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Implementation Science: IS

Kate Seers, Jo Rycroft-Malone, Karen Cox, Nicola Crichton, Rhiannon Tudor Edwards, Ann Catrine Eldh, Carole A Estabrooks, Gill Harvey, Claire Hawkes, Carys Jones, Alison Kitson, Brendan McCormack, Christel McMullan, Carole Mockford, Theo Niessen, Paul Slater, Angie Titchen, Teatske van der Zijpp, Lars Wallin
BACKGROUND: Health care practice needs to be underpinned by high quality research evidence, so that the best possible care can be delivered. However, evidence from research is not always utilised in practice. This study used the Promoting Action on Research Implementation in Health Services (PARIHS) framework as its theoretical underpinning to test whether two different approaches to facilitating implementation could affect the use of research evidence in practice. METHODS: A pragmatic clustered randomised controlled trial with embedded process and economic evaluation was used...
November 16, 2018: Implementation Science: IS
Jo Rycroft-Malone, Kate Seers, Ann Catrine Eldh, Karen Cox, Nicola Crichton, Gill Harvey, Claire Hawkes, Alison Kitson, Brendan McCormack, Christel McMullan, Carole Mockford, Theo Niessen, Paul Slater, Angie Titchen, Teatske van der Zijpp, Lars Wallin
BACKGROUND: Facilitation is a promising implementation intervention, which requires theory-informed evaluation. This paper presents an exemplar of a multi-country realist process evaluation that was embedded in the first international randomised controlled trial evaluating two types of facilitation for implementing urinary continence care recommendations. We aimed to uncover what worked (and did not work), for whom, how, why and in what circumstances during the process of implementing the facilitation interventions in practice...
November 16, 2018: Implementation Science: IS
Gill Harvey, Brendan McCormack, Alison Kitson, Elizabeth Lynch, Angie Titchen
BACKGROUND: The 'Facilitating Implementation of Research Evidence' study found no significant differences between sites that received two types of facilitation support and those that did not on the primary outcome of documented compliance with guideline recommendations. Process evaluation highlighted factors that influenced local, internal facilitators' ability to enact the roles as envisaged. In this paper, the external facilitators responsible for designing and delivering the two types of facilitation intervention analyse why the interventions proved difficult to implement as expected, including the challenge of balancing fidelity and adaptation...
November 16, 2018: Implementation Science: IS
T J Stephens, C J Peden, R M Pearse, S E Shaw, T E F Abbott, E Jones, D Kocman, G Martin
BACKGROUND: Improving the quality and safety of perioperative care is a global priority. The Enhanced Peri-Operative Care for High-risk patients (EPOCH) trial was a stepped-wedge cluster randomised trial of a quality improvement (QI) programme to improve 90-day survival for patients undergoing emergency abdominal surgery in 93 hospitals in the UK National Health Service. METHODS: The aim of this process evaluation is to describe how the EPOCH intervention was planned, delivered and received, at both cluster and local hospital levels...
November 13, 2018: Implementation Science: IS
Mona Jabbour, Amanda S Newton, David Johnson, Janet A Curran
BACKGROUND: While clinical pathways have the potential to improve patient outcomes and reduce healthcare costs, their true impact has been limited by variable implementation strategies and suboptimal research designs. This paper explores a comprehensive set of factors perceived by emergency department staff and administrative leads to influence clinical pathway implementation within the complex and dynamic environments of community emergency department settings. METHODS: This descriptive, qualitative study involved emergency health professionals and administrators of 15 community hospitals across Ontario, Canada...
November 12, 2018: Implementation Science: IS
Bindu Patel, Tim Usherwood, Mark Harris, Anushka Patel, Kathryn Panaretto, Nicholas Zwar, David Peiris
BACKGROUND: A computerised, multifaceted quality improvement (QI) intervention for cardiovascular disease (CVD) management in Australian primary healthcare was evaluated in a cluster randomised controlled trial. The intervention was associated with improved CVD risk factor screening but there was no improvement in prescribing rates of guideline-recommended medicines. The aim of this study was to conduct a process evaluation to identify and explain the underlying mechanisms by which the intervention did and did not have an impact...
November 12, 2018: Implementation Science: IS
Lara J Cooke, Diane Duncan, Laura Rivera, Shawn K Dowling, Christopher Symonds, Heather Armson
BACKGROUND: Audit and feedback interventions may be strengthened using social interaction. The Calgary office of the Alberta Physician Learning Program (CPLP) developed a process for audit and group feedback for physicians. This paper extends previous work in which we developed a conceptual model of physician responses to audit and group feedback based on a qualitative analysis of six audit and group feedback sessions. The present study explored the mediating factors for successfully engaging physician groups in change planning through audit and group feedback...
