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Implementation Science: IS

Allan Riis, Cathrine Elgaard Jensen, Flemming Bro, Helle Terkildsen Maindal, Karin Dam Petersen, Mette Dahl Bendtsen, Martin Bach Jensen
BACKGROUND: Guidelines are often slowly adapted into clinical practice. However, actively supporting healthcare professionals in evidence-based treatment may speed up guideline implementation. Danish low back pain (LBP) guidelines focus on primary care treatment of LBP, to reduce referrals from primary care to secondary care. The primary aim of this project was to reduce secondary care referral within 12 weeks by a multifaceted implementation strategy (MuIS). METHODS: In a cluster randomised design, 189 general practices from the North Denmark Region were invited to participate...
October 21, 2016: Implementation Science: IS
Falk Schwendicke, Gerd Göstemeyer
BACKGROUND: Increasing evidence supports selective/incomplete (SE) or stepwise (SW) instead of non-selective/complete tissue removal for deep carious lesions in vital teeth, mainly as pulpal risks are significantly reduced. Our aims were to analyze the proportion of dentists who utilize SE/SW for deep lesions in permanent teeth and to identify barriers and facilitators of utilizing SE/SW. METHODS: We included studies that were original, and reported on the proportion of dentists utilizing SE/SW (quantitative studies), or reported on barriers or facilitators of such utilization (qualitative studies)...
October 19, 2016: Implementation Science: IS
Carl R May, Mark Johnson, Tracy Finch
BACKGROUND: Context is a problem in research on health behaviour change, knowledge translation, practice implementation and health improvement. This is because many intervention and evaluation designs seek to eliminate contextual confounders, when these represent the normal conditions into which interventions must be integrated if they are to be workable in practice. DISCUSSION: We present an ecological model of the ways that participants in implementation and health improvement processes interact with contexts...
October 19, 2016: Implementation Science: IS
Dwayne Van Eerd, Kristine Newman, Ryan DeForge, Robin Urquhart, Evelyn Cornelissen, Katie N Dainty
BACKGROUND: Developing a healthcare delivery system that is more responsive to the future challenges of an aging population is a priority in Canada. The World Health Organization acknowledges the need for knowledge translation frameworks in aging and health. Knowledge brokering (KB) is a specific knowledge translation approach that includes making connections between people to facilitate the use of evidence. Knowledge gaps exist about KB roles, approaches, and guiding frameworks. The objective of the scoping review is to identify and describe KB approaches and the underlying conceptual frameworks (models, theories) used to guide the approaches that could support healthy aging...
October 19, 2016: Implementation Science: IS
Sandy Middleton, Chris Levi, Simeon Dale, N Wah Cheung, Elizabeth McInnes, Julie Considine, Catherine D'Este, Dominique A Cadilhac, Jeremy Grimshaw, Richard Gerraty, Louise Craig, Verena Schadewaldt, Patrick McElduff, Mark Fitzgerald, Clare Quinn, Greg Cadigan, Sonia Denisenko, Mark Longworth, Jeanette Ward
BACKGROUND: Internationally recognised evidence-based guidelines recommend appropriate triage of patients with stroke in emergency departments (EDs), administration of tissue plasminogen activator (tPA), and proactive management of fever, hyperglycaemia and swallowing before prompt transfer to a stroke unit to maximise outcomes. We aim to evaluate the effectiveness in EDs of a theory-informed, nurse-initiated, intervention to improve multidisciplinary triage, treatment and transfer (T(3)) of patients with acute stroke to improve 90-day death and dependency...
October 18, 2016: Implementation Science: IS
Michael L Parchman, Lyle J Fagnan, David A Dorr, Peggy Evans, Andrea J Cook, Robert B Penfold, Clarissa Hsu, Allen Cheadle, Laura-Mae Baldwin, Leah Tuzzio
BACKGROUND: Little attention has been paid to quality improvement (QI) capacity within smaller primary care practices which comprise nearly half of all primary care settings. Strategies for external support to build such capacity include practice facilitation (PF), shared learning opportunities, and educational outreach. Although PF has proven effectiveness, little is known about the comparative effectiveness of combining these strategies. Here, we describe the protocol of the "Healthy Hearts Northwest" (H2N) study, a randomized trial designed to address these questions while improving risk factors for cardiovascular disease...
October 13, 2016: Implementation Science: IS
Douglas A Luke, Ana A Baumann, Bobbi J Carothers, John Landsverk, Enola K Proctor
BACKGROUND: Training investigators for the rapidly developing field of implementation science requires both mentoring and scientific collaboration. Using social network descriptive analyses, visualization, and modeling, this paper presents results of an evaluation of the mentoring and collaborations fostered over time through the National Institute of Mental Health (NIMH) supported by Implementation Research Institute (IRI). METHODS: Data were comprised of IRI participant self-reported collaborations and mentoring relationships, measured in three annual surveys from 2012 to 2014...
