Implementation Science : IS最新文献

{"title":"Protocol for a hybrid type 2 cluster randomized trial of trauma-focused cognitive behavioral therapy and a pragmatic individual-level implementation strategy.","authors":"Aaron R Lyon,&nbsp;Michael D Pullmann,&nbsp;Shannon Dorsey,&nbsp;Carol Levin,&nbsp;Larissa M Gaias,&nbsp;Stephanie K Brewer,&nbsp;Madeline Larson,&nbsp;Catherine M Corbin,&nbsp;Chayna Davis,&nbsp;Ian Muse,&nbsp;Mahima Joshi,&nbsp;Rosemary Reyes,&nbsp;Nathaniel J Jungbluth,&nbsp;Rachel Barrett,&nbsp;David Hong,&nbsp;Michael D Gomez,&nbsp;Clayton R Cook","doi":"10.1186/s13012-020-01064-1","DOIUrl":"https://doi.org/10.1186/s13012-020-01064-1","url":null,"abstract":"<p><strong>Background: </strong>More than two-thirds of youth experience trauma during childhood, and up to 1 in 5 of these youth develops posttraumatic stress symptoms that significantly impair their functioning. Although trauma-focused cognitive behavior therapy (TF-CBT) has a strong evidence base, it is rarely adopted, delivered with adequate fidelity, or evaluated in the most common setting where youth access mental health services-schools. Given that individual behavior change is ultimately required for successful implementation, even when organizational factors are firmly in place, focusing on individual-level processes represents a potentially parsimonious approach. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a pragmatic, motivationally focused multifaceted strategy that augments training and consultation and is designed to target precise mechanisms of behavior change to produce enhanced implementation and youth clinical outcomes. This study protocol describes a hybrid type 2 effectiveness-implementation trial designed to concurrently evaluate the main effects, mediators, and moderators of both the BASIS implementation strategy on implementation outcomes and TF-CBT on youth mental health outcomes.</p><p><strong>Methods: </strong>Using a cluster randomized controlled design, this trial will assign school-based mental health (SMH) clinicians and schools to one of three study arms: (a) enhanced treatment-as-usual (TAU), (b) attention control plus TF-CBT, or (c) BASIS+TF-CBT. With a proposed sample of 120 SMH clinicians who will each recruit 4-6 youth with a history of trauma (480 children), this project will gather data across 12 different time points to address two project aims. Aim 1 will evaluate, relative to an enhanced TAU condition, the effects of TF-CBT on identified mechanisms of change, youth mental health outcomes, and intervention costs and cost-effectiveness. Aim 2 will compare the effects of BASIS against an attention control plus TF-CBT condition on theoretical mechanisms of clinician behavior change and implementation outcomes, as well as examine costs and cost-effectiveness.</p><p><strong>Discussion: </strong>This study will generate critical knowledge about the effectiveness and cost-effectiveness of BASIS-a pragmatic, theory-driven, and generalizable implementation strategy designed to enhance motivation-to increase the yield of evidence-based practice training and consultation, as well as the effectiveness of TF-CBT in a novel service setting.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov registration number NCT04451161 . Registered on June 30, 2020.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"3"},"PeriodicalIF":7.2,"publicationDate":"2021-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s13012-020-01064-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38793332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of collaborative quality improvement on stillbirths, neonatal mortality and newborn care practices in hospitals of Telangana and Andhra Pradesh, India: evidence from a quasi-experimental mixed-methods study.","authors":"Karen Zamboni,&nbsp;Samiksha Singh,&nbsp;Mukta Tyagi,&nbsp;Zelee Hill,&nbsp;Claudia Hanson,&nbsp;Joanna Schellenberg","doi":"10.1186/s13012-020-01058-z","DOIUrl":"https://doi.org/10.1186/s13012-020-01058-z","url":null,"abstract":"<p><strong>Background: </strong>Improving quality of care is a key priority to reduce neonatal mortality and stillbirths. The Safe Care, Saving Lives programme aimed to improve care in newborn care units and labour wards of 60 public and private hospitals in Telangana and Andhra Pradesh, India, using a collaborative quality improvement approach. Our external evaluation of this programme aimed to evaluate programme effects on implementation of maternal and newborn care practices, and impact on stillbirths, 7- and 28-day neonatal mortality rate in labour wards and neonatal care units. We also aimed to evaluate programme implementation and mechanisms of change.