Implementation science communications最新文献

{"title":"Development of a method for qualitative data integration to advance implementation science within research consortia.","authors":"Lisa DiMartino, Allison J Carroll, Jennifer L Ridgeway, Anna Revette, Joan M Griffin, Bryan J Weiner, Sandra A Mitchell, Wynne E Norton, Christine Cronin, Andrea L Cheville, Ann Marie Flores, Justin D Smith","doi":"10.1186/s43058-025-00701-4","DOIUrl":"10.1186/s43058-025-00701-4","url":null,"abstract":"<p><strong>Background: </strong>Methods of integrating qualitative data across diverse studies and within multi-site research consortia are less developed than those for integrating quantitative data. The development ofsuchmethods is essential to support the data exchange needed for cross-study qualitative inquiry and given the increasing emphasis on data sharing and open science. We describe methods for qualitative data integration within the National Cancer Institute's Improving the Management of symPtoms During And following Cancer Treatment (IMPACT) Consortium funded by the Cancer Moonshot^SM. Data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR). Our case study highlights potential solutions for unique challenges faced when integrating qualitative data across multiple settings in a research consortium.</p><p><strong>Methods: </strong>The IMPACT consortium is comprised of three research centers (RCs) each conducting pragmatic trials examining the effectiveness of routine symptom management on patient-centered outcomes. After reaching consensus on use of CFIR as the common implementation determinant framework, RCs developed a semi-structured interview guide and tailored it to features of their healthcare setting and symptom management interventions. RCs conducted interviews/focus groups with healthcare system partners to examine contextual factors impacting implementation. RCs exchanged 1-2 transcripts (n = 5 total) for purposes of pilot testing the methodology.</p><p><strong>Results: </strong>Given the heterogeneity of study settings and contexts, it was challenging to simultaneously assign codes at both domain and construct levels and the process was resource intensive. Recommendations include employing a common framework for data collection and analyses from the outset, coding at domain level first and then incorporating construct codes, and centralizing processes via a coordinating center (or similar entity) and combining coded transcripts using qualitative software. We also generated an iteratively refined codebook that employed the CFIR schema and incorporated CFIR 2.0 to provide detailed guidance for coders conducting cross-study qualitative inquiry.</p><p><strong>Conclusions: </strong>Limited guidance exists on how to support qualitative data integration, data exchange, and sharing across multiple studies. This paper describes a systematic method for employing an implementation determinant framework-guided approach to foster data integration. This methodology can be adopted by other research consortia to support qualitative data integration, cross-site qualitative inquiry, and generate improved understanding of evidence-based intervention implementation.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"21"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11853699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506535","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":"The \"good enough\" facilitator: elucidating the role of working alliance in the mechanism of facilitation.","authors":"Vera Yakovchenko, Monica Merante, Matthew J Chinman, Brittney Neely, Carolyn Lamorte, Sandra Gibson, JoAnn Kirchner, Timothy R Morgan, Shari S Rogal","doi":"10.1186/s43058-025-00705-0","DOIUrl":"10.1186/s43058-025-00705-0","url":null,"abstract":"<p><strong>Background: </strong>While facilitation is a widely used implementation strategy with proven effectiveness, the development of the facilitator-recipient relationship, i.e., working alliance, has received limited attention. However, we hypothesize that working alliance may be part of the mechanism by which facilitation activates change. This study aimed to examine the associations between working alliance, facilitation, and change in clinical care in a hybrid type 3 trial of a manualized intervention, Getting to Implementation (GTI).</p><p><strong>Methods: </strong>This concurrent triangulation mixed-methods study was conducted at 12 sites in a stepped-wedge trial. We collected surveys using the Working Alliance Inventory-Short instrument (WAI), which includes three subscales of goal alignment, task alignment, and affective bond, from three respondent types (clinical facilitator, evaluation facilitator, and site team members) after a year of intervention. Facilitation activity type and dose were tracked. Summative qualitative interviews with site champions and facilitators) elicited perceptions on working alliance, facilitation, and experiences with the intervention, and results were triangulated with statistical bivariate analyses. The associations between WAI and facilitation time, fidelity, and change in liver cancer screening rate (the primary trial outcome) were assessed.