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Implementation Science: IS

Meghan Finch, Fiona Stacey, Jannah Jones, Sze Lin Yoong, Alice Grady, Luke Wolfenden
BACKGROUND: While it is recommended that childcare services implement policies and practices to support obesity prevention, there remains limited evidence to inform policy and practice. The aim of this study is to examine the effectiveness of performance review and facilitated feedback in increasing the implementation of healthy eating and physical activity-promoting policies and practices in childcare services. METHODS: The study was conducted with childcare services in the Hunter New England region of New South Wales, Australia...
February 18, 2019: Implementation Science: IS
Jennifer Watling Neal, Zachary P Neal
BACKGROUND: Although there is growing recognition that the implementation of evidence-based practices is a social process, the conceptualization of social capital in implementation frameworks often conflates bonding and bridging social capital. This conflation makes it difficult to concretely operationalize social capital and limits the concept's utility for explaining implementation outcomes. DISCUSSION: We propose a new framework of implementation capital that merges an existing conceptual framework of implementation outcomes with an existing operational framework of social capital...
February 14, 2019: Implementation Science: IS
R Urquhart, C Kendell, L Geldenhuys, A Ross, M Rajaraman, A Folkes, L L Madden, V Sullivan, D Rayson, G A Porter
BACKGROUND: Health care delivery and outcomes can be improved by using innovations (i.e., new ideas, technologies, and practices) supported by scientific evidence. However, scientific evidence may not be the foremost factor in adoption decisions and is rarely sufficient. The objective of this study was to examine the role of scientific evidence in decisions to adopt complex innovations in cancer care. METHODS: Using an explanatory, multiple case study design, we examined the adoption of complex innovations in five purposively sampled cases in Nova Scotia, Canada...
February 12, 2019: Implementation Science: IS
Nathaniel J Williams, Hannah E Frank, Lindsay Frederick, Rinad S Beidas, David S Mandell, Gregory A Aarons, Philip Green, Jill Locke
BACKGROUND: Implementation researchers have typically studied organizational culture and climate by testing whether individual dimensions are linked to the implementation of evidence-based practices (EBPs) rather than examining how the overarching social context influences implementation. This approach may limit implementation theory and strategy development to the extent that individual dimensions of culture and climate interact, mutually reinforce or counteract one another, or exhibit non-linear relationships...
February 12, 2019: Implementation Science: IS
Nadine E Andrew, Sandy Middleton, Rohan Grimley, Craig S Anderson, Geoffrey A Donnan, Natasha A Lannin, Enna Stroil-Salama, Brenda Grabsch, Monique F Kilkenny, Janet E Squires, Dominique A Cadilhac
Following publication of the original article [1], the authors reported an error in one of the authors' names. In this Correction the incorrect and correct author name are shown. The original article has been corrected.
February 8, 2019: Implementation Science: IS
Kavita Singh, Raji Devarajan, Padinhare P Mohanan, Abigail S Baldridge, Dimple Kondal, David E Victorson, Kunal N Karmali, Lihui Zhao, Donald M Lloyd-Jones, Dorairaj Prabhakaran, Shifalika Goenka, Mark D Huffman
BACKGROUND: The ACS QUIK trial showed that a multicomponent quality improvement toolkit intervention resulted in improvements in processes of care for patients with acute myocardial infarction in Kerala but did not improve clinical outcomes in the context of background improvements in care. We describe the development of the ACS QUIK intervention and evaluate its implementation, acceptability, and sustainability. METHODS: We performed a mixed methods process evaluation alongside a cluster randomized, stepped-wedge trial in Kerala, India...
February 6, 2019: Implementation Science: IS
Randall C Gale, Justina Wu, Taryn Erhardt, Mark Bounthavong, Caitlin M Reardon, Laura J Damschroder, Amanda M Midboe
BACKGROUND: It is challenging to conduct and quickly disseminate findings from in-depth qualitative analyses, which can impede timely implementation of interventions because of its time-consuming methods. To better understand tradeoffs between the need for actionable results and scientific rigor, we present our method for conducting a framework-guided rapid analysis (RA) and a comparison of these findings to an in-depth analysis of interview transcripts. METHODS: Set within the context of an evaluation of a successful academic detailing (AD) program for opioid prescribing in the Veterans Health Administration, we developed interview guides informed by the Consolidated Framework for Implementation Research (CFIR) and interviewed 10 academic detailers (clinical pharmacists) and 20 primary care providers to elicit detail about successful features of the program...
