Implementation Science : IS最新文献

{"title":"Exploring a novel method for optimising the implementation of a colorectal cancer risk prediction tool into primary care: a qualitative study","authors":"Shakira Milton, J. Emery, Jane Rinaldi, Joanne Kinder, A. Bickerstaffe, S. Saya, M. Jenkins, Jennifer G McIntosh","doi":"10.1186/s13012-022-01205-8","DOIUrl":"https://doi.org/10.1186/s13012-022-01205-8","url":null,"abstract":"","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121088587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effectiveness of quality improvement collaboratives in improving stroke care and the facilitators and barriers to their implementation: a systematic review.","authors":"Hayley J Lowther, Joanna Harrison, James E Hill, Nicola J Gaskins, Kimberly C Lazo, Andrew J Clegg, Louise A Connell, Hilary Garrett, Josephine M E Gibson, Catherine E Lightbody, Caroline L Watkins","doi":"10.1186/s13012-021-01162-8","DOIUrl":"10.1186/s13012-021-01162-8","url":null,"abstract":"<p><strong>Background: </strong>To successfully reduce the negative impacts of stroke, high-quality health and care practices are needed across the entire stroke care pathway. These practices are not always shared across organisations. Quality improvement collaboratives (QICs) offer a unique opportunity for key stakeholders from different organisations to share, learn and 'take home' best practice examples, to support local improvement efforts. This systematic review assessed the effectiveness of QICs in improving stroke care and explored the facilitators and barriers to implementing this approach.</p><p><strong>Methods: </strong>Five electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO, and Cochrane Library) were searched up to June 2020, and reference lists of included studies and relevant reviews were screened. Studies conducted in an adult stroke care setting, which involved multi-professional stroke teams participating in a QIC, were included. Data was extracted by one reviewer and checked by a second. For overall effectiveness, a vote-counting method was used. Data regarding facilitators and barriers was extracted and mapped to the Consolidated Framework for Implementation Research (CFIR).</p><p><strong>Results: </strong>Twenty papers describing twelve QICs used in stroke care were included. QICs varied in their setting, part of the stroke care pathway, and their improvement focus. QIC participation was associated with improvements in clinical processes, but improvements in patient and other outcomes were limited. Key facilitators were inter- and intra-organisational networking, feedback mechanisms, leadership engagement, and access to best practice examples. Key barriers were structural changes during the QIC's active period, lack of organisational support or prioritisation of QIC activities, and insufficient time and resources to participate in QIC activities. Patient and carer involvement, and health inequalities, were rarely considered.</p><p><strong>Conclusions: </strong>QICs are associated with improving clinical processes in stroke care; however, their short-term nature means uncertainty remains as to whether they benefit patient outcomes. Evidence around using a QIC to achieve system-level change in stroke is equivocal. QIC implementation can be influenced by individual and organisational level factors, and future efforts to improve stroke care using a QIC should be informed by the facilitators and barriers identified. Future research is needed to explore the sustainability of improvements when QIC support is withdrawn.</p><p><strong>Trial registration: </strong>Protocol registered on PROSPERO ( CRD42020193966 ).</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"95"},"PeriodicalIF":0.0,"publicationDate":"2021-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8564999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39676260","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":"Dissemination interventions to improve healthcare workers' adherence with infection prevention and control guidelines: a systematic review and meta-analysis.","authors":"Marcus Tolentino Silva, Tais Freire Galvao, Evelina Chapman, Everton Nunes da Silva, Jorge Otávio Maia Barreto","doi":"10.1186/s13012-021-01164-6","DOIUrl":"10.1186/s13012-021-01164-6","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic has challenged health systems worldwide since 2020. At the frontline of the pandemic, healthcare workers are at high risk of exposure. Compliance with infection prevention and control (IPC) should be encouraged at the frontline. This systematic review aimed to assess the effects of dissemination interventions to improve healthcare workers' adherence with IPC guidelines for respiratory infectious diseases in the workplace.</p><p><strong>Methods: </strong>We searched CENTRAL, MEDLINE, Embase, and the Cochrane COVID-19 Study Register. We included randomized controlled trials (RCTs) and cluster RCTs that assessed the effect of any dissemination strategy in any healthcare settings. Certainty of evidence was assessed using the GRADE approach. We synthesized data using random-effects model meta-analysis in Stata 14.2.