</p><p><strong>Results: </strong>Across 12 sites, facilitators and site team members completed 21 interviews and 40 WAI surveys, with site aggregate average working alliance scores of 5.9 ± 0.4 on a seven-point scale. Bond scores were highest (6.1 ± 0.5), followed by Goal (6.0 ± 0.4) and Task (5.8 ± 0.5) scores. Overall and subscale scores differed by respondent type, with site respondents consistently rating items higher than facilitators, particularly in Task items. Fidelity to the GTI process (e.g., timely completion of steps and tools) was significantly positively associated with WAI scores overall (r = 0.41, p = 0.007) and subscale scores, including Goal (r = 0.39, p = 0.011), Task (r = 0.42, p = 0.006), and Bond (r = 0.33, p = 0.039). WAI scores were not correlated with facilitation time (dose). WAI scores overall and the Bond and Goal scores were significantly positively associated with sustained improvement in cancer screening rates (r = 0.57, p = 0.015).</p><p><strong>Conclusions: </strong>In this implementation trial, working alliance between site teams and facilitators was positively associated with both fidelity and cancer screening outcomes and was notably independent of time spent providing facilitation. Findings highlight the importance of working alliance in implementation studies.</p><p><strong>Trial registration: </strong>This project was registered at ClinicalTrials.Gov ( NCT04178096 ) on 4/29/20.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"22"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506536","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":"Improving cancer prevention and control through implementing academic-local public health department partnerships - protocol for a cluster-randomized implementation trial using a positive deviance approach.","authors":"Stephanie Mazzucca-Ragan, Peg Allen, Kathleen Amos, Abigail R Barker, Madisen Brewer, Paul C Erwin, Jessica Gannon, Feng Gao, Rebekah R Jacob, Rebecca Lengnick-Hall, Ross C Brownson","doi":"10.1186/s43058-025-00706-z","DOIUrl":"10.1186/s43058-025-00706-z","url":null,"abstract":"<p><strong>Background: </strong>Local public health departments in the United States are responsible for implementing cancer-related programs and policies in their communities; however, many staff have not been trained to use evidence-based processes, and the organizational climate may be unsupportive of evidence-based processes. A promising approach to address these gaps is through academic-public health department (AHD) partnerships, in which practitioners and academics collaborate to improve public health practice and education through joint research projects and educational opportunities. Prior research has demonstrated the benefits of AHD partnerships to public health practice and education. However, knowledge about how AHD partnerships should be structured to support implementation of programs and policies is sparse.</p><p><strong>Methods: </strong>This is a mixed methods, two-phase study, guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework, in which AHD partnerships are a relational type of bridging factor. A positive deviance approach will be used to understand how AHD partnerships are best structured and supported. In the formative phase, we will survey academics and local health department staff (n = 500) to characterize AHD partnerships and understand contextual influences. We will conduct in-depth interviews with eight AHD partnerships (four high and four low engagement), to identify differences between high and low engagement partnerships. The second, experimental phase will be a paired group randomized trial with 28 AHD partnerships (n = 14 randomized to implementation arm and n = 14 to the control arm). A menu of strategies will be refined through survey and interview findings, literature, and our team's previous work. The trial will assess whether these strategies can be used to strengthen partnerships and improve adoption of cancer prevention and control programs and policies. We will evaluate changes in AHD partnership engagement and implementation of evidence-based programs and policies.</p><p><strong>Discussion: </strong>This first-of-its-kind study will focus on collaborations that leverage complementary expertise of health department staff and academics to improve public health practice. Our results can impact the field by identifying new, sustainable models for how public health practitioners and academics can work together to meet common goals, increase the use of evidence-based programs and policies, and expand our understanding of bridging factors within the EPIS framework.</p><p><strong>Trial registration: </strong>Prospective registered on 9/17/2024 at clinicaltrials.gov no. NCT06605196 ( https://clinicaltrials.gov/study/NCT06605196 ).