Implementation Science最新文献

Background: Implementation science has a history of drawing from other fields to advance its science, yet understanding how approaches from marketing might enhance the field remains a largely untapped area of theoretical and methodological potential. Social marketing (i.e., applying commercial marketing to solve social or health problems) is a branch of marketing that shares many conceptual features with implementation science (e.g., behaviour change), but remains an unrealized opportunity for synergy. This review aimed to 1) describe studies that have tested social marketing interventions in controlled designs; 2) describe these interventions including their context, mechanism, and outcome; and 3) propose social marketing approaches that might be usefully applied to implementation science.

Methods: This scoping review, with a team consensus discussion, followed JBI (formerly the Joanna Briggs Institute) methodological guidance and included a team of researchers and practitioners in implementation, marketing, and social marketing. Twelve databases were searched. Studies were included that 1) utilized a randomized or non-randomized controlled intervention design; and 2) tested a social marketing intervention as defined by five essential social marketing criteria. Two reviewers independently completed all screening and extraction. Variables extracted included intervention details per social marketing criteria and the intervention's context, mechanism, and outcome. Team consensus discussions of the scoping review results were used to determine approaches that might be usefully applied more broadly across implementation science.

Results: Screening of 4,867 citations yielded 28 included studies published from 1999-2023. All topics were from the health field and included nutrition (13, 46%), sexual health/family planning (6, 21%), physical activity (3, 11%), child safety (1, 4%), cancer screening (1, 4%), fall prevention (1, 4%), worksite safety (1, 4%), sanitation (1, 4%), and substance abuse (1, 4%). Novel theories identified included 'Exchange Theory' and 'Consumer Information Processing Model'. Proposed approaches to consider for application included: leverage emotions; design for appeal; consider what your audience values; understand the price; understand the place; emphasize competitive advantage; and use branding.

Conclusions: This review examined the application of social marketing theories and approaches to implementation science. Applying social marketing approaches could invigorate novel and creative thinking in implementation science.

Registration: Open Science Framework Registration link: osf.io/6q834.

Background: Grounded in the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, we investigated the Train-the-Trainer (TTT) to expand access to evidence-based psychological treatments (EBPTs) in community mental health centers (CMHCs), focusing on the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TSC).

Methods: Eight Californian counties were cluster-randomized to Standard TSC or an adapted version designed to improve the "fit" of TSC to CMHCs. University-based trainers trained CMHC providers ("Generation 1 providers") in either Adapted or Standard TSC. These trained providers were then trained to become local CMHC trainers ("Generation 1 trainers"), who then trained a new cohort of providers ("Generation 2 providers") in TSC. Within each county, patients diagnosed with serious mental illness (SMI) were randomized to receive either immediate TSC or usual care and delayed treatment with TSC (UC-DT) from the Generation 2 providers ("Generation 2 patients"). This study focused on 53 Generation 2 providers (Adapted TSC = 47; Standard TSC = 6), and 143 Generation 2 patients (Adapted TSC = 127; Standard TSC = 16) (the larger Adapted sample was driven by recruitment, perhaps reflecting preference for the "fitted" approach). Patient assessments were conducted pre-treatment, post-treatment, and six-month follow-up (6FU). Provider assessments occurred after completing TSC training and post-treatment for each patient treated.

Results: Combining Adapted and Standard, TSC was associated with improvements for Generation 2 patients from pre- to post-treatment in sleep disturbance (p < 0.001, d = -0.90), sleep-related impairment (p = 0.001, d = -0.69), psychiatric symptoms (p = 0.002, d = -0.48), and functional impairment (p = 0.002, d = -0.54), relative to UC-DT. The effects of sleep disturbance and impairment on the relationship between treatment condition (TSC vs. UC-DT) and psychiatric symptoms and functional impairment were significant. Higher provider perception of TSC fit predicted improvements in selected patient outcomes.