</p><p><strong>Results: </strong>We identified 14 RCTs conducted from 2004 to 2020 with over 65,370 healthcare workers. Adherence to IPC guidelines was assessed by influenza vaccination uptake, hand hygiene compliance, and knowledge on IPC. The most assessed intervention was educational material in combined strategies (plus educational meetings, local opinion leaders, audit and feedback, reminders, tailored interventions, monitoring the performance of the delivery of health care, educational games, and/or patient-mediated interventions). Combined dissemination strategies compared to usual routine improve vaccination uptake (risk ratio [RR] 1.59, 95% confidence interval [CI] 1.54 to 1.81, moderate-certainty evidence), and may improve hand hygiene compliance (RR 1.70; 95% CI 1.03 to 2.83, moderate-certainty). When compared to single strategies, combined dissemination strategies probably had no effect on vaccination uptake (RR 1.01, 95% CI 0.95 to 1.07, low-certainty), and hand hygiene compliance (RR 1.16, 95% CI 0.99 to 1.36, low-certainty). Knowledge of healthcare workers on IPC improved when combined dissemination strategies were compared with usual activities, and the effect was uncertain in comparison to single strategy (very low-certainty evidence).</p><p><strong>Conclusions: </strong>Combined dissemination strategies increased workers' vaccination uptake, hand hygiene compliance, and knowledge on IPC in comparison to usual activities. The effect was negligible when compared to single dissemination strategies. The adoption of dissemination strategies in a planned and targeted way for healthcare workers may increase adherence to IPC guidelines and thus prevent dissemination of infectious disease in the workplace.</p><p><strong>Trial registration: </strong>Protocol available at http://osf.io/aqxnp .</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"92"},"PeriodicalIF":0.0,"publicationDate":"2021-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8542414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39568812","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":"Study protocol for a type III hybrid effectiveness-implementation trial of strategies to implement firearm safety promotion as a universal suicide prevention strategy in pediatric primary care.","authors":"Rinad S Beidas,&nbsp;Brian K Ahmedani,&nbsp;Kristin A Linn,&nbsp;Steven C Marcus,&nbsp;Christina Johnson,&nbsp;Melissa Maye,&nbsp;Joslyn Westphal,&nbsp;Leslie Wright,&nbsp;Arne L Beck,&nbsp;Alison M Buttenheim,&nbsp;Matthew F Daley,&nbsp;Molly Davis,&nbsp;Marisa E Elias,&nbsp;Shari Jager-Hyman,&nbsp;Katelin Hoskins,&nbsp;Adina Lieberman,&nbsp;Bridget McArdle,&nbsp;Debra P Ritzwoller,&nbsp;Dylan S Small,&nbsp;Courtney Benjamin Wolk,&nbsp;Nathaniel J Williams,&nbsp;Jennifer M Boggs","doi":"10.1186/s13012-021-01154-8","DOIUrl":"https://doi.org/10.1186/s13012-021-01154-8","url":null,"abstract":"<p><strong>Background: </strong>Insights from behavioral economics, or how individuals' decisions and behaviors are shaped by finite cognitive resources (e.g., time, attention) and mental heuristics, have been underutilized in efforts to increase the use of evidence-based practices in implementation science. Using the example of firearm safety promotion in pediatric primary care, which addresses an evidence-to-practice gap in universal suicide prevention, we aim to determine: is a less costly and more scalable behavioral economic-informed implementation strategy (i.e., \"Nudge\") powerful enough to change clinician behavior or is a more intensive and expensive facilitation strategy needed to overcome implementation barriers?</p><p><strong>Methods: </strong>The Adolescent and child Suicide Prevention in Routine clinical Encounters (ASPIRE) hybrid type III effectiveness-implementation trial uses a longitudinal cluster randomized design. We will test the comparative effectiveness of two implementation strategies to support clinicians' use of an evidence-based firearm safety practice, S.A.F.E. Firearm, in 32 pediatric practices across two health systems. All pediatric practices in the two health systems will receive S.A.F.E. Firearm materials, including training and cable locks. Half of the practices (k = 16) will be randomized to receive Nudge; the other half (k = 16) will be randomized to receive Nudge plus 1 year of facilitation to target additional practice and clinician implementation barriers (Nudge+). The primary implementation outcome is parent-reported clinician fidelity to the S.A.F.E Firearm program. Secondary implementation outcomes include reach and cost. To understand how the implementation strategies work, the primary mechanism to be tested is practice adaptive reserve, a self-report practice-level measure that includes relationship infrastructure, facilitative leadership, sense-making, teamwork, work environment, and culture of learning.