</p><p><strong>Methods: </strong>We used a quasi-experimental plausibility design with a nested process evaluation. We evaluated effects on stillbirths, mortality and secondary outcomes relating to adherence to 20 evidence-based intrapartum and newborn care practices, comparing survey data from 29 hospitals receiving the intervention to 31 hospitals expected to receive the intervention later, using a difference-in-difference analysis. We analysed programme implementation data and conducted 42 semi-structured interviews in four case studies to describe implementation and address four theory-driven questions to explain the quantitative results.</p><p><strong>Results: </strong>Only 7 of the 29 intervention hospitals were engaged in the intervention for its entire duration. There was no evidence of an effect of the intervention on stillbirths [DiD - 1.3 percentage points, 95% CI - 2.6-0.1], on neonatal mortality at age 7 days [DiD - 1.6, 95% CI - 9-6.2] or 28 days [DiD - 3.0, 95% CI - 12.9-6.9] or on adherence to target evidence-based intrapartum and newborn care practices. The process evaluation identified challenges in engaging leaders; challenges in developing capacity for quality improvement; and challenges in activating mechanisms of change at the unit level, rather than for a few individuals, and in sustaining these through the creation of new social norms.</p><p><strong>Conclusion: </strong>Despite careful planning and substantial resources, the intervention was not feasible for implementation on a large scale. Greater focus is required on strategies to engage leadership. Quality improvement may need to be accompanied by clinical training. Further research is also needed on quality improvement using a health systems perspective.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"4"},"PeriodicalIF":7.2,"publicationDate":"2021-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s13012-020-01058-z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38793325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Designing provider-focused implementation trials with purpose and intent: introducing the PRECIS-2-PS tool.","authors":"Wynne E Norton,&nbsp;Kirsty Loudon,&nbsp;David A Chambers,&nbsp;Merrick Zwarenstein","doi":"10.1186/s13012-020-01075-y","DOIUrl":"https://doi.org/10.1186/s13012-020-01075-y","url":null,"abstract":"<p><strong>Background: </strong>First articulated by Schwartz and Lellouch (1967), randomized controlled trials (RCTs) can be conceptualized along a continuum from more explanatory to more pragmatic. The purpose and intent of the former is to test interventions under ideal contexts, and the purpose and intent of the latter is to test interventions in real-world contexts. The PRagmatic Explanatory Continuum Indicator Summary-2 (PRECIS-2) is a validated tool that helps researchers make decisions about the elements of the trial to match the overall purpose and intent of the trial along the continuum. The PRECIS-2 tool has guided the design of hundreds of RCTs. However, a few aspects of the tool would benefit from greater clarity, including its application to provider-focused implementation trials rather than patient-focused intervention trials.</p><p><strong>Main text: </strong>We describe the newly developed PRECIS-2-Provider Strategies (PRECIS-2-PS) tool, an extension of the PRECIS-2 tool, which has been adapted for trials testing provider-focused strategies. We elaborate on nine domains that can make a provider-focused trial more explanatory or more pragmatic, including eligibility, recruitment, setting, implementation resources, flexibility of provider strategies, flexibility of intervention, data collection, primary outcome, and primary analysis. We detail the complementary roles that researchers and stakeholders play in the trial design phase, with implications for generalizability of trial results to the contexts in which they are intended to be applied.</p><p><strong>Conclusions: </strong>The PRECIS-2-PS tool is designed to help research and practice teams plan for provider-focused trials that reflect the overall intent and purpose of the trial. The tool has potential to help advance the science of provider-focused strategies across a range of trials, with the ultimate goal of facilitating the adoption, integration, and sustainability of provider-focused strategies outside the context of trials.