Conclusion: TSC can be delivered by CMHC providers trained by local CMHC trainers with strong outcomes. These data contribute to the dearth of evidence for TTT collected from locally trained providers and from patients treated by local CMHC trainers.

Trial registration: Clinicaltrials.gov identifier: NCT05805657 . Registered on March 10, 2023.

Background: Up to 50% of individuals with musculoskeletal road traffic injury (RTI) develop chronic pain, resulting in substantial individual and societal burden. Integrated psychological and physical care, such as StressModex, improves patient outcomes compared to physical treatment alone. However, StressModex is not routinely implemented in physiotherapy practice, due to limited training access and physiotherapists' lack of confidence in delivering psychological care. To address this gap, we developed a blended learning implementation strategy-Physiotherapist bIopsyChosocial On-line Training (PICOT)-guided by the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. The aims of this trial are to compare: (1) the effectiveness of PICOT versus in-person training on the reach of StressModex in routine community private physiotherapy practice; (2) the effectiveness of PICOT versus in-person training on adoption, implementation fidelity, sustainability, and maintenance of StressModex; (3) the effectiveness of PICOT versus in-person training on patient health outcomes; and (4) the cost-effectiveness of PICOT versus in-person training. Trial outcomes are informed by the RE-AIM framework.

Methods: This is a hybrid type III implementation-effectiveness, cluster randomised, superiority trial with embedded economic and qualitative process evaluations. Thirty primary care physiotherapy clinics across Australia will be randomly assigned to either the PICOT or traditional 2-day in-person training. PICOT includes a 6-week online program, 6 weeks (once/week) of real-time online group training with individualised feedback, then 3 clinical supervision on-line sessions (once per fortnight). All on-line sessions are co-facilitated by a clinical psychologist and expert physiotherapist. Following training, physiotherapists will deliver StressModex to eligible patients (≥ 18 years, ≤ 12 weeks of musculoskeletal spinal pain post RTI, and at risk of poor recovery). The primary implementation outcome is reach, defined as the proportion of eligible patients treated with StressModex over 8 months. Secondary outcomes include adoption (training participation and initial uptake), implementation (dose, fidelity, and sustainability of delivery), patient health outcomes (collected at Time1, 8 weeks, 6-, and 12 months), and cost-effectiveness.

Discussion: This trial will provide critical evidence on scalable training models for embedding integrated psychological and physical care into physiotherapy practice. Findings will inform strategies to improve the implementation and sustainment of evidence-based interventions for musculoskeletal RTIs.

Trial registration: ACTRN12624001268538. Registered on 18 October 2024. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspxid=388006&showOriginal=true&isReview=true.

Background: The Hypertension Treatment in Nigeria Program was implemented across 60 primary healthcare centers (PHCs) in Nigeria to improve hypertension treatment and control using the World Health Organization's HEARTS package. This study reports the program's implementation outcomes.

Methods: The Hypertension Treatment in Nigeria Program used a type 2 hybrid interrupted time series design, and data were collected from January 2020 to December 2023. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework guided the evaluation, focusing on key metrics such as patients' and clinics' characteristics, prescription rate of fixed dose combination (FDC) drugs, medication availability, and retention.

Results: Among 21,922 patients recruited (mean [SD] age = 49 [12], 68.1% female) from 60 primary healthcare centers (78.3% rural). Prescription of FDC increased from 16.3 (95% CI: 4.8%-27.8%) to 65.2% (95% CI: 64.0%-66.3%). The program distributed 336,116 30-day medication supplies, and nearly all (95%) PHCs had at least one 30-day supply of any BP-lowering medication in stock after the drug revolving fund implemented. The patient retention rate at 6 months increased between the pre-implementation to implementation periods from 59.9% to 63.1%.

Conclusions: The Hypertension Treatment in Nigeria Program successfully integrated hypertension services into Nigerian primary healthcare centers. Future efforts should focus on sustaining and scaling up the program's success.