February 1, 2019: Implementation Science: IS
Lisa A Cranley, Janice M Keefe, Deanne Taylor, Genevieve Thompson, Amanda M Beacom, Janet E Squires, Carole A Estabrooks, James W Dearing, Peter G Norton, Whitney B Berta
BACKGROUND: Interpersonal relationships among professionals drive both the adoption and rejection of consequential innovations. Through relationships, decision-makers learn which colleagues are choosing to adopt innovations, and why. The purpose of our study was to understand how and why long-term care (LTC) leaders in a pan-Canadian interpersonal network provide and seek advice about care improvement innovations, for the eventual dissemination and implementation of these innovations...
January 30, 2019: Implementation Science: IS
Rachel Gold, Arwen Bunce, Erika Cottrell, Miguel Marino, Mary Middendorf, Stuart Cowburn, Dagan Wright, Ned Mossman, Katie Dambrun, Byron J Powell, Inga Gruß, Laura Gottlieb, Marla Dearing, Jason Scott, Nadia Yosuf, Molly Krancari
BACKGROUND: National leaders recommend documenting social determinants of health and actions taken to address social determinants of health in electronic health records, and a growing body of evidence suggests the health benefits of doing so. However, little evidence exists to guide implementation of social determinants of health documentation/action. METHODS: This paper describes a 5-year, mixed-methods, stepped-wedge trial with realist evaluation, designed to test the impact of providing 30 community health centers with step-by-step guidance on implementing electronic health record-based social determinants of health documentation...
January 28, 2019: Implementation Science: IS
Steven L Bernstein, June Weiss, Michelle DeWitt, Jeanette M Tetrault, Allen L Hsiao, James Dziura, Scott Sussman, Ted Miller, Kelly Carpenter, Patrick O'Connor, Benjamin Toll
BACKGROUND: Smokers usually abstain from tobacco while hospitalized but relapse after discharge. Inpatient interventions may encourage sustained quitting. We previously demonstrated that a decision support tool embedded in an electronic health record (EHR) improved physicians' treatment of hospitalized smokers. This report describes the effect on quit rates of this decision support tool and order set for hospitalized smokers. METHODS: In a single hospital system, 254 physicians were randomized 1:1 to receive a decision support tool and order set, embedded in the EHR...
January 22, 2019: Implementation Science: IS
Laura Boland, Ian D Graham, France Légaré, Krystina Lewis, Janet Jull, Allyson Shephard, Margaret L Lawson, Alexandra Davis, Audrey Yameogo, Dawn Stacey
BACKGROUND: Shared decision-making (SDM) is rarely implemented in pediatric practice. Pediatric health decision-making differs from that of adult practice. Yet, little is known about the factors that influence the implementation of pediatric shared decision-making (SDM). We synthesized pediatric SDM barriers and facilitators from the perspectives of healthcare providers (HCP), parents, children, and observers (i.e., persons who evaluated the SDM process, but were not directly involved)...
January 18, 2019: Implementation Science: IS
Matthew Chinman, Walid F Gellad, Sharon McCarthy, Adam J Gordon, Shari Rogal, Maria K Mor, Leslie R M Hausmann
BACKGROUND: Mitigating the risks of adverse outcomes from opioids is critical. Thus, the Veterans Affairs (VA) Healthcare System developed the Stratification Tool for Opioid Risk Management (STORM), a dashboard to assist clinicians with opioid risk evaluation and mitigation. Updated daily, STORM calculates a "risk score" of adverse outcomes (e.g., suicide-related events, overdoses, overdose death) from variables in the VA medical record for all patients with an opioid prescription and displays this information along with documentation of recommended risk mitigation strategies and non-opioid pain treatments...
January 18, 2019: Implementation Science: IS
Nadine E Andrew, Sandy Middleton, Rohan Grimley, Craig S Anderson, Geoffrey A Donnan, Natasha A Lannin, Enna Striol-Salama, Brenda Grabsch, Monique F Kilkenny, Janet E Squires, Dominique A Cadilhac
BACKGROUND: Organizational context is one factor influencing the translation of evidence into practice, but data pertaining to patients with acute stroke are limited. We aimed to determine the associations of organizational context in relation to four important evidence-based stroke care processes. METHODS: This was a mixed methods cross-sectional study. Among 19 hospitals in Queensland, Australia, a survey was conducted of the perceptions of stroke clinicians about their work using the Alberta Context Tool (ACT), a validated measure covering 10 concepts of organizational context, and with additional stroke-specific contextual questions...