</p><p><strong>Discussion: </strong>The ASPIRE trial will integrate implementation science and behavioral economic approaches to advance our understanding of methods for implementing evidence-based firearm safety promotion practices in pediatric primary care. The study answers a question at the heart of many practice change efforts: which strategies are sufficient to support change, and why? Results of the trial will offer valuable insights into how best to implement evidence-based practices that address sensitive health matters in pediatric primary care.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT04844021 . Registered 14 April 2021.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"89"},"PeriodicalIF":7.2,"publicationDate":"2021-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8456701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39439640","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":"Organizational contextual factors that predict success of a quality improvement collaborative approach to enhance integrated HIV-tuberculosis services: a sub-study of the Scaling up TB/HIV Integration trial.","authors":"Santhanalakshmi Gengiah, Catherine Connolly, Nonhlanhla Yende-Zuma, Pierre M Barker, Andrew J Nunn, Nesri Padayatchi, Myra Taylor, Marian Loveday, Kogieleum Naidoo","doi":"10.1186/s13012-021-01155-7","DOIUrl":"10.1186/s13012-021-01155-7","url":null,"abstract":"<p><strong>Background: </strong>A quality improvement (QI) collaborative approach to enhancing integrated HIV-Tuberculosis (TB) services may be effective in scaling up and improving the quality of service delivery. Little is known of the role of organizational contextual factors (OCFs) in influencing the success of QI collaboratives. This study aims to determine which OCFs were associated with improvement in a QI collaborative intervention to enhance integrated HIV-TB services delivery.</p><p><strong>Methods: </strong>This is a nested sub-study embedded in a cluster-randomized controlled trial. Sixteen nurse supervisors (clusters) overseeing 40 clinics were randomized (1:1) to receive QI training and mentorship, or standard of care support (SOC). In the QI arm, eight nurse supervisors and 20 clinics formed a \"collaborative\" which aimed to improve HIV-TB process indicators, namely HIV testing, TB screening, isoniazid preventive therapy (IPT) initiations, viral load testing, and antiretroviral therapy for TB patients. OCFs measured at baseline were physical infrastructure, key staff, flexibility of clinic hours, monitoring data for improvement (MDI), and leadership support. Surveys were administered to clinic staff at baseline and month 12 to assess perceptions of supportiveness of contexts for change, and clinic organization for delivering integrated HIV-TB services. Linear mixed modelling was used to test for associations between OCFs and HIV-TB process indicators.</p><p><strong>Results: </strong>A total of 209 clinic staff participated in the study; 97 (46.4%) and 112 (53.6%) from QI and SOC arms, respectively. There were no differences between the QI and SOC arms scores achieved for physical infrastructure (78.9% vs 64.7%; p = 0.058), key staff (95.8 vs 92; p = 0.270), clinic hours (66.9 vs 65.5; p = 0.900), MDI (63.3 vs 65; p = 0.875, leadership support (46.0 vs 57.4; p = 0.265), and perceptions of supportiveness of contexts for change (76.2 vs 79.7; p = 0.128 and clinic organization for delivering integrated HIV-TB services (74.1 vs 80.1; p = 0.916). IPT initiation was the only indicator that was significantly improved in the parent study. MDI was a significantly associated with increasing IPT initiation rates [beta coefficient (β) = 0.004; p = 0.004].</p><p><strong>Discussion: </strong>MDI is a practice that should be fostered in public health facilities to increase the likelihood of success of future QI collaboratives to improve HIV-TB service delivery.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov , NCT02654613 . Registered 01 June 2015.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"88"},"PeriodicalIF":0.0,"publicationDate":"2021-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8447673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39426697","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":"Influence of physician networks on prescribing a new ingredient combination in heart failure: a longitudinal claim data-based study.","authors":"Christine Arnold,&nbsp;Jan Koetsenruijter,&nbsp;Johanna Forstner,&nbsp;Frank Peters-Klimm,&nbsp;Michel Wensing","doi":"10.1186/s13012-021-01150-y","DOIUrl":"https://doi.org/10.1186/s13012-021-01150-y","url":null,"abstract":"<p><strong>Background: </strong>Since 2016, the combination of sacubitril/valsartan, which combines an angiotensin receptor and neprilysin inhibitor (ARNI), has been recommended in the guidelines for the treatment of heart failure. The adoption of new drugs may be influenced by collaboration and exchange between physicians. We aimed to determine whether characteristics of the professional networks of prescribing physicians were associated with the prescribing of ARNI in Germany.