Implementation Science最新文献

{"title":"Improving measurement-based care implementation in youth mental health through organizational leadership and climate: a mechanistic analysis within a randomized trial","authors":"Nathaniel J. Williams, Mark G. Ehrhart, Gregory A. Aarons, Susan Esp, Marisa Sklar, Kristine Carandang, Nallely R. Vega, Lauren Brookman-Frazee, Steven C. Marcus","doi":"10.1186/s13012-024-01356-w","DOIUrl":"https://doi.org/10.1186/s13012-024-01356-w","url":null,"abstract":"Theory and correlational research indicate organizational leadership and climate are important for successful implementation of evidence-based practices (EBPs) in healthcare settings; however, experimental evidence is lacking. We addressed this gap using data from the WISDOM (Working to Implement and Sustain Digital Outcome Measures) hybrid type III effectiveness-implementation trial. Primary outcomes from WISDOM indicated the Leadership and Organizational Change for Implementation (LOCI) strategy improved fidelity to measurement-based care (MBC) in youth mental health services. In this study, we tested LOCI’s hypothesized mechanisms of change, namely: (1) LOCI will improve implementation and transformational leadership, which in turn will (2) mediate LOCI’s effect on implementation climate, which in turn will (3) mediate LOCI’s effect on MBC fidelity. Twenty-one outpatient mental health clinics serving youth were randomly assigned to LOCI plus MBC training and technical assistance or MBC training and technical assistance only. Clinicians rated their leaders’ implementation leadership, transformational leadership, and clinic implementation climate for MBC at five time points (baseline, 4-, 8-, 12-, and 18-months post-baseline). MBC fidelity was assessed using electronic metadata for youth outpatients who initiated treatment in the 12 months following MBC training. Hypotheses were tested using longitudinal mixed-effects models and multilevel mediation analyses. LOCI significantly improved implementation leadership and implementation climate from baseline to follow-up at 4-, 8-, 12-, and 18-month post-baseline (all ps < .01), producing large effects (range of ds = 0.76 to 1.34). LOCI’s effects on transformational leadership were small at 4 months (d = 0.31, p = .019) and nonsignificant thereafter (ps > .05). LOCI’s improvement of clinic implementation climate from baseline to 12 months was mediated by improvement in implementation leadership from baseline to 4 months (proportion mediated [pm] = 0.82, p = .004). Transformational leadership did not mediate LOCI’s effect on implementation climate (p = 0.136). Improvement in clinic implementation climate from baseline to 12 months mediated LOCI’s effect on MBC fidelity during the same period (pm = 0.71, p = .045). LOCI improved MBC fidelity in youth mental health services by improving clinic implementation climate, which was itself improved by increased implementation leadership. Fidelity to EBPs in healthcare settings can be improved by developing organizational leaders and strong implementation climates. ClinicalTrials.gov identifier: NCT04096274. Registered September 18, 2019.","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":"6 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140312267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proceedings of the 6th UK and Ireland implementation science research conference","authors":"","doi":"10.1186/s13012-024-01341-3","DOIUrl":"https://doi.org/10.1186/s13012-024-01341-3","url":null,"abstract":"&lt;p&gt;\u0000&lt;i&gt;Sustaining Health and Public Services in an Uncertain Future: What Role for Implementation Science?&lt;/i&gt;\u0000&lt;/p&gt;&lt;p&gt;\u0000&lt;b&gt;Institute of Psychiatry, Psychology and Neuroscience, King's College London &amp; University of Limerick&lt;/b&gt;\u0000&lt;/p&gt;&lt;h3&gt;Carmel Davies&lt;sup&gt;1&lt;/sup&gt;, Deirdre O’Donnell&lt;sup&gt;1&lt;/sup&gt;, Apolonia Radomska&lt;sup&gt;1&lt;/sup&gt;, Éidín Ní Shé&lt;sup&gt;3&lt;/sup&gt;, Marie O’Shea&lt;sup&gt;1&lt;/sup&gt;, Catherine Devaney&lt;sup&gt;2&lt;/sup&gt;, Sarah Donnelly&lt;sup&gt;1&lt;/sup&gt;, Gráinne O’Donoghue&lt;sup&gt;1&lt;/sup&gt;, Aoife De Brún&lt;sup&gt;1&lt;/sup&gt;, Helen Whitty&lt;sup&gt;2&lt;/sup&gt;, PJ Harnett&lt;sup&gt;2&lt;/sup&gt;, Deirdre Lang&lt;sup&gt;2&lt;/sup&gt;, Reema Harrison&lt;sup&gt;4&lt;/sup&gt;, Eilish McAuliffe&lt;sup&gt;1&lt;/sup&gt;, Emer Ahern&lt;sup&gt;2&lt;/sup&gt;\u0000&lt;/h3&gt;&lt;h4&gt;\u0000&lt;sup&gt;1&lt;/sup&gt;University College Dublin, Dublin 