Trial registration: The trial has been registered at www.

Clinicaltrials: gov under NCT04158154.

Background: Stroke risk screening using transcranial Doppler (TCD) is a critical evidence-based tool for children with sickle cell anemia (SCA) that has been poorly implemented in the United States. The Dissemination and Implementation of Stroke Prevention Looking at the Care Environment (DISPLACE) study was designed to improve rates of stroke risk screening for SCA using interventions informed by an extensive multi-level barriers and facilitators assessment. This report describes the final outcomes of a large, randomized implementation trial comparing two intervention arms: 1) an application designed to track TCD implementation, ProviderMinder™, versus 2) ProviderMinder™ plus a single coordinator intervention. All sites additionally received a rebranding and educational intervention. The primary outcome was the difference in stroke risk screening rates between intervention arms. The intervention group was compared to four sites that did not implement either intervention and to their baseline rates as secondary outcomes.

Methods: The initial part of DISPLACE included 28 sites from which 16 sites with poor stroke risk screening implementation were included in the trial and randomized to intervention arms. All sites entered patient data into a secure, customized electronic database and were required to use ProviderMinder™ for stroke risk screening data entry. Three sites were unable to adopt ProviderMinder™ and a fourth site from the original DISPLACE cohort was added to this group, resulting in thirteen intervention sites and four non-implementing sites (NIS). NIS collected data retrospectively for the same period as the implementation trial. A generalized quasi-likelihood Poisson mixed effects regression model compared screening rates between groups and timepoints while controlling for baseline screening rates and site size. Unadjusted stroke risk screening rates were also compared via two-proportion Z-tests for all outcomes.

Results: The intervention-by-timepoint interaction indicated statistically significant improvement for the ProviderMinder™ arm relative to the combined intervention arm (difference of 10.0%) and for the intervention group (both arms) compared to NIS (difference of 15.9%). Screening rates increased by 28.0% from baseline to intervention, with an overall rate of 76.8%.

Conclusions: Our intervention approach in DISPLACE significantly improved stroke risk screening for children with SCA, with procedure-patient tracking emerging as an important component for improving care.

Trial registration: Clinical trial number: ClinicalTrials.gov; NCT04173026; 6/4/2020; https://clinicaltrials.gov/study/NCT04173026?cond=NCT04173026&rank=1.

Background: Excessive postoperative antibiotic use in pediatric surgical patients contributes to antibiotic resistance and increases the risk of Clostridioides difficile infection. Despite established guidelines recommending limited postoperative antibiotic duration, many hospitals struggle with de-implementation. This study aims to disseminate and evaluate the impact of a combined strategy to reduce unnecessary postoperative antibiotic use which combines enhanced antimicrobial stewardship program facilitation, defined as a set of actions to enable implementation, combined with order set review and modification. This multi-center study builds on an initial stepped wedge cluster randomized trial involving nine children's hospitals, where facilitation training improved implementation of surgical prophylaxis guidelines and improved post-operative antibiotic use.

Methods: The current study expands the strategy to a diverse set of hospitals caring for children in the US. Antimicrobial stewardship teams and surgeons from any hospital providing pediatric surgical care will be eligible to participate in facilitation training either as a single session webinar or as asynchronous modules. Based on the integrated Promoting Action on Research Implementation in Health Services (iPARiHS), the facilitation training includes didactic presentations and activities that focus on current evidence related to surgical prophylaxis, evaluation of context, interpersonal relationships, and structured processes to foster change. We will use a quasi-experimental time-series design collecting data from clinicians using a structured interview guide every six months on implementation of prophylaxis guideline congruent order sets as the primary implementation outcome. We will also evaluate trends in at least 20 hospitals collecting quality improvement data through the National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) on postoperative antibiotic use, surgical site infections, and Clostridioides difficile infections from 2022-2027.

