effects of Different Transitional Care Strategies on Outcomes after Hospital Discharge-Trust Matters, Too. Jt Comm J Qual Patient Saf 2021; 48:40-52. [PMID: 34764025 DOI: 10.1016/j.jcjq.2021.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/08/2021] [Accepted: 09/21/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND As health systems shift toward value-based care, strategies to reduce readmissions and improve patient outcomes become increasingly important. Despite extensive research, the combinations of transitional care (TC) strategies associated with best patient-centered outcomes remain uncertain. METHODS Using an observational, prospective cohort study design, Project ACHIEVE sought to determine the association of different combinations of TC strategies with patient-reported and postdischarge health care utilization outcomes. Using purposive sampling, the research team recruited a diverse sample of short-term acute care and critical access hospitals in the United States (N = 42) and analyzed data on eligible Medicare beneficiaries (N = 7,939) discharged from their medical/surgical units. Using both hospital- and patient-reported TC strategy exposure data, the project compared patients "exposed" to each of five overlapping groups of TC strategies to their "control" counterparts. Primary outcomes included 30-day hospital readmissions, 7-day postdischarge emergency department (ED) visits and patient-reported physical and mental health, pain, and participation in daily activities. RESULTS Participants averaged 72.3 years old (standard deviation =10.1), 53.4% were female, and most were White (78.9%). Patients exposed to one TC group (Hospital-Based Trust, Plain Language, and Coordination) were less likely to have 30-day readmissions (risk ratio [RR], 0.72; 95% confidence interval [CI] = 0.57-0.92, p < 0.001) or 7-day ED visits (RR, 0.72; 95% CI, 0.55-0.93, p < 0.001) and more likely to report excellent physical and mental health, greater participation in daily activities, and less pain (RR ranged from 1.11 to 1.15, p < 0.01). CONCLUSION In concert with care coordination activities that bridge the transition from hospital to home, hospitals' clear communication and fostering of trust with patients were associated with better patient-reported outcomes and reduced health care utilization.
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Lewis CC, Powell BJ, Brewer SK, Nguyen AM, Schriger SH, Vejnoska SF, Walsh-Bailey C, Aarons GA, Beidas RS, Lyon AR, Weiner B, Williams N, Mittman B. Advancing mechanisms of implementation to accelerate sustainable evidence-based practice integration: protocol for generating a research agenda. BMJ Open 2021; 11:e053474. [PMID: 34663668 PMCID: PMC8524292 DOI: 10.1136/bmjopen-2021-053474] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/04/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Mechanisms explain how implementation strategies work. Implementation research requires careful operationalisation and empirical study of the causal pathway(s) by which strategies effect change, and factors that may amplify or weaken their effects. Understanding mechanisms is critically important to replicate findings, learn from negative studies or adapt an implementation strategy developed in one setting to another. Without understanding implementation mechanisms, it is difficult to design strategies to produce expected effects across contexts, which may have disproportionate effects on settings in which priority populations receive care. This manuscript outlines the protocol for an Agency for Healthcare Research and Quality-funded initiative to: (1) establish priorities for an agenda to guide research on implementation mechanisms in health and public health, and (2) disseminate the agenda to research, policy and practice audiences. METHODS AND ANALYSIS A network of scientific experts will convene in 'Deep Dive' meetings across 3 years. A research agenda will be generated through analysis and synthesis of information from six sources: (1) systematic reviews, (2) network members' approaches to studying mechanisms, (3) new proposals presented in implementation proposal feedback sessions, (4) working group sessions conducted in a leading implementation research training institute, (5) breakout sessions at the Society for Implementation Research Collaboration's (SIRC) 2019 conference and (6) SIRC conference abstracts. Two members will extract mechanism-relevant text segments from each data source and a third member will generate statements as an input for concept mapping. Concept mapping will generate unique clusters of challenges, and the network will engage in a nominal group process to identify priorities for the research agenda. ETHICS AND DISSEMINATION This initiative will yield an actionable research agenda to guide research to identify and test mechanisms of change for implementation strategies. The agenda will be disseminated via multiple channels to solicit feedback and promote rigorous research on implementation mechanisms.
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Affiliation(s)
- Cara C Lewis
- MacColl Center, Kaiser Permanente, Seattle, Washington, USA
| | - Byron J Powell
- Brown School, Washington University in St Louis, St. Louis, Missouri, USA
| | - Stephanie K Brewer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ann M Nguyen
- Center for State Health Policy, Rutgers, New Brunswick, New Jersey, USA
| | - Simone H Schriger
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah F Vejnoska
- Department of Psychiatry and Behavioral Sciences, UC Davis MIND Institute, Sacramento, California, USA
| | | | - Gregory A Aarons
- Department of Psychiatry and Dissemination and Implementation Science Center, University of California San Diego, La Jolla, California, USA
| | - Rinad S Beidas
- Departments of Psychiatry, Medical Ethics and Health Policy, and Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Penn Implementation Science Center at the Leonard Davis Institute (PISCE@LDI), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Bryan Weiner
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - Brian Mittman
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
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Towfighi A, Cheng EM, Ayala-Rivera M, Barry F, McCreath H, Ganz DA, Lee ML, Sanossian N, Mehta B, Dutta T, Razmara A, Bryg R, Song SS, Willis P, Wu S, Ramirez M, Richards A, Jackson N, Wacksman J, Mittman B, Tran J, Johnson RR, Ediss C, Sivers-Teixeira T, Shaby B, Montoya AL, Corrales M, Mojarro-Huang E, Castro M, Gomez P, Muñoz C, Garcia D, Moreno L, Fernandez M, Lopez E, Valdez S, Haber HR, Hill VA, Rao NM, Martinez B, Hudson L, Valle NP, Vickrey BG. Effect of a Coordinated Community and Chronic Care Model Team Intervention vs Usual Care on Systolic Blood Pressure in Patients With Stroke or Transient Ischemic Attack: The SUCCEED Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2036227. [PMID: 33587132 PMCID: PMC7885035 DOI: 10.1001/jamanetworkopen.2020.36227] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
IMPORTANCE Few stroke survivors meet recommended cardiovascular goals, particularly among racial/ethnic minority populations, such as Black or Hispanic individuals, or socioeconomically disadvantaged populations. OBJECTIVE To determine if a chronic care model-based, community health worker (CHW), advanced practice clinician (APC; including nurse practitioners or physician assistants), and physician team intervention improves risk factor control after stroke in a safety-net setting (ie, health care setting where all individuals receive care, regardless of health insurance status or ability to pay). DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial included participants recruited from 5 hospitals serving low-income populations in Los Angeles County, California, as part of the Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities (SUCCEED) clinical trial. Inclusion criteria were age 40 years or older; experience of ischemic or hemorrhagic stroke or transient ischemic attack (TIA) no more than 90 days prior; systolic blood pressure (BP) of 130 mm Hg or greater or 120 to 130 mm Hg with history of hypertension or using hypertensive medications; and English or Spanish language proficiency. The exclusion criterion was inability to consent. Among 887 individuals screened for eligibility, 542 individuals were eligible, and 487 individuals were enrolled and randomized, stratified by stroke type (ischemic or TIA vs hemorrhagic), language (English vs Spanish), and site to usual care vs intervention in a 1:1 fashion. The study was conducted from February 2014 to September 2018, and data were analyzed from October 2018 to November 2020. INTERVENTIONS Participants randomized to intervention were offered a multimodal coordinated care intervention, including hypothesized core components (ie, ≥3 APC clinic visits, ≥3 CHW home visits, and Chronic Disease Self-Management Program workshops), and additional telephone visits, protocol-driven risk factor management, culturally and linguistically tailored education materials, and self-management tools. Participants randomized to the control group received usual care, which varied by site but frequently included a free BP monitor, self-management tools, and linguistically tailored information materials. MAIN OUTCOMES AND MEASURES The primary outcome was change in systolic BP at 12 months. Secondary outcomes were non-high density lipoprotein cholesterol, hemoglobin A1c, and C-reactive protein (CRP) levels, body mass index, antithrombotic adherence, physical activity level, diet, and smoking status at 12 months. Potential mediators assessed included access to care, health and stroke literacy, self-efficacy, perceptions of care, and BP monitor use. RESULTS Among 487 participants included, the mean (SD) age was 57.1 (8.9) years; 317 (65.1%) were men, and 347 participants (71.3%) were Hispanic, 87 participants (18.3%) were Black, and 30 participants (6.3%) were Asian. A total of 246 participants were randomized to usual care, and 241 participants were randomized to the intervention. Mean (SD) systolic BP improved from 143 (17) mm Hg at baseline to 133 (20) mm Hg at 12 months in the intervention group and from 146 (19) mm Hg at baseline to 137 (22) mm Hg at 12 months in the usual care group, with no significant differences in the change between groups. Compared with the control group, participants in the intervention group had greater improvements in self-reported salt intake (difference, 15.4 [95% CI, 4.4 to 26.0]; P = .004) and serum CRP level (difference in log CRP, -0.4 [95% CI, -0.7 to -0.1] mg/dL; P = .003); there were no differences in other secondary outcomes. Although 216 participants (89.6%) in the intervention group received some of the 3 core components, only 35 participants (14.5%) received the intended full dose. CONCLUSIONS AND RELEVANCE This randomized clinical trial of a complex multilevel, multimodal intervention did not find vascular risk factor improvements beyond that of usual care; however, further studies may consider testing the SUCCEED intervention with modifications to enhance implementation and participant engagement. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01763203.
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Affiliation(s)
- Amytis Towfighi
- University of Southern California, Los Angeles
- Los Angeles County Department of Health Services, Los Angeles, California
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- LAC+USC Medical Center, Los Angeles, California
| | | | - Monica Ayala-Rivera
- University of Southern California, Los Angeles
- Los Angeles County Department of Health Services, Los Angeles, California
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- LAC+USC Medical Center, Los Angeles, California
| | | | | | - David A. Ganz
- University of California, Los Angeles
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Martin L. Lee
- University of California, Los Angeles
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Nerses Sanossian
- University of Southern California, Los Angeles
- LAC+USC Medical Center, Los Angeles, California
| | - Bijal Mehta
- University of California, Los Angeles
- Harbor-UCLA Medical Center, Torrance, California
| | - Tara Dutta
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- University of Maryland, Baltimore
| | - Ali Razmara
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- Kaiser Permanente, Irvine, California
| | - Robert Bryg
- University of California, Los Angeles
- Olive View-UCLA Medical Center, Sylmar, California
| | - Shlee S. Song
- Cedars Sinai Medical Center, Los Angeles, California
| | - Phyllis Willis
- Watts Labor Community Action Committee, Los Angeles, California
| | - Shinyi Wu
- University of Southern California, Los Angeles
| | - Magaly Ramirez
- University of Washington School of Public Health, Seattle
| | - Adam Richards
- Community Partners International, San Francisco, California
| | | | | | - Brian Mittman
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Kaiser Permanente, Los Angeles, California
| | - Jamie Tran
- Harbor-UCLA Medical Center, Torrance, California
| | - Renee R. Johnson
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- LAC+USC Medical Center, Los Angeles, California
- California State University, Los Angeles
| | - Chris Ediss
- Rancho Los Amigos National Rehabilitation Center, Downey, California
| | - Theresa Sivers-Teixeira
- University of Southern California, Los Angeles
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- LAC+USC Medical Center, Los Angeles, California
| | - Betty Shaby
- Olive View-UCLA Medical Center, Sylmar, California
| | - Ana L. Montoya
- Harbor-UCLA Medical Center, Torrance, California
- Olive View-UCLA Medical Center, Sylmar, California
| | - Marilyn Corrales
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- LAC+USC Medical Center, Los Angeles, California
- University of California, Riverside
| | - Elizabeth Mojarro-Huang
- University of Southern California, Los Angeles
- LAC+USC Medical Center, Los Angeles, California
| | - Marissa Castro
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- Cedars Sinai Medical Center, Los Angeles, California
| | - Patricia Gomez
- Rancho Los Amigos National Rehabilitation Center, Downey, California
| | - Cynthia Muñoz
- University of Southern California, Los Angeles
- Rancho Los Amigos National Rehabilitation Center, Downey, California
| | - Diamond Garcia
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- Harbor-UCLA Medical Center, Torrance, California
| | - Lilian Moreno
- Rancho Los Amigos National Rehabilitation Center, Downey, California
| | - Maura Fernandez
- University of Southern California, Los Angeles
- LAC+USC Medical Center, Los Angeles, California
| | - Enrique Lopez
- Rancho Los Amigos National Rehabilitation Center, Downey, California
| | - Sarah Valdez
- Harbor-UCLA Medical Center, Torrance, California
| | - Hilary R. Haber
- Dimagi, Cambridge, Massachusetts
- Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Neal M. Rao
- University of California, Los Angeles
- Olive View-UCLA Medical Center, Sylmar, California
| | - Beatrice Martinez
- University of Southern California, Los Angeles
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- LAC+USC Medical Center, Los Angeles, California
- Harbor-UCLA Medical Center, Torrance, California
| | - Lillie Hudson
- University of Southern California, Los Angeles
- Rancho Los Amigos National Rehabilitation Center, Downey, California
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Miller MJ, Xu L, Qin J, Hahn EE, Ngo-Metzger Q, Mittman B, Tewari D, Hodeib M, Wride P, Saraiya M, Chao CR. Impact of COVID-19 on Cervical Cancer Screening Rates Among Women Aged 21-65 Years in a Large Integrated Health Care System - Southern California, January 1-September 30, 2019, and January 1-September 30, 2020. MMWR Morb Mortal Wkly Rep 2021; 70:109-113. [PMID: 33507893 PMCID: PMC7842810 DOI: 10.15585/mmwr.mm7004a1] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Osuji TA, Macias M, McMullen C, Haupt E, Mittman B, Mularski RA, Wang SE, Werch H, Nguyen HQ. Clinician Perspectives on Implementing Video Visits in Home-Based Palliative Care. Palliat Med Rep 2020; 1:221-226. [PMID: 34223480 PMCID: PMC8241367 DOI: 10.1089/pmr.2020.0074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Despite the increasing use and acceptance of technology in health care, there is limited evidence on the usefulness and appropriate use of telehealth in home-based palliative care (HBPC). As part of the process evaluation of a pragmatic trial of video visits in HBPC, we assessed clinician experience with video visit implementation. Methods: We assessed clinicians' experiences with and perception of the usefulness and appropriateness of video visits using anonymous surveys and brief qualitative interviews with a subset of survey participants. Qualitative analyses were guided by sociotechnical frameworks that emphasize technology's “value proposition” for its end users as being key to adoption. Results: Clinicians (36 physicians and 48 registered nurses) generally had favorable attitudes toward video visits and telehealth. Respondents felt confident in the skills needed to make their role in video visits successful. Clinicians were neutral on whether video visits were useful for their practice or enhanced the patient–caregiver experience. Clinicians found video visits to be most appropriate for follow-up care (as opposed to start of care). The interviews yielded two themes that complemented the survey findings: (1) factors enhancing the value proposition (positive responses from patients and families and convenience) and (2) factors diminishing the value proposition (issues related to the technology and scheduling). Discussion: Our findings provide insights into clinicians' experiences with implementing remote video physician consultations, facilitated by a nurse in the patient's home in the pre-COVID-19 era. Clinician views about video visits may have shifted with the pandemic, which occurred after our data collection was complete. Clinical Trials Registration No. NCT#03694431.