</p><p><strong>Methods: </strong>We conducted a longitudinal analysis based on claims data in 2016-2018 in Germany. The characteristics of ambulatory care physicians' networks were determined in the analysis of the patient-sharing networks of physicians in 2017. Binary logistic regression analysis with the outcome 'prescribes ARNI in 2018' (present or absent) was carried out, using network characteristics as predictors, adjusted for specialty and sociodemographic characteristics of physicians.</p><p><strong>Results: </strong>The network analysis included 8370 physicians, who had 144,636 connections. Prescribers had more connections to other physicians compared to non-prescribers (median 31 vs. 23). Regression analysis showed that the numbers of linkages to prescribers of ARNI were positively associated with prescribing ARNI. For 6-10 connections, the average marginal effect (AME) was 0.04 (confidence interval [CI] 95% 0.01-0.06) and for > 10 links the AME 0.07 (CI 95% 0.05-0.10) compared to 0-5 connections to prescriber.</p><p><strong>Conclusion: </strong>Physicians who shared patients with many other physicians were more likely to prescribe ARNI, independent of physicians' specialty. This suggested that collaboration and exchange on the basis of patient-sharing with other physicians influenced their medication prescribing decisions.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"84"},"PeriodicalIF":7.2,"publicationDate":"2021-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8401102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39361985","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":"Psychometric properties of leadership scales for health professionals: a systematic review.","authors":"Melissa A Carlson, Sarah Morris, Fiona Day, Ann Dadich, Annika Ryan, Elizabeth A Fradgley, Christine Paul","doi":"10.1186/s13012-021-01141-z","DOIUrl":"10.1186/s13012-021-01141-z","url":null,"abstract":"<p><strong>Background: </strong>The important role of leaders in the translation of health research is acknowledged in the implementation science literature. However, the accurate measurement of leadership traits and behaviours in health professionals has not been directly addressed. This review aimed to identify whether scales which measure leadership traits and behaviours have been found to be reliable and valid for use with health professionals.</p><p><strong>Methods: </strong>A systematic review was conducted. MEDLINE, EMBASE, PsycINFO, Cochrane, CINAHL, Scopus, ABI/INFORMIT and Business Source Ultimate were searched to identify publications which reported original research testing the reliability, validity or acceptability of a leadership-related scale with health professionals.</p><p><strong>Results: </strong>Of 2814 records, a total of 39 studies met the inclusion criteria, from which 33 scales were identified as having undergone some form of psychometric testing with health professionals. The most commonly used was the Implementation Leadership Scale (n = 5) and the Multifactor Leadership Questionnaire (n = 3). Of the 33 scales, the majority of scales were validated in English speaking countries including the USA (n = 15) and Canada (n = 4), but also with some translations and use in Europe and Asia, predominantly with samples of nurses (n = 27) or allied health professionals (n = 10). Only two validation studies included physicians. Content validity and internal consistency were evident for most scales (n = 30 and 29, respectively). Only 20 of the 33 scales were found to satisfy the acceptable thresholds for good construct validity. Very limited testing occurred in relation to test-re-test reliability, responsiveness, acceptability, cross-cultural revalidation, convergent validity, discriminant validity and criterion validity.</p><p><strong>Conclusions: </strong>Seven scales may be sufficiently sound to be used with professionals, primarily with nurses. There is an absence of validation of leadership scales with regard to physicians. Given that physicians, along with nurses and allied health professionals have a leadership role in driving the implementation of evidence-based healthcare, this constitutes a clear gap in the psychometric testing of leadership scales for use in healthcare implementation research and practice.</p><p><strong>Trial registration: </strong>This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (see Additional File 1) (PLoS Medicine. 6:e1000097, 2009) and the associated protocol has been registered with the PROSPERO International Prospective Register of Systematic Reviews (Registration Number CRD42019121544 ).