4, Ireland; &lt;sup&gt;2&lt;/sup&gt;National Clinical Programme for Older Persons, Dublin, Ireland; &lt;sup&gt;3&lt;/sup&gt;Royal College of Surgeons of Ireland, Dublin, Ireland; &lt;sup&gt;4&lt;/sup&gt;Macquarie University, Sydney, Australia&lt;/h4&gt;&lt;h5&gt;\u0000&lt;b&gt;Correspondence:&lt;/b&gt; Carmel Davies (carmel.davies@ucd.ie)&lt;/h5&gt;&lt;p&gt;&lt;i&gt;Implementation Science 2024&lt;/i&gt;, &lt;b&gt;19(1)&lt;/b&gt;:P1&lt;/p&gt;&lt;br/&gt;&lt;p&gt;\u0000&lt;b&gt;Background&lt;/b&gt;\u0000&lt;/p&gt;&lt;p&gt;Within global healthcare policy, interprofessional integrated models of care are integral to quality healthcare for older people yet are challenging to implement [1,2,3]. Evidence to guide implementation remains underdeveloped [4]. Drawing on international research evidence, this review identifies interventions to promote effective interprofessional collaboration for improving care for older people. Healthcare implementation is complex and influenced by context, explaining why an intervention might work in one place and not another. Realist approaches explain ‘how’ complex interventions work through dynamic interactions between context, mechanisms, and outcomes [5].&lt;/p&gt;&lt;p&gt;\u0000&lt;b&gt;Methods&lt;/b&gt;\u0000&lt;/p&gt;&lt;p&gt;The review follows the reporting standards of realist reviews [6]. A systematic search in PubMed, CINAHL, PsycINFO, EMBASE and SCOPUS identified primary research studies from 2013-2023. Data were extracted from the theory of interprofessional collaboration in community for older people. Context, interventions, outcomes, and mechanisms were identified and developed into Programme Theories (PTs).&lt;/p&gt;&lt;p&gt;\u0000&lt;b&gt;Results&lt;/b&gt;\u0000&lt;/p&gt;&lt;p&gt;A suite of PTs in the form of Context Mechanism and Outcomes (CMOs) and Resource (R) configurations are presented with the following as an example:&lt;/p&gt;&lt;p&gt;Where CST members have professional experience in different areas of service delivery (C), they bring to the team pre-existing relationships with other HCPs (R), enabling good cross sectoral communication and trust (M), leading to enhanced continuity of care (O).&lt;/p&gt;&lt;p&gt;\u0000&lt;b&gt;Conclusion&lt;/b&gt;\u0000&lt;/p&gt;&lt;p&gt;The paper explains what interventions work to support interprofessional collaboration and integrated care for older people. It provides a roadmap for implementation planning to help workforce planning and capacity building to improve older people’s health services. The realist synthesis is the first phase of a larger realist evaluatio","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":"17 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140169112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Assessing the impact of public funding in alleviating participant reduction and improving the retention rate in methadone maintenance treatment clinics in Taiwan: an interrupted time series analysis","authors":"Yu-Chu Ella Chung, Yu-Chi Tung, Sheng-Chang Wang, Chieh-Liang Huang, Lian-Yu Chen, Wei J. Chen","doi":"10.1186/s13012-024-01358-8","DOIUrl":"https://doi.org/10.1186/s13012-024-01358-8","url":null,"abstract":"&lt;p&gt;&lt;b&gt;Correction&lt;/b&gt;&lt;b&gt;: &lt;/b&gt;&lt;b&gt;Implement Sci 19, 18 (2024)&lt;/b&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;https://doi.org/10.1186/s13012-024-01351-1&lt;/b&gt;&lt;/p&gt;&lt;p&gt;Following the publication of the original article [1], the authors reported errors in Figure 1 and in a line of Page 3. In the original article, Figure 1 is shown as below.&lt;/p&gt;&lt;figure&gt;&lt;picture&gt;&lt;source srcset=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13012-024-01358-8/MediaObjects/13012_2024_1358_Figa_HTML.png?as=webp\" type=\"image/webp\"/&gt;&lt;img alt=\"figure a\" aria-describedby=\"Figa\" height=\"632\" loading=\"lazy\" src=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13012-024-01358-8/MediaObjects/13012_2024_1358_Figa_HTML.png\" width=\"685\"/&gt;&lt;/picture&gt;&lt;/figure&gt;&lt;p&gt;There was an error with regard to the Large number (150-700); as it should have been (151-700).