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Affiliation(s)
- Thearis A. Osuji
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, California, USA
| | - Mayra Macias
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, California, USA
| | - Carmit McMullen
- Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Eric Haupt
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, California, USA
| | - Brian Mittman
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, California, USA
| | - Richard A. Mularski
- Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Susan E. Wang
- Kaiser Permanente Southern California, West Los Angeles Medical Center, Los Angeles, California, USA
| | - Henry Werch
- Kaiser Permanente Northwest, Member-Caregiver, Stakeholder Advisory Committee, Portland, Oregon, USA
| | - Huong Q. Nguyen
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, California, USA
- Address correspondence to: Huong Q. Nguyen, PhD, RN, Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Avenue, 2nd Floor, Pasadena, CA 91101, USA
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9
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Towfighi A, Cheng EM, Hill VA, Barry F, Lee M, Valle NP, Mittman B, Ayala-Rivera M, Moreno L, Espinosa A, Dombish H, Wang D, Ochoa D, Chu A, Atkins M, Vickrey BG. Results of a Pilot Trial of a Lifestyle Intervention for Stroke Survivors: Healthy Eating and Lifestyle after Stroke. J Stroke Cerebrovasc Dis 2020; 29:105323. [PMID: 33002791 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/13/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Although healthy lifestyle practices mitigate recurrent stroke risk and mortality, few stroke survivors adhere to them, particularly among socioeconomically disadvantaged communities. We developed and pilot tested a occupational therapy-based lifestyle management intervention, Healthy Eating And Lifestyle after Stroke (HEALS), to improve stroke survivors' self-management skills relating to diet and physical activity and evaluated it in a diverse safety-net population. MATERIALS AND METHODS One hundred English- or Spanish-speaking participants with stroke or transient ischemic attack were randomized to a 6-week occupational therapist-led group lifestyle intervention vs. usual care. Each of the six 2-h group sessions included didactic presentations on diet and physical activity, peer exchange, personal exploration with goal setting, and direct experience through participation in a relevant activity. Primary outcomes at 6 months were change in body mass index, fruit/vegetable intake, and physical activity. Secondary outcomes included change in waist circumference, smoking, blood pressure, high-density lipoprotein, low-density lipoprotein, triglyceride, total cholesterol, glycosylated hemoglobin levels, quality of care, and perceptions of care. Effect sizes were determined in preparation for a larger randomized controlled trial powered to detect a difference in primary outcomes. A nested formative evaluation assessed facilitators and barriers to implementation, acceptance, and intervention adherence. RESULTS There were no significant changes in primary or secondary outcomes at 6 months. Effect sizes for all outcomes were small (< 0.2). Focus group participants recommended extending the intervention program duration with more sessions, additional information on stroke and vascular risk factors, an interdisciplinary approach, additional family involvement, and incentives. Providers recommended longer program duration, more training, fidelity checks to ensure standardized program delivery, and additional incentives for participants. CONCLUSIONS The HEALS intervention was feasible in a safety-net setting, but effect sizes were small. A longer-duration intervention, with intervener fidelity checks may be warranted. TRIAL REGISTRATION NCT01550822.
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Affiliation(s)
- Amytis Towfighi
- Los Angeles County + University of Southern California Medical Center, 1100 N State St, A4E, Los Angeles, CA 90033, United States; Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States; Los Angeles County Department of Health Services, Los Angeles, CA, United States.
| | - Eric M Cheng
- University of California, Los Angeles, Los Angeles, CA, United States
| | - Valerie A Hill
- Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States; University of Cincinnati, Cincinnati, OH, United States
| | - Frances Barry
- University of California, Los Angeles, Los Angeles, CA, United States
| | - Martin Lee
- University of California, Los Angeles, Los Angeles, CA, United States
| | | | | | - Monica Ayala-Rivera
- Los Angeles County + University of Southern California Medical Center, 1100 N State St, A4E, Los Angeles, CA 90033, United States
| | - Lilian Moreno
- Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States
| | - Annaliese Espinosa
- Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States
| | - Heidi Dombish
- Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States
| | - Debbie Wang
- Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States
| | - Dina Ochoa
- Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States
| | - Allison Chu
- Los Angeles County + University of Southern California Medical Center, 1100 N State St, A4E, Los Angeles, CA 90033, United States.
| | - Michal Atkins
- Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States
| | - Barbara G Vickrey
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
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10
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Davis R, Mittman B, Boyton M, Keohane A, Goulding L, Sandall J, Thornicroft G, Sevdalis N. Developing implementation research capacity: longitudinal evaluation of the King's College London Implementation Science Masterclass, 2014-2019. Implement Sci Commun 2020; 1:74. [PMID: 32944717 PMCID: PMC7488442 DOI: 10.1186/s43058-020-00066-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/18/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Despite an increasing number of training opportunities in implementation science becoming available, the demand for training amongst researchers and practitioners is unmet. To address this training shortfall, we developed the King's College London 'Implementation Science Masterclass' (ISM), an innovative 2-day programme (and currently the largest of its kind in Europe), developed and delivered by an international faculty of implementation experts. METHODS This paper describes the ISM and provides delegates' quantitative and qualitative evaluations (gathered through a survey at the end of the ISM) and faculty reflections over the period it has been running (2014-2019). RESULTS Across the 6-year evaluation, a total of 501 delegates have attended the ISM, with numbers increasing yearly from 40 (in 2014) to 147 (in 2019). Delegates represent a diversity of backgrounds and 29 countries from across the world. The overall response rate for the delegate survey was 64.5% (323/501). Annually, the ISM has been rated 'highly' in terms of delegates' overall impression (92%), clear and relevant learning objectives (90% and 94%, respectively), the course duration (85%), pace (86%) and academic level 87%), and the support provided on the day (92%). Seventy-one percent of delegates reported the ISM would have an impact on how they approached their future work. Qualitative feedback revealed key strengths include the opportunities to meet with an international and diverse pool of experts and individuals working in the field, the interactive nature of the workshops and training sessions, and the breadth of topics and contexts covered. CONCLUSIONS Yearly, the UK ISM has grown, both in size and in its international reach. Rated consistently favourably by delegates, the ISM helps to tackle current training demands from all those interested in learning and building their skills in implementation science. Evaluation of the ISM will continue to be an annual iterative process, reflective of changes in the evidence base and delegates changing needs as the field evolves.
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Affiliation(s)
- Rachel Davis
- Centre for Implementation Science, Health Service and Population Research Department, King’s College London, London, UK
| | - Brian Mittman
- Department of Research and Evaluation, Kaiser Permanente, Pasadena, USA
| | - Madelene Boyton
- Centre for Implementation Science, Health Service and Population Research Department, King’s College London, London, UK
| | - Aoife Keohane
- Centre for Implementation Science, Health Service and Population Research Department, King’s College London, London, UK
| | - Lucy Goulding
- Centre for Implementation Science, Health Service and Population Research Department, King’s College London, London, UK
| | - Jane Sandall
- Department of Women and Children’s Health, School of Life Course Science, King’s College London, London, UK
| | - Graham Thornicroft
- Centre for Implementation Science, Health Service and Population Research Department, King’s College London, London, UK
- Centre for Global Mental Health, Health Service and Population Research Department, King’s College London, London, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, King’s College London, London, UK
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11
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Lewis CC, Boyd MR, Walsh-Bailey C, Lyon AR, Beidas R, Mittman B, Aarons GA, Weiner BJ, Chambers DA. A systematic review of empirical studies examining mechanisms of implementation in health. Implement Sci 2020; 15:21. [PMID: 32299461 PMCID: PMC7164241 DOI: 10.1186/s13012-020-00983-3] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [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: 11/12/2019] [Accepted: 03/12/2020] [Indexed: 11/15/2022] Open
Abstract
Background Understanding the mechanisms of implementation strategies (i.e., the processes by which strategies produce desired effects) is important for research to understand why a strategy did or did not achieve its intended effect, and it is important for practice to ensure strategies are designed and selected to directly target determinants or barriers. This study is a systematic review to characterize how mechanisms are conceptualized and measured, how they are studied and evaluated, and how much evidence exists for specific mechanisms. Methods We systematically searched PubMed and CINAHL Plus for implementation studies published between January 1990 and August 2018 that included the terms “mechanism,” “mediator,” or “moderator.” Two authors independently reviewed title and abstracts and then full texts for fit with our inclusion criteria of empirical studies of implementation in health care contexts. Authors extracted data regarding general study information, methods, results, and study design and mechanisms-specific information. Authors used the Mixed Methods Appraisal Tool to assess study quality. Results Search strategies produced 2277 articles, of which 183 were included for full text review. From these we included for data extraction 39 articles plus an additional seven articles were hand-entered from only other review of implementation mechanisms (total = 46 included articles). Most included studies employed quantitative methods (73.9%), while 10.9% were qualitative and 15.2% were mixed methods. Nine unique versions of models testing mechanisms emerged. Fifty-three percent of the studies met half or fewer of the quality indicators. The majority of studies (84.8%) only met three or fewer of the seven criteria stipulated for establishing mechanisms. Conclusions Researchers have undertaken a multitude of approaches to pursue mechanistic implementation research, but our review revealed substantive conceptual, methodological, and measurement issues that must be addressed in order to advance this critical research agenda. To move the field forward, there is need for greater precision to achieve conceptual clarity, attempts to generate testable hypotheses about how and why variables are related, and use of concrete behavioral indicators of proximal outcomes in the case of quantitative research and more directed inquiry in the case of qualitative research.
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Affiliation(s)
- Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA. .,Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th Street, Bloomington, IN, 47405, USA. .,Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 1959 NE Pacific Avenue, Seattle, WA, 98195, USA.
| | - Meredith R Boyd
- Department of Psychology, University of California Los Angeles, 1177 Franz Hall, 502 Portola Plaza, Los Angeles, CA, 90095, USA
| | - Callie Walsh-Bailey
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.,Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 1959 NE Pacific Avenue, Seattle, WA, 98195, USA
| | - Rinad Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA
| | - Brian Mittman
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Avenue, Pasadena, CA, 91101, USA
| | - Gregory A Aarons
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Bryan J Weiner
- Department of Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - David A Chambers
- Division of Cancer Control and Population Science, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
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12
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Waterman AD, Lipsey AF, Ranasinghe ON, Wood EH, Anderson C, Bozzolo C, Henry SL, Dub B, Mittman B. Recommendations for Systematizing Transplant Education Within a Care Delivery System for Patients With Chronic Kidney Disease Stages 3 to 5. Prog Transplant 2020; 30:76-87. [PMID: 32238045 DOI: 10.1177/1526924820913520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
CONTEXT Early tailored transplant education could help patients make informed transplant choices. OBJECTIVE We interviewed 40 patients with chronic kidney disease (CKD) stages 3 to 5, 13 support persons, and 10 providers at Kaiser Permanente Southern California to understand: (1) barriers to transplant education and (2) transplant educational preferences and recommendations based on CKD stage and primary language spoken. DESIGN A grounded theory analysis identified central themes related to transplant education barriers, preferences, and recommendations. RESULTS Barriers included confusion about diagnosis and when transplant may be necessary, concerns about transplant risks, families' lack of transplant knowledge, financial burdens, transportation and scheduling, and the emotional overload of chronic illness. Hispanic and Spanish-speaking participants reported difficulty in understanding transplant education and medical mistrust. Recommendations included providing general education, earlier introduction to transplant, wait-listing information, transplant education for support persons, living donation education for patients and potential donors, opportunities to meet living donors and kidney recipients, information on the benefits of transplant, recovery, and available financial resources, flexible class scheduling, online and print resources, and more provider follow-up. Spanish-speaking and Hispanic participants recommended using bilingual educators, print, video, and online resources in Spanish, and culturally responsive education. Patients with CKD stages 3 to 4 wanted information on slowing disease progression and avoiding transplant. CONCLUSION Increasing access to culturally responsive transplant education in multiple languages, pairing appropriate content to the disease stage, and increasing system-wide follow-up as the disease progresses might help patients make more informed choices about transplant.
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Affiliation(s)
- Amy D Waterman
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, CA, USA.,Terasaki Research Institute, Los Angeles, CA, USA
| | | | - Omesh N Ranasinghe
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | - Emily H Wood
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | - Crystal Anderson
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | | | - Shayna L Henry
- Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Bhanuja Dub
- Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Brian Mittman
- Kaiser Permanente Southern California, Pasadena, CA, USA
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13
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Baumann AA, Carothers BJ, Landsverk J, Kryzer E, Aarons GA, Brownson RC, Glisson C, Mittman B, Proctor EK. Evaluation of the Implementation Research Institute: Trainees' Publications and Grant Productivity. Adm Policy Ment Health 2020; 47:254-264. [PMID: 31667667 PMCID: PMC7285898 DOI: 10.1007/s10488-019-00977-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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] [Indexed: 11/24/2022]
Abstract
With growth in the field of dissemination and implementation (D&I) research, there has been growth in capacity building, with many training opportunities. As such, it is important to continue to evaluate D&I research training programs. This paper reports the results of an evaluation of the Implementation Research Institute (IRI), a R25 funded by the National Institute of Mental Health with additional funding by the Department of Veterans Affairs (VA). The fourth cohort also had a supplement from the National Institute on Drug Abuse. Using bibliometrics data, we report on a quasi-experimental retrospective cohort study assessing whether the rates of scholarly productivity in D&I science of IRI fellows (those who applied and were accepted to the training) were greater than those who applied but were not accepted to IRI. Our findings show that Selected Applicants' odds of publishing in implementation science were higher for earlier alumni, starting at 12% 1 year out and increasing to 94% for those who were 4 years out from starting training. Chances for Non-Selected Applicants remained relatively stable, starting at 47% at 1 year and going to 33% at 4 years since their application, a pattern that was stable even after controlling for demographic characteristics. These results support the hypothesis that IRI is increasing the D&I research productivity of those selected to the program, and that our fellows are advancing the field of D&I compared to those investigators not selected to our institute. Our finding also indicates the importance of a 2-year training.