</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"20"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494755","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":"A cluster randomized stepped wedge implementation trial of scale-up approaches to ending pregnancy-related and -associated morbidity and mortality disparities in 12 Michigan counties: rationale and study protocol.","authors":"Jennifer E Johnson, Jaye Clement, Alla Sikorskii, Amy Loree, Margaret Vander Meulen, LeeAnne Roman, James W Dearing, Hannah Bolder, Jonne McCoy White, Robert Sokol, Cristian Meghea","doi":"10.1186/s43058-024-00677-7","DOIUrl":"10.1186/s43058-024-00677-7","url":null,"abstract":"<p><strong>Background: </strong>Hospital-focused maternal health safety and quality guidelines have been found to reduce pregnancy-related and -associated morbidity and mortality (PRAMM). Unfortunately, quality of obstetric care can improve without affecting disparities. This project is the first controlled implementation trial to test approaches to implementing safety guidelines that: (1) target PRAMM disparities; and (2) focus on community care (care provided outside hospitals in outpatient and other community settings, and coordination among care settings), where most deaths occur. It is also one of the first to test scale-up or sustainment implementation approaches to addressing maternal morbidity and mortality disparities.</p><p><strong>Methods: </strong>This project, one of three in the federally funded Multilevel Interventions for Raci.a.l Equity (MIRACLE) Maternal Health Research Center of Excellence, will develop and evaluate an implementation approach for scaling up bundled equity-focused maternal health safety guidelines in community care settings county-wide. The scale-up approach will be co-developed with partners, and then tested using a cluster randomized stepped-wedge trial of 12 Michigan counties with a total population of nearly 6 million. Randomization occurs at the county level; birthing people and providers are clustered within counties. PRAMM outcomes (individual level; primary) will be extracted from a pre-existing statewide linked dataset that includes Medicaid claims and vital records data. The sample will include all Medicaid insured individuals in the 12 counties observed during pregnancy, at birth, and up to 1 year postpartum during the project period (~ 151,920 births, including ~ 49,110 births to Black and/or Hispanic mothers). Implementation outcomes (provider level) will be collected using annual provider (n = 600) surveys and will include scale-up (penetration, reach, control for delivery, and intervention effectiveness at scale) and sustainment (maintenance of fidelity to core elements, health benefits, and capacity to deliver core elements over time) of bundles and cost-effectiveness of implementation approaches.</p><p><strong>Discussion: </strong>This implementation trial will be the first to evaluate an implementation approach to scaling community health equity-focused maternal safety guidelines, addressing an understudied aspect of implementation science (i.e., scale-up). The study will also provide information about implementation cost-effectiveness needed to drive policy decisions.</p><p><strong>Trial registration: </strong>The study was prospectively registered on Clinicaltrials.gov (NCT06541951) on August 6, 2024. The first participant has not yet been recruited. The url for the trial registration is: https://clinicaltrials.gov/study/NCT06541951?locStr=Flint,%20MI&country=United%20States&state=Michigan&city=Flint&rank=1 .</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"19"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470066","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":"A qualitative study of how clinicians reach agreement in perioperative pathway development: the Consensus Model for Standardising Healthcare.","authors":"Lisa Pagano, Janet C Long, Emilie Francis-Auton, Andrew Hirschhorn, Gaston Arnolda, Jeffrey Braithwaite, Mitchell N Sarkies","doi":"10.1186/s43058-025-00699-9","DOIUrl":"10.1186/s43058-025-00699-9","url":null,"abstract":"<p><strong>Background: </strong>Variation in perioperative care persists globally. Consensus discussions may facilitate standardisation, yet the processes used to reach agreement are poorly understood. This study aimed to develop a model for conducting local consensus discussions when implementing standardised perioperative pathways. Specifically, we 1) describe how local consensus discussions are operationalised; 2) identify what guides decision making and consensus between clinicians; and 3) formulate explanatory mechanisms and identify determinants that facilitate consensus discussions.