&lt;/p&gt;&lt;p&gt;Thus, the correct Figure 1 is shown below:&lt;/p&gt;&lt;figure&gt;&lt;picture&gt;&lt;source srcset=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13012-024-01358-8/MediaObjects/13012_2024_1358_Figb_HTML.png?as=webp\" type=\"image/webp\"/&gt;&lt;img alt=\"figure b\" aria-describedby=\"Figb\" height=\"629\" loading=\"lazy\" src=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13012-024-01358-8/MediaObjects/13012_2024_1358_Figb_HTML.png\" width=\"685\"/&gt;&lt;/picture&gt;&lt;/figure&gt;&lt;p&gt;Another error was also found on Page 3 of the Original Article. The second sentence of the second paragraph of the &lt;i&gt;Context of the MMT policy intervention&lt;/i&gt; section was read “For MMT clinics with larger capacities that were not eligible for the MCAM, we designated their scale as “large”, i.e., monthly average number of daily participants of 150 to 700.”&lt;/p&gt;&lt;p&gt;The correct sentence is: For MMT clinics with larger capacities that were not eligible for the MCAM, we designated their scale as “large”, i.e., monthly average number of daily participants of 151 to 700.&lt;/p&gt;&lt;p&gt;The original article [1] has been updated.&lt;/p&gt;&lt;ol data-track-component=\"outbound reference\"&gt;&lt;li data-counter=\"1.\"&gt;&lt;p&gt;Chung YCE, Tung YC, Wang SC, et al. Assessing the impact of public funding in alleviating participant reduction and improving the retention rate in methadone maintenance treatment clinics in Taiwan: an interrupted time series analysis. Implement Sci. 2024;19:18. https://doi.org/10.1186/s13012-024-01351-1.&lt;/p&gt;&lt;p&gt;Article PubMed PubMed Central Google Scholar &lt;/p&gt;&lt;/li&gt;&lt;/ol&gt;&lt;p&gt;Download references&lt;svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"&gt;&lt;use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"&gt;&lt;/use&gt;&lt;/svg&gt;&lt;/p&gt;&lt;h3&gt;Authors and Affiliations&lt;/h3&gt;&lt;ol&gt;&lt;li&gt;&lt;p&gt;Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan&lt;/p&gt;&lt;p&gt;Yu-Chu Ella Chung, Sheng-Chang Wang &amp; Wei J. Chen&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;p&gt;Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan&lt;/p&gt;&lt;p&gt;Yu-Chi Tung&lt;/p&gt;&lt;/li&gt;&lt;li&gt;&lt;p&gt;Tsaotun Psychiatric Center, Ministry of Health ","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":"38 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140168849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Generative AI in healthcare: an implementation science informed translational path on application, integration and governance.","authors":"Sandeep Reddy","doi":"10.1186/s13012-024-01357-9","DOIUrl":"10.1186/s13012-024-01357-9","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Artificial intelligence (AI), particularly generative AI, has emerged as a transformative tool in healthcare, with the potential to revolutionize clinical decision-making and improve health outcomes. Generative AI, capable of generating new data such as text and images, holds promise in enhancing patient care, revolutionizing disease diagnosis and expanding treatment options. However, the utility and impact of generative AI in healthcare remain poorly understood, with concerns around ethical and medico-legal implications, integration into healthcare service delivery and workforce utilisation. Also, there is not a clear pathway to implement and integrate generative AI in healthcare delivery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This article aims to provide a comprehensive overview of the use of generative AI in healthcare, focusing on the utility of the technology in healthcare and its translational application highlighting the need for careful planning, execution and management of expectations in adopting generative AI in clinical medicine. Key considerations include factors such as data privacy, security and the irreplaceable role of clinicians' expertise. Frameworks like the technology acceptance model (TAM) and the Non-Adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) model are considered to promote responsible integration. These frameworks allow anticipating and proactively addressing barriers to adoption, facilitating stakeholder participation and responsibly transitioning care systems to harness generative AI's potential.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Generative AI has the potential to transform healthcare through automated systems, enhanced clinical decision-making and democratization of expertise with diagnostic support tools providing timely, personalized suggestions. Generative AI applications across billing, diagnosis, treatment and research can also make healthcare delivery more efficient, equitable and effective. However, integration of generative AI necessitates meticulous change management and risk mitigation strategies. Technological capabilities alone cannot shift complex care ecosystems overnight; rather, structured adoption programs grounded in implementation science are imperative.