</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"85"},"PeriodicalIF":0.0,"publicationDate":"2021-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8403357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39362313","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":"Sustained effects of the INFORM cluster randomized trial: an observational post-intervention study.","authors":"Matthias Hoben,&nbsp;Liane R Ginsburg,&nbsp;Peter G Norton,&nbsp;Malcolm B Doupe,&nbsp;Whitney B Berta,&nbsp;James W Dearing,&nbsp;Janice M Keefe,&nbsp;Carole A Estabrooks","doi":"10.1186/s13012-021-01151-x","DOIUrl":"https://doi.org/10.1186/s13012-021-01151-x","url":null,"abstract":"<p><strong>Background: </strong>Numerous studies have examined the efficacy and effectiveness of health services interventions. However, much less research is available on the sustainability of study outcomes. The purpose of this study was to assess the lasting benefits of INFORM (Improving Nursing Home Care Through Feedback On perfoRMance data) and associated factors 2.5 years after removal of study supports. INFORM was a complex, theory-based, three-arm, parallel cluster-randomized trial. In 2015-2016, we successfully implemented two theory-based feedback strategies (compared to a simple feedback approach) to increase nursing home (NH) care aides' involvement in formal communications about resident care.</p><p><strong>Methods: </strong>Sustainability analyses included 51 Western Canadian NHs that had been randomly allocated to a simple and two assisted feedback interventions in INFORM. We measured care aide involvement in formal interactions (e.g., resident rounds, family conferences) and other study outcomes at baseline (T1, 09/2014-05/2015), post-intervention (T2, 01/2017-12/2017), and long-term follow-up (T3, 06/2019-03/2020). Using repeated measures, hierarchical mixed models, adjusted for care aide, care unit, and facility variables, we assess sustainability and associated factors: organizational context (leadership, culture, evaluation) and fidelity of the original INFORM intervention.</p><p><strong>Results: </strong>We analyzed data from 18 NHs (46 units, 529 care aides) in simple feedback, 19 NHs (60 units, 731 care aides) in basic assisted feedback, and 14 homes (41 units, 537 care aides) in enhanced assisted feedback. T2 (post-intervention) scores remained stable at T3 in the two enhanced feedback arms, indicating sustainability. In the simple feedback group, where scores were had remained lower than in the enhanced groups during the intervention, T3 scores rose to the level of the two enhanced feedback groups. Better culture (β = 0.099, 95% confidence interval [CI] 0.005; 0.192), evaluation (β = 0.273, 95% CI 0.196; 0.351), and fidelity enactment (β = 0.290, 95% CI 0.196; 0.384) increased care aide involvement in formal interactions at T3.</p><p><strong>Conclusions: </strong>Theory-informed feedback provides long-lasting improvement in care aides' involvement in formal communications about resident care. Greater intervention intensity neither implies greater effectiveness nor sustainability. Modifiable context elements and fidelity enactment during the intervention period may facilitate sustained improvement, warranting further study-as does possible post-intervention spread of our intervention to simple feedback homes.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"83"},"PeriodicalIF":7.2,"publicationDate":"2021-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8381143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39338038","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 well do critical care audit and feedback interventions adhere to best practice? Development and application of the REFLECT-52 evaluation tool.","authors":"Madison Foster,&nbsp;Justin Presseau,&nbsp;Eyal Podolsky,&nbsp;Lauralyn McIntyre,&nbsp;Maria Papoulias,&nbsp;Jamie C Brehaut","doi":"10.1186/s13012-021-01145-9","DOIUrl":"https://doi.org/10.1186/s13012-021-01145-9","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Healthcare Audit and Feedback (A&F) interventions have been shown to be an effective means of changing healthcare professional behavior, but work is required to optimize them, as evidence suggests that A&F interventions are not improving over time. Recent published guidance has suggested an initial set of best practices that may help to increase intervention effectiveness, which focus on the \"Nature of the desired action,\" \"Nature of the data available for feedback,\" \"Feedback display,\" and \"Delivering the feedback intervention.\" We aimed to develop a generalizable evaluation tool that can be used to assess whether A&F interventions conform to these suggestions for best practice and conducted initial testing of the tool through application to a sample of critical care A&F interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used a consensus-based approach to develop an evaluation tool from published guidance and subsequently applied the tool to conduct a secondary analysis of A&F interventions. To start, the 15 suggestions for improved feedback interventions published by Brehaut et al. were deconstructed into rateable items. Items were developed through iterative consensus meetings among researchers. These items were then piloted on 12 A&F studies (two reviewers met for consensus each time after independently applying the tool to four A&F intervention studies). After each consensus meeting, items were modified to improve clarity and specificity, and to help increase the reliability between coders. We then assessed the conformity to best practices of 17 critical care A&F interventions, sourced from a systematic review of A&F interventions on provider