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"7"},"PeriodicalIF":7.2,"publicationDate":"2021-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s13012-020-01075-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39129504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How effective are social norms interventions in changing the clinical behaviours of healthcare workers? A systematic review and meta-analysis.","authors":"Mei Yee Tang, Sarah Rhodes, Rachael Powell, Laura McGowan, Elizabeth Howarth, Benjamin Brown, Sarah Cotterill","doi":"10.1186/s13012-020-01072-1","DOIUrl":"10.1186/s13012-020-01072-1","url":null,"abstract":"<p><strong>Background: </strong>Healthcare workers perform clinical behaviours which impact on patient diagnoses, care, treatment and recovery. Some methods of supporting healthcare workers in changing their behaviour make use of social norms by exposing healthcare workers to the beliefs, values, attitudes or behaviours of a reference group or person. This review aimed to evaluate evidence on (i) the effect of social norms interventions on healthcare worker clinical behaviour change and (ii) the contexts, modes of delivery and behaviour change techniques (BCTs) associated with effectiveness.</p><p><strong>Methods: </strong>Systematic review and meta-analysis of randomised controlled trials. Searches were undertaken in seven databases. The primary outcome was compliance with a desired healthcare worker clinical behaviour and the secondary outcome was patient health outcomes. Outcomes were converted into standardised mean differences (SMDs). We performed meta-analyses and presented forest plots, stratified by five social norms BCTs (social comparison, credible source, social reward, social incentive and information about others' approval). Sources of variation in social norms BCTs, context and mode of delivery were explored using forest plots, meta-regression and network meta-analysis.</p><p><strong>Results: </strong>Combined data from 116 trials suggested that social norms interventions were associated with an improvement in healthcare worker clinical behaviour outcomes of 0.08 SMDs (95%CI 0.07 to 0.10) (n = 100 comparisons), and an improvement in patient health outcomes of 0.17 SMDs (95%CI 0.14 to 0.20) (n = 14), on average. Heterogeneity was high, with an overall I² of 85.4% (healthcare worker clinical behaviour) and 91.5% (patient health outcomes). Credible source was more effective on average, compared to control conditions (SMD 0.30, 95%CI 0.13 to 0.47, n = 7). Social comparison also appeared effective, both on its own (SMD 0.05, 95%CI 0.03 to 0.08, n = 33) and with other BCTs, and seemed particularly effective when combined with prompts/cues (0.33, 95%CI 0.22 to 0.44, n = 5).</p><p><strong>Conclusions: </strong>Social norms interventions appeared to be an effective method of changing the clinical behaviour of healthcare workers and have a positive effect on patient health outcomes in a variety of health service contexts. Although the overall result is modest and variable, there is the potential for social norms interventions to be applied at large scale.</p><p><strong>Trial registration: </strong>PROSPERO CRD42016045718 .</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"8"},"PeriodicalIF":0.0,"publicationDate":"2021-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39142045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators of implementation of a community cardiovascular disease prevention programme in Mukono and Buikwe districts in Uganda using the Consolidated Framework for Implementation Research.","authors":"Rawlance Ndejjo,&nbsp;Rhoda K Wanyenze,&nbsp;Fred Nuwaha,&nbsp;Hilde Bastiaens,&nbsp;Geofrey Musinguzi","doi":"10.1186/s13012-020-01065-0","DOIUrl":"https://doi.org/10.1186/s13012-020-01065-0","url":null,"abstract":"<p><strong>Background: </strong>In low- and middle-income countries, there is an increasing attention towards community approaches to deal with the growing burden of cardiovascular disease (CVD). However, few studies have explored the implementation processes of such interventions to inform their scale up and sustainability. Using the consolidated framework for implementation research (CFIR), we examined the barriers and facilitators influencing the implementation of a community CVD programme led by community health workers (CHWs) in Mukono and Buikwe districts in Uganda.