Implementation Science最新文献

{"title":"Ready to screen implementation trial protocol: a cluster randomized implementation trial comparing a bundled implementation strategy versus a simple implementation strategy to improve intention to screen in the Australian National Lung Cancer Screening Program.","authors":"Dzenana Kartal, Christine Paul, Georgia Bartlett, Skye Abraham, Sarah York, Billie Bonevski, Jon D Emery, Shalini K Vinod, Fraser Brims, Daniel Barker, Rachael H Dodd, Susan McCullough, Justin Tse, Joel Rhee, Mark Brooke, Jennifer May, Sarah Norris, Maria A R Lantin, Tescha Nicholls, Henry M Marshall, Emily Stone, Shakira Onwuka, Samantha L Quaife, Nicole M Rankin","doi":"10.1186/s13012-026-01496-1","DOIUrl":"10.1186/s13012-026-01496-1","url":null,"abstract":"<p><strong>Background: </strong>Uptake of lung cancer screening (LCS) in high-risk populations remains suboptimal internationally. Primary care practitioners play a critical role in identifying eligible patients and initiating referrals for LCS. Targeted implementation strategies are needed to address health care barriers to the uptake of LCS such as limited awareness, eligibility assessment, low engagement, and poor health system preparedness. Implementation trials are needed to determine optimal decision-making and participant knowledge gains to ultimately increase screening uptake.</p><p><strong>Design: </strong>The Ready to Screen trial is a cluster randomized controlled implementation trial to compare participants' intention to screen for lung cancer in the Australian National Lung Cancer Screening Program (hereafter 'the Program') between bundled (intervention: core + link to multilingual trial website + SMS and email reminders, clinical decision support prompts for general practitioners) and core (control (core): initial letter mail out with LCS brochure only) implementation strategies.</p><p><strong>Method: </strong>Twenty-eight general practices recruited across Australia will be randomly allocated (1:1 ratio) to either control or intervention. Practices will generate eligible patient lists using medical records to issue participation invitations. Eligible patients are aged 50-70 years and currently smoke or have quit within the past 10 years or have an unknown quit date. The primary outcome is participant intention to screen from self-report survey at patient recruitment. Secondary outcomes will be evaluated using the RE-AIM framework-examining Reach, Effectiveness (including cost-effectiveness), Adoption, Implementation and Maintenance. The PRISM framework will guide assessment of multi-level contextual factors hypothesized to influence these outcomes. Data collection will include trial recruitment and practice records, participant and provider self-report surveys, and semi-structured interviews.</p><p><strong>Discussion: </strong>This trial will generate timely evidence about the effectiveness and cost-effectiveness of the bundled implementation strategy to support delivery of the Program within primary care practices. Findings will provide insights into contextual factors shaping implementation success and inform the future scaling and sustainability of LCS in Australia and internationally.</p><p><strong>Trial registration: </strong>ACTRN12625000045415 registered on 20/01/2025.</p>","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":" ","pages":""},"PeriodicalIF":13.4,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progress in sustainment? Reflections on ongoing gaps and opportunities for the field of implementation science in response to Dopp et al., 2025.","authors":"Rachel C Shelton, Corianna E Sichel","doi":"10.1186/s13012-026-01495-2","DOIUrl":"10.1186/s13012-026-01495-2","url":null,"abstract":"","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":"21 1","pages":""},"PeriodicalIF":13.4,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13001234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of optimized kangaroo care for infection prevention and control in neonatal intensive care units (NeoIPC): Protocol for the implementation elements of a multicenter parallel cluster randomized hybrid type 2 implementation-effectiveness study.","authors":"Marie-Therese Schultes, Julia Baenziger, Emanuela Nyantakyi, Cassie Xueqi Wu, Giovanfrancesco Ferrari, Elske Sieswerda, C Henri van Werkhoven, Chiara Minotti, Aline Wolfensberger, Fabrizio Tediosi, Federica D'Ambrosio, Julia A Bielicki, Lauren Clack","doi":"10.1186/s13012-026-01488-1","DOIUrl":"10.1186/s13012-026-01488-1","url":null,"abstract":"<p><strong>Background: </strong>Hospital-acquired neonatal severe infections and resistant bacterial colonization in neonatal care are a world-wide challenge. Preventing the spread of resistant bacteria in neonatal intensive care units (NICUs) is specifically challenging, for example, due to multi-patient rooms, spaces being crowded with equipment, and high antibiotic use in these settings. Kangaroo care (KC), a practice that involves skin-to-skin contact between newborn infants and caregivers, is a promising, low-cost intervention that has been associated with reduced morbidity and mortality in low-birthweight infants. Despite these and other health benefits, KC has not been implemented systematically or consistently in NICUs following current WHO guidelines. The NeoIPC project aims to optimize KC practices in NICUs and to determine the effect on severe neonatal infections and resistant bacterial colonization among high-risk infants.