</p><p><strong>Methods: </strong>A qualitative, modified grounded theory study was conducted in one private hospital in metropolitan Sydney, Australia. Thirty-one participants from clinical disciplines and hospital management/leadership were included. Data were collected from nine semi-structured interviews and 16 h of participant observations during consensus development or implementation meetings. Data collection and analysis occurred concurrently until theoretical saturation was achieved. Interviews and field notes were recorded and transcribed verbatim. Data were analysed using coding, constant comparison, detailed memo writing and data interpretation.</p><p><strong>Results: </strong>Seven individual and contextual factors crucial for building consensus, and eight mechanisms for reaching agreement were identified and integrated into a conceptual model. Seeking evidence to support decision-making emerged as the primary driver of consensus. Strong research evidence in support of a pathway component facilitated swift agreement. Where there was ambiguous evidence for a pathway component, clinicians based their decisions on a desire for professional autonomy, consideration of how their peers practice, patient preferences, practices from external organisations, or the feasibility of implementing the pathway component.</p><p><strong>Conclusions: </strong>The Consensus Model for Standardising Healthcare provides a map for healthcare organisations seeking to conduct local consensus discussions to reduce variation in care. Our findings advance our understanding of how local consensus discussions are conducted and factors that impact success when standardising care amongst clinicians.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"17"},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11796167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191485","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":"Qualitative application of the diffusion of innovation theory to maternity waiting homes in rural Zambia.","authors":"Jeanette L Kaiser, Rachel M Fiorillo, Taryn Vian, Thandiwe Ngoma, Kayla J Kuhfeldt, Michelle L Munro-Kramer, Davidson H Hamer, Misheck Bwalya, Viviane R Sakanga, Jody R Lori, Eden Ahmed Mdluli, Peter C Rockers, Godfrey Biemba, Nancy A Scott","doi":"10.1186/s43058-025-00696-y","DOIUrl":"10.1186/s43058-025-00696-y","url":null,"abstract":"<p><strong>Background: </strong>Understanding factors affecting adoption of an innovation is critical to its long-term success. Maternity waiting homes (MWHs) increase access to facility-based delivery in low-resourced settings; yet, quality issues deter utilization of this innovative approach. We sought to understand how attributes that are thought to promote diffusion of innovations (e.g., relative advantage, compatibility, observability, complexity, etc.) affected MWH use after implementation of an improved quality MWH model in rural Zambia compared to standard of care.</p><p><strong>Methods: </strong>We conducted 158 in-depth interviews (IDIs) with randomly selected rural-living women who had delivered a baby in the prior 12 months. Half lived in catchment areas where new quality MWHs were constructed, half in catchment areas with standard of care (ranging from low quality community structures to no MWH). We applied content analysis to identify themes.</p><p><strong>Results: </strong>Utilization of MWHs was higher among intervention (65.4%) than control women (42.5%). Respondents in both study arms perceived relative advantages to pregnant women staying at MWHs compared to going directly to health facilities when labor begins. MWH stays allowed for clinical staff to routinely check on and educate women, and address complications immediately. Compatibility of the homes with cultural values and needs depended on implementation. While some women from intervention sites complained about overcrowding, women in control sites more often perceived the lack of cleanliness, amenities, and safety as deterrents to utilization. Women at intervention sites received sensitization about MWHs from a wider range of sources, including traditional leaders. Required preparations needed to stay at MWHs (e.g. delivery supplies, food, and childcare) made adoption complex and may have deterred utilization.</p><p><strong>Conclusions: </strong>The improved MWH model addressed most community concerns around quality. Having opinion leaders who communicate the relative advantage of MWHs to pregnant women and their social networks may facilitate MWH utilization. The complexity of decisions and resources needed to stay at MWHs remains a critical barrier to use. To facilitate equitable adoption of MWHs among the most vulnerable women, planners should explore how to support women during their delivery preparations and MWH stays, particularly regarding food security and lack of social support for childcare.</p><p><strong>Trial registration: </strong>clinicaltrials.gov, NCT02620436, Registered 02 December 2015, https://clinicaltrials.gov/study/NCT02620436?term=NCT02620436&rank=1.