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Affiliation(s)
- Ana A Baumann
- Brown School of Social Work, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Bobbi J Carothers
- Center for Public Health Systems Science, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - John Landsverk
- Oregon Social Learning Center, 10 Shelton Mcmurphey Blvd, Eugene, OR, 97401, USA
| | - Emily Kryzer
- Brown School of Social Work, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Gregory A Aarons
- Department of Psychiatry, Child and Adolescent Services Research Center (CASRC), UC San Diego, 9500 Gilmar Drive 0812, La Jolla, CA, 92093-0812, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Charles Glisson
- Center for Behavioral Health Research, College of Social Work, The University of Tennessee, Knoxville, 1618 W. Cumberland Ave, 201 Henson Hall, Knoxville, TN, 37996-332, USA
| | - Brian Mittman
- Kaiser Permanente Southern California Department of Research and Evaluation, 100 S. Los Robles Ave, Pasadena, CA, 91101-2453, USA
| | - Enola K Proctor
- Brown School of Social Work, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
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14
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Waterman AD, Anderson C, Alem A, Peipert JD, Beaumont JL, Henry SL, Dub B, Ambriz L, Bijjala N, Lipsey AF, Mittman B. A randomized controlled trial of Explore Transplant at Home to improve transplant knowledge and decision-making for CKD 3-5 patients at Kaiser Permanente Southern California. BMC Nephrol 2019; 20:78. [PMID: 30832619 PMCID: PMC6399838 DOI: 10.1186/s12882-019-1262-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/09/2018] [Accepted: 02/20/2019] [Indexed: 01/31/2023] Open
Abstract
Background Five-year survival on dialysis is only 40%, compared to 74% with a deceased donor kidney transplant (DDKT) and 87% with a living donor kidney transplant (LDKT). An American Society of Transplantation (AST) Consensus Conference recommended that patients with chronic kidney disease (CKD) Stages 3–5 have the opportunity to learn about and decide which treatment option is right for them, particularly about LDKT. However, early education about LDKT and DDKT outside of transplant centers is inconsistent and often poor, with patients in CKD 3 and 4 and ethnic/racial minorities even less likely to receive it. A new randomized control trial (RCT), in partnership with Kaiser Permanente Southern California (KPSC), will assess knowledge gaps and the effectiveness of a supplementary video-guided, print and technology-based education intervention for English- and Spanish-speaking patients in CKD Stages 3, 4, and 5 to increase LDKT knowledge and decision-making. To date, no published LDKT educational interventions have studied such a large and diverse CKD population. Methods In this RCT, 1200 English and Spanish-speaking CKD Stage 3–5 patients will be randomly assigned to one of two education conditions: ET@Home or KPSC standard of care education. Randomization will be stratified by CKD stage and primary language spoken. Those in the ET@Home condition will receive brochures, postcards, DVDs, and text messages delivering educational content in modules over a six-month period. Baseline data collection will measure demographics, transplant derailers, and the amount of previous CKD and transplant education they have received. Changes in CKD and transplant knowledge, ability to make an informed decision about transplant, and self-efficacy to pursue LDKT will be captured with surveys administered at baseline and at six months. Discussion At the conclusion of the study, investigators will understand key knowledge gaps for patients along the CKD continuum and between patients who speak different languages and have assessed the effectiveness of both English- and Spanish-language supplementary education in increasing KPSC patients’ knowledge about the opportunities for and risks and benefits of LDKT. We hope this program will reduce disparities in access to transplant. Trial Registration ClinicalTrials.gov Identifier: NCT03389932; date registered: 12/26/2017.
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Affiliation(s)
- Amy D Waterman
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA. .,Terasaki Research Institute, Terasaki Research Institute, 1018 Westwood Blvd, Los Angeles, CA, 90024, USA.
| | - Crystal Anderson
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Terasaki Research Institute, Terasaki Research Institute, 1018 Westwood Blvd, Los Angeles, CA, 90024, USA
| | - Angelika Alem
- Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA, 91101, USA
| | - John D Peipert
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Terasaki Research Institute, Terasaki Research Institute, 1018 Westwood Blvd, Los Angeles, CA, 90024, USA.,Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Jennifer L Beaumont
- Terasaki Research Institute, Terasaki Research Institute, 1018 Westwood Blvd, Los Angeles, CA, 90024, USA
| | - Shayna L Henry
- Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA, 91101, USA
| | - Bhanuja Dub
- Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA, 91101, USA
| | - Lizeth Ambriz
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Terasaki Research Institute, Terasaki Research Institute, 1018 Westwood Blvd, Los Angeles, CA, 90024, USA
| | - Neha Bijjala
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Terasaki Research Institute, Terasaki Research Institute, 1018 Westwood Blvd, Los Angeles, CA, 90024, USA
| | - Amanda Faye Lipsey
- Terasaki Research Institute, Terasaki Research Institute, 1018 Westwood Blvd, Los Angeles, CA, 90024, USA
| | - Brian Mittman
- Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA, 91101, USA
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15
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Towfighi A, Hill VA, Valle NP, Cheng EM, Mittman B, Ayala-Rivera M, Barry F, Moreno L, Dombish H, Espinoza A, Wang D, Ochoa D, Vickrey B. Abstract WP229:
H
ealthy
E
ating and
L
ifestyle After
S
troke (HEALS): A Pilot Trial of a Lifestyle Intervention for Stroke Survivors in the Safety-Net. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wp229] [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: 11/16/2022]
Abstract
Background:
Although healthy lifestyle practices mitigate stroke risk and mortality, few stroke survivors adhere to them, particularly among socioeconomically disadvantaged communities. We developed and pilot tested a lifestyle management intervention, HEALS, to improve stroke survivors’ diet and physical activity and tested it in a diverse population receiving care at a safety-net county facility.
Methods:
One hundred English- or Spanish-speaking participants with stroke or TIA were randomly assigned to a 6-week weekly occupational therapist-led group lifestyle intervention vs. usual care. Each 2 hour session included didactics, goal setting, activities, and peer exchange. Primary outcomes measured at baseline and 6 months were body mass index, abdominal obesity, fruit/vegetable intake, and physical activity. Secondary outcomes were blood pressure, high-density lipoprotein cholesterol, and glycosylated hemoglobin. Outcomes were compared with repeated measures analysis. Effect sizes for continuous variables were determined using partial eta-squared. A nested formative evaluation assessed facilitators and barriers to implementation, acceptance, and adherence to the intervention.
Results:
Mean age was 60 years, 62% were men, 68% were Hispanic, 60% were Spanish-speaking, 35% had ≤8
th
grade education, 31% were working at enrollment, and 69% had modified Rankin scale <3. Seventy-three percent participated in at least one HEALS session. Over one third (37%) attended all 6 sessions. There were no significant changes in primary or secondary outcomes at 6-months, even after adjusting for number of sessions attended. Effect sizes for primary outcomes were small (<0.05). Focus group participants recommended more sessions for a longer treatment duration, additional information on diet and physical activity, and monetary incentives for participation. Providers agreed with a need for a longer treatment duration and suggested more robust provider training and fidelity checks to ensure standardized program delivery.
Conclusions:
The HEALS intervention was feasible in a safety-net setting, but the effect sizes were small. An RCT of a longer-duration intervention, with more formal provider training, may be warranted.
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16
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Øvretveit J, Garofalo L, Mittman B. Scaling up improvements more quickly and effectively. Int J Qual Health Care 2018; 29:1014-1019. [PMID: 29177491 DOI: 10.1093/intqhc/mzx147] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 04/03/2017] [Accepted: 10/26/2017] [Indexed: 11/14/2022] Open
Abstract
Faster and more widespread implementation could help more patients to benefit more quickly from known effective treatments. So could more effective implementation of better assessment methods, service delivery models, treatments and services. Implementation at scale and 'descaling' are ways for hospitals and health systems to respond to rising demands and costs. The paper proposes ways to provide leaders with the information that would help them to decide whether and how to scale up a proven improvement. We draw on our knowledge of the improvement and implementation literature on the subject and on our experience of scale up programs in Kaiser Permanente, in Swedish county health systems, and in international health. We describe a '3S' scale up infrastructure and other ingredients that appear necessary for successful widespread improvement, and list the resources that we have found useful for developing scale up programs. The paper aims to encourage more actionable research into scale up, and shows the opportunities for researchers to both advance implementation and improvement science and contribute to reducing suffering and costs in a more timely and effective way.
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Affiliation(s)
- John Øvretveit
- Health Innovation Implementation and Evaluation, LIME/MMC, Karolinska Institutet, Stockholm 17177, Sweden
| | - Lynn Garofalo
- Performance Improvement, Kaiser Permanente, Southern California, Regional Offices, Walnut 393 E. Walnut St., Pasadena, CA 91101, USA
| | - Brian Mittman
- Health Services Research and Implementation Science, Kaiser Permanente Southern California, Department of Research & Evaluation, 100S. Los Robles Ave., 3rd Floor, Pasadena, CA 91101, USA
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17
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Ovretveit J, Mittman B, Rubenstein L, Ganz DA. Using implementation tools to design and conduct quality improvement projects for faster and more effective improvement. Int J Health Care Qual Assur 2017; 30:755-768. [DOI: 10.1108/ijhcqa-01-2017-0019] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Purpose
The purpose of this paper is to enable improvers to use recent knowledge from implementation science to carry out improvement changes more effectively. It also highlights the importance of converting research findings into practical tools and guidance for improvers so as to make research easier to apply in practice.
Design/methodology/approach
This study provides an illustration of how a quality improvement (QI) team project can make use of recent findings from implementation research so as to make their improvement changes more effective and sustainable. The guidance is based on a review and synthesis of improvement and implementation methods.
Findings
The paper illustrates how research can help a quality project team in the phases of problem definition and preparation, in design and planning, in implementation, and in sustaining and spreading a QI. Examples of the use of different ideas and methods are cited where they exist.
Research limitations/implications
The example is illustrative and there is little limited experimental evidence of whether using all the steps and tools in the one approach proposed do enable a quality team to be more effective. Evidence supporting individual guidance proposals is cited where it exists.
Practical implications
If the steps proposed and illustrated in the paper were followed, it is possible that quality projects could avoid waste by ensuring the conditions they need for success are in place, and sustain and spread improvement changes more effectively.
Social implications
More patients could benefit more quickly from more effective implementation of proven interventions.
Originality/value
The paper is the first to describe how improvement and implementation science can be combined in a tangible way that practical improvers can use in their projects. It shows how QI project teams can take advantage of recent advances in improvement and implementation science to make their work more effective and sustainable.