</p><p><strong>Methods: </strong>Within the NeoIPC project, NeoDeco is a multi-center, parallel-group, cluster-randomized type 2 hybrid effectiveness-implementation study with 24 NICUs from five European countries representing clusters. NeoImplement, comprising the implementation elements of NeoDeco, focuses on (1) providing implementation support to sites in the intervention arm of the study and (2) evaluating the implementation of optimized KC in intervention sites. Implementation support consists of core implementation strategies that are offered to all intervention sites as well as the co-design of tailored implementation strategies for each individual site. Innovative methods supporting this co-design process are presented in this protocol. The implementation evaluation comprises a mixed-methods longitudinal study evaluating barriers and facilitators and various implementation outcomes, including a comprehensive economic evaluation.</p><p><strong>Discussion: </strong>NeoImplement focuses on implementing optimized KC in participating NICUs by offering and co-developing strategies that can be sustained beyond the duration of the study. The accompanying implementation evaluation will provide insights into the effectiveness, feasibility, acceptability, sustainability, and cost-effectiveness of strategies targeting the implementation of optimized KC in European NICUs. A long-term goal of the study is to develop strategies for implementing KC that can be applied by NICUs beyond this study and to present an approach for how KC champions in NICUs themselves can develop context-sensitive implementation strategies.</p><p><strong>Trial registration: </strong>NCT05993442, December 27, 2024 https://classic.</p><p><strong>Clinicaltrials: </strong>gov/ct2/history/NCT05993442 .</p>","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":" ","pages":""},"PeriodicalIF":13.4,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13059342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147312697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative effectiveness trial for universal psychosocial screening with the Psychosocial Assessment Tool (PAT) across 18 childhood cancer programs in the United States: adoption, penetration, and health equity.","authors":"Lamia P Barakat, Michele A Scialla, Nithyasri Ramaswamy, Janet A Deatrick, Kamyar Arasteh, Eric Sandler, Shannon N Hammer, Anne E Kazak","doi":"10.1186/s13012-026-01493-4","DOIUrl":"10.1186/s13012-026-01493-4","url":null,"abstract":"<p><strong>Background: </strong>Universal, systematic psychosocial screening in childhood cancer assures care matched to need and achieves a Standard of Psychosocial Care. It is accomplished inconsistently due to barriers at the family, provider, and institution level, potentially contributing to disparities in care and outcomes. We conducted a comparative effectiveness trial of two implementation strategies of an established measure (Psychosocial Assessment Tool; PAT3.0) across 18 children's cancer programs to identify strategies that resulted in higher levels of screening in English and Spanish (penetration, health equity). We also examined uptake at the institution level (adoption).</p><p><strong>Methods: </strong>Sites were randomized to Strategy I (web-based training curriculum [WebTC] + a written, site-specific Implementation Plan) or Strategy II (Strategy I + Consultation Calls + a Champion) and to one of three year-long cohorts. Randomization was stratified by site size (new patients/year (small [< 50], medium [50-149], large [> 150]). Sites provided data to a central data coordinating site, including eligible and screened patients/families and type of insurance as a proxy for socioeconomic status (SES). ANOVAs compared percentage of eligible patients/families screened, eligible Hispanic patients/families screened, patients/families screened by identified race, patients/families screened by SES, and feedback provided to families across Strategy. Data from a WebTC feedback form and the sites' PAT implementation plans were summarized.</p><p><strong>Results: </strong>There were no differences between Strategy I and II in percentage of patients/families screened for 1) all eligible families; 2) Hispanic families; 3) identified race; 4) SES; and 5) feedback provided. Exploratory analyses examining strategy by size by cohort, identified lower percentages of patients/families screened in the second cohort. The WebTC was rated as clear and helpful in understanding the importance of screening and how to screen as part of workflow. On the PAT Implementation Plan, most sites screened a subsample of their cancer program population (e.g., inpatients, hematologic malignancies) with social workers or psychologists as screeners.