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"18"},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11796199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190319","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 integrated knowledge translation worked to reduce federal policy barriers to the implementation of medication abortion in Canada: a realist evaluation.","authors":"Sarah Munro, Kate Wahl, Sheila Dunn, Courtney Devane, Linda C Li, Wendy V Norman","doi":"10.1186/s43058-025-00694-0","DOIUrl":"10.1186/s43058-025-00694-0","url":null,"abstract":"<p><strong>Background: </strong>Initial Canadian federal regulations for the abortion pill, mifepristone, had the potential to impede safe and equitable access to this medication. To catalyze evidence-based regulatory change, we engaged health policy, health system, and health services decision makers, and health professional organizations in integrated knowledge translation (iKT), a research approach that engages the users of research as equal partners.</p><p><strong>Methods: </strong>We conducted a realist evaluation of what iKT strategies worked, for whom, and in what context to impact federal mifepristone regulations. We constructed initial program theories (if-then statements about how iKT worked). We tested the initial program theories using interviews with researchers and knowledge partners and triangulated with analysis of research programme documents. We configured the evidence in relation to the initial program theories, and refined program theories into causal explanatory configurations.</p><p><strong>Results: </strong>We analyzed 38 interviews with researchers, health professional leaders, advocacy group leaders, and administrative government policy makers, as well as 49 program documents. Our results indicated that researcher partnerships with stakeholders had a meaningful impact on the removal of restrictions. We found key components of the causal explanatory configurations included: researcher motivation to move evidence into action, trusted reputations as credible sources of evidence, strategic partnerships, understanding of health policy processes, and researcher roles as a trusted convenor between key groups and decision makers.</p><p><strong>Conclusions: </strong>Our study identifies several practical and transferable approaches to impactful iKT. The findings may be of relevance to researchers focused on public health topics subject to stigma.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"16"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124124","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":"Correction: Education strategies are the most commonly used in pediatric rehabilitation implementation research: a scoping review.","authors":"Sahar Ghahramani, Sophia C Larson, Allison J L'Hotta, Kelly M Harris, Kim Lipsey, Elvin H Geng, Lisa A Juckett, Catherine R Hoyt","doi":"10.1186/s43058-025-00700-5","DOIUrl":"10.1186/s43058-025-00700-5","url":null,"abstract":"","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"14"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076711","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: type II hybrid effectiveness-implementation study of routine functional status screening in VA primary care.","authors":"Francesca M Nicosia, Kara Zamora, LauraEllen Ashcraft, Gregory Krautner, Marybeth Groot, Bruce Kinosian, Cathy C Schubert, Sumedha Chhatre, Helene Moriarty, Orna Intrator, Andrea Wershof Schwartz, Ariela R Orkaby, Jason Prigge, Rebecca T Brown","doi":"10.1186/s43058-025-00698-w","DOIUrl":"10.1186/s43058-025-00698-w","url":null,"abstract":"<p><strong>Background: </strong>Maintaining functional status, defined as the ability to perform daily activities such as bathing, dressing, and preparing meals, is central to older adults' quality of life, health, and ability to remain independent. Identifying functional impairments - defined as having difficulty or needing help performing these activities - is essential for clinicians to provide optimal care to older adults, and on a population level, understanding function can help anticipate service needs. Yet uptake of standardized measurement of functional status into routine patient care has been slow and inconsistent due to the burden posed by current tools. The goal of the Patient-Aligned Care Team (PACT) Functional Status Screening Initiative is to implement and evaluate a patient-centered, low-burden intervention to improve identification and management of functional impairment among older veterans in Veterans Health Administration (VHA) primary care settings.