Discussion: By scaling up this intervention, the study aims to provide a robust evaluation of its effectiveness across diverse hospital settings. If successful, this approach could inform future antimicrobial stewardship efforts in pediatric and adult surgical populations, offering a scalable model for reducing inappropriate antibiotic use while maintaining patient safety.

Objective: The aim of this scoping review was to investigate the published literature on the use of champions to implement collaborative practices in healthcare.

Methods: A systematic review of the literature was conducted, and PubMed and Embase were screened for the period of 01.2000-02.2025. Two pairs of researchers conducted the articles selection. Three researchers extracted the data, and two researchers analyzed the data regarding the type of projects involving local champions, their focus in terms of collaborative practices and as well as the facilitators and barriers local champions face in implementing collaborative practice.

Results: From 1768 articles, 41 were included and underwent full data extraction. Most articles were monocentric, qualitative and half of them had a clear focus on the effects of championing to implement collaborative practices. Champions covered a variety of professions and were mainly integrated in multi-professional implementation teams. Descriptions of champions' characteristics, training, roles and responsibilities were sparse and vague. Collaborative practices were regularly integrated in a broader project and were not the implementation's focus. Conceptual frameworks to guide implementation efforts were used in less than a third of the included articles. Most enabling and disabling factors were related to the internal organizational context. Factors such as innovation's fit or partnerships and collaborations influencing the implementation were mostly reported as change facilitators.

Conclusion: Our results highlight that although champions are recognized for their ability to drive change, little is known about how they are selected, trained, and positioned within institutions and how effective they are in implementing changes in collaborative practices. Use of a theoretical framework to guide the implementation process may help define outcome measures as well as better clarify the factors facilitating or impending such process.

Background: The World Health Organization has identified Stenotrophomonas maltophilia (SM) as a high-risk antibiotic-resistant pathogen. Notably, determining the effectiveness of current antibiotics against SM is challenging, leading to improper therapy and the spread of resistance. This study assessed how an artificial intelligence-clinical decision support system (AI-CDSS) utilizing mass spectrometry data to predict resistance enhances prescribing decisions and boosts survival.

Methods: This randomized controlled trial (ISRCTN16278872) involved 400 healthcare professionals, with 1,600 SM infections randomized in a 1:1 ratio to either standard practice (control, n = 800) or an AI-CDSS predicting resistance 1 day earlier (intervention, n = 800). Outcomes were assessed by healthcare professionals using structured surveys on days 3, 5, 7, and 14 after treatment initiation. Patient mortality was analyzed over a 14-day follow-up period.

Results: The AI-CDSS group demonstrated significantly higher confidence (p < 0.001) in antibiotic prescription, decision-making efficiency, and appropriate antibiotic selection across all time points. Mortality was lower in the AI-CDSS group (92/800, 11.5%) than in the control group (121/800, 15.1%) (p = 0.03). Effective antibiotic choices and reliance on the AI-CDSS during the critical early stages of treatment contributed to improved patient outcomes.

Conclusions: Implementation of the AI-CDSS in a clinical trial setting enhances prescribing confidence, improves decision-making and antibiotic selection, reduces mortality, and demonstrates clinical potential.

Trial registration: ISRCTN, ISRCTN16278872. Registered 28 June 2024, https://www.isrctn.com/ISRCTN16278872 .

Background:  People with serious mental illness die 10-20 years earlier than the overall population, mainly from cardiovascular disease. Although effective interventions to manage cardiovascular disease risk in this population exist, they have not been widely implemented in community settings. IDEAL Goals is an empirically supported, cardiovascular risk reduction program tailored for people with serious mental illness (i.e., "clients") and designed to be delivered by clinicians and staff in community mental health settings. In this trial, we use Replicating Effective Programs (REP) as the foundational implementation strategy to test the effects of two additional strategies, Coaching and Facilitation, on improving the number of IDEAL Goals sessions clients receive in community mental health organizations in Maryland and Michigan.