</p><p><strong>Methods: </strong>This qualitative study is a process evaluation of an ongoing type II hybrid stepped wedge cluster trial guided by the CFIR. Data for this analysis were collected through regular meetings and focus group discussions (FGDs) conducted during the first cycle (6 months) of intervention implementation. A total of 20 CHWs participated in the implementation programme in 20 villages during the first cycle. Meeting reports and FGD transcripts were analysed following inductive thematic analysis with the aid of Nvivo 12.6 to generate emerging themes and sub-themes and thereafter deductive analysis was used to map themes and sub-themes onto the CFIR domains and constructs.</p><p><strong>Results: </strong>The barriers to intervention implementation were the complexity of the intervention (complexity), compatibility with community culture (culture), the lack of an enabling environment for behaviour change (patient needs and resources) and mistrust of CHWs by community members (relative priority). In addition, the low community awareness of CVD (tension for change), competing demands (other personal attributes) and unfavourable policies (external policy and incentives) impeded intervention implementation. On the other hand, facilitators of intervention implementation were availability of inputs and protective equipment (design quality and packaging), training of CHWs (Available resources), working with community structures including leaders and groups (process-opinion leaders), frequent support supervision and engagements (process-formally appointed internal implementation leaders) and access to quality health services (process-champions).</p><p><strong>Conclusion: </strong>Using the CFIR, we identified drivers of implementation success or failure for a community CVD prevention programme in a low-income context. These findings are key to inform the design of impactful, scalable and sustainable CHW programmes for non-communicable diseases prevention and control.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"106"},"PeriodicalIF":7.2,"publicationDate":"2020-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s13012-020-01065-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38354925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors affecting the use of clinical practice guidelines by hospital physicians: the interplay of IT infrastructure and physician attitudes.","authors":"Noriko Sasaki,&nbsp;Naohito Yamaguchi,&nbsp;Akiko Okumura,&nbsp;Masahiro Yoshida,&nbsp;Hiroyuki Sugawara,&nbsp;Jung-Ho Shin,&nbsp;Susumu Kunisawa,&nbsp;Yuichi Imanaka","doi":"10.1186/s13012-020-01056-1","DOIUrl":"https://doi.org/10.1186/s13012-020-01056-1","url":null,"abstract":"<p><strong>Background: </strong>Compliance with clinical practice guidelines (CPGs) remains insufficient around the world, despite frequent updates and continuing efforts to disseminate and implement these guidelines through a variety of strategies. We describe the current status of young resident physician practices towards CPGs and investigate the multiple factors associated with the active use of CPGs, including the physician's knowledge, attitudes, behaviours, CPG-related education received, and the hospital's IT infrastructures. The aim is to identify a more effective point for intervention to promote CPG implementation.</p><p><strong>Methods: </strong>We conducted a questionnaire survey among resident physicians working at 111 hospitals across Japan in 2015 and used results with hospital IT score data collected from a prior survey. Multivariable logistic regression analysis was performed to examine the determinants of frequent use of CPGs (defined at least once per week). The independent variables were selected based on physician demographics, clinical speciality and careers, daily knowledge and behaviour items, CPG-related education received, digital preference, and hospital IT score (high/medium/low), with and without interaction terms.</p><p><strong>Results: </strong>Responses from 535 resident physicians, at 61 hospitals, were analysed. The median hospital IT score was 6 out of a possible 10 points. Physicians who had learned about CPGs tended to work at hospitals with medium to high IT scores, had easier access to paywalled medical databases, and had better knowledge of the guideline network 'Minds'. In addition, these physicians tended to use CPGs electronically. A physician's behaviour towards using CPGs for therapeutic decision-making was strongly associated with frequent use of CPGs (odds ratio [95% CI] 6.1 [3.6-10.4]), which indicated that a physician's habit strongly promotes CPG use. Moreover, CPG-related education was associated with active use of CPGs (OR1.7 [1.1-2.5]). The interaction effects between individual digital preferences and higher hospital IT score were also observed for frequent CPG use (OR2.9 [0.9-8.8]).