October 30, 2018: Implementation Science: IS
Andrea M Patey, Catherine S Hurt, Jeremy M Grimshaw, Jill J Francis
BACKGROUND: Implementing evidence-based care requires healthcare practitioners to do less of some things (de-implementation) and more of others (implementation). Variations in effectiveness of behaviour change interventions may result from failure to consider a distinction between approaches by which behaviour increases and decreases in frequency. The distinction is not well represented in methods for designing interventions. This review aimed to identify whether there is a theoretical rationale to support this distinction...
October 29, 2018: Implementation Science: IS
B Brouns, J J L Meesters, M M Wentink, A J de Kloet, H J Arwert, T P M Vliet Vlieland, L W Boyce, L van Bodegom-Vos
BACKGROUND: The uptake of eRehabilitation programs in stroke care is insufficient, despite the growing availability. The aim of this study was to explore which factors influence the uptake of eRehabilitation in stroke rehabilitation, among stroke patients, informal caregivers, and healthcare professionals. METHODS: A qualitative focus group study with eight focus groups (6-8 participants per group) was conducted: six with stroke patients/informal caregivers and two with healthcare professionals involved in stroke rehabilitation (rehabilitation physicians, physical therapists, occupational therapists, psychologists, managers)...
October 29, 2018: Implementation Science: IS
Ružica Tokalić, Marin Viđak, Ivan Buljan, Ana Marušić
BACKGROUND: Health practice guidelines (HPGs) are important tools for the translation of evidence into practice. Reporting Items for Practice Guidelines in HealThcare (RIGHT) checklist provides guidance on reporting health practice guidelines (HPGs). We assessed the reporting completeness and quality of a set of national (Croatian) and relevant transnational (European) HPGs. METHODS: The national sample included all HPGs published in the official journal of the Croatian Medical Association in 2014-2016...
October 29, 2018: Implementation Science: IS
Matthew Chinman, Patricia Ebener, Patrick S Malone, Jill Cannon, Elizabeth J D'Amico, Joie Acosta
BACKGROUND: Community organizations can have difficulty implementing evidence-based prevention programs. More research is needed on implementation support interventions designed to help these organizations implement programs with quality. METHODS: Preparing to Run Effective Programs (PREP) is a randomized controlled trial testing Getting To Outcomes (GTO), a 2-year implementation support intervention. It compares 15 Boys and Girls Club sites implementing CHOICE (control group), a five-session evidence-based alcohol and drug prevention program, with 14 similar sites implementing CHOICE supported by GTO (intervention group)...
October 22, 2018: Implementation Science: IS
Tim Crocker-Buque, Michael Edelstein, Sandra Mounier-Jack
BACKGROUND: In recent years, the incidence of several pathogens of public health importance (measles, mumps, pertussis and rubella) has increased in Europe, leading to outbreaks. This has included England, where GP practices implement the vaccination programme based on government guidance. However, there has been no study of how implementation takes place, which makes it difficult to identify organisational variation and thus limits the ability to recommend interventions to improve coverage...
October 22, 2018: Implementation Science: IS
Lorraine K McDonagh, John M Saunders, Jackie Cassell, Tyrone Curtis, Hamad Bastaki, Thomas Hartney, Greta Rait
BACKGROUND: Chlamydia is a major public health concern, with high economic and social costs. In 2016, there were over 200,000 chlamydia diagnoses made in England. The highest prevalence rates are found among young people. Although annual testing for sexually active young people is recommended, many do not receive testing. General practice is one ideal setting for testing, yet attempts to increase testing in this setting have been disappointing. The Capability, Opportunity, and Motivation Model of Behaviour (COM-B model) may help improve understanding of the underpinnings of chlamydia testing...
October 22, 2018: Implementation Science: IS
Isabelle Vedel, Melanie Le Berre, Nadia Sourial, Geneviève Arsenault-Lapierre, Howard Bergman, Liette Lapointe
BACKGROUND: Passive dissemination of information in healthcare refers to the publication or mailing of newly established guidelines or recommendations. It is one of the least costly knowledge translation activities. This approach is generally considered to be ineffective or to result in only small changes in practice. Recent research, however, suggests that passive dissemination could, under certain conditions, result in modifications of practice, similar to more active dissemination approaches...