</p><p><strong>Methods: </strong>We will conduct a hybrid type 2 implementation-effectiveness cluster-randomized adaptive trial at 8 VHA sites using the Practical, Robust Implementation and Sustainability Model (PRISM) to guide implementation and evaluation. During a Pre-Implementation phase, we will engage clinical partners and develop local adaptations to maximize intervention-setting fit. During an Implementation phase, we will launch a standard bundle of implementation strategies (coalition building, champions, technical assistance) and system-level audit and feedback, identify sites with low uptake, and randomize those sites to receive continued standard vs. enhanced strategies (standard strategies plus clinician-level audit and feedback). The primary implementation outcome is reach (proportion of eligible patients at each site who receive screening/assessment) and the primary effectiveness outcome is appropriate management of impairment (proportion of patients with identified impairments who receive related referrals).</p><p><strong>Discussion: </strong>Implementing routine measurement of functional status in primary care has the potential to improve identification and management of functional impairment for older veterans. Improved management includes increasing access to services and supports for veterans and family caregivers, reducing potentially preventable acute care utilization, and allowing veterans to live in the least restrictive setting for as long as possible. Implementation will also provide data to inform the delivery of proactive interventions to prevent and delay development of functional impairment and improve quality of life, health, and independence.</p><p><strong>Trial registration: </strong>Registered at ClinicalTrials.gov on May 7, 2024, at NCT06404970 ( https://clinicaltrials.gov/ ).</p><p><strong>Reporting guidelines: </strong>Standards for Reporting Implementation Studies (Additional file 1).</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"15"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076714","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":"A qualitative process evaluation of SBIRT implementation in pediatric trauma centers using the Science to Service Laboratory implementation strategy.","authors":"Kelli Scott, Michael J Mello, Geraldine Almonte, Emely Arenas Lemus, Julie R Bromberg, Janette Baird, Anthony Spirito, Mark R Zonfrillo, Karla Lawson, Lois K Lee, Emily Christison-Lagay, Stephanie Ruest, Jeremy Aidlen, Andrew Kiragu, Charles Pruitt, Isam Nasr, Robert Todd Maxson, Beth Ebel, Sara J Becker","doi":"10.1186/s43058-025-00697-x","DOIUrl":"10.1186/s43058-025-00697-x","url":null,"abstract":"<p><strong>Background: </strong>Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice that can identify adolescents who use alcohol and other drugs and support proper referral to treatment. Despite an American College of Surgeons mandate to deliver SBIRT in pediatric trauma care, trauma centers throughout the United States have faced numerous patient, provider, and organizational level barriers to SBIRT implementation. The Implementing Alcohol Misuse Screening, Brief Intervention, and Referral to Treatment Study (IAMSBIRT) aimed to implement SBIRT across 10 pediatric trauma centers using the Science-to-Service Laboratory (SSL), an empirically supported implementation strategy. This manuscript aimed to assess trauma center staff preferences and experience with the didactic training, performance feedback, and ongoing coaching elements of the SSL via a retrospective qualitative process evaluation.</p><p><strong>Methods: </strong>Nurses, social workers, and site leaders that participated in IAMSBIRT were recruited to complete qualitative exit interviews guided by the Consolidated Framework for Implementation Research. Qualitative interviews were recorded, transcribed, and analyzed by two coders using a directed content analysis approach in NVivo software. Codes were then translated into frequently endorsed themes by the IAMSBIRT study research team.</p><p><strong>Results: </strong>Thirty-six exit interviews were conducted with site leaders, social workers, and nurses across the 10 IAMSBIRT pediatric trauma centers. Findings revealed key strengths as well as areas for improvement across the IAMSBIRT preparation phase and the three elements of the SSL: didactic training, performance feedback, and ongoing coaching. Trauma center staff generally reported that all three elements of the SSL were high quality and helpful for supporting SBIRT implementation. However, staff also noted that performance feedback and ongoing coaching were generally only available to center leadership or to individuals selected by leadership, making it challenging for non-leaders to troubleshoot SBIRT delivery.</p><p><strong>Conclusions: </strong>Findings from the qualitative process evaluation revealed discrepancies in the experience of the SSL strategy between those in leadership roles and those involved in direct care delivery. These results suggest the need for several modifications to the SSL strategy, including increasing engagement of direct care staff in all elements of the SSL throughout the implementation process.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov NCT03297060 . Registered 29 September 2017.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"13"},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069969","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}