</p><p><strong>Conclusions: </strong>A physician's habitual behaviours, CPG-related education, and a combination of individual digital preference and superior hospital IT infrastructure are key to bridging the gap between the use and implementation of CPGs.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"101"},"PeriodicalIF":7.2,"publicationDate":"2020-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s13012-020-01056-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38643417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing a multilevel intervention to accelerate colorectal cancer screening and follow-up in federally qualified health centers using a stepped wedge design: a study protocol.","authors":"Karen Kim,&nbsp;Blasé Polite,&nbsp;Donald Hedeker,&nbsp;David Liebovitz,&nbsp;Fornessa Randal,&nbsp;Manasi Jayaprakash,&nbsp;Michael Quinn,&nbsp;Sang Mee Lee,&nbsp;Helen Lam","doi":"10.1186/s13012-020-01045-4","DOIUrl":"https://doi.org/10.1186/s13012-020-01045-4","url":null,"abstract":"<p><strong>Background: </strong>Screening for colorectal cancer (CRC) not only detects disease early when treatment is more effective but also prevents cancer by finding and removing precancerous polyps. Because many of our nation's most disadvantaged and vulnerable individuals obtain health care at federally qualified health centers, these centers play a significant role in increasing CRC screening among the most vulnerable populations. Furthermore, the full benefits of cancer screenings must include timely and appropriate follow-up of abnormal results. Thus, the purpose of this study is to implement a multilevel intervention to increase rates of CRC screening, follow-up, and referral-to-care in federally qualified health centers, as well as simultaneously to observe and to gather information on the implementation process to improve the adoption, implementation, and sustainment of the intervention. The multilevel intervention will target three different levels of influences: organization, provider, and individual. It will have multiple components, including provider and staff education, provider reminder, provider assessment and feedback, patient reminder, and patient navigation.</p><p><strong>Methods: </strong>This study is a multilevel, three-phase, stepped wedge cluster randomized trial with four clusters of clinics from four different FQHC systems. In the first phase, there will be a 3-month waiting period during which no intervention components will be implemented. After the 3-month waiting period, we will randomize two clusters to cross from the control to the intervention and the remaining two clusters to follow 3 months later. All clusters will stay at the same phase for 9 months, followed by a 3-month transition period, and then cross over to the next phase.</p><p><strong>Discussion: </strong>There is a pressing need to reduce disparities in CRC outcomes, especially among racial/ethnic minority populations and among populations who live in poverty. Single-level interventions are often insufficient to lead to sustainable changes. Multilevel interventions, which target two or more levels of changes, are needed to address multilevel contextual influences simultaneously. Multilevel interventions with multiple components will affect not only the desired outcomes but also each other. How to take advantage of multilevel interventions and how to implement such interventions and evaluate their effectiveness are the ultimate goals of this study.</p><p><strong>Trial registration: </strong>This protocol is registered at clinicaltrials.gov ( NCT04514341 ) on 14 August 2020.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"96"},"PeriodicalIF":7.2,"publicationDate":"2020-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s13012-020-01045-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38550057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the uptake of a clinical innovation for osteoarthritis in primary care: a qualitative study of knowledge mobilisation using the i-PARIHS framework.","authors":"Laura Swaithes, Krysia Dziedzic, Andrew Finney, Elizabeth Cottrell, Clare Jinks, Christian Mallen, Graeme Currie, Zoe Paskins","doi":"10.1186/s13012-020-01055-2","DOIUrl":"10.1186/s13012-020-01055-2","url":null,"abstract":"<p><strong>Background: </strong>Osteoarthritis is a leading cause of pain and disability worldwide. Despite research supporting best practice, evidence-based guidelines are often not followed. Little is known about the implementation of non-surgical models of care in routine primary care practice. From a knowledge mobilisation perspective, the aim of this study was to understand the uptake of a clinical innovation for osteoarthritis and explore the journey from a clinical trial to implementation.