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Hill V, Vickrey B, Mittman B, Sivers-Texeira T, Towfighi A. Adapting a Team-Based Secondary Stroke Prevention Intervention in a Safety-Net Setting. Arch Phys Med Rehabil 2017. [DOI: 10.1016/j.apmr.2017.08.091] [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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Chambers D, Simpson L, Neta G, Schwarz UVT, Percy-Laurry A, Aarons GA, Neta G, Brownson R, Vogel A, Stirman SW, Sherr K, Sturke R, Norton WE, Varley A, Chambers D, Vinson C, Klesges L, Heurtin-Roberts S, Massoud MR, Kimble L, Beck A, Neely C, Boggs J, Nichols C, Wan W, Staab E, Laiteerapong N, Moise N, Shah R, Essock S, Handley M, Jones A, Carruthers J, Davidson K, Peccoralo L, Sederer L, Molfenter T, Scudder A, Taber-Thomas S, Schaffner K, Herschell A, Woodward E, Pitcock J, Ritchie M, Kirchner J, Moore JE, Khan S, Rashid S, Park J, Courvoisier M, Straus S, Blonigen D, Rodriguez A, Manfredi L, Nevedal A, Rosenthal J, Smelson D, Timko C, Stadnick N, Regan J, Barnett M, Lau A, Brookman-Frazee L, Guerrero E, Fenwick K, Kong Y, Aarons G, Lengnick-Hall R, Fenwick K, Henwood B, Sayer N, Rosen C, Orazem R, Smith B, Rosen C, Zimmerman L, Lounsbury D, Rosen C, Kimerling R, Trafton JA, Lindley S, Bhargava R, Roberts H, Gibson L, Escobar GJ, Liu V, Turk B, Ragins A, Kipnis P, Gruszkowski AK, Kennedy MW, Drobek ER, Turgeman L, Milicevic AS, Hubert TL, Myaskovsky L, Tjader YC, Monte RJ, Sapnas KG, Ramly E, Lauver DR, Bartels CM, Elnahal S, Ippolito A, Peabody H, Clancy C, Cebul R, Love T, Einstadter D, Bolen S, Watts B, Yakovchenko V, Park A, Lukesh W, Miller DR, Thornton D, Drainoni ML, Gifford AL, Smith S, Kyle J, Bauer MS, Eisenberg D, Liebrecht C, Barbaresso M, Kilbourne A, Park E, Perez G, Ostroff J, Greene S, Parchman M, Austin B, Larson E, Ferreri S, Shea C, Smith M, Turner K, Bacci J, Bigham K, Curran G, Ferreri S, Frail C, Hamata C, Jankowski T, Lantaff W, McGivney MS, Snyder M, McCullough M, Gillespie C, Petrakis BA, Jones E, Park A, Lukas CV, Rose A, Shoemaker SJ, Curran G, Thomas J, Teeter B, Swan H, Teeter B, Thomas J, Curran G, Balamurugan A, Lane-Fall M, Beidas R, Di Taranti L, Buddai S, Hernandez ET, Watts J, Fleisher L, Barg F, Miake-Lye I, Olmos T, Chuang E, Rodriguez H, Kominski G, Yano B, Shortell S, Hook M, Fleisher L, Fiks A, Halkyard K, Gruver R, Sykes E, Vesco K, Beadle K, Bulkley J, Stoneburner A, Leo M, Clark A, Smith J, Smyser C, Wolf M, Trivedi S, Hackett B, Rao R, Cole FS, McGonigle R, Donze A, Proctor E, Mathur A, Sherr K, Gakidou E, Gloyd S, Audet C, Salato J, Vermund S, Amico R, Smith S, Nyirandagijimana B, Mukasakindi H, Rusangwa C, Franke M, Raviola G, Cummings M, Goldberg E, Mwaka S, Kabajaasi O, Cattamanchi A, Katamba A, Jacob S, Kenya-Mugisha N, Davis JL, Reed J, Ramaswamy R, Parry G, Sax S, Kaplan H, Huang KY, Cheng S, Yee S, Hoagwood K, McKay M, Shelley D, Ogedegbe G, Brotman LM, Kislov R, Humphreys J, Harvey G, Wilson P, Lieberthal R, Payton C, Sarfaty M, Valko G, Bolton R, Lukas CV, Hartmann C, Mueller N, Holmes SK, Bokhour B, Ono S, Crabtree B, Gordon L, Miller W, Balasubramanian B, Solberg L, Cohen D, McGraw K, Blatt A, Pittman D, McCullough M, Hartmann C, Kales H, Berlowitz D, Hudson T, Gillespie C, Helfrich C, Finley E, Garcia A, Rosen K, Tami C, McGeary D, Pugh MJ, Potter JS, Helfrich C, Stryczek K, Au D, Zeliadt S, Sayre G, Gillespie C, Leeman J, Myers A, Grant J, Wangen M, Queen T, Morshed A, Dodson E, Tabak R, Brownson RC, Sheldrick RC, Mackie T, Hyde J, Leslie L, Yanovitzky I, Weber M, Gesualdo N, Kristensen T, Stanick C, Halko H, Dorsey C, Powell B, Weiner B, Lewis C, Powell B, Weiner B, Stanick C, Halko H, Dorsey C, Lewis C, Weiner B, Dorsey C, Stanick C, Halko H, Powell B, Lewis C, Stirman SW, Carreno P, Mallard K, Masina T, Monson C, Swindle T, Curran G, Patterson Z, Whiteside-Mansell L, Hanson R, Saunders B, Schoenwald S, Moreland A, Birken S, Powell B, Presseau J, Miake-Lye I, Ganz D, Mittman B, Delevan D, Finley E, Hill JN, Locatelli S, Bokhour B, Fix G, Solomon J, Mueller N, Lavela SL, Scott V, Scaccia J, Alia K, Skiles B, Wandersman A, Wilson P, Sales A, Roberts M, Kennedy A, Chambers D, Khoury MJ, Sperber N, Orlando L, Carpenter J, Cavallari L, Denny J, Elsey A, Fitzhenry F, Guan Y, Horowitz C, Johnson J, Madden E, Pollin T, Pratt V, Rakhra-Burris T, Rosenman M, Voils C, Weitzel K, Wu R, Damschroder L, Lu C, Ceccarelli R, Mazor KM, Wu A, Rahm AK, Buchanan AH, Schwartz M, McCormick C, Manickam K, Williams MS, Murray MF, Escoffery NC, Lebow-Skelley E, Udelson H, Böing E, Fernandez ME, Wood RJ, Mullen PD, Parekh J, Caldas V, Stuart EA, Howard S, Thomas G, Jennings JM, Torres J, Markham C, Shegog R, Peskin M, Rushing SC, Gaston A, Gorman G, Jessen C, Williamson J, Ward D, Vaughn A, Morris E, Mazzucca S, Burney R, Ramanadhan S, Minsky S, Martinez-Dominguez V, Viswanath K, Barker M, Fahim M, Ebnahmady A, Dragonetti R, Selby P, Farrell M, Tompkins J, Norton W, Rapport K, Hargreaves M, Lee R, Ramanadhan S, Kruse G, Deutsch C, Lanier E, Gray A, Leppin A, Christiansen L, Schaepe K, Egginton J, Branda M, Gaw C, Dick S, Montori V, Shah N, Korn A, Hovmand P, Fullerton K, Zoellner N, Hennessy E, Tovar A, Hammond R, Economos C, Kay C, Gazmararian J, Vall E, Cheung P, Franks P, Barrett-Williams S, Weiss P, Kay C, Gazmararian J, Hamilton E, Cheung P, Kay C, Vall E, Gazmararian J, Marques L, Dixon L, Ahles E, Valentine S, Monson C, Shtasel D, Stirman SW, Parra-Cardona R, Northridge M, Kavathe R, Zanowiak J, Wyatt L, Singh H, Islam N, Monteban M, Freedman D, Bess K, Walsh C, Matlack K, Flocke S, Baily H, Harden S, Ramalingam N, Alia K, Scaccia J, Scott V, Ramaswamy R, Wandersman A, Gold R, Cottrell E, Hollombe C, Dambrun K, Bunce A, Middendorf M, Dearing M, Cowburn S, Mossman N, Melgar G, Hopfer S, Hecht M, Ray A, Miller-Day M, BeLue R, Zimet G, Nelson EL, Kuhlman S, Doolittle G, Krebill H, Spaulding A, Levin T, Sanchez M, Landau M, Escobar P, Minian N, Selby P, Noormohamed A, Zawertailo L, Baliunas D, Giesbrecht N, Le Foll B, Samokhvalov A, Meisel Z, Polsky D, Schackman B, Mitchell J, Sevarino K, Gimbel S, Mwanza M, Nisingizwe MP, Michel C, Hirschhorn L, Lane-Fall M, Beidas R, Di Taranti L, Choudhary M, Thonduparambil D, Fleisher L, Barg F, Meissner P, Pinnock H, Barwick M, Carpenter C, Eldridge S, Grandes-Odriozola G, Griffiths C, Rycroft-Malone J, Murray E, Patel A, Sheikh A, Taylor SJC, Mittman B, Guilliford M, Pearce G, Korngiebel D, West K, Burke W, Hannon P, Harris J, Hammerback K, Kohn M, Chan GKC, Mafune R, Parrish A, Helfrich C, Beresford S, Pike KJ, Shelton R, Jandorf L, Erwin D, Charles TA, Parchman M, Baldwin LM, Ike B, Fickel J, Lind J, Cowper D, Fleming M, Sadler A, Dye M, Katzburg J, Ong M, Tubbesing S, McCullough M, Simmons M, Yakovchenko V, Harnish A, Gabrielian S, McInnes K, Smith J, Smelson D, Ferrand J, Torres E, Green A, Aarons G, Bradbury AR, Patrick-Miller LJ, Egleston BL, Domchek SM, Olopade OI, Hall MJ, Daly MB, Fleisher L, Grana G, Ganschow P, Fetzer D, Brandt A, Chambers R, Clark DF, Forman A, Gaber RS, Gulden C, Horte J, Long J, Lucas T, Madaan S, Mattie K, McKenna D, Montgomery S, Nielsen S, Powers J, Rainey K, Rybak C, Seelaus C, Stoll J, Stopfer J, Yao XS, Savage M, Miech E, Damush T, Rattray N, Myers J, Homoya B, Winseck K, Klabunde C, Langer D, Aggarwal A, Neilson E, Gunderson L, Escobar GJ, Gardner M, O’Sulleabhain L, Kroenke C, Liu V, Kipnis P. Proceedings from the 9th annual conference on the science of dissemination and implementation. Implement Sci 2017. [PMCID: PMC5414666 DOI: 10.1186/s13012-017-0575-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Naylor MD, Shaid EC, Carpenter D, Gass B, Levine C, Li J, Malley A, McCauley K, Nguyen HQ, Watson H, Brock J, Mittman B, Jack B, Mitchell S, Callicoatte B, Schall J, Williams MV. Components of Comprehensive and Effective Transitional Care. J Am Geriatr Soc 2017; 65:1119-1125. [PMID: 28369722 DOI: 10.1111/jgs.14782] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Transitional care (TC) has received widespread attention from researchers, health system leaders, clinicians, and policy makers as they attempt to improve health outcomes and reduce preventable hospital readmissions, yet little is known about the critical elements of effective TC and how they relate to patients' and caregivers' needs and experiences. To address this gap, the Patient-Centered Outcomes Research Institute (PCORI) funded a national study, Achieving patient-centered Care and optimized Health In care transitions by Evaluating the Value of Evidence (Project ACHIEVE). A primary aim of the study is the identification of TC components that yield desired patient and caregiver outcomes. Project ACHIEVE established a multistakeholder workgroup to recommend essential TC components for vulnerable Medicare beneficiaries. Guided by a review of published evidence, the workgroup identified and defined a preliminary set of components and then analyzed how well the set aligned with real-world patients' and caregivers' experiences. Through this process, the workgroup identified eight TC components: patient engagement, caregiver engagement, complexity and medication management, patient education, caregiver education, patients' and caregivers' well-being, care continuity, and accountability. Although the degree of attention given to each component will vary based on the specific needs of patients and caregivers, workgroup members agree that health systems need to address all components to ensure optimal TC for all Medicare beneficiaries.
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Affiliation(s)
- Mary D Naylor
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth C Shaid
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Deborah Carpenter
- Center for Healthcare Delivery Research and Evaluation, Westat, Rockville, Maryland
| | - Brianna Gass
- Division of Health Management, Telligen, Greenwood Village, Colorado
| | - Carol Levine
- Families and Health Care Project, United Hospital Fund, New York, New York
| | - Jing Li
- Center for Health Services Research, University of Kentucky, Lexington, Kentucky
| | - Ann Malley
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathleen McCauley
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Huong Q Nguyen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Heather Watson
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Jane Brock
- Division of Health Management, Telligen, Greenwood Village, Colorado
| | - Brian Mittman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Brian Jack
- School of Medicine, Boston University, Boston Medical Center, Boston, Massachusetts
| | - Suzanne Mitchell
- School of Medicine, Boston University, Boston Medical Center, Boston, Massachusetts
| | - Becky Callicoatte
- School of Medicine, Louisiana State University, Baton Rouge, Louisiana
| | - John Schall
- Caregiver Action Network, Washington, District of Columbia
| | - Mark V Williams
- Center for Health Services Research, University of Kentucky, Lexington, Kentucky
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Towfighi A, Cheng EM, Ayala-Rivera M, McCreath H, Sanossian N, Dutta T, Mehta B, Bryg R, Rao N, Song S, Razmara A, Ramirez M, Sivers-Teixeira T, Tran J, Mojarro-Huang E, Montoya A, Corrales M, Martinez B, Willis P, Macias M, Ibrahim N, Wu S, Wacksman J, Haber H, Richards A, Barry F, Hill V, Mittman B, Cunningham W, Liu H, Ganz DA, Factor D, Vickrey BG. Randomized controlled trial of a coordinated care intervention to improve risk factor control after stroke or transient ischemic attack in the safety net: Secondary stroke prevention by Uniting Community and Chronic care model teams Early to End Disparities (SUCCEED). BMC Neurol 2017; 17:24. [PMID: 28166784 PMCID: PMC5294765 DOI: 10.1186/s12883-017-0792-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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: 05/10/2016] [Accepted: 01/09/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Recurrent strokes are preventable through awareness and control of risk factors such as hypertension, and through lifestyle changes such as healthier diets, greater physical activity, and smoking cessation. However, vascular risk factor control is frequently poor among stroke survivors, particularly among socio-economically disadvantaged blacks, Latinos and other people of color. The Chronic Care Model (CCM) is an effective framework for multi-component interventions aimed at improving care processes and outcomes for individuals with chronic disease. In addition, community health workers (CHWs) have played an integral role in reducing health disparities; however, their effectiveness in reducing vascular risk among stroke survivors remains unknown. Our objectives are to develop, test, and assess the economic value of a CCM-based intervention using an Advanced Practice Clinician (APC)-CHW team to improve risk factor control after stroke in an under-resourced, racially/ethnically diverse population. METHODS/DESIGN In this single-blind randomized controlled trial, 516 adults (≥40 years) with an ischemic stroke, transient ischemic attack or intracerebral hemorrhage within the prior 90 days are being enrolled at five sites within the Los Angeles County safety-net setting and randomized 1:1 to intervention vs usual care. Participants are excluded if they do not speak English, Spanish, Cantonese, Mandarin, or Korean or if they are unable to consent. The intervention includes a minimum of three clinic visits in the healthcare setting, three home visits, and Chronic Disease Self-Management Program group workshops in community venues. The primary outcome is blood pressure (BP) control (systolic BP <130 mmHg) at 1 year. Secondary outcomes include: (1) mean change in systolic BP; (2) control of other vascular risk factors including lipids and hemoglobin A1c, (3) inflammation (C reactive protein [CRP]), (4) medication adherence, (5) lifestyle factors (smoking, diet, and physical activity), (6) estimated relative reduction in risk for recurrent stroke or myocardial infarction (MI), and (7) cost-effectiveness of the intervention versus usual care. DISCUSSION If this multi-component interdisciplinary intervention is shown to be effective in improving risk factor control after stroke, it may serve as a model that can be used internationally to reduce race/ethnic and socioeconomic disparities in stroke in resource-constrained settings. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01763203 .