ordering of laboratory tests and transfusions in the critical care setting. Data for each criteria item was extracted by one coder and confirmed by a second; results were then aggregated and presented graphically or in a table and described narratively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 52 criteria items were developed (38 ratable items and 14 descriptive items). Eight studies targeted lab test ordering behaviors, and 10 studies targeted blood transfusion ordering. Items focused on specifying the \"Nature of the Desired Action\" were adhered to most commonly-feedback was often presented in the context of an external priority (13/17), showed or described a discrepancy in performance (14/17), and in all cases it was reasonable for the recipients to be responsible for the change in behavior (17/17). Items focused on the \"Nature of the Data Available for Feedback\" were adhered to less often-only some interventions provided individual (5/17) or patient-level data (5/17), and few included aspirational comparators (2/17), or justifications for specificity of feedback (4/17), choice of comparator (0/9) or the interval between reports (3/13). Items focused on the \"Nature of the Feedback Display\" were reported poorly-just under half of interventions reported providing feedback","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"81"},"PeriodicalIF":7.2,"publicationDate":"2021-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8369748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39320564","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 nudges to promote utilization of low tidal volume ventilation (INPUT): a stepped-wedge, hybrid type III trial of strategies to improve evidence-based mechanical ventilation management.","authors":"Meeta Prasad Kerlin,&nbsp;Dylan Small,&nbsp;Barry D Fuchs,&nbsp;Mark E Mikkelsen,&nbsp;Wei Wang,&nbsp;Teresa Tran,&nbsp;Stefania Scott,&nbsp;Aerielle Belk,&nbsp;Jasmine A Silvestri,&nbsp;Tamar Klaiman,&nbsp;Scott D Halpern,&nbsp;Rinad S Beidas","doi":"10.1186/s13012-021-01147-7","DOIUrl":"https://doi.org/10.1186/s13012-021-01147-7","url":null,"abstract":"<p><strong>Background: </strong>Behavioral economic insights have yielded strategies to overcome implementation barriers. For example, default strategies and accountable justification strategies have improved adherence to best practices in clinical settings. Embedding such strategies in the electronic health record (EHR) holds promise for simple and scalable approaches to facilitating implementation. A proven-effective but under-utilized treatment for patients who undergo mechanical ventilation involves prescribing low tidal volumes, which protects the lungs from injury. We will evaluate EHR-based implementation strategies grounded in behavioral economic theory to improve evidence-based management of mechanical ventilation.</p><p><strong>Methods: </strong>The Implementing Nudges to Promote Utilization of low Tidal volume ventilation (INPUT) study is a pragmatic, stepped-wedge, hybrid type III effectiveness implementation trial of three strategies to improve adherence to low tidal volume ventilation. The strategies target clinicians who enter electronic orders and respiratory therapists who manage the mechanical ventilator, two key stakeholder groups. INPUT has five study arms: usual care, a default strategy within the mechanical ventilation order, an accountable justification strategy within the mechanical ventilation order, and each of the order strategies combined with an accountable justification strategy within flowsheet documentation. We will create six matched pairs of twelve intensive care units (ICUs) in five hospitals in one large health system to balance patient volume and baseline adherence to low tidal volume ventilation. We will randomly assign ICUs within each matched pair to one of the order panels, and each pair to one of six wedges, which will determine date of adoption of the order panel strategy. All ICUs will adopt the flowsheet documentation strategy 6 months afterwards. The primary outcome will be fidelity to low tidal volume ventilation. The secondary effectiveness outcomes will include in-hospital mortality, duration of mechanical ventilation, ICU and hospital length of stay, and occurrence of potential adverse events.</p><p><strong>Discussion: </strong>This stepped-wedge, hybrid type III trial will provide evidence regarding the role of EHR-based behavioral economic strategies to improve adherence to evidence-based practices among patients who undergo mechanical ventilation in ICUs, thereby advancing the field of implementation science, as well as testing the effectiveness of low tidal volume ventilation among broad patient populations.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov , NCT04663802 . Registered 11 December 2020.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"78"},"PeriodicalIF":7.2,"publicationDate":"2021-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8353429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39298896","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}