October 13, 2016: Implementation Science: IS
Wade Skoien, Katie Page, William Parsonage, Sarah Ashover, Tanya Milburn, Louise Cullen
BACKGROUND: The translation of healthcare research into practice is typically challenging and limited in effectiveness. The Theoretical Domains Framework (TDF) identifies 12 domains of behaviour determinants which can be used to understand the principles of behavioural change, a key factor influencing implementation. The Accelerated Chest pain Risk Evaluation (ACRE) project has successfully translated research into practice, by implementing an intervention to improve the assessment of low to intermediate risk patients presenting to emergency departments (EDs) with chest pain...
October 12, 2016: Implementation Science: IS
J Mc Sharry, P J Murphy, M Byrne
BACKGROUND: Decreased sexual activity and sexual problems are common among people with cardiovascular disease, negatively impacting relationship satisfaction and quality of life. International guidelines recommend routine delivery of sexual counselling to cardiac patients. The Cardiac Health and Relationship Management and Sexuality (CHARMS) baseline study in Ireland found, similar to international findings, limited implementation of sexual counselling guidelines in practice. The aim of the current study was to develop the CHARMS multi-level intervention to increase delivery of sexual counselling by healthcare professionals...
October 10, 2016: Implementation Science: IS
Jill Locke, Rinad S Beidas, Steven Marcus, Aubyn Stahmer, Gregory A Aarons, Aaron R Lyon, Carolyn Cannuscio, Frances Barg, Shannon Dorsey, David S Mandell
BACKGROUND: The significant lifelong impairments associated with autism spectrum disorder (ASD), combined with the growing number of children diagnosed with ASD, have created urgency in improving school-based quality of care. Although many interventions have shown efficacy in university-based research, few have been effectively implemented and sustained in schools, the primary setting in which children with ASD receive services. Individual- and organizational-level factors have been shown to predict the implementation of evidence-based interventions (EBIs) for the prevention and treatment of other mental disorders in schools, and may be potential targets for implementation strategies in the successful use of autism EBIs in schools...
October 10, 2016: Implementation Science: IS
Ingrid Hegger, Lisanne K Marks, Susan W J Janssen, Albertine J Schuit, Jolanda F M Keijsers, Hans A M van Oers
BACKGROUND: To improve knowledge utilization in policymaking, alignment between researchers and policymakers during knowledge production is essential, but difficult to maintain. In three previously reported case studies, we extensively evaluated complex research projects commissioned by policymakers to investigate how alignment is achieved in a research process and to discover ways to enhance knowledge contributions to health policy. In the present study, we investigated how the findings of these three research projects could be integrated into a practical tool for researchers to enhance their contribution to evidence-based policy...
September 30, 2016: Implementation Science: IS
Anne E Sales, Mary Ersek, Orna K Intrator, Cari Levy, Joan G Carpenter, Robert Hogikyan, Helen C Kales, Zach Landis-Lewis, Tobie Olsan, Susan C Miller, Marcos Montagnini, Vyjeyanthi S Periyakoil, Sheri Reder
BACKGROUND: The program "Implementing Goals of Care Conversations with Veterans in VA LTC Settings" is proposed in partnership with the US Veterans Health Administration (VA) National Center for Ethics in Health Care and the Geriatrics and Extended Care Program Offices, together with the VA Office of Nursing Services. The three projects in this program are designed to support a new system-wide mandate requiring providers to conduct and systematically record conversations with veterans about their preferences for care, particularly life-sustaining treatments...
September 29, 2016: Implementation Science: IS
David J T Campbell, Marcello Tonelli, Brenda Hemmelgarn, Chad Mitchell, Ross Tsuyuki, Noah Ivers, Tavis Campbell, Raj Pannu, Eric Verkerke, Scott Klarenbach, Kathryn King-Shier, Peter Faris, Derek Exner, Vikas Chaubey, Braden Manns
BACKGROUND: Chronic diseases result in significant morbidity and costs. Although medications and lifestyle changes are effective for improving outcomes in chronic diseases, many patients do not receive these treatments, in part because of financial barriers, patient and provider-level knowledge gaps, and low patient motivation. The Assessing outcomes of enhanced chronic disease care through patient education and a value-based formulary study (ACCESS) will determine the impact of two interventions: (1) a value-based formulary which eliminates copayment for high-value preventive medications; and (2) a comprehensive self-management support program aimed at promoting health behavior change and medication adherence, combined with relay of information on medication use to healthcare providers, on cardiovascular events and/or mortality in low-income seniors with elevated cardiovascular risk...