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Affiliation(s)
- Amytis Towfighi
- Los Angeles County Department of Health Services, Los Angeles, California USA
- University of Southern California, Los Angeles, California USA
- Rancho Los Amigos National Rehabilitation Center, Downey, California USA
| | - Eric M. Cheng
- University of California, Los Angeles (UCLA), Los Angeles, California USA
| | - Monica Ayala-Rivera
- Rancho Los Amigos National Rehabilitation Center, Downey, California USA
- University of California, Los Angeles (UCLA), Los Angeles, California USA
| | - Heather McCreath
- University of California, Los Angeles (UCLA), Los Angeles, California USA
| | - Nerses Sanossian
- University of Southern California, Los Angeles, California USA
- Los Angeles County-University of Southern California (USC) Medical Center, Los Angeles, California USA
| | - Tara Dutta
- Rancho Los Amigos National Rehabilitation Center, Downey, California USA
- Kaiser Permanente, Sacramento, California USA
| | - Bijal Mehta
- University of California, Los Angeles (UCLA), Los Angeles, California USA
- Harbor-UCLA Medical Center, Torrance, California USA
| | - Robert Bryg
- University of California, Los Angeles (UCLA), Los Angeles, California USA
- Olive View-UCLA Medical Center, Sylmar, California USA
| | - Neal Rao
- University of California, Los Angeles (UCLA), Los Angeles, California USA
- Olive View-UCLA Medical Center, Sylmar, California USA
| | - Shlee Song
- Cedars Sinai Medical Center, Los Angeles, California USA
| | - Ali Razmara
- Rancho Los Amigos National Rehabilitation Center, Downey, California USA
- Kaiser Permanente, Irvine, California USA
| | - Magaly Ramirez
- Fielding School of Public Health, Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, California USA
| | - Theresa Sivers-Teixeira
- University of Southern California, Los Angeles, California USA
- Rancho Los Amigos National Rehabilitation Center, Downey, California USA
| | - Jamie Tran
- Harbor-UCLA Medical Center, Torrance, California USA
| | - Elizabeth Mojarro-Huang
- Rancho Los Amigos National Rehabilitation Center, Downey, California USA
- Los Angeles County-University of Southern California (USC) Medical Center, Los Angeles, California USA
| | - Ana Montoya
- Rancho Los Amigos National Rehabilitation Center, Downey, California USA
- Harbor-UCLA Medical Center, Torrance, California USA
- Olive View-UCLA Medical Center, Sylmar, California USA
| | - Marilyn Corrales
- Los Angeles County Department of Health Services, Los Angeles, California USA
- Rancho Los Amigos National Rehabilitation Center, Downey, California USA
| | - Beatrice Martinez
- Rancho Los Amigos National Rehabilitation Center, Downey, California USA
- Harbor-UCLA Medical Center, Torrance, California USA
| | - Phyllis Willis
- Watts Labor Community Action Committee, Watts, California USA
| | - Mireya Macias
- Worker Education and Resource Center, Los Angeles, California USA
| | - Nancy Ibrahim
- Esperanza Community Housing, Los Angeles, California USA
| | - Shinyi Wu
- School of Social Work, Edward R. Roybal Institute on Aging, and Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, California USA
- RAND Corporation, Santa Monica, California USA
| | | | | | - Adam Richards
- University of California, Los Angeles (UCLA), Los Angeles, California USA
| | - Frances Barry
- University of California, Los Angeles (UCLA), Los Angeles, California USA
| | - Valerie Hill
- Rancho Los Amigos National Rehabilitation Center, Downey, California USA
| | - Brian Mittman
- Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California USA
| | - William Cunningham
- University of California, Los Angeles (UCLA), Los Angeles, California USA
| | - Honghu Liu
- University of California, Los Angeles (UCLA), Los Angeles, California USA
| | - David A. Ganz
- University of California, Los Angeles (UCLA), Los Angeles, California USA
- RAND Corporation, Santa Monica, California USA
- Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California USA
| | - Diane Factor
- Worker Education and Resource Center, Los Angeles, California USA
| | - Barbara G. Vickrey
- University of California, Los Angeles (UCLA), Los Angeles, California USA
- Icahn School of Medicine at Mount Sinai, New York, New York USA
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Shen E, Koyama SY, Huynh DN, Watson HL, Mittman B, Kanter MH, Nguyen HQ. Association of a Dedicated Post-Hospital Discharge Follow-up Visit and 30-Day Readmission Risk in a Medicare Advantage Population. JAMA Intern Med 2017; 177:132-135. [PMID: 27893040 DOI: 10.1001/jamainternmed.2016.7061] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ernest Shen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Sandra Y Koyama
- Clincial Operations, Kaiser Permanente Southern California, Pasadena
| | - Dan N Huynh
- Clincial Operations, Kaiser Permanente Southern California, Pasadena
| | - Heather L Watson
- Clincial Operations, Kaiser Permanente Southern California, Pasadena
| | - Brian Mittman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Michael H Kanter
- Clincial Operations, Kaiser Permanente Southern California, Pasadena
| | - Huong Q Nguyen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
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Chambers D, Simpson L, Hill-Briggs F, Neta G, Vinson C, Chambers D, Beidas R, Marcus S, Aarons G, Hoagwood K, Schoenwald S, Evans A, Hurford M, Rubin R, Hadley T, Barg F, Walsh L, Adams D, Mandell D, Martin L, Mignogna J, Mott J, Hundt N, Kauth M, Kunik M, Naik A, Cully J, McGuire A, White D, Bartholomew T, McGrew J, Luther L, Rollins A, Salyers M, Cooper B, Funaiole A, Richards J, Lee A, Lapham G, Caldeiro R, Lozano P, Gildred T, Achtmeyer C, Ludman E, Addis M, Marx L, Bradley K, VanDeinse T, Wilson AB, Stacey B, Powell B, Bunger A, Cuddeback G, Barnett M, Stadnick N, Brookman-Frazee L, Lau A, Dorsey S, Pullmann M, Mitchell S, Schwartz R, Kirk A, Dusek K, Oros M, Hosler C, Gryczynski J, Barbosa C, Dunlap L, Lounsbury D, O’Grady K, Brown B, Damschroder L, Waltz T, Powell B, Ritchie M, Waltz T, Atkins D, Imel ZE, Xiao B, Can D, Georgiou P, Narayanan S, Berkel C, Gallo C, Sandler I, Brown CH, Wolchik S, Mauricio AM, Gallo C, Brown CH, Mehrotra S, Chandurkar D, Bora S, Das A, Tripathi A, Saggurti N, Raj A, Hughes E, Jacobs B, Kirkendall E, Loeb D, Trinkley K, Yang M, Sprowell A, Nease D, Lyon A, Lewis C, Boyd M, Melvin A, Nicodimos S, Liu F, Jungbluth N, Lyon A, Lewis C, Boyd M, Melvin A, Nicodimos S, Liu F, Jungbluth N, Flynn A, Landis-Lewis Z, Sales A, Baloh J, Ward M, Zhu X, Bennett I, Unutzer J, Mao J, Proctor E, Vredevoogd M, Chan YF, Williams N, Green P, Bernstein S, Rosner JM, DeWitt M, Tetrault J, Dziura J, Hsiao A, Sussman S, O’Connor P, Toll B, Jones M, Gassaway J, Tobin J, Zatzick D, Bradbury AR, Patrick-Miller L, Egleston B, Olopade OI, Hall MJ, Daly MB, Fleisher L, Grana G, Ganschow P, Fetzer D, Brandt A, Farengo-Clark D, Forman A, Gaber RS, Gulden C, Horte J, Long J, Chambers RL, Lucas T, Madaan S, Mattie K, McKenna D, Montgomery S, Nielsen S, Powers J, Rainey K, Rybak C, Savage M, Seelaus C, Stoll J, Stopfer J, Yao S, Domchek S, Hahn E, Munoz-Plaza C, Wang J, Delgadillo JG, Mittman B, Gould M, Liang S, Kegler MC, Cotter M, Phillips E, Hermstad A, Morton R, Beasley D, Martinez J, Riehman K, Gustafson D, Marsch L, Mares L, Quanbeck A, McTavish F, McDowell H, Brown R, Thomas C, Glass J, Isham J, Shah D, Liebschutz J, Lasser K, Watkins K, Ober A, Hunter S, Lamp K, Ewing B, Iwelunmor J, Gyamfi J, Blackstone S, Quakyi NK, Plange-Rhule J, Ogedegbe G, Kumar P, Van Devanter N, Nguyen N, Nguyen L, Nguyen T, Phuong N, Shelley D, Rudge S, Langlois E, Tricco A, Ball S, Lambert-Kerzner A, Sulc C, Simmons C, Shell-Boyd J, Oestreich T, O’Connor A, Neely E, McCreight M, Labebue A, DiFiore D, Brostow D, Ho PM, Aron D, Harvey J, McHugh M, Scanlon D, Lee R, Soltero E, Parker N, McNeill L, Ledoux T, McIsaac JL, MacLeod K, Ata N, Jarvis S, Kirk S, Purtle J, Dodson E, Brownson R, Mittman B, Curran G, Curran G, Pyne J, Aarons G, Ehrhart M, Torres E, Miech E, Miech E, Stevens K, Hamilton A, Cohen D, Padgett D, Morshed A, Patel R, Prusaczyk B, Aron DC, Gupta D, Ball S, Hand R, Abram J, Wolfram T, Hastings M, Moreland-Russell S, Tabak R, Ramsey A, Baumann A, Kryzer E, Montgomery K, Lewis E, Padek M, Powell B, Brownson R, Mamaril CB, Mays G, Branham K, Timsina L, Mays G, Hogg R, Fagan A, Shapiro V, Brown E, Haggerty K, Hawkins D, Oesterle S, Hawkins D, Catalano R, McKay V, Dolcini MM, Hoffer L, Moin T, Li J, Duru OK, Ettner S, Turk N, Chan C, Keckhafer A, Luchs R, Ho S, Mangione C, Selby P, Zawertailo L, Minian N, Balliunas D, Dragonetti R, Hussain S, Lecce J, Chinman M, Acosta J, Ebener P, Malone PS, Slaughter M, Freedman D, Flocke S, Lee E, Matlack K, Trapl E, Ohri-Vachaspati P, Taggart M, Borawski E, Parrish A, Harris J, Kohn M, Hammerback K, McMillan B, Hannon P, Swindle T, Curran G, Whiteside-Mansell L, Ward W, Holt C, Santos SL, Tagai E, Scheirer MA, Carter R, Bowie J, Haider M, Slade J, Wang MQ, Masica A, Ogola G, Berryman C, Richter K, Shelton R, Jandorf L, Erwin D, Truong K, Javier JR, Coffey D, Schrager SM, Palinkas L, Miranda J, Johnson V, Hutcherson V, Ellis R, Kharmats A, Marshall-King S, LaPradd M, Fonseca-Becker F, Kepka D, Bodson J, Warner E, Fowler B, Shenkman E, Hogan W, Odedina F, De Leon J, Hooper M, Carrasquillo O, Reams R, Hurt M, Smith S, Szapocznik J, Nelson D, Mandal P, Teufel J. Proceedings of the 8th Annual Conference on the Science of Dissemination and Implementation : Washington, DC, USA. 14-15 December 2015. Implement Sci 2016; 11 Suppl 2:100. [PMID: 27490260 PMCID: PMC4977475 DOI: 10.1186/s13012-016-0452-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A1 Introduction to the 8th Annual Conference on the Science of Dissemination and Implementation: Optimizing Personal and Population Health David Chambers, Lisa Simpson D1 Discussion forum: Population health D&I research Felicia Hill-Briggs D2 Discussion forum: Global health D&I research Gila Neta, Cynthia Vinson D3 Discussion forum: Precision medicine and D&I research David Chambers S1 Predictors of community therapists’ use of therapy techniques in a large public mental health system Rinad Beidas, Steven Marcus, Gregory Aarons, Kimberly Hoagwood, Sonja Schoenwald, Arthur Evans, Matthew Hurford, Ronnie Rubin, Trevor Hadley, Frances Barg, Lucia Walsh, Danielle Adams, David Mandell S2 Implementing brief cognitive behavioral therapy (CBT) in primary care: Clinicians' experiences from the field Lindsey Martin, Joseph Mignogna, Juliette Mott, Natalie Hundt, Michael Kauth, Mark Kunik, Aanand Naik, Jeffrey Cully S3 Clinician competence: Natural variation, factors affecting, and effect on patient outcomes Alan McGuire, Dominique White, Tom Bartholomew, John McGrew, Lauren Luther, Angie Rollins, Michelle Salyers S4 Exploring the multifaceted nature of sustainability in community-based prevention: A mixed-method approach Brittany Cooper, Angie Funaiole S5 Theory informed behavioral health integration in primary care: Mixed methods evaluation of the implementation of routine depression and alcohol screening and assessment Julie Richards, Amy Lee, Gwen Lapham, Ryan Caldeiro, Paula Lozano, Tory Gildred, Carol Achtmeyer, Evette Ludman, Megan Addis, Larry Marx, Katharine Bradley S6 Enhancing the evidence for specialty mental health probation through a hybrid efficacy and implementation study Tonya VanDeinse, Amy Blank Wilson, Burgin Stacey, Byron Powell, Alicia Bunger, Gary Cuddeback S7 Personalizing evidence-based child mental health care within a fiscally mandated policy reform Miya Barnett, Nicole Stadnick, Lauren Brookman-Frazee, Anna Lau S8 Leveraging an existing resource for technical assistance: Community-based supervisors in public mental health Shannon Dorsey, Michael Pullmann S9 SBIRT implementation for adolescents in urban federally qualified health centers: Implementation outcomes Shannon Mitchell, Robert Schwartz, Arethusa Kirk, Kristi Dusek, Marla Oros, Colleen Hosler, Jan Gryczynski, Carolina Barbosa, Laura Dunlap, David Lounsbury, Kevin O'Grady, Barry Brown S10 PANEL: Tailoring Implementation Strategies to Context - Expert recommendations for tailoring strategies to context Laura Damschroder, Thomas Waltz, Byron Powell S11 PANEL: Tailoring Implementation Strategies to Context - Extreme facilitation: Helping challenged healthcare settings implement complex programs Mona Ritchie S12 PANEL: Tailoring Implementation Strategies to Context - Using menu-based choice tasks to obtain expert recommendations for implementing three high-priority practices in the VA Thomas Waltz S13 PANEL: The Use of Technology to Improve Efficient Monitoring of Implementation of Evidence-based Programs - Siri, rate my therapist: Using technology to automate fidelity ratings of motivational interviewing David Atkins, Zac E. Imel, Bo Xiao, Doğan Can, Panayiotis Georgiou, Shrikanth Narayanan S14 PANEL: The Use of Technology to Improve Efficient Monitoring of Implementation of Evidence-based Programs - Identifying indicators of implementation quality for computer-based ratings Cady Berkel, Carlos Gallo, Irwin Sandler, C. Hendricks Brown, Sharlene Wolchik, Anne Marie Mauricio S15 PANEL: The Use of Technology to Improve Efficient Monitoring of Implementation of Evidence-based Programs - Improving implementation of behavioral interventions by monitoring emotion in spoken speech Carlos Gallo, C. Hendricks Brown, Sanjay Mehrotra S16 Scorecards and dashboards to assure data quality of health management information system (HMIS) using R Dharmendra Chandurkar, Siddhartha Bora, Arup Das, Anand Tripathi, Niranjan Saggurti, Anita Raj S17 A big data approach for discovering and implementing patient safety insights Eric Hughes, Brian Jacobs, Eric Kirkendall S18 Improving the efficacy of a depression registry for use in a collaborative care model Danielle Loeb, Katy Trinkley, Michael Yang, Andrew Sprowell, Donald Nease S19 Measurement feedback systems as a strategy to support implementation of measurement-based care in behavioral health Aaron Lyon, Cara Lewis, Meredith Boyd, Abigail Melvin, Semret Nicodimos, Freda Liu, Nathanial Jungbluth S20 PANEL: Implementation Science and Learning Health Systems: Intersections and Commonalities - Common loop assay: Methods of supporting learning collaboratives Allen Flynn S21 PANEL: Implementation Science and Learning Health Systems: Intersections and Commonalities - Innovating audit and feedback using message tailoring models for learning health systems Zach Landis-Lewis S22 PANEL: Implementation Science and Learning Health Systems: Intersections and Commonalities - Implementation science and learning health systems: Connecting the dots Anne Sales S23 Facilitation activities of Critical Access Hospitals during TeamSTEPPS implementation Jure Baloh, Marcia Ward, Xi Zhu S24 Organizational and social context of federally qualified health centers and variation in maternal depression outcomes Ian Bennett, Jurgen Unutzer, Johnny Mao, Enola Proctor, Mindy Vredevoogd, Ya-Fen Chan, Nathaniel Williams, Phillip Green S25 Decision support to enhance treatment of hospitalized smokers: A randomized trial Steven Bernstein, June-Marie Rosner, Michelle DeWitt, Jeanette Tetrault, James Dziura, Allen Hsiao, Scott Sussman, Patrick O’Connor, Benjamin Toll S26 PANEL: Developing Sustainable Strategies for the Implementation of Patient-Centered Care across Diverse US Healthcare Systems - A patient-centered approach to successful community transition after catastrophic injury Michael Jones, Julie Gassaway S27 PANEL: Developing Sustainable Strategies for the Implementation of Patient-Centered Care across Diverse US Healthcare Systems - Conducting PCOR to integrate mental health and cancer screening services in primary care Jonathan Tobin S28 PANEL: Developing Sustainable Strategies for the Implementation of Patient-Centered Care across Diverse US Healthcare Systems - A comparative effectiveness trial of optimal patient-centered care for US trauma care systems Douglas Zatzick S29 Preferences for in-person communication among patients in a multi-center randomized study of in-person versus telephone communication of