</p><p><strong>Conclusions: </strong>Comprehensive web-based training + Implementation Plan supported implementation of an established psychosocial screener, inclusive of racial and ethnic minoritized, English and Spanish-speaking, and lower SES patients/families. Implementation planning to address barriers at the patient, providers, and institution levels is indicated for successful screening of all patients and as part of childhood cancer program efforts to meet the Psychosocial Standards.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT04446728, registered 23 June 2020. https://clinicaltrials.gov/study/NCT04446728 .</p>","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":" ","pages":""},"PeriodicalIF":13.4,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13059491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147312758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The HEALing Measurement Center: a stepped wedge cluster randomized study protocol to enhance opioid use disorder recovery through measurement based care.","authors":"Renee M Cloutier, Arnie Aldridge, Ani Lessley, David Loveland, Rebekah Sedlock, Kelli Scott","doi":"10.1186/s13012-026-01492-5","DOIUrl":"10.1186/s13012-026-01492-5","url":null,"abstract":"<p><strong>Background: </strong>Opioid use disorder (OUD) remains a critical public health crisis across the United States. To address this challenge, the HEALing Measurement Center, funded by the National Institutes of Health (NIH) Helping to End Addiction Long-term (HEAL) Initiative, aims to enhance the quality, equity, and sustainment of care delivered in Pennsylvania opioid treatment programs (OTPs) through the implementation of measurement-based care (MBC). This initiative leverages interdisciplinary collaboration among academic researchers, state and community partners, payers, and OTP providers to address critical gaps in OUD treatment and implementation science.</p><p><strong>Methods: </strong>Three research projects were designed to address immediate implementation support needs expressed by community partners while simultaneously meeting critical research gaps. Research Project 1 develops an MBC implementation blueprint co-designed with key constituents to address barriers such as paperwork burden and facilitate technical assistance and learning networks. Research Project 2 evaluates the effectiveness and implementation of an enhanced MBC implementation strategy (MBC +) compared to measurement implementation as usual (MAU) through a hybrid type 2 stepped-wedge effectiveness-implementation trial. Research Project 3 focuses on the clinical impact of MBC + on patients with OUD and co-occurring mental health conditions, exploring mechanisms underlying treatment success.</p><p><strong>Discussion: </strong>This protocol provides an overview of the research design as well as the unique community partnerships leveraged to enhance MBC implementation. Overall, the projects within the HEALing Measurement Center aim to establish a foundation for future MBC scale-up and sustainment across Pennsylvania, provide learnings that can inform other implementation efforts, and enhance the quality of interventions for individuals with OUD.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov, NCT06965010, Registered 11 May 2025, https://clinicaltrials.gov/study/NCT06965010 .</p>","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":" ","pages":""},"PeriodicalIF":13.4,"publicationDate":"2026-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13040839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146777052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustainable improvement of interprofessional care for better resident outcomes: protocol for the INTERSCALE hybrid type III effectiveness cluster-randomized trial comparing individualized and collaborative delivery of an evidence-based care model for long-term care.","authors":"Franziska Zúñiga, Lea Saringer-Hamiti, Flaka Siqeca, Sarah Holzer, Raphaëlle-Ashley Guerbaai, Thekla Brunkert, Farah Islam, Jana Bartáková, Anja Orschulko, Sandra Staudacher, Reto W Kressig, Andreas Zeller, Christine Serdaly, Nathalie I H Wellens, Sabina M De Geest, Vanessa Litschgi, Natalie Zimmermann, Michael Simon","doi":"10.1186/s13012-026-01489-0","DOIUrl":"10.1186/s13012-026-01489-0","url":null,"abstract":"<p><strong>Background: </strong>Over recent decades, multifaceted nurse-led care models have been developed to reduce unplanned hospital transfers from long-term care facilities (LTCFs). In Switzerland, the INTERCARE model has demonstrated effectiveness, with core components including deployment of nurses in expanded roles (INTERCARE nurses), evidence-based communication tools, and advance care planning. However, resource-intensive implementation strategies such as 1:1 support meetings for model implementers pose challenges for scale-up, underscoring the need for more scalable implementation support. The INTERSCALE study compares two modes of delivering implementation support-an individualized and a collective-oriented approach-testing the hypothesis that the latter achieves non-inferior fidelity to the INTERCARE model and comparable reductions in unplanned hospital transfers at the LTCF level. Secondary aims are to compare implementation (acceptability, feasibility), economic (costs, cost-effectiveness), clinical (unplanned transfers), and organizational (staff absences, turnover) outcomes.