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;It is strongly argued in this article that generative AI can usher in tremendous healthcare progress, if introduced responsibly. Strategic adoption based on implementation science, incremental deployment and balanced messaging around opportunities versus limitations helps promote safe, ethical generative AI integration. Extensive real-world piloting and iteration aligned to clinical priorities should drive development. With conscientious governance centred on human wellbeing over technological novelty, generative AI can enhance accessibility, affordability and quality of care. As these models continue advancing rapidly, ongoing reassessment and transparent communicatio","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":"19 1","pages":"27"},"PeriodicalIF":7.2,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10941464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140141169","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":"Navigating the field of implementation science towards maturity: challenges and opportunities.","authors":"David A Chambers, Karen M Emmons","doi":"10.1186/s13012-024-01352-0","DOIUrl":"10.1186/s13012-024-01352-0","url":null,"abstract":"<p><strong>Background: </strong>The field of implementation science has significantly expanded in size and scope over the past two decades, although work related to understanding implementation processes have of course long preceded the more systematic efforts to improve integration of evidence-based interventions into practice settings. While this growth has had significant benefits to research, practice, and policy, there are some clear challenges that this period of adolescence has uncovered.</p><p><strong>Main body: </strong>This invited commentary reflects on the development of implementation science, its rapid growth, and milestones in its establishment as a viable component of the biomedical research enterprise. The authors reflect on progress in research and training, and then unpack some of the consequences of rapid growth, as the field has grappled with the competing challenges of legitimacy among the research community set against the necessary integration and engagement with practice and policy partners. The article then enumerates a set of principles for the field's next developmental stage and espouses the aspirational goal of a \"big tent\" to support the next generation of impactful science.</p><p><strong>Conclusion: </strong>For implementation science to expand its relevance and impact to practice and policy, researchers must not lose sight of the original purpose of the field-to support improvements in health and health care at scale, the importance of building a community of research and practice among key partners, and the balance of rigor, relevance, and societal benefit.</p>","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":"19 1","pages":"26"},"PeriodicalIF":7.2,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10936041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140121404","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":"Comparative effectiveness of implementation strategies for Accelerating Cervical Cancer Elimination through the integration of Screen-and-treat Services (ACCESS study): protocol for a cluster randomized hybrid type III trial in Nigeria","authors":"Babayemi O. Olakunde, Ijeoma U. Itanyi, John O. Olawepo, Lin Liu, Chinenye Bembir, Ngozi Idemili-Aronu, Nwamaka N. Lasebikan, Tonia C. Onyeka, Cyril C. Dim, Chibuike O. Chigbu, Echezona E. Ezeanolue, Gregory A. Aarons","doi":"10.1186/s13012-024-01349-9","DOIUrl":"https://doi.org/10.1186/s13012-024-01349-9","url":null,"abstract":"Despite the increased risk of cervical cancer (CC) among women living with HIV (WLHIV), CC screening and treatment (CCST) rates remain low in Africa. The integration of CCST services into established HIV programs in Africa can improve CC prevention and control. However, the paucity of evidence on effective implementation strategies (IS) has limited the success of integration in many countries. In this study, we seek to identify effective IS to enhance the integration of CCST services into existing HIV programs in Nigeria. Our proposed study has formative and experimental activities across the four phases of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Through an implementation mapping conducted with stakeholders in the exploration phase, we identified a core package