genetic test results for cancer susceptibility Angela R Bradbury, Linda Patrick-Miller, Brian Egleston, Olufunmilayo I Olopade, Michael J Hall, Mary B Daly, Linda Fleisher, Generosa Grana, Pamela Ganschow, Dominique Fetzer, Amanda Brandt, Dana Farengo-Clark, Andrea Forman, Rikki S Gaber, Cassandra Gulden, Janice Horte, Jessica Long, Rachelle Lorenz Chambers, Terra Lucas, Shreshtha Madaan, Kristin Mattie, Danielle McKenna, Susan Montgomery, Sarah Nielsen, Jacquelyn Powers, Kim Rainey, Christina Rybak, Michelle Savage, Christina Seelaus, Jessica Stoll, Jill Stopfer, Shirley Yao and Susan Domchek S30 Working towards de-implementation: A mixed methods study in breast cancer surveillance care Erin Hahn, Corrine Munoz-Plaza, Jianjin Wang, Jazmine Garcia Delgadillo, Brian Mittman Michael Gould S31Integrating evidence-based practices for increasing cancer screenings in safety-net primary care systems: A multiple case study using the consolidated framework for implementation research Shuting (Lily) Liang, Michelle C. Kegler, Megan Cotter, Emily Phillips, April Hermstad, Rentonia Morton, Derrick Beasley, Jeremy Martinez, Kara Riehman S32 Observations from implementing an mHealth intervention in an FQHC David Gustafson, Lisa Marsch, Louise Mares, Andrew Quanbeck, Fiona McTavish, Helene McDowell, Randall Brown, Chantelle Thomas, Joseph Glass, Joseph Isham, Dhavan Shah S33 A multicomponent intervention to improve primary care provider adherence to chronic opioid therapy guidelines and reduce opioid misuse: A cluster randomized controlled trial protocol Jane Liebschutz, Karen Lasser S34 Implementing collaborative care for substance use disorders in primary care: Preliminary findings from the summit study Katherine Watkins, Allison Ober, Sarah Hunter, Karen Lamp, Brett Ewing S35 Sustaining a task-shifting strategy for blood pressure control in Ghana: A stakeholder analysis Juliet Iwelunmor, Joyce Gyamfi, Sarah Blackstone, Nana Kofi Quakyi, Jacob Plange-Rhule, Gbenga Ogedegbe S36 Contextual adaptation of the consolidated framework for implementation research (CFIR) in a tobacco cessation study in Vietnam Pritika Kumar, Nancy Van Devanter, Nam Nguyen, Linh Nguyen, Trang Nguyen, Nguyet Phuong, Donna Shelley S37 Evidence check: A knowledge brokering approach to systematic reviews for policy Sian Rudge S38 Using Evidence Synthesis to Strengthen Complex Health Systems in Low- and Middle-Income Countries Etienne Langlois S39 Does it matter: timeliness or accuracy of results? The choice of rapid reviews or systematic reviews to inform decision-making Andrea Tricco S40 Evaluation of the veterans choice program using lean six sigma at a VA medical center to identify benefits and overcome obstacles Sherry Ball, Anne Lambert-Kerzner, Christine Sulc, Carol Simmons, Jeneen Shell-Boyd, Taryn Oestreich, Ashley O'Connor, Emily Neely, Marina McCreight, Amy Labebue, Doreen DiFiore, Diana Brostow, P. Michael Ho, David Aron S41 The influence of local context on multi-stakeholder alliance quality improvement activities: A multiple case study Jillian Harvey, Megan McHugh, Dennis Scanlon S42 Increasing physical activity in early care and education: Sustainability via active garden education (SAGE) Rebecca Lee, Erica Soltero, Nathan Parker, Lorna McNeill, Tracey Ledoux S43 Marking a decade of policy implementation: The successes and continuing challenges of a provincial school food and nutrition policy in Canada Jessie-Lee McIsaac, Kate MacLeod, Nicole Ata, Sherry Jarvis, Sara Kirk S44 Use of research evidence among state legislators who prioritize mental health and substance abuse issues Jonathan Purtle, Elizabeth Dodson, Ross Brownson S45 PANEL: Effectiveness-Implementation Hybrid Designs: Clarifications, Refinements, and Additional Guidance Based on a Systematic Review and Reports from the Field - Hybrid type 1 designs Brian Mittman, Geoffrey Curran S46 PANEL: Effectiveness-Implementation Hybrid Designs: Clarifications, Refinements, and Additional Guidance Based on a Systematic Review and Reports from the Field - Hybrid type 2 designs Geoffrey Curran S47 PANEL: Effectiveness-Implementation Hybrid Designs: Clarifications, Refinements, and Additional Guidance Based on a Systematic Review and Reports from the Field - Hybrid type 3 designs Jeffrey Pyne S48 Linking team level implementation leadership and implementation climate to individual level attitudes, behaviors, and implementation outcomes Gregory Aarons, Mark Ehrhart, Elisa Torres S49 Pinpointing the specific elements of local context that matter most to implementation outcomes: Findings from qualitative comparative analysis in the RE-inspire study of VA acute stroke care Edward Miech S50 The GO score: A new context-sensitive instrument to measure group organization level for providing and improving care Edward Miech S51 A research network approach for boosting implementation and improvement Kathleen Stevens, I.S.R.N. Steering Council S52 PANEL: Qualitative methods in D&I Research: Value, rigor and challenge - The value of qualitative methods in implementation research Alison Hamilton S53 PANEL: Qualitative methods in D&I Research: Value, rigor and challenge - Learning evaluation: The role of qualitative methods in dissemination and implementation research Deborah Cohen S54 PANEL: Qualitative methods in D&I Research: Value, rigor and challenge - Qualitative methods in D&I research Deborah Padgett S55 PANEL: Maps & models: The promise of network science for clinical D&I - Hospital network of sharing patients with acute and chronic diseases in California Alexandra Morshed S56 PANEL: Maps & models: The promise of network science for clinical D&I - The use of social network analysis to identify dissemination targets and enhance D&I research study recruitment for pre-exposure prophylaxis for HIV (PrEP) among men who have sex with men Rupa Patel S57 PANEL: Maps & models: The promise of network science for clinical D&I - Network and organizational factors related to the adoption of patient navigation services among rural breast cancer care providers Beth Prusaczyk S58 A theory of de-implementation based on the theory of healthcare professionals’ behavior and intention (THPBI) and the becker model of unlearning David C. Aron, Divya Gupta, Sherry Ball S59 Observation of registered dietitian nutritionist-patient encounters by dietetic interns highlights low awareness and implementation of evidence-based nutrition practice guidelines Rosa Hand, Jenica Abram, Taylor Wolfram S60 Program sustainability action planning: Building capacity for program sustainability using the program sustainability assessment tool Molly Hastings, Sarah Moreland-Russell S61 A review of D&I study designs in published study protocols Rachel Tabak, Alex Ramsey, Ana Baumann, Emily Kryzer, Katherine Montgomery, Ericka Lewis, Margaret Padek, Byron Powell, Ross Brownson S62 PANEL: Geographic variation in the implementation of public health services: Economic, organizational, and network determinants - Model simulation techniques to estimate the cost of implementing foundational public health services Cezar Brian Mamaril, Glen Mays, Keith Branham, Lava Timsina S63 PANEL: Geographic variation in the implementation of public health services: Economic, organizational, and network determinants - Inter-organizational network effects on the implementation of public health services Glen Mays, Rachel Hogg S64 PANEL: Building capacity for implementation and dissemination of the communities that care prevention system at scale to promote evidence-based practices in behavioral health - Implementation fidelity, coalition functioning, and community prevention system transformation using communities that care Abigail Fagan, Valerie Shapiro, Eric Brown S65 PANEL: Building capacity for implementation and dissemination of the communities that care prevention system at scale to promote evidence-based practices in behavioral health - Expanding capacity for implementation of communities that care at scale using a web-based, video-assisted training system Kevin Haggerty, David Hawkins S66 PANEL: Building capacity for implementation and dissemination of the communities that care prevention system at scale to promote evidence-based practices in behavioral health - Effects of communities that care on reducing youth behavioral health problems Sabrina Oesterle, David Hawkins, Richard Catalano S68 When interventions end: the dynamics of intervention de-adoption and replacement Virginia McKay, M. Margaret Dolcini, Lee Hoffer S69 Results from next-d: can a disease specific health plan reduce incident diabetes development among a national sample of working-age adults with pre-diabetes? Tannaz Moin, Jinnan Li, O. Kenrik Duru, Susan Ettner, Norman Turk, Charles Chan, Abigail Keckhafer, Robert Luchs, Sam Ho, Carol Mangione S70 Implementing smoking cessation interventions in primary care settings (STOP): using the interactive systems framework Peter Selby, Laurie Zawertailo, Nadia Minian, Dolly Balliunas, Rosa Dragonetti, Sarwar Hussain, Julia Lecce S71 Testing the Getting To Outcomes implementation support intervention in prevention-oriented, community-based settings Matthew Chinman, Joie Acosta, Patricia Ebener, Patrick S Malone, Mary Slaughter S72 Examining the reach of a multi-component farmers’ market implementation approach among low-income consumers in an urban context Darcy Freedman, Susan Flocke, Eunlye Lee, Kristen Matlack, Erika Trapl, Punam Ohri-Vachaspati, Morgan Taggart, Elaine Borawski S73 Increasing implementation of evidence-based health promotion practices at large workplaces: The CEOs Challenge Amanda Parrish, Jeffrey Harris, Marlana Kohn, Kristen Hammerback, Becca McMillan, Peggy Hannon S74 A qualitative assessment of barriers to nutrition promotion and obesity prevention in childcare Taren Swindle, Geoffrey Curran, Leanne Whiteside-Mansell, Wendy Ward S75 Documenting institutionalization of a health communication intervention in African American churches Cheryl Holt, Sheri Lou Santos, Erin Tagai, Mary Ann Scheirer, Roxanne Carter, Janice Bowie, Muhiuddin Haider, Jimmie Slade, Min Qi Wang S76 Reduction in hospital utilization by underserved patients through use of a community-medical home Andrew Masica, Gerald Ogola, Candice Berryman, Kathleen Richter S77 Sustainability of evidence-based lay health advisor programs in African American communities: A mixed methods investigation of the National Witness Project Rachel Shelton, Lina Jandorf, Deborah Erwin S78 Predicting the long-term uninsured population and analyzing their gaps in physical access to healthcare in South Carolina Khoa Truong S79 Using an evidence-based parenting intervention in churches to prevent behavioral problems among Filipino youth: A randomized pilot study Joyce R. Javier, Dean Coffey, Sheree M. Schrager, Lawrence Palinkas, Jeanne Miranda S80 Sustainability of elementary school-based health centers in three health-disparate southern communities Veda Johnson, Valerie Hutcherson, Ruth Ellis S81 Childhood obesity prevention partnership in Louisville: creative opportunities to engage families in a multifaceted approach to obesity prevention Anna Kharmats, Sandra Marshall-King, Monica LaPradd, Fannie Fonseca-Becker S82 Improvements in cervical cancer prevention found after implementation of evidence-based Latina prevention care management program Deanna Kepka, Julia Bodson, Echo Warner, Brynn Fowler S83 The OneFlorida data trust: Achieving health equity through research & training capacity building Elizabeth Shenkman, William Hogan, Folakami Odedina, Jessica De Leon, Monica Hooper, Olveen Carrasquillo, Renee Reams, Myra Hurt, Steven Smith, Jose Szapocznik, David Nelson, Prabir Mandal S84 Disseminating and sustaining medical-legal partnerships: Shared value and social return on investment James Teufel
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Li J, Brock J, Jack B, Mittman B, Naylor M, Sorra J, Mays G, Williams MV. Erratum to: Project ACHIEVE - using implementation research to guide the evaluation of transitional care effectiveness. BMC Health Serv Res 2016; 16:326. [PMID: 27480756 PMCID: PMC4969640 DOI: 10.1186/s12913-016-1560-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jing Li
- Administrative Director of the Center for Health Services Research, Assistant Professor of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Jane Brock
- Care Transitions Theme Support Center, Telligen, Englewood, CO, USA
| | - Brian Jack
- Family Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Brian Mittman
- Research Scientist, Research and Evaluation, Kaiser Permanente, Pasadena, CA, USA.,US Department of Veterans Affairs Greater Los Angeles Healthcare System, VA Center for Implementation Practice and Research, Los Angeles, CA, USA.,UCLA School of Medicine, UCLA Clinical Translational Science Institute, Los Angeles, CA, USA
| | - Mary Naylor
- Director of NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - Glen Mays
- National Coordinating Center for Public Health Services & Systems Research, University of Kentucky, Lexington, KY, USA
| | - Mark V Williams
- Center for Health Services Research, Department of Internal Medicine, University of Kentucky, Kentucky Clinic J525, Lexington, KY, 40536-0284, USA.
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Li J, Brock J, Jack B, Mittman B, Naylor M, Sorra J, Mays G, Williams MV. Project ACHIEVE - using implementation research to guide the evaluation of transitional care effectiveness. BMC Health Serv Res 2016; 16:70. [PMID: 26896024 PMCID: PMC4759940 DOI: 10.1186/s12913-016-1312-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 02/11/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Poorly managed hospital discharges and care transitions between health care facilities can cause poor outcomes for both patients and their caregivers. Unfortunately, the usual approach to health care delivery does not support continuity and coordination across the settings of hospital, doctors' offices, home or nursing homes. Though complex efforts with multiple components can improve patient outcomes and reduce 30-day readmissions, research has not identified which components are necessary. Also we do not know how delivery of core components may need to be adjusted based on patient, caregiver, setting or characteristics of the community, or how system redesign can be accelerated. METHODS/DESIGN Project ACHIEVE focuses on diverse Medicare populations such as individuals with multiple chronic diseases, patients with low health literacy/numeracy and limited English proficiency, racial and ethnic minority groups, low-income groups, residents of rural areas, and individuals with disabilities. During the first phase, we will use focus groups to identify the transitional care outcomes and components that matter most to patients and caregivers to inform development and validation of assessment instruments. During the second phase, we will evaluate the comparative effectiveness of multi-component care transitions programs occurring across the U.S. Using a mixed-methods approach for this evaluation, we will study historical (retrospective) and current and future (prospective) groups of patients, caregivers and providers using site visits, surveys, and clinical and claims data. In this natural experiment observational study, we use a fractional factorial study design to specify comparators and estimate the individual and combined effects of key transitional care components. DISCUSSION Our study will determine which evidence-based transitional care components and/or clusters most effectively produce patient and caregiver desired outcomes overall and among diverse patient and caregiver populations in different healthcare settings. Using the results, we will develop concrete, actionable recommendations regarding how best to implement these strategies. Finally, this work will provide tools for hospitals, community-based organizations, patients, caregivers, clinicians and other stakeholders to help them make informed decisions about which strategies are most effective and how best to implement them in their communities. TRIAL REGISTRATION Registered as NCT02354482 on clinicaltrials.gov on 1/29/2015.
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Affiliation(s)
- Jing Li
- Administrative Director of the Center for Health Services Research, Assistant Professor of Internal Medicine, University of Kentucky, Lexington, KY, USA.
| | - Jane Brock
- Care Transitions Theme Support Center, Telligen, Englewood, CO, USA.
| | - Brian Jack
- Family Medicine, Boston University School of Medicine, Boston, MA, USA.
| | - Brian Mittman
- Research Scientist, Research and Evaluation, Kaiser Permanente, Pasadena, CA, USA.
- US Department of Veterans Affairs Greater Los Angeles Healthcare System, VA Center for Implementation Practice and Research, Los Angeles, CA, USA.
- UCLA School of Medicine, UCLA Clinical Translational Science Institute, Los Angeles, CA, USA.
| | - Mary Naylor
- Director of NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
| | | | - Glen Mays
- National Coordinating Center for Public Health Services & Systems Research, University of Kentucky, Lexington, KY, USA.
| | - Mark V Williams
- Center for Health Services Research, Department of Internal Medicine, University of Kentucky, Kentucky Clinic J525, Lexington, KY, 40536-0284, USA.
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Clarke R, Bharmal N, Di Capua P, Tseng CH, Mangione CM, Mittman B, Skootsky SA. Innovative approach to patient-centered care coordination in primary care practices. Am J Manag Care 2015; 21:623-630. [PMID: 26618365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Although care coordination is an essential component of the patient-centered medical home structure, current case manager models have limited usefulness to population health because they typically serve a small group of patients defined based on disease or utilization. Our objective was to support our health system's population health by implementing and evaluating a program that embedded nonlicensed coordinators within our primary care practices to support physicians in executing care plans and communicating with patients. STUDY DESIGN Matched case-control differences-in-differences. METHODS Comprehensive care coordinators (CCC) were introduced into 14 of the system's 28 practice sites in 2 waves. After a structured training program, CCCs identified, engaged, and intervened among patients within the practice in conjunction with practice primary care providers. We counted and broadly coded CCC activities that were documented in the intervention database. We examined the impact of CCC intervention on emergency department (ED) utilization at the practice level using a negative binomial multivariate regression model controlling for age, gender, and medical complexity. RESULTS CCCs touched 10,500 unique patients over a 1-year period. CCC interventions included execution of care (38%), coordination of transitions (32%), self-management support/link to community resources (15%), monitor and follow-up (10%), and patient assessment (1%). The CCC intervention group had a 20% greater reduction in its prepost ED visit rate compared with the control group (P < .0001). CONCLUSIONS Our CCC intervention demonstrated a significant reduction in ED visits by focusing on the centrality of the primary care provider and practice. Our model may serve as a cost-effective and scalable alternative for care coordination in primary care.
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Affiliation(s)
- Robin Clarke
- UCLA Faculty Practice Group, Assistant Clinical Professor, Division of General Internal Medicine, 10945 Le Conte Ave, Ste 1401, Los Angeles, CA 90024. E-mail:
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Kwon I, Choi S, Mittman B, Bharmal N, Liu H, Vickrey B, Song S, Araiza D, McCreath H, Seeman T, Oh SM, Trejo L, Sarkisian C. Study protocol of "Worth the Walk": a randomized controlled trial of a stroke risk reduction walking intervention among racial/ethnic minority older adults with hypertension in community senior centers. BMC Neurol 2015; 15:91. [PMID: 26072359 PMCID: PMC4465734 DOI: 10.1186/s12883-015-0346-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 05/06/2015] [Accepted: 05/28/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Stroke disproportionately kills and disables ethnic minority seniors. Up to 30 % of ischemic strokes in the U.S. can be attributed to physical inactivity, yet most Americans, especially older racial/ethnic minorities, fail to participate in regular physical activity. We are conducting a randomized controlled trial (RCT) to test a culturally-tailored community-based walking intervention designed to reduce stroke risk by increasing physical activity among African American, Latino, Chinese, and Korean seniors with hypertension. We hypothesize that the intervention will yield meaningful changes in seniors' walking levels and stroke risk with feasibility to sustain and scale up across the aging services network. METHODS/DESIGN In this randomized single-blind wait-list control study, high-risk ethnic minority seniors are enrolled at senior centers, complete baseline data collection, and are randomly assigned to receive the intervention "Worth the Walk" immediately (N = 120, intervention group) or in 90 days upon completion of follow-up data collection (N = 120, control group). Trained case managers employed by the senior centers implement hour-long intervention sessions twice weekly for four consecutive weeks to the intervention group. Research staff blinded to participants' group assignment collect outcome data from both intervention and wait-list control participants 1 and 3-months after baseline data collection. Primary outcome measures are mean steps/day over 7 days, stroke knowledge, and self-efficacy for reducing stroke risk. Secondary and exploratory outcome measures include selected biological markers of health, healthcare seeking, and health-related quality of life. Outcomes will be compared between the two groups using standard analytic methods for randomized trials. We will conduct a formal process evaluation to assess barriers and facilitators to successful integration of Worth the Walk into the aging services network and to calculate estimated costs to sustain and scale up the intervention. Data collection is scheduled to be completed in December 2016. DISCUSSION If this RCT demonstrates superior improvements in physical activity and stroke knowledge in the intervention group compared to the control group and is found to be sustainable and scalable, Worth the Walk could serve as a primary stroke prevention model for racial/ethnic communities across the nation. TRIAL REGISTRATION ClinicalTrials.gov NCT02181062 ; registered on June 30, 2014.
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Affiliation(s)
- Ivy Kwon
- Department of Medicine, Division of Geriatrics, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave, Suite 2339, Los Angeles, CA, 90095, USA.
| | - Sarah Choi
- Nursing Science, College of Health Sciences, UC Irvine, 100B Berk Hall, University of California Irvine, Irvine, CA, 92697, USA.
| | - Brian Mittman
- VA Greater Los Angeles Healthcare System, Center for Implementation Practice and Research Support, 16111 Plummer Street, North Hills, CA, 91343, USA.
| | - Nazleen Bharmal
- UCLA Division of General Internal Medicine and Health Services Research, 911 Broxton Avenue, Los Angeles, CA, 90095, USA.
| | - Honghu Liu
- Department of Biostatistics at UCLA, CHS 63-037A, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Barbara Vickrey
- Department of Neurology at UCLA, 710 Westwood Plaza, C109 RNRC, Los Angeles, CA, 90095, USA.
| | - Sarah Song
- Vascular Neurology at Rush University, Professional Office Building, 1725 W. Harrison St, Suite 1121, Chicago, IL, 60612, USA.
| | - Daniel Araiza
- Department of Medicine, Division of Geriatrics, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave, Suite 2339, Los Angeles, CA, 90095, USA.
| | - Heather McCreath
- Geriatrics Research Center, Division of Geriatrics, David Geffen School of Medicine at UCLA, 10880 Wilshire Boulevard, Suite 860, Los Angeles, CA, 90024, USA.
| | - Teresa Seeman
- Department of Medicine, Division of Geriatrics, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave, Suite 2339, Los Angeles, CA, 90095, USA.
| | - Sang-Mi Oh
- American Heart Association/American Stroke Association, One South Almaden Boulevard, Suite 500, San Jose, CA, 95113, USA.
| | - Laura Trejo
- City of Los Angeles Department of Aging, 221 N. Figueroa St., Suite 180, Los Angeles, CA, 90012, USA.
| | - Catherine Sarkisian
- Department of Medicine, Division of Geriatrics, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave, Suite 2339, Los Angeles, CA, 90095, USA.
- VA Greater Los Angeles Healthcare System Geriatric Research Education Clinical Center (GRECC), Building 220, Room 315 (11G), 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA.
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Sahay A, Mittman B, Heidenreich PA. Abstract 249: Formative Evaluation of a National Social Network of Heart Failure Providers: What is its Perceived Value by the Participating Members? Circ Cardiovasc Qual Outcomes 2015. [DOI: 10.1161/circoutcomes.8.suppl_2.249] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
There is growing interest in the use of networks to facilitate knowledge exchange in health-care settings. The goal of the Dept. of Veterans Affairs (VA) Chronic Heart Failure (CHF) QUERI program is to improve the quality of care for heart failure (HF) patients and implement evidence-based practices (EBP) throughout the VA system. One strategy to achieve this goal was to create a VA Heart Failure Provider Network which occurred in 2006. We sought to conduct a formative evaluation of this well-established network to assess its perceived value by the members participating in it to improve HF care for Veterans.
Method:
Qualitative data was gathered using semi-structured phone interviews with selected HF Network members (n=25). All current members who had been participating in the HF Network for at least six months and hadn’t participated in the phone interview completed a web-based survey (n=878). The survey response rate was 24.9%. The HF Network members include leaders from Central Office, regional and facilities, chiefs of cardiology, physicians, nurses and others from all VA facilities (n=144).
Results:
Qualitative analysis of interviews showed that members participated in the HF Network to stay informed and maintain or enhance their knowledge in this area. Collaboration within and between VA facilities was frequently mentioned as a facilitator to achieve the goals of the HF Network. Also, many members mentioned that the web-based meetings and conference calls about HF clinics/programs were the most helpful because these methods provided access to new and practical ideas about solving problems and implementing changes in their own facility and to the members stay informed concerning heart failure care. Regarding barriers to greater involvement in HF Network activities, the most commonly noted barrier was lack of resources with members frequently mentioning lack of staff, time and local support.
Quantitative findings strongly support the findings. Among the respondents (n=219), 90% of all members reported that the HF Network helped them establish collaborations and/or to network among members of the HF Network at least to a moderate extent. Interestingly, 63.8% of all members also reported that their participation in the HF Network provided them with names of contacts for networking and potential problem solving. 94.1% of the members found attending the web-based meetings and conference calls helpful in learning about barriers and facilitators in setting up or running HF program.
Conclusions:
Members perceived this social network of heart failure providers as a platform for the exchange of both explicit and tacit knowledge with the goal of improving quality of care for Veterans with heart failure.
Implications for Policy or Practice:
Social networks offer an effective platform for the implementation of EBP to improve the quality of HF care from local, regional to national levels.
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Sahay A, Mittman B, Heidenreich PA. Abstract 148: Evaluation of Value, Relevance and Comprehensiveness of a Web-based Heart Failure Toolkit. Circ Cardiovasc Qual Outcomes 2015. [DOI: 10.1161/circoutcomes.8.suppl_2.148] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
Reducing readmission rates for heart failure (HF) patients is the primary goal of the Department of Veterans Affairs (VA) and its Chronic Heart Failure (CHF) QUERI. Since its establishment in 2005 the CHF QUERI has undertaken many initiatives to improve the quality of HF care by providers for Veterans. One such initiative is the development of a comprehensive evidence-based “Heart Failure Toolkit for Providers”. This is a web-based toolkit with links and downloadable PDF documents. It has been developed through collaboration with the members of the CHF QUERI’s Heart Failure (HF) Provider Network along with existing quality tools provided by non-VA organizations.
Method:
Using a mixed methods approach we gathered quantitative data using a cross-sectional web-based survey from all current members of the HF Network who have been participating in it for at least six months (n=878). The response rate was 24.9%. Qualitative data was gathered from semi-structured phone interviews of selected HF Network members who hadn’t responded to the survey (n=25).
Results:
Survey finding showed 133 member respondents (61.3%) were aware of the HF Toolkit and all of them had accessed it 1-9 times. Among them 60.9% had recommended and/or sent the link for the toolkit to other providers. These members perceived the toolkit positively in terms of its usability to manage HF patients (96.6%), comprehensiveness of topics (98.3%), layout of web-based toolkit (97.4%) and opportunity to provide feedback about the availability of tools and/or upload other tools (93.0%). These members felt the toolkit helped provide evidence-based care for HF patients (98.0%), helped improve their quality of care (98.1%), helped educate providers about current standards of HF care (99.0%), and can be used by providers in primary care and by teamlets (98.0%) at all types of small/ large and urban/rural facilities (98.0%).
Interestingly, qualitative data substantiated these findings. 75% of the members had heard about the HF Toolkit, and 57% of them specifically mentioned the following components as being extremely useful: patient education, guidelines, clinical pathways, order sets and discharge instructions. The organization of the toolkit was cited as a key contributor to its ease of use. Several of the members also appreciated the direct access to information specific to the VA context.
Conclusions:
VA providers and staff found an online toolkit valuable in the management of heart failure patients.
Implications:
Evidence-based comprehensive, well-organized and easily accessible resources are helpful for improved outcomes of heart failure patients.
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Sharp AL, Klau M, Keschner D, Macy E, Tang T, Shen E, Munoz-Plaza C, Kanter M, Silver MA, Mittman B, Gould MK. Assessing Current Practices in the Evaluation and Treatment of Acute Sinusitis: A Comparison of Primary Care, Urgent Care and Emergency Department Care. J Patient Cent Res Rev 2015. [DOI: 10.17294/2330-0698.1185] [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: 11/04/2022] Open
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Mittman B. P014 Guideline Implementation in a 21st Century Health System. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.14] [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: 11/03/2022]
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Meissner HI, Glasgow RE, Vinson CA, Chambers D, Brownson RC, Green LW, Ammerman AS, Weiner BJ, Mittman B. The U.S. training institute for dissemination and implementation research in health. Implement Sci 2013; 8:12. [PMID: 23347882 PMCID: PMC3564839 DOI: 10.1186/1748-5908-8-12] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 12/12/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The science of dissemination and implementation (D&I) is advancing the knowledge base for how best to integrate evidence-based interventions within clinical and community settings and how to recast the nature or conduct of the research itself to make it more relevant and actionable in those settings. While the field is growing, there are only a few training programs for D&I research; this is an important avenue to help build the field's capacity. To improve the United States' capacity for D&I research, the National Institutes of Health and Veterans Health Administration collaborated to develop a five-day training institute for postdoctoral level applicants aspiring to advance this science. METHODS We describe the background, goals, structure, curriculum, application process, trainee evaluation, and future plans for the Training in Dissemination and Implementation Research in Health (TIDIRH). RESULTS The TIDIRH used a five-day residential immersion to maximize opportunities for trainees and faculty to interact. The train-the-trainer-like approach was intended to equip participants with materials that they could readily take back to their home institutions to increase interest and further investment in D&I. The TIDIRH curriculum included a balance of structured large group discussions and interactive small group sessions.Thirty-five of 266 applicants for the first annual training institute were accepted from a variety of disciplines, including psychology (12 trainees); medicine (6 trainees); epidemiology (5 trainees); health behavior/health education (4 trainees); and 1 trainee each from education & human development, health policy and management, health services research, public health studies, public policy and social work, with a maximum of two individuals from any one institution. The institute was rated as very helpful by attendees, and by six months after the institute, a follow-up survey (97% return rate) revealed that 72% had initiated a new grant proposal in D&I research; 28% had received funding, and 77% had used skills from TIDIRH to influence their peers from different disciplines about D&I research through building local research networks, organizing formal presentations and symposia, teaching and by leading interdisciplinary teams to conduct D&I research. CONCLUSIONS The initial TIDIRH training was judged successful by trainee evaluation at the conclusion of the week's training and six-month follow-up, and plans are to continue and possibly expand the TIDIRH in coming years. Strengths are seen as the residential format, quality of the faculty and their flexibility in adjusting content to meet trainee needs, and the highlighting of concrete D&I examples by the local host institution, which rotates annually. Lessons learned and plans for future TIDIRH trainings are summarized.