</p><p><strong>Methods: </strong>This study used two methods: secondary analysis of focus groups undertaken with general practice staff from the Managing OSteoArthritis in ConsultationS research trial, which investigated the effectiveness of an enhanced osteoarthritis consultation, and interviews with stakeholders from an implementation project which started post-trial following demand from general practices. Data from three focus groups with 21 multi-disciplinary clinical professionals (5-8 participants per group), and 13 interviews with clinical and non-clinical stakeholders, were thematically analysed utilising the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, in a theoretically informative approach. Public contributors were involved in topic guide design and interpretation of results.</p><p><strong>Results: </strong>In operationalising implementation of an innovation for osteoarthritis following a trial, the importance of a whole practice approach, including the opportunity for reflection and planning, were identified. The end of a clinical trial provided opportune timing for facilitating implementation planning. In the context of osteoarthritis in primary care, facilitation by an inter-disciplinary knowledge brokering service, nested within an academic institution, was instrumental in supporting ongoing implementation by providing facilitation, infrastructure and resource to support the workload burden. 'Instinctive facilitation' may involve individuals who do not adopt formal brokering roles or fully recognise their role in mobilising knowledge for implementation. Public contributors and lay communities were not only recipients of healthcare innovations but also potential powerful facilitators of implementation.</p><p><strong>Conclusion: </strong>This theoretically informed knowledge mobilisation study into the uptake of a clinical innovation for osteoarthritis in primary care has enabled further characterisation of the facilitation and recipient constructs of i-PARIHS by describing optimum timing for facilitation and roles and characteristics of facilitators.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"95"},"PeriodicalIF":0.0,"publicationDate":"2020-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38537956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Avoiding unnecessary hospitalisation for patients with chronic conditions: a systematic review of implementation determinants for hospital avoidance programmes.","authors":"Mitchell Sarkies, Janet C Long, Chiara Pomare, Wendy Wu, Robyn Clay-Williams, Hoa Mi Nguyen, Emilie Francis-Auton, Johanna Westbrook, Jean-Frédéric Levesque, Diane E Watson, Jeffrey Braithwaite","doi":"10.1186/s13012-020-01049-0","DOIUrl":"10.1186/s13012-020-01049-0","url":null,"abstract":"<p><strong>Background: </strong>Studies of clinical effectiveness have demonstrated the many benefits of programmes that avoid unnecessary hospitalisations. Therefore, it is imperative to examine the factors influencing implementation of these programmes to ensure these benefits are realised across different healthcare contexts and settings. Numerous factors may act as determinants of implementation success or failure (facilitators and barriers), by either obstructing or enabling changes in healthcare delivery. Understanding the relationships between these determinants is needed to design and tailor strategies that integrate effective programmes into routine practice. Our aims were to describe the implementation determinants for hospital avoidance programmes for people with chronic conditions and the relationships between these determinants.</p><p><strong>Methods: </strong>An electronic search of four databases was conducted from inception to October 2019, supplemented by snowballing for additional articles. Data were extracted using a structured data extraction tool and risk of bias assessed using the Hawker Tool. Thematic synthesis was undertaken to identify determinants of implementation success or failure for hospital avoidance programmes for people with chronic conditions, which were categorised according to the Consolidated Framework for Implementation Research (CFIR). The relationships between these determinants were also mapped.</p><p><strong>Results: </strong>The initial search returned 3537 articles after duplicates were removed. After title and abstract screening, 123 articles underwent full-text review. Thirteen articles (14 studies) met the inclusion criteria. Thematic synthesis yielded 23 determinants of implementation across the five CFIR domains. 