</p><p><strong>Methods: </strong>This non-inferiority, effectiveness-implementation hybrid type III trial uses a cluster-randomized controlled design, with LTCFs as the unit of randomization. Forty German-speaking LTCFs in Switzerland (≥20 long-term care beds; cantonal accreditation) will be randomized (1:1) after formal consent to either individualized or collective implementation support, without blinding of LTCFs or the research team. In the individualized arm (20 LTCFs), leadership receives 1:1 support meetings, and INTERCARE nurses receive 1:1 coaching, mirroring the original INTERCARE trial. In the collective arm (20 LTCFs), leadership support and INTERCARE nurse coaching are delivered in group formats involving several LTCFs/INTERCARE nurses together at two-monthly intervals. The primary outcome is LTCF-level fidelity to the INTERCARE core components, analyzed with a binomial generalized linear mixed model including a random LTCF effect. Non-inferiority of the collective mode will be concluded if the lower bound of its 95% confidence interval for fidelity is within 15% of the individualized mode. A 12-month cost-effectiveness analysis from a multi-stakeholder perspective (LTCFs and research group) will estimate the incremental cost-effectiveness ratio using differences in implementation costs and unplanned transfers between arms; secondary outcomes include unplanned transfers, staff turnover, and absences.</p><p><strong>Discussion: </strong>This type III hybrid cluster trial addresses a key scaling challenge in implementation science by testing less resource-intensive implementation strategies for disseminating an evidence-based care model across LTCFs in routine practice.</p><p><strong>Trial registration: </strong>Prospectively registered on June 25, 2024, at ClinicalTrials.gov nr. NCT06473051 .</p>","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":" ","pages":""},"PeriodicalIF":13.4,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13032367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146229879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing an intervention to facilitate early detection of deterioration in aged care residents: process evaluation of the EDDIE + trial.","authors":"Ella L Bracci, Michelle J Allen, Hannah E Carter, Elizabeth Cyarto, Trudy Dwyer, Alison Farrington, Nicholas Graves, Xing J Lee, Claudia Meyer, Florin Oprescu, Jeffrey Rowland, Carla Shield, Nicole White, Gillian Harvey","doi":"10.1186/s13012-026-01484-5","DOIUrl":"10.1186/s13012-026-01484-5","url":null,"abstract":"<p><strong>Background: </strong>EDDIE + was a stepped wedge cluster randomised controlled trial with an embedded process evaluation in 11 residential aged care (RAC) homes in Queensland, Australia. The intervention aimed to upskill RAC staff to identify and manage deterioration to reduce unnecessary hospital transfer through education, decision support tools, diagnostic equipment and local facilitation. Main trial results indicated 46% of hospital admissions were due to falls and no significant improvements to outcome measures including hospital bed days were achieved. These findings were examined through a process evaluation.</p><p><strong>Methods: </strong>A mixed methods approach guided by the i-PARIHS framework was used to assess fidelity, acceptability, mechanisms of impact and feasibility of implementation, including barriers and enablers. Semi-structured interviews, self-efficacy surveys, and project tracking documents were used. Qualitative data were coded to the i-PARIHS framework and quantitative data were analysed using linear mixed modelling.</p><p><strong>Results: </strong>Fidelity varied considerably due to workforce shortages including vacancy in the local clinical facilitator role, high workload, COVID-19, and other contextual factors. Differences in job and team-related staff self-efficacy before and after the introduction of EDDIE + were not statistically significant. However, inductive thematic analysis of the questionnaires indicated that staff felt their knowledge, skills, confidence and communication had increased.</p><p><strong>Conclusions: </strong>The process evaluation indicates high acceptability of the EDDIE + intervention. However, fidelity and intended mechanisms of impact were mixed despite substantial pre-planning prior to implementation. For future studies, specific barriers in the RAC setting such as staffing and turnover may be unable to be adequately addressed without systemic change.