September 26, 2016: Implementation Science: IS
Shuting Liang, Michelle C Kegler, Megan Cotter, Emily Phillips, Derrick Beasley, April Hermstad, Rentonia Morton, Jeremy Martinez, Kara Riehman
No abstract text is available yet for this article.
2016: Implementation Science: IS
Adina Hayek, Rohina Joshi, Tim Usherwood, Ruth Webster, Baldeep Kaur, Bandana Saini, Carol Armour, Ines Krass, Tracey-Lea Laba, Christopher Reid, Louise Shiel, Charlotte Hespe, Fred Hersch, Stephen Jan, Serigne Lo, David Peiris, Anthony Rodgers, Anushka Patel
BACKGROUND: Cardiovascular diseases (CVD) are responsible for significant morbidity, premature mortality, and economic burden. Despite established evidence that supports the use of preventive medications among patients at high CVD risk, treatment gaps remain. Building on prior evidence and a theoretical framework, a complex intervention has been designed to address these gaps among high-risk, under-treated patients in the Australian primary care setting. This intervention comprises a general practice quality improvement tool incorporating clinical decision support and audit/feedback capabilities; availability of a range of CVD polypills (fixed-dose combinations of two blood pressure lowering agents, a statin ± aspirin) for prescription when appropriate; and access to a pharmacy-based program to support long-term medication adherence and lifestyle modification...
2016: Implementation Science: IS
Aaron R Lyon, Cara C Lewis, Abigail Melvin, Meredith Boyd, Semret Nicodimos, Freda F Liu, Nathaniel Jungbluth
BACKGROUND: Health information technologies (HIT) have become nearly ubiquitous in the contemporary healthcare landscape, but information about HIT development, functionality, and implementation readiness is frequently siloed. Theory-driven methods of compiling, evaluating, and integrating information from the academic and commercial sectors are necessary to guide stakeholder decision-making surrounding HIT adoption and to develop pragmatic HIT research agendas. This article presents the Health Information Technologies-Academic and Commercial Evaluation (HIT-ACE) methodology, a structured, theory-driven method for compiling and evaluating information from multiple sectors...
2016: Implementation Science: IS
Julii Brainard, Paul R Hunter
BACKGROUND: The lens of complexity theory is widely advocated to improve health care delivery. However, empirical evidence that this lens has been useful in designing health care remains elusive. This review assesses whether it is possible to reliably capture evidence for efficacy in results or process within interventions that were informed by complexity science and closely related conceptual frameworks. METHODS: Systematic searches of scientific and grey literature were undertaken in late 2015/early 2016...
2016: Implementation Science: IS
Arnela Suman, Marije F Dikkers, Frederieke G Schaafsma, Maurits W van Tulder, Johannes R Anema
BACKGROUND: For the optimal use of clinical guidelines in daily practice, mere distribution of guidelines and materials is not enough, and active implementation is needed. This review investigated the effectiveness of multifaceted implementation strategies compared to minimal, single, or no implementation strategy for the implementation of non-specific low back and/or neck pain guidelines in health care. METHODS: The following electronic databases were searched from inception to June 1, 2015: MEDLINE, Embase, PsycInfo, the Cochrane Library, and CINAHL...
2016: Implementation Science: IS
Lotus Sofie Bast, Pernille Due, Pernille Bendtsen, Lene Ringgard, Louise Wohllebe, Mogens Trab Damsgaard, Morten Grønbæk, Annette Kjær Ersbøll, Anette Andersen
BACKGROUND: Implementation fidelity describes how well an intervention is implemented in the real-world setting. Assessing implementation fidelity is essential in the understanding of intervention results. In most studies, implementation fidelity is measured insufficiently, though, not taking into account the complexity of the concept nor the intervention. The objective of the present study was to develop an overall quantitative measure of implementation fidelity, to examine the degree of implementation fidelity and the association of implementation and effect of a randomized school-based smoking prevention trial-the X:IT study...
2016: Implementation Science: IS
Merrick Zwarenstein, Jeremy M Grimshaw, Justin Presseau, Jill J Francis, Gaston Godin, Marie Johnston, Martin P Eccles, Jacqueline Tetroe, Susan K Shiller, Ruth Croxford, Diane Kelsall, J Michael Paterson, Peter C Austin, Karen Tu, Lingsong Yun, Janet E Hux
BACKGROUND: Evidence on the effectiveness of printed educational messages in contributing to increasing evidence-based clinical practice is contradictory. Nonetheless, these messages flood physician offices, in an attempt to promote treatments that can reduce costs while improving patient outcomes. This study evaluated the ability of printed educational messages to promote the choice of thiazides as the first-line treatment for individuals newly diagnosed with hypertension, a practice supported by good evidence and included in guidelines, and one which could reduce costs to the health care system...
2016: Implementation Science: IS
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