of IS (Core) and an enhanced package of IS (Core+) mostly selected from the Expert Recommendations for Implementing Change. In the preparation phase, we refined and tailored the Core and Core+ IS with the implementation resource teams for local appropriateness. In the implementation phase, we will conduct a cluster-randomized hybrid type III trial to assess the comparative effectiveness of Core versus Core+. HIV comprehensive treatment sites (k = 12) will be matched by region and randomized to Core or Core+ in the ratio of 1:1 stratified by region. In the sustainment phase, we will assess the sustainment of CCST at each site. The study outcomes will be assessed using RE-AIM: reach (screening rate), adoption (uptake of IS by study sites), IS fidelity (degree to which the IS occurred according to protocol), clinical intervention fidelity (delivery of CC screening, onsite treatment, and referral according to protocol), clinical effectiveness (posttreatment screen negative), and sustainment (continued integrated CCST service delivery). Additionally, we will descriptively explore potential mechanisms, including organizational readiness, implementation climate, CCST self-efficacy, and implementation intentions. The assessment of IS to increase CCST rates is consistent with the global plan of eliminating CC as a public health threat by 2030. Our study will identify a set of evidence-based IS for low-income settings to integrate evidence-based CCST interventions into routine HIV care in order to improve the health and life expectancy of WLHIV. Prospectively registered on November 7, 2023, at ClinicalTrials.gov no. NCT06128304. https://classic.clinicaltrials.gov/ct2/show/study/NCT06128304 ","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":"66 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140097696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE): protocol for a helix-counterbalanced randomised controlled trial","authors":"J. Simon Bell, Adam La Caze, Michelle Steeper, Terry P. Haines, Sarah N. Hilmer, Lakkhina Troeung, Lyntara Quirke, Jacqueline Wesson, Constance Dimity Pond, Laurie Buys, Nazanin Ghahreman-Falconer, Michael T. Lawless, Shakti Shrestha, Angelita Martini, Nancy Ochieng, Francesca Glamorgan, Carmela Lagasca, Rebecca Walton, Dayna Cenin, Alison Kitson, Monica Jung, Alexandra Bennett, Amanda J. Cross","doi":"10.1186/s13012-024-01353-z","DOIUrl":"https://doi.org/10.1186/s13012-024-01353-z","url":null,"abstract":"Clinical practice guidelines recommend against the routine use of psychotropic medications in residential aged care facilities (RACFs). Knowledge brokers are individuals or groups who facilitate the transfer of knowledge into practice. The objective of this trial is to evaluate the effectiveness and cost-effectiveness of using knowledge brokers to translate Australia’s new Clinical Practice Guidelines for the Appropriate Use of Psychotropic Medications in People Living with Dementia and in Residential Aged Care. The Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE) trial is a helix-counterbalanced randomised controlled trial. The 12-month trial will be conducted in up to 19 RACFs operated by four Australian aged care provider organisations in Victoria, New South Wales, Western Australia and Queensland. RACFs will be randomised to receive three levels of implementation strategies (knowledge broker service, pharmacist-led quality use of medications education activities and distribution of the Guidelines and supporting materials) across three medication contexts (antipsychotics, benzodiazepines and antidepressants). Implementation strategies will be delivered by an embedded on-site aged care pharmacist working at a system level across each participating RACF. All RACFs will receive all implementation strategies simultaneously but for different medication contexts. The primary outcome will be a composite dichotomous measure of 6-month RACF-level concordance with Guideline recommendations and good practice statements among people using antipsychotics, benzodiazepines and antidepressants for changed behaviours. Secondary outcomes will include proportion of residents with Guideline concordant use of antipsychotics, benzodiazepines and antidepressants measured at the RACF-level and proportion of residents with psychotropic medication use, hospitalisation, falls, falls with injury, polypharmacy, quality of life, activities of daily living, medication incidents and behavioural incidents measured at the RACF-level. The EMBRACE trial investigates a novel guideline implementation strategy to improve the safe and effective use of psychotropic medications in RACFs. We anticipate that the findings will provide new information on the potential role of knowledge brokers for successful and cost-effective guideline implementation. Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623001141639. Registered 6 November 2023 — retrospectively registered, https://www.anzctr.org.au/TrialSearch.aspx .","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":"40 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140026055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protocol for a parallel cluster randomized trial of a participatory tailored approach to reduce overuse of antibiotics at hospital discharge: the ROAD home trial","authors":"Julia E. Szymczak, Lindsay A. Petty, Tejal N. Gandhi, Robert A. Neetz, Adam Hersh, Angela P. Presson, Peter K. Lindenauer, Steven J. Bernstein, Brandi M. Muller, Andrea T. White, Jennifer K. Horowitz, Scott A. Flanders, Justin D. Smith, Valerie M. Vaughn","doi":"10.1186/s13012-024-01348-w","DOIUrl":"https://doi.org/10.1186/s13012-024-01348-w","url":null,"abstract":"Antibiotic overuse at hospital discharge is common, costly, and harmful. While discharge-specific antibiotic stewardship interventions are effective, they are resource-intensive and often infeasible for hospitals with resource constraints. This weakness impacts generalizability of stewardship interventions and has health equity implications as not all patients have access to the benefits of stewardship based on where they receive care. There may be different pathways to improve discharge antibiotic prescribing that vary widely in feasibility. Supporting hospitals in selecting interventions tailored to their context may be an effective approach to feasibly reduce antibiotic overuse at discharge across diverse hospitals. The objective of this study is to evaluate the effectiveness of the Reducing Overuse of Antibiotics at Discharge Home multicomponent implementation strategy (“ROAD Home”) on antibiotic overuse at discharge for community-acquired pneumonia and urinary tract infection. This 4-year two-arm parallel cluster-randomized trial will include three phases: baseline (23 months), intervention (12 months), and postintervention (12 months). Forty hospitals recruited from the Michigan Hospital Medicine Safety Consortium will undergo covariate-constrained randomization with half randomized to the ROAD Home implementation strategy and half to a “stewardship as usual” control. ROAD Home is informed by the integrated-Promoting Action on Research Implementation in Health Services Framework and includes (1) a baseline needs assessment to create a tailored suite of potential stewardship interventions, (2) supported decision-making in selecting interventions to implement, and (3) external facilitation following an implementation blueprint. The primary outcome is baseline-adjusted days of antibiotic overuse at discharge. Secondary outcomes include 30-day patient outcomes and antibiotic-associated adverse events. A mixed-methods concurrent process evaluation will identify contextual factors influencing the implementation of tailored interventions, and assess implementation outcomes including acceptability, feasibility, fidelity, and sustainment. Reducing antibiotic overuse at discharge across hospitals with varied resources requires tailoring of interventions. This trial will assess whether a multicomponent implementation strategy that supports hospitals in selecting evidence-based stewardship interventions tailored to local context leads to reduced overuse of antibiotics at discharge. Knowledge gained during this study could inform future efforts to implement stewardship in diverse hospitals and promote equity in access to the benefits of quality improvement initiatives. Clinicaltrials.gov NCT06106204 on 10/30/23","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":"30 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140026058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organize and mobilize for implementation effectiveness to improve overdose education and naloxone distribution from syringe services programs: a randomized controlled trial.","authors":"Barrot H Lambdin, Ricky N Bluthenthal, Bryan R Garner, Lynn D Wenger, Erica N Browne, Terry Morris, Lee Ongais, Cariné E Megerian, Alex H Kral","doi":"10.1186/s13012-024-01354-y","DOIUrl":"10.1186/s13012-024-01354-y","url":null,"abstract":"<p><strong>Background: </strong>The United