</p><p><strong>Trial registration: </strong>The trial is prospectively registered with the Australia New Zealand Clinical Trial Registry (ACTRN12620000507987, registered 23/04/2020).</p>","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":" ","pages":""},"PeriodicalIF":13.4,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13011326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application status of the CFIR-ERIC matching tool in healthcare context: a scoping review.","authors":"Meiqi Meng, Ziyan Wang, Dan Yang, Hongzhan Jiang, Jie Lu, Sihan Chen, Xiaoyan Zhang, Junjie Huang, Ting Feng, Xuejing Li, Yufang Hao","doi":"10.1186/s13012-026-01490-7","DOIUrl":"10.1186/s13012-026-01490-7","url":null,"abstract":"<p><strong>Background: </strong>The CFIR-ERIC matching tool, developed by Waltz et al. in 2019 to integrate implementation strategies with theoretical frameworks, enables rapid and targeted generation of implementation strategies in healthcare. However, no comprehensive synthesis of its application exists. This scoping review addresses this gap to inform tool optimization and implementation science advancement.</p><p><strong>Methods: </strong>Following the Joanna Briggs Institute scoping review methodology and PRISMA-ScR guidelines, we searched eight databases (PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, VIP, and SinoMed) for studies applying the CFIR-ERIC matching tool in healthcare (April 29, 2019, to February 8, 2025). Data on application purpose, process, advantages, and limitations were extracted and analyzed via descriptive and content analysis.</p><p><strong>Results: </strong>A total of 53 studies were included. The tool was mainly used to efficiently formulate targeted implementation strategies (51/53, 96.23%) and primarily applied in clinical intervention improvement (25/53, 47.17%). Regarding the tool's five-step application process, all 51 strategy-generating studies completed the first two steps (barrier identification and strategy generation), while only 50.98% (26/51) further adjusted, 15.69% (8/51) validated, and 7.84% (4/51) evaluated the generated strategies. Commonly reported advantages included providing a structured process for strategy matching (14/53, 26.42%) and references for generating targeted strategies (13/53, 24.53%). Key challenges were the need for context-specific adaptation (13/53, 24.53%) and inherent subjective bias from expert consensus reliance (9/53, 16.98%). Additionally, four studies (7.55%) proposed suggestions for tool refinements.</p><p><strong>Conclusion: </strong>This review is the first to map the CFIR-ERIC matching tool's application in healthcare, confirming its significant potential and notable strengths in implementation research. Although efforts to update and revise the tool remain limited, there are some approaches offer promising directions for optimization. Future research should focus on leveraging the tool's strengths while addressing its limitations to advance implementation science and improve global healthcare delivery efficiency and quality.</p><p><strong>Registration: </strong>Open Science Framework, https://doi.org/10.17605/OSF.IO/PE2QD .</p>","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":" ","pages":""},"PeriodicalIF":13.4,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13011528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testing normalization process theory in a randomized trial of mental health clinics implementing digital measurement-based care.","authors":"Nathaniel J Williams, Mimi Choy-Brown, Nallely Vega, Gregory A Aarons, Mark G Ehrhart, Steven C Marcus","doi":"10.1186/s13012-026-01485-4","DOIUrl":"10.1186/s13012-026-01485-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Normalization process theory (NPT) is one of the most highly cited implementation theories that explains the mechanisms by which new complex health interventions become embedded and sustained in healthcare settings; however, few of its predictions have been subjected to inferential hypothesis testing. In this theory-driven, ancillary analysis of a large hybrid type 3 effectiveness-implementation trial, we tested two NPT predictions: (1) its generative mechanisms of coherence, cognitive participation, collective action, and reflexive monitoring are modifiable in response to deliberate change efforts, and (2) greater enactment of these mechanisms predicts greater future sustainment of complex health interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The trial tested two strategies to improve the implementation and sustainment of digital measurement-based care in outpatient mental health clinics serving youth. Twenty-one clinics were randomized to either training and technical assistance alone (k = 10) or training and technical assistance plus the Leadership and Organizational Change for Implementation (LOCI) strategy, in which leaders received training, coaching, and consultation to support implementation (k = 11). Six months after implementation strategies concluded, clinicians (N = 144) in both arms completed the