January 18, 2019: Implementation Science: IS
Marije Bosch, Joanne E McKenzie, Jennie L Ponsford, Simon Turner, Marisa Chau, Emma J Tavender, Jonathan C Knott, Russell L Gruen, Jill J Francis, Sue E Brennan, Andrew Pearce, Denise A O'Connor, Duncan Mortimer, Jeremy M Grimshaw, Jeffrey V Rosenfeld, Susanne Meares, Tracy Smyth, Susan Michie, Sally E Green
BACKGROUND: Evidence-based guidelines for management of mild traumatic brain injury (mTBI) in the emergency department (ED) are now widely available; however, clinical practice remains inconsistent with these guidelines. A targeted, theory-informed implementation intervention (Neurotrauma Evidence Translation (NET) intervention) was designed to increase the uptake of three clinical practice recommendations regarding the management of patients who present to Australian EDs with mild head injuries...
January 17, 2019: Implementation Science: IS
Enola Proctor, Cole Hooley, Amber Morse, Stacey McCrary, Hyunil Kim, Patricia L Kohl
BACKGROUND: Many psychosocial interventions are disseminated and supported by organizations, termed "Intermediary/Purveyor Organizations" (IPOs). Because IPOs remain largely unstudied, we lack understanding of their scale and the strategies they utilize. The role and function of organizations that link resource systems with user systems, such as IPOs, have been identified as an important but understudied issue in implementation science. The objectives of this paper are to describe features of IPOs that disseminate evidence-based interventions (EBIs) for child behavioral health and identify the strategies they use to support their implementation...
January 14, 2019: Implementation Science: IS
Alex R Dopp, Peter Mundey, Lana O Beasley, Jane F Silovsky, Daniel Eisenberg
BACKGROUND: Guidance from economic evaluations on which implementation strategies represent the best return on investment will be critical to advancing the Triple Aim of health care: improving patient care and population health while minimizing per-capita cost. The results of traditional (quantitative) economic evaluations are limited by a remaining "qualitative residual" of contextual information and stakeholders perspectives, which cannot be captured by monetary values alone and is particularly prevalent in implementation science research...
January 11, 2019: Implementation Science: IS
Joanna C Moullin, Kelsey S Dickson, Nicole A Stadnick, Borsika Rabin, Gregory A Aarons
BACKGROUND: Effective implementation of evidence-based practices (EBPs) remains a significant challenge. Numerous existing models and frameworks identify key factors and processes to facilitate implementation. However, there is a need to better understand how individual models and frameworks are applied in research projects, how they can support the implementation process, and how they might advance implementation science. This systematic review examines and describes the research application of a widely used implementation framework, the Exploration, Preparation, Implementation, Sustainment (EPIS) framework...
January 5, 2019: Implementation Science: IS
Thomas Grischott, Stefan Zechmann, Yael Rachamin, Stefan Markun, Corinne Chmiel, Oliver Senn, Thomas Rosemann, Nicolas Rodondi, Stefan Neuner-Jehle
BACKGROUND: Inappropriate medication and polypharmacy increase morbidity, hospitalisation rate, costs and mortality in multimorbid patients. At hospital discharge of elderly patients, polypharmacy is often even more pronounced than at admission. However, the optimal discharge strategy in view of sustained medication appropriateness remains unclear. In particular, unreflectingly switching back to the pre-hospitalisation medication must be avoided. Therefore, both the patients and the follow-up physicians should be involved in the discharge process...
December 27, 2018: Implementation Science: IS
H Manisha Yapa, Till Bärnighausen
BACKGROUND: Implementation science in resource-poor countries and communities is arguably more important than implementation science in resource-rich settings, because resource poverty requires novel solutions to ensure that research results are translated into routine practice and benefit the largest possible number of people. METHODS: We reviewed the role of resources in the extant implementation science frameworks and literature. We analyzed opportunities for implementation science in resource-poor countries and communities, as well as threats to the realization of these opportunities...
December 27, 2018: Implementation Science: IS
Jeff Kirk Svane, Shu-Ti Chiou, Oliver Groene, Milena Kalvachova, Mirna Zagrajski Brkić, Isao Fukuba, Tiiu Härm, Jerneja Farkas, Yen Ang, Mikkel Østerheden Andersen, Hanne Tønnesen
BACKGROUND: Implementation of clinical health promotion (CHP) aiming at better health gain is slow despite its effect. CHP focuses on potentially modifiable lifestyle risks such as smoking, alcohol, diet, and physical inactivity. An operational program was created to improve implementation. It included patients, staff, and the organization, and it combined existing standards, indicators, documentation models, a performance recognition process, and a fast-track implementation model. The aim of this study was to evaluate if the operational program improved implementation of CHP in clinical hospital departments, as measured by health status of patients and staff, frequency of CHP service delivery, and standards compliance...
December 22, 2018: Implementation Science: IS
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