Methods:  This cluster-randomized hybrid Type 3 effectiveness-implementation trial will use a non-restricted sequential, multiple-assignment randomized trial (SMART) design that randomizes organizations at two points, months 0 and 6, of the 18-month IDEAL Goals intervention. Organizations will receive one of four sequences of implementation strategies: (1) REP only; (2) REP + Coaching; (3) REP + Facilitation; or (4) REP + Coaching + Facilitation. The primary aim is to determine the effect of the most intensive sequence of strategies (REP + Coaching + Facilitation) versus REP only on the number of IDEAL Goals sessions clients receive over 18 months. The secondary aim is to determine the marginal effects of Coaching and Facilitation on the number of IDEAL Goals sessions clients receive over 18 months. Exploratory aims include: (1) assessing tailoring variables to inform a future adaptive implementation intervention to scale IDEAL Goals; (2) estimating the cost of delivering IDEAL Goals and implementation strategies; and (3) examining the relationship between different sequences of implementation strategies on: clients' receipt of cardiovascular disease risk factor management processes and outcomes over 18 months; and clients' receipt of IDEAL Goals over 30 months. Qualitative efforts will explore implementation strategy mechanisms, adaptations, and participants' experience of delivering and receiving IDEAL Goals.

Discussion: To meaningfully reduce premature mortality for people with serious mental illness, it is imperative to test strategies that can facilitate optimal uptake and continued sustainability of cardiovascular risk reduction programs in community settings.

Trial registration: ClinicalTrials.gov identifier: NCT06674616 , registered on November 1, 2024.

Background: Excessive use of postoperative prophylactic antibiotics in children's hospitals is a significant public health concern, leading to increased risks of infections like Clostridioides difficile, multidrug-resistant organisms, and unnecessary healthcare costs. Antibiotic stewardship programs (ASPs) are designed to optimize antibiotic use, but ideal strategies for implementing evidence-based guidelines remain unclear. We tested facilitation, a dynamic process where trained individuals support healthcare personnel in bridging evidence-practice gaps, as a promising strategy for the de-implementation of unnecessary postoperative antibiotics in healthcare.

Methods: The OPerAtiC trial employed a stepped-wedge cluster randomized controlled design across nine hospitals to compare the effectiveness of two ASP-led strategies, specifically order set changes to align with antibiotic guidelines (baseline arm) and facilitation training (intervention arm). Facilitation workshops were informed by the i-PARIHS framework, emphasizing context analysis, evidence application, and recipient engagement; and were conducted remotely. Data were collected from 2019 to 2024, involving interviews with stewardship team members every two months. Data collected included proximal implementation outcomes of each ASP team member (acceptability, feasibility, appropriateness), intermediate outcomes (facilitation skill use) reported by the ASP team, and order set change completion rates.

Results: Proximal implementation outcomes for both strategies were rated high across all study phases, indicating strong baseline enthusiasm among participants (N = 30). Key facilitation skills-effective communication, conflict resolution, and data presentation-were pivotal for successful implementation. Most order set changes (76%) were completed post-facilitation, targeting various specialties and achieving reductions or eliminations in antibiotic use. Facilitation was associated with significantly more completed order sets targeting antibiotic reduction (p = 0.01), suggesting a potential pathway to improve the appropriateness of antibiotic use through implementation strategies.

Conclusions: Facilitation is a valuable approach in refining ASP efforts, contributing to the successful reduction and de-implementation of unnecessary antibiotic use in children's hospitals. The study underscores the need for ongoing training and support for ASP teams to enhance their effectiveness in promoting appropriate antibiotic-prescribing practices. Future research should explore the long-term impacts of facilitation on antibiotic stewardship and patient outcomes.

Trial registration information: ClinicalTrials.gov ID NCT04366440, https://clinicaltrials.gov/study/NCT04366440?term=OPERATIC&rank=1&tab=history , registered on 04/27/2020.