Normalization MeAsure Development (NoMAD) questionnaire to describe the extent to which NPT mechanisms were enacted in their clinics. The primary outcome was a monthly, clinic-level, binary indicator of measurement-based care sustainment, derived from automatically-generated system usage data, for 16 months after the NoMAD assessment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The NPT mechanisms were highly responsive to the organizational implementation strategy, which had a large effect overall (NoMAD total score: d&lt;sub&gt;adj&lt;/sub&gt; = 1.08, [0.63-1.52]) and on individual mechanisms of coherence (d&lt;sub&gt;adj&lt;/sub&gt; = 1.02, 95% CI = [0.60-1.44]), cognitive participation (d&lt;sub&gt;adj&lt;/sub&gt; = 1.00, [0.57-1.42]), collective action (d&lt;sub&gt;adj&lt;/sub&gt; = 0.96, [0.50-1.42]), and reflexive monitoring (d&lt;sub&gt;adj&lt;/sub&gt; = 1.01, [0.61-1.42]). Greater enactment of NPT mechanisms predicted significantly higher likelihood of measurement-based care sustainment in the month following the NoMAD assessment (adjusted event rate ratio for high versus low mechanism enactment = 2.96, [CI = 1.94-3.99]) and a significantly less steep decline in the log-odds of sustainment over the 16-month follow-up (b&lt;sub&gt;adj&lt;/sub&gt; = 0.32, SE = 0.15, p = .032).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The generative mechanisms proposed by NPT are modifiable in response to theoretically-aligned implementation strategies, and greater enactment of these mechanisms predicts greater sustainment of complex health interventions over 16 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;/strong&gt;ClinicalTrials.gov Identifier: NCT04096274 (Working to Implement and Sustain Digital Outcome Measu","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":" ","pages":"16"},"PeriodicalIF":13.4,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12918388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful adoption of an advance care planning evidence-based practice: impact of clinical champion and site factors.","authors":"Kate H Magid, Andrew Murray, Leah M Haverhals, Connie Cole, Jennifer Kononowech, Cari Levy, Mary Ersek, Joan G Carpenter","doi":"10.1186/s13012-026-01483-6","DOIUrl":"10.1186/s13012-026-01483-6","url":null,"abstract":"<p><strong>Background: </strong>Clinical champions are often engaged to implement new evidence-based practices in health care settings. Previous research suggests that the mere presence of a champion does not guarantee successful implementation; therefore, we aimed to identify specific champion attributes and site-level factors that contribute to evidence-based practice adoption. During a Department of Veterans Affairs (VA) quality improvement program, we engaged site champions to implement an advance care planning evidence-based practice with seriously ill Veterans in VA home based primary care (HBPC) and community nursing homes (CNHs).</p><p><strong>Methods: </strong>We conducted interviews (N = 99) with champions and leadership at 11 HBPC programs and 6 VA CNH programs. Guided by the Tailored Implementation in Chronic Diseases (TICD) framework and Shea's conceptual model of champion impact, we analyzed interview data to examine champion characteristics and site factors associated with successful adoption of the evidence-based practice. Additionally, we categorized sites as successful or not successful in terms of adopting the evidence-based practice and compared champion characteristics and site factors between these sites using a Matrixed Multiple Case Study approach.</p><p><strong>Results: </strong>Eight HBPC programs (73%) and four CNH programs (67%) were successful. Champions at successful sites believed in the importance of eliciting and documenting Veterans goals of care, were motivated and committed to participating in the project, and were dedicated to serving as champions. Successful sites had champions who engaged in champion activities beyond attending coaching calls, including supporting and educating peers. The degree of leadership support, as well as the relative priority of the project varied; unsuccessful sites mentioned competing priorities and lower levels of leadership engagement.</p><p><strong>Conclusion: </strong>Results suggest that champion belief in the importance of the evidence-based practice, commitment to the program, motivation to serve as a champion, and engagement with peers are characteristics common among champions at sites that successfully adopted the evidence-based practice. At the site-level, the degree of leadership engagement and the priority of implementing the evidence-based practice emerged as factors influencing success. These findings can assist future healthcare interventions and programs in identifying clinical champions for implementing evidence-based practices.</p>","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":" ","pages":""},"PeriodicalIF":13.4,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12964825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}