States (US) continues to face decades-long increases in opioid overdose fatalities. As an opioid overdose reversal medication, naloxone can dramatically reduce opioid overdose mortality rates when distributed to people likely to experience or witness an opioid overdose and packaged with education on its use, known as overdose education and naloxone distribution (OEND). Syringe services programs (SSPs) are ideal venues for OEND with staff who are culturally competent in providing services for people who are at risk of experiencing or observing an opioid overdose. We carried out a randomized controlled trial of SSPs to understand the effectiveness of the organize and mobilize for implementation effectiveness (OMIE) approach at improving OEND implementation effectiveness within SSPs.</p><p><strong>Methods: </strong>Using simple randomization, 105 SSPs were enrolled into the trial and assigned to one of two study arms - (1) dissemination of OEND best practice recommendations (Control SSPs) or the OMIE approach along with dissemination of the OEND best practice recommendations (i.e., OMIE SSPs). OMIE SSPs could participate in 60-min OMIE sessions once a month for up to 12 months. At 12-month post-baseline, 102 of 105 SSPs (97%) responded to the follow-up survey.</p><p><strong>Results: </strong>The median number of sessions completed by OMIE SSPs was 10. Comparing OMIE SSPs to control SSPs, we observed significant increases in the number of participants receiving naloxone (incidence rate ratio: 2.15; 95% CI: 1.42, 3.25; p < 0.01) and the rate of naloxone doses distributed per SSP participant (adjusted incidence rate ratio: 1.97; 95% CI: 1.18, 3.30; p = 0.01). We observed no statistically significant difference in the number of adopted best practices between conditions (difference in means 0.2, 95% CI: - 0.7, 1.0; p = 0.68). We also observed a threshold effect where SSPs receiving a higher OMIE dose had greater effect sizes with regard to the number of people given naloxone and the number of naloxone doses distributed.</p><p><strong>Conclusions: </strong>In conclusion, the multifaceted OMIE approach was effective at increasing naloxone distribution from SSPs, despite substantial external shocks during the trial. These findings have major implications for addressing the overdose crisis, which has continued unabated for decades.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT03924505 . Registered 19 April 2019.</p>","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":"19 1","pages":"22"},"PeriodicalIF":7.2,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10900734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139991928","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 strategies in suicide prevention: a scoping review","authors":"Jason I. Chen, Brandon Roth, Steven K. Dobscha, Julie C. Lowery","doi":"10.1186/s13012-024-01350-2","DOIUrl":"https://doi.org/10.1186/s13012-024-01350-2","url":null,"abstract":"Implementation strategies can be a vital leveraging point for enhancing the implementation and dissemination of evidence-based suicide prevention interventions and programming. However, much remains unknown about which implementation strategies are commonly used and effective for supporting suicide prevention efforts. In light of the limited available literature, a scoping review was conducted to evaluate implementation strategies present in current suicide prevention studies. We identified studies that were published between 2013 and 2022 that focused on suicide prevention and incorporated at least one implementation strategy. Studies were coded by two independent coders who showed strong inter-rater reliability. Data were synthesized using descriptive statistics and a narrative synthesis of findings. Overall, we found that studies most commonly utilized strategies related to iterative evaluation, training, and education. The majority of studies did not include direct measurement of suicide behavior outcomes, and there were few studies that directly tested implementation strategy effectiveness. Implementation science strategies remain an important component for improving suicide prevention and intervention implementation. Future research should consider the incorporation of more type 3 hybrid designs as well as increased systematic documentation of implementation strategies. < de-identified > ","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":"5 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139969420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}