Frontiers in health services最新文献

Introduction: This study evaluated a novel strategy to improve accessibility of implementation science to clinicians in a large health network. The strategy, called Accelerating Research Translation (ART), was based on an adaptation of the A3 problem-solving method developed for use in healthcare quality improvement.

Method: An observational pre-post design was used to conduct a 'proof-of-concept' trial of the ART strategy. Clinicians who identified a gap between a clinical practice guideline and usual care were recruited as Project Leads to conduct research translation projects over a 6-month period, supported by a training programme involving a workshop series and mentor. The proportion of patients receiving guideline-consistent care for each project was measured pre- and post-intervention, and results across projects were combined in a planned pooled meta-analysis. Secondary outcomes included changes in confidence in research translation for Project Leads and the degree of evidence of implementation, mapped against Meyer and Goes' stages of healthcare implementation.

Results: Ten projects were completed by 13 Project Leads, involving a diverse range of professional disciplines, clinical specialties, and healthcare settings. Pooled analysis of data from 768 patients suggests the ART programme increased the odds of receiving evidence-based care (logOR 2.52, 95% CI: 0.93-4.11, p < 0.01). Effects were stronger for evidence-practice gaps that could be addressed with changes to local policies and processes than those dependent on changing behaviour or complex systems. Confidence of Project Leads improved, and all reported increases in the level of implementation of evidence.

Conclusion: This novel approach empowered clinicians to tackle evidence-practice gaps within a familiar structure already well-accepted and understood by health service providers. This concept provides a promising mechanism to demystify implementation science and address local evidence-practice gaps at scale.

Background: Effective and cost-effective treatments are not always optimally implemented. The benefit forgone due to sub-optimal implementation is often not considered or estimated. We use the economic concept of "incremental net monetary benefit" (INMB) to demonstrate how this can be valued. This approach can inform decision-making when used to estimate the value for money of potential future quality improvement (QI) programmes. We illustrate these analyses using the case of antenatal magnesium sulphate (MgSO₄), a cost-effective treatment for the prevention of cerebral palsy in preterm births. We estimate the optimal implementation of MgSO₄, the INMB lost due to sub-optimal implementation, and the value of future implementation initiatives to increase the use of MgSO₄.

Methods: We estimated MgSO₄ treatment implementation for babies under 32 weeks' gestation using routine data on its uptake between 2014 and 2022 in England, Scotland, and Wales. The optimal uptake level of MgSO₄ was estimated using clinical judgment. The societal lifetime INