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Implementation Science: IS

Lila J Finney Rutten, Carmen Radecki Breitkopf, Jennifer L St Sauver, Ivana T Croghan, Debra J Jacobson, Patrick M Wilson, Jeph Herrin, Robert M Jacobson
BACKGROUND: Each year, human papillomavirus (HPV) causes 30,000 cancers in the USA despite the availability of effective and safe vaccines. Uptake of HPV vaccine has been low and lags behind other adolescent vaccines. This protocol describes a multilevel intervention to improve HPV vaccination rates. METHODS: Using a cluster randomized trial, we will evaluate the independent and combined impact of two evidence-based implementation strategies with innovative enhancements on HPV vaccination rates for female and male patients...
July 13, 2018: Implementation Science: IS
Alvaro Sanchez, Gonzalo Grandes, Susana Pablo, Maite Espinosa, Artemis Torres, Arturo García-Alvarez
BACKGROUND: There is a lack of evidence concerning the effectiveness of different strategies to engage healthcare professionals in collaborative processes that seek to optimise clinical practice. The PREDIAPS project aims to assess the effect of different primary health care (PHC) providers' engagement procedures in the creation and execution of a facilitated interprofessional collaborative process to optimise the integration of the recommended clinical practice for the prevention of type-2 diabetes (T2D) in routine PHC...
July 11, 2018: Implementation Science: IS
Wendy Gnich, Andrea Sherriff, Debbie Bonetti, David I Conway, Lorna M D Macpherson
BACKGROUND: Financial incentives are often used to influence professional practice, yet the factors which influence their effectiveness and their behavioural mechanisms are not fully understood. In keeping with clinical guidelines, Childsmile (Scotland's oral health improvement programme) advocates twice yearly fluoride varnish application (FVA) for children in dental practice. To support implementation Childsmile offered dental practitioners a fee-per-item payment for varnishing 2-5-year-olds' teeth through a pilot...
July 11, 2018: Implementation Science: IS
Shawna N Smith, Daniel Almirall, Katherine Prenovost, David E Goodrich, Kristen M Abraham, Celeste Liebrecht, Amy M Kilbourne
BACKGROUND: Organizational culture and climate are considered key factors in implementation efforts but have not been examined as moderators of implementation strategy comparative effectiveness. We investigated organizational culture and climate as moderators of comparative effectiveness of two sequences of implementation strategies (Immediate vs. Delayed Enhanced Replicating Effective Programs [REP]) combining Standard REP and REP enhanced with facilitation on implementation of an outreach program for Veterans with serious mental illness lost to care at Veterans Health Administration (VA) facilities nationwide...
July 9, 2018: Implementation Science: IS
Bryan R Garner, Aung K Lwin, Gail K Strickler, Brooke D Hunter, Donald S Shepard
BACKGROUND: Pay-for-performance (P4P) has been recommended as a promising strategy to improve implementation of high-quality care. This study examined the incremental cost-effectiveness of a P4P strategy found to be highly effective in improving the implementation and effectiveness of the Adolescent Community Reinforcement Approach (A-CRA), an evidence-based treatment (EBT) for adolescent substance use disorders (SUDs). METHODS: Building on a $30 million national initiative to implement A-CRA in SUD treatment settings, urn randomization was used to assign 29 organizations and their 105 therapists and 1173 patients to one of two conditions (implementation-as-usual (IAU) control condition or IAU+P4P experimental condition)...
July 4, 2018: Implementation Science: IS
Alison Porter, Jeremy Dale, Theresa Foster, Pip Logan, Bridget Wells, Helen Snooks
BACKGROUND: Computerised clinical decision support (CCDS) has been shown to improve processes of care in some healthcare settings, but there is little evidence related to its use or effects in pre-hospital emergency care. CCDS in this setting aligns with policies to increase IT use in ambulance care, enhance paramedic decision-making skills, reduce avoidable emergency department attendances and improve quality of care and patient experience. This qualitative study was conducted alongside a cluster randomised trial in two ambulance services of the costs and effects of web-based CCDS system designed to support paramedic decision-making in the care of older people following a fall...
July 4, 2018: Implementation Science: IS
Byamah B Mutamba, Brandon A Kohrt, James Okello, Janet Nakigudde, Bernard Opar, Seggane Musisi, William Bazeyo, Joop de Jong
BACKGROUND: Evidence for the effectiveness of psychological treatments in low- and middle-income countries is increasing. However, there is a lack of systematic approaches to guide implementation in government health systems. The objective of this study was to address this gap by employing the Replicating Effective Programs (REP) framework to guide contextualization of a psychological treatment in the Uganda public health system for caregivers of children affected by nodding syndrome, a neuropsychiatric disorder endemic to Sub-Saharan Africa associated with high morbidity and disability...
June 28, 2018: Implementation Science: IS
Joanna C Moullin, Mark G Ehrhart, Gregory A Aarons
BACKGROUND: Implementation is proposed to be a multiphase, multilevel process. After a period of exploration, an adoption decision is made, typically at the upper management or policy level. Nevertheless, movement through each of the subsequent phases of the implementation process involves clinicians or providers at the individual level to adopt the innovation and then change their behavior to use/deliver the innovation. Multiple behavioral change theories propose that intentions are a critical determinant of implementation behavior...
June 28, 2018: Implementation Science: IS
Tamara Schloemer, Peter Schröder-Bäck
BACKGROUND: Improving the public's health in different countries requires the consideration of diverse health care systems and settings. For evidence-based public health, decision-makers need to consider the transferability of effective health interventions from a primary context to their specific target context. The aim of this systematic review was to develop a model for the assessment of transferability of health interventions through identification and systematization of influencing criteria, including facilitators and barriers...
June 26, 2018: Implementation Science: IS
Carolyn Steele Gray, Jan Barnsley, Dominique Gagnon, Louise Belzile, Tim Kenealy, James Shaw, Nicolette Sheridan, Paul Wankah Nji, Walter P Wodchis
BACKGROUND: Information communication technology (ICT) is a critical enabler of integrated models of community-based primary health care; however, little is known about how existing technologies have been used to support new models of integrated care. To address this gap, we draw on data from an international study of integrated models, exploring how ICT is used to support activities of integrated care and the organizational and environmental barriers and enablers to its adoption. METHODS: We take an embedded comparative multiple-case study approach using data from a study of implementation of nine models of integrated community-based primary health care, the Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH) study...
June 26, 2018: Implementation Science: IS
Stijn Van de Velde, Ilkka Kunnamo, Pavel Roshanov, Tiina Kortteisto, Bert Aertgeerts, Per Olav Vandvik, Signe Flottorp
BACKGROUND: Computerised decision support (CDS) based on trustworthy clinical guidelines is a key component of a learning healthcare system. Research shows that the effectiveness of CDS is mixed. Multifaceted context, system, recommendation and implementation factors may potentially affect the success of CDS interventions. This paper describes the development of a checklist that is intended to support professionals to implement CDS successfully. METHODS: We developed the checklist through an iterative process that involved a systematic review of evidence and frameworks, a synthesis of the success factors identified in the review, feedback from an international expert panel that evaluated the checklist in relation to a list of desirable framework attributes, consultations with patients and healthcare consumers and pilot testing of the checklist...
June 25, 2018: Implementation Science: IS
Nathaniel J Williams, Mark G Ehrhart, Gregory A Aarons, Steven C Marcus, Rinad S Beidas
BACKGROUND: Behavioral health organizations are characterized by multiple organizational climates, including molar climate, which encompasses clinicians' shared perceptions of how the work environment impacts their personal well-being, and strategic implementation climate, which includes clinicians' shared perceptions of the extent to which evidence-based practice implementation is expected, supported, and rewarded by the organization. Theory suggests these climates have joint, cross-level effects on clinicians' implementation of evidence-based practice and that these effects may be long term (i...
June 25, 2018: Implementation Science: IS
Christine Marquez, Alekhya Mascarenhas Johnson, Sabrina Jassemi, Jamie Park, Julia E Moore, Caroline Blaine, Gertrude Bourdon, Mark Chignell, Moriah E Ellen, Jacques Fortin, Ian D Graham, Anne Hayes, Jemila Hamid, Brenda Hemmelgarn, Michael Hillmer, Bev Holmes, Jayna Holroyd-Leduc, Linda Hubert, Brian Hutton, Monika Kastner, John N Lavis, Karen Michell, David Moher, Mathieu Ouimet, Laure Perrier, Andrea Proctor, Thomas Noseworthy, Victoria Schuckel, Sharlene Stayberg, Marcello Tonelli, Andrea C Tricco, Sharon E Straus
BACKGROUND: Systematic reviews are infrequently used by health care managers (HCMs) and policy-makers (PMs) in decision-making. HCMs and PMs co-developed and tested novel systematic review of effects formats to increase their use. METHODS: A three-phased approach was used to evaluate the determinants to uptake of systematic reviews of effects and the usability of an innovative and a traditional systematic review of effects format. In phase 1, survey and interviews were conducted with HCMs and PMs in four Canadian provinces to determine perceptions of a traditional systematic review format...
June 22, 2018: Implementation Science: IS
Sarah B Hunter, Allison J Ober, Colleen M McCullough, Erik D Storholm, Praise O Iyiewuare, Chau Pham, Katherine E Watkins
BACKGROUND: Efforts to integrate substance use disorder treatment into primary care settings are growing. Little is known about how well primary care settings can sustain treatment delivery to address substance use following the end of implementation support. METHODS: Data from two clinics operated by one multi-site federally qualified health center (FQHC) in the US, including administrative data, staff surveys, interviews, and focus groups, were used to gather information about changes in organizational capacity related to alcohol and opioid use disorder (AOUD) treatment delivery during and after a multi-year implementation intervention was executed...
June 18, 2018: Implementation Science: IS
Anna-Janina Stephan, Eva Kovacs, Amanda Phillips, Jörg Schelling, Susanne Marlene Ulrich, Eva Grill
After publication of the original article [1] it was brought to the authors' attention that a sentence was missing in the acknowledgement section. The full acknowledgement is included in this Correction article.
June 15, 2018: Implementation Science: IS
Nyawira Mwangi, Muchai Gachago, Michael Gichangi, Stephen Gichuhi, Kibata Githeko, Atieno Jalango, Jefitha Karimurio, Joseph Kibachio, Lawrence Muthami, Nancy Ngugi, Carmichael Nduri, Patrick Nyaga, Joseph Nyamori, Alain Nazaire Mbongo Zindamoyen, Covadonga Bascaran, Allen Foster
BACKGROUND: The use of clinical practice guidelines envisages augmenting quality and best practice in clinical outcomes. Generic guidelines that are not adapted for local use often fail to produce these outcomes. Adaptation is a systematic and rigorous process that should maintain the quality and validity of the guideline, while making it more usable by the targeted users. Diverse skills are required for the task of adaptation. Although adapting a guideline is not a guarantee that it will be implemented, adaptation may improve acceptance and adherence to its recommendations...
June 15, 2018: Implementation Science: IS
Carl R May, Amanda Cummings, Melissa Girling, Mike Bracher, Frances S Mair, Christine M May, Elizabeth Murray, Michelle Myall, Tim Rapley, Tracy Finch
BACKGROUND: Normalization Process Theory (NPT) identifies, characterises and explains key mechanisms that promote and inhibit the implementation, embedding and integration of new health techniques, technologies and other complex interventions. A large body of literature that employs NPT to inform feasibility studies and process evaluations of complex healthcare interventions has now emerged. The aims of this review were to review this literature; to identify and characterise the uses and limits of NPT in research on the implementation and integration of healthcare interventions; and to explore NPT's contribution to understanding the dynamics of these processes...
June 7, 2018: Implementation Science: IS
Heather Armson, Stefanie Roder, Tom Elmslie, Sobia Khan, Sharon E Straus
BACKGROUND: Implementation tools (iTools) may enhance uptake of guidelines. However, little evidence exists on their use by primary care clinicians. This study explored which iTools clinicians used and how often; how satisfied clinicians were with the tools; whether tool use was associated with practice changes; and identified mediators for practice change(s) related to breast cancer screening (BCS). METHODS: Canadian primary care providers who are members of the Practice-Based Small Group Learning Program (n = 1464) were invited to participate in this mixed methods study...
June 7, 2018: Implementation Science: IS
Marie Höjriis Storkholm, Pamela Mazzocato, Mesfin Kassaye Tessma, Carl Savage
BACKGROUND: Organizational change initiatives in health care frequently achieve only partial implementation success. Understanding an organizational readiness for change (ORC) may be a way to develop more effective and efficient change strategies. Denmark, like many countries, has begun a major system-wide structural reform which involves considerable changes in service delivery. Due to the lack of a validated Danish instrument, we aimed to translate and validate a Danish version of the Organizational Readiness for Implementing Change (ORIC) questionnaire...
June 5, 2018: Implementation Science: IS
Joseph Mignogna, Lindsey Ann Martin, Juliette Harik, Natalie E Hundt, Michael Kauth, Aanand D Naik, Kristen Sorocco, Justin Benzer, Jeffrey Cully
BACKGROUND: Primary care clinics present challenges to implementing evidence-based psychotherapies (EBPs) for depression and anxiety, and frontline providers infrequently adopt these treatments. The current study explored providers' perspectives on fidelity to a manualized brief cognitive behavioral therapy (CBT) as delivered in primary care clinics as part of a pragmatic randomized trial. Data from the primary study demonstrated the clinical effectiveness of the treatment and indicated that providers delivered brief CBT with high fidelity, as evaluated by experts using a standardized rating form...
June 5, 2018: Implementation Science: IS
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