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Affiliation(s)
- Helen I Meissner
- Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD, USA.
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33
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Kaisey M, Mittman B, Pearson M, Connor KI, Chodosh J, Vassar SD, Nguyen FT, Vickrey BG. Predictors of acceptance of offered care management intervention services in a quality improvement trial for dementia. Int J Geriatr Psychiatry 2012; 27:1078-85. [PMID: 22190354 DOI: 10.1002/gps.2830] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Accepted: 11/09/2011] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Care management approaches have been proven to improve outcomes for patients with dementia and their family caregivers (dyads). However, acceptance of services in these programs is incomplete, impacting effectiveness. Acceptance may be related to dyad as well as healthcare system characteristics, but knowledge about factors associated with program acceptance is lacking. This study investigates patient, caregiver, and healthcare system characteristics associated with acceptance of offered care management services. METHODS This study analyzed data from the intervention arm of a cluster randomized controlled trial of a comprehensive dementia care management intervention. There were 408 patient-caregiver dyads enrolled in the study, of which 238 dyads were randomized to the intervention. Caregiver, patient, and health system factors associated with participation in offered care management services were assessed through bivariate and multivariate regression analyses. RESULTS Out of the 238 dyads, 9 were ineligible for this analysis, leaving data of 229 dyads in this sample. Of these, 185 dyads accepted offered care management services, and 44 dyads did not. Multivariate analyses showed that higher likelihood of acceptance of care management services was uniquely associated with cohabitation of caregiver and patient (p < 0.001), lesser severity of dementia (p = 0.03), and higher patient comorbidity (p = 0.03); it also varied across healthcare organization sites. CONCLUSIONS Understanding factors that influence care management participation could result in increased adoption of successful programs to improve quality of care. Using these factors to revise both program design as well as program promotion may also benefit external validity of future quality improvement research trials.
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Affiliation(s)
- Marwa Kaisey
- School of Medicine, University of Michigan, Ann Arbor, MI, USA
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34
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Eccles MP, Foy R, Sales A, Wensing M, Mittman B. Implementation Science six years on--our evolving scope and common reasons for rejection without review. Implement Sci 2012; 7:71. [PMID: 22839967 PMCID: PMC3443070 DOI: 10.1186/1748-5908-7-71] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 07/13/2012] [Indexed: 11/18/2022] Open
Abstract
Implementation Science has been published for six years and over that time has gone from receiving 100 articles in 2006 to receiving 354 in 2011; our impact factor has risen from 2.49 in June 2010 to 3.10 in June 2012. Whilst our article publication rate has also risen, it has risen much less slowly than our submission rate—we published 29 papers in 2006 and 134 papers in 2011 and we now publish only around 40 % of submissions. About one-half of submitted manuscripts are rejected without being sent out for peer review; it has become clear that there are a number of common issues that result in manuscripts being rejected at this stage. We hope that by publishing this editorial on our common reasons for rejection without peer review we can help authors to better judge the relevance of their papers to Implementation Science.
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Affiliation(s)
- Martin P Eccles
- Institute of Health and Society, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.
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35
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Lisi A, Khorsan R, Smith M, Mittman B. P05.53. Variations in the implementation and characteristics of chiropractic services in VA. BMC Complement Altern Med 2012. [PMCID: PMC3373885 DOI: 10.1186/1472-6882-12-s1-p413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care 2012; 50:217-26. [PMID: 22310560 PMCID: PMC3731143 DOI: 10.1097/mlr.0b013e3182408812] [Citation(s) in RCA: 2086] [Impact Index Per Article: 173.8] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study proposes methods for blending design components of clinical effectiveness and implementation research. Such blending can provide benefits over pursuing these lines of research independently; for example, more rapid translational gains, more effective implementation strategies, and more useful information for decision makers. This study proposes a "hybrid effectiveness-implementation" typology, describes a rationale for their use, outlines the design decisions that must be faced, and provides several real-world examples. RESULTS An effectiveness-implementation hybrid design is one that takes a dual focus a priori in assessing clinical effectiveness and implementation. We propose 3 hybrid types: (1) testing effects of a clinical intervention on relevant outcomes while observing and gathering information on implementation; (2) dual testing of clinical and implementation interventions/strategies; and (3) testing of an implementation strategy while observing and gathering information on the clinical intervention's impact on relevant outcomes. CONCLUSIONS The hybrid typology proposed herein must be considered a construct still in evolution. Although traditional clinical effectiveness and implementation trials are likely to remain the most common approach to moving a clinical intervention through from efficacy research to public health impact, judicious use of the proposed hybrid designs could speed the translation of research findings into routine practice.
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Affiliation(s)
- Geoffrey M Curran
- Central Arkansas Veterans Healthcare System, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Eccles MP, Weijer C, Mittman B. Requirements for ethics committee review for studies submitted to Implementation Science. Implement Sci 2011; 6:32. [PMID: 21453451 PMCID: PMC3076240 DOI: 10.1186/1748-5908-6-32] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 03/31/2011] [Indexed: 11/19/2022] Open
Abstract
The requirement for ethics review of studies submitted to Implementation Science has been unclear. Therefore, in this editorial, we set out our requirements for ethics committee review of experimental and non-experimental studies. For any study that meets the criteria of human subject research (which includes research on healthcare providers), irrespective of study design, we will require proof of either satisfactory ethics committee review or of the granting of an official exemption or waiver.
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Affiliation(s)
- Martin P Eccles
- Institute of Health & Society, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, UK.
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Proctor EK, Landsverk J, Aarons G, Chambers D, Glisson C, Mittman B. Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Adm Policy Ment Health 2009; 36:24-34. [PMID: 19104929 PMCID: PMC3808121 DOI: 10.1007/s10488-008-0197-4] [Citation(s) in RCA: 982] [Impact Index Per Article: 65.5] [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: 11/25/2008] [Accepted: 11/28/2008] [Indexed: 10/21/2022]
Abstract
One of the most critical issues in mental health services research is the gap between what is known about effective treatment and what is provided to consumers in routine care. Concerted efforts are required to advance implementation science and produce skilled implementation researchers. This paper seeks to advance implementation science in mental health services by over viewing the emergence of implementation as an issue for research, by addressing key issues of language and conceptualization, by presenting a heuristic skeleton model for the study of implementation processes, and by identifying the implications for research and training in this emerging field.
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Affiliation(s)
- Enola K Proctor
- George Warren Brown School of Social Work, Washington University, 1 Brookings Drive, St Louis, MO 63130, USA.
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Proctor EK, Landsverk J, Aarons G, Chambers D, Glisson C, Mittman B. Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Adm Policy Ment Health 2008. [PMID: 19104929 DOI: 10.1007/s10488–008-0197–4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
One of the most critical issues in mental health services research is the gap between what is known about effective treatment and what is provided to consumers in routine care. Concerted efforts are required to advance implementation science and produce skilled implementation researchers. This paper seeks to advance implementation science in mental health services by over viewing the emergence of implementation as an issue for research, by addressing key issues of language and conceptualization, by presenting a heuristic skeleton model for the study of implementation processes, and by identifying the implications for research and training in this emerging field.
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Affiliation(s)
- Enola K Proctor
- George Warren Brown School of Social Work, Washington University, 1 Brookings Drive, St Louis, MO 63130, USA.
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Chodosh J, Berry E, Lee M, Connor K, DeMonte R, Ganiats T, Heikoff L, Rubenstein L, Mittman B, Vickrey B. Effect of a dementia care management intervention on primary care provider knowledge, attitudes, and perceptions of quality of care. J Am Geriatr Soc 2006; 54:311-7. [PMID: 16460384 DOI: 10.1111/j.1532-5415.2005.00564.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the effect of a multicomponent dementia care management program on primary care provider knowledge, attitudes, and perceptions of quality of dementia care. DESIGN A clinic-level randomized, controlled trial of a comprehensive care management program for patients with dementia and their nonprofessional caregivers. The program included provider education and protocols for care managers to communicate with patients' medical providers. SETTING Eighteen clinics (nine intervention, nine [corrected] usual care) in three healthcare systems in San Diego, California. PARTICIPANTS Two hundred thirty-two medical providers; 129 from nine [corrected] intervention clinics; 103 from nine [corrected] usual-care clinics. MEASUREMENTS Providers were surveyed 9 months after intervention onset on knowledge (five items on four topics), attitudes about dementia (three items), and perception of quality of dementia care in their practice setting (three items). Multivariable linear and logistic regression models were used to evaluate the differences between intervention and usual-care providers, adjusting for covariate effects across groups and clustering by clinic. RESULTS One hundred sixty-six of 232 (72%) providers responded. Intervention providers had better knowledge about assessing decision-making capacity than usual-care providers (adjusted difference in percentage correct = 12%; adjusted odds ratio = 2.4, 95% confidence interval = 1.2-4.8). Intervention providers viewed dementia patients as more difficult to manage in primary care than usual-care providers (P = .03). There were no other differences in knowledge, attitudes, or care quality perceptions across intervention and usual-care providers. CONCLUSION A comprehensive dementia care management model resulted in few differences in provider knowledge or attitudes favorable to dementia care, suggesting that this care model's effects on quality were primarily mediated through other components of the care management program.
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Affiliation(s)
- Joshua Chodosh
- Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California 90073, USA.
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Cummings JL, Frank JC, Cherry D, Kohatsu ND, Kemp B, Hewett L, Mittman B. Guidelines for managing Alzheimer's disease: Part II. Treatment. Am Fam Physician 2002; 65:2525-34. [PMID: 12086242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Once the clinical diagnosis of Alzheimer's disease has been made, a treatment plan must be developed. This plan should include cholinesterase inhibitor therapy to temporarily improve cognition or slow the rate of cognitive decline, management of comorbid conditions, treatment of behavioral symptoms and mood disorders, provision of support and resources for patient and caregiver, and compliance with state-mandated reporting requirements for driving impairment and elder abuse. The primary caregiver can be a valuable ally in communication, management of care, and implementation of the care plan. Patient symptoms and care needs change as Alzheimer's disease progresses. In the early stage of the disease, the family physician should discuss realistic expectations for drug therapy, solicit patient and family preferences on future care choices, and assist with advance planning for future care challenges. In the middle stage, the patient may exhibit behavioral symptoms that upset the caregiver and are difficult to manage. When the patient is in the advanced stage of Alzheimer's disease, the caregiver may need support to provide for activities of daily living, help in making a difficult placement decision, and guidance in considering terminal care options. Throughout the course of the disease, routine use of community resources allows care to be provided by a network of professionals, many of whom will be specialists in Alzheimer's disease.
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Cummings JL, Frank JC, Cherry D, Kohatsu ND, Kemp B, Hewett L, Mittman B. Guidelines for managing Alzheimer's disease: part I. Assessment. Am Fam Physician 2002; 65:2263-72. [PMID: 12074525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Family physicians play a key role in assessing and managing patients with Alzheimer's disease and in linking the families of these patients to supportive services within the community. As part of comprehensive management, the family physician may be responsible for coordinating assessments of patient function, cognition, comorbid medical conditions, disorders of mood and emotion, and caregiver status. Suggestions for easily administered and scored assessment tools are provided, and practical tips are given for supporting primary caregivers, thereby increasing efficiency and quality of care for patients with Alzheimer's disease.
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Abstract
Explores the underlying behavioral processes influencing the clinical behavior of physicians toward their patients. Utilizing educational and social influence explanatory models as a baseline, we sought how each, through peer group settings, would affect clinical specific practice decisions. Focusing on family physicians in Israel who were engaged in ongoing professional peer group meetings, it is suggested that health decisions affecting clinical practice are not universal but particularistic and depend a great deal on the transfer of clinical knowledge through selective social networks. Health managers, utilizing these findings, can therefore intervene in the formation of clinical practice decisions. This can be done primarily through management policy to induce the formation of specific types of peer group social networks.
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Affiliation(s)
- R Mano-Negrin
- Department of Human Services, University of Haifa, Israel
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Mittman B. Company executive keeps military ties as a chief nurse in Air Guard. Rev Fed Am Hosp 1983; 16:54. [PMID: 10262230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Abstract
Five groups of subjects, consisting of 20 schizophrenics, 20 depressives, 20 nonpatient adolescents, and 40 nonpatient adults split at the median on the MMPI K Scale, were instructed to give as many responses as possible to each Rorschach card within a 60-second time limit per card. The average number of answers given by each group was dramatically greater than the mean number obtained under standard test conditions, with approximately two-thirds of all answers occurring during the first 30 seconds of card exposure. Evaluation of form quality shows no deterioration of goodness of it with the increase in R, that is, all groups, except the schizophrenics, consistently gave good form quality answers. After testing was completed, subjects in the four adult groups were asked to select their two "best" answers to each card. The high K nonpatients and depressive tended to select the greatest number of Popular answers while the schizophrenics selected the fewest Populars and picked a significant number of poor form answers. In a related study, 20 therapists recruited two each of their own patients for testing. Each therapist tested one of his own patients while the second patient was tested by another therapist. Results show that therapists and to obtain longer and more "revealing" protocols from their own patients. The findings of these studies are discussed in the context of stimulus assimilation, ranking of interpretations, and the issue of social desirability.
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Mittman B, Bumgarner B. What happened in San Francisco. Am J Nurs 1967; 67:80-4. [PMID: 5180239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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