October 16, 2018: Implementation Science: IS
Nathalie Moise, Ravi N Shah, Susan Essock, Amy Jones, Jay Carruthers, Margaret A Handley, Lauren Peccoralo, Lloyd Sederer
BACKGROUND: In a large statewide initiative, New York State implemented collaborative care (CC) from 2012 to 2014 in 32 primary care settings where residents were trained and supported its sustainability through payment reforms implemented in 2015. Twenty-six clinics entered the sustainability phase and six opted out, providing an opportunity to examine factors predicting continued CC participation and fidelity. METHODS: We used descriptive statistics to assess implementation metrics in sustaining vs...
October 12, 2018: Implementation Science: IS
Wendy A Gifford, Janet E Squires, Douglas E Angus, Lisa A Ashley, Lucie Brosseau, Janet M Craik, Marie-Cécile Domecq, Mary Egan, Paul Holyoke, Linda Juergensen, Lars Wallin, Liquaa Wazni, Ian D Graham
BACKGROUND: Leadership by point-of-care and senior managers is increasingly recognized as critical to the acceptance and use of research evidence in practice. The purpose of this systematic review was to identify the leadership behaviours of managers that are associated with research use by clinical staff in nursing and allied health professionals. METHODS: A mixed methods systematic review was performed. Eight electronic bibliographic databases were searched. Studies examining the association between leadership behaviours and nurses and allied health professionals' use of research were eligible for inclusion...
September 27, 2018: Implementation Science: IS
Rebecca Vitale, Timothy Blaine, Elizabeth Zofkie, Sarah Moreland-Russell, Todd Combs, Ross C Brownson, Doug A Luke
BACKGROUND: The emergence of dissemination and implementation (D&I) science has driven a rapid increase in studies of how new scientific discoveries are translated and developed into evidence-based programs and policies. However, D&I science has paid much less attention to what happens to programs once they have been implemented. Public health programs can only deliver benefits if they reach maturity and sustain activities over time. In order to achieve the full benefits of significant investment in public health research and program development, there must be an understanding of the factors that relate to sustainability to inform development of tools and trainings to support strategic long-term program sustainability...
September 26, 2018: Implementation Science: IS
Cam Escoffery, E Lebow-Skelley, R Haardoerfer, E Boing, H Udelson, R Wood, M Hartman, M E Fernandez, P D Mullen
BACKGROUND: Adaptations of evidence-based interventions (EBIs) often occur. However, little is known about the reasons for adaptation, the adaptation process, and outcomes of adapted EBIs. To address this gap, we conducted a systematic review to answer the following questions: (1) What are the reasons for and common types of adaptations being made to EBIs in community settings as reported in the published literature? (2) What steps are described in making adaptations to EBIs? and (3) What outcomes are assessed in evaluations of adapted EBIs? METHODS: We conducted a systematic review of English language publications that described adaptations of public health EBIs...
September 26, 2018: Implementation Science: IS
Loveday Penn-Kekana, Timothy Powell-Jackson, Manon Haemmerli, Varun Dutt, Isabelle L Lange, Aniva Mahapatra, Gaurav Sharma, Kultar Singh, Sunita Singh, Vasudha Shukla, Catherine Goodman
BACKGROUND: A prominent strategy to engage private sector health providers in low- and middle-income countries is clinical social franchising, an organisational model that applies the principles of commercial franchising for socially beneficial goals. The Matrika programme, a multi-faceted social franchise model to improve maternal health, was implemented in three districts of Uttar Pradesh, India, between 2013 and 2016. Previous research indicates that the intervention was not effective in improving the quality and coverage of maternal health services at the population level...
September 24, 2018: Implementation Science: IS
Monica Cations, Maria Crotty, Janna Anneke Fitzgerald, Susan Kurrle, Ian D Cameron, Craig Whitehead, Jane Thompson, Billingsley Kaambwa, Kate Hayes, Lenore de la Perrelle, Gorjana Radisic, Kate E Laver
BACKGROUND: Dissemination of clinical practice guidelines alone is insufficient to create meaningful change in clinical practice. Quality improvement collaborative models have potential to address the evidence-practice gap in dementia care because they capitalise on known knowledge translation enablers and incorporate optimal approaches to implementation. Non-pharmacological interventions focused on promoting independence are effective and favoured by people with dementia and their carers but are not routinely implemented...
September 24, 2018: Implementation Science: IS
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