'Availability of resources', 'compatibility and fit', and 'engagement of interprofessional team' emerged as the most prominent determinants across the included studies. The most interconnected implementation determinants were the 'compatibility and fit' of interventions and 'leadership influence' factors.</p><p><strong>Conclusions: </strong>Evidence is emerging for how chronic condition hospital avoidance programmes can be successfully implemented and scaled across different settings and contexts. This review provides a summary of key implementation determinants and their relationships. We propose a hypothesised causal loop diagram to represent the relationship between determinants within a complex adaptive system.</p><p><strong>Trial registration: </strong>PROSPERO 162812.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"91"},"PeriodicalIF":0.0,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38517788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Getting to implementation: a protocol for a Hybrid III stepped wedge cluster randomized evaluation of using data-driven implementation strategies to improve cirrhosis care for Veterans.","authors":"Shari S Rogal,&nbsp;Vera Yakovchenko,&nbsp;Timothy Morgan,&nbsp;Jasmohan S Bajaj,&nbsp;Rachel Gonzalez,&nbsp;Angela Park,&nbsp;Lauren Beste,&nbsp;Edward J Miech,&nbsp;Carolyn Lamorte,&nbsp;Brittney Neely,&nbsp;Sandra Gibson,&nbsp;Patrick S Malone,&nbsp;Maggie Chartier,&nbsp;Tamar Taddei,&nbsp;Guadalupe Garcia-Tsao,&nbsp;Byron J Powell,&nbsp;Jason A Dominitz,&nbsp;David Ross,&nbsp;Matthew J Chinman","doi":"10.1186/s13012-020-01050-7","DOIUrl":"https://doi.org/10.1186/s13012-020-01050-7","url":null,"abstract":"<p><strong>Background: </strong>Cirrhosis is a rapidly increasing cause of global mortality. To improve cirrhosis care, the Veterans Health Administration (VHA) developed the Hepatic Innovation Team (HIT) Collaborative to support VA Medical Centers (VAMCs) to deliver evidence-based cirrhosis care. This randomized HIT program evaluation aims to develop and assess a novel approach for choosing and applying implementation strategies to improve the quality of cirrhosis care.</p><p><strong>Methods: </strong>Evaluation aims are to (1) empirically determine which combinations of implementation strategies are associated with successful implementation of evidence-based practices (EBPs) for Veterans with cirrhosis, (2) manualize these \"data-driven\" implementation strategies, and (3) assess the effectiveness of data-driven implementation strategies in increasing cirrhosis EBP uptake. Aim 1 will include an online survey of all VAMCs' use of 73 implementations strategies to improve cirrhosis care, as defined by the Expert Recommendations for Implementing Change taxonomy. Traditional statistical as well as configurational comparative methods will both be employed to determine which combinations of implementation strategies are associated with site-level adherence to EBPs for cirrhosis. In aim 2, semi-structured interviews with high-performing VAMCs will be conducted to operationalize successful implementation strategies for cirrhosis care. These data will be used to inform the creation of a step-by-step guide to tailoring and applying the implementation strategies identified in aim 1. In aim 3, this manualized implementation intervention will be assessed using a hybrid type III stepped-wedge cluster randomized design. This evaluation will be conducted in 12 VAMCs, with four VAMCs crossing from control to intervention every 6 months, in order to assess the effectiveness of using data-driven implementation strategies to improve guideline-concordant cirrhosis care.</p><p><strong>Discussion: </strong>Successful completion of this innovative evaluation will establish the feasibility of using early evaluation data to inform a manualized, user-friendly implementation intervention for VAMCs with opportunities to improve care. This evaluation will provide implementation support tools that can be applied to enhance the implementation of other evidence-based practices.</p><p><strong>Trial registration: </strong>This project was registered at ClinicalTrials.Gov ( NCT04178096 ) on 4/29/20.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"92"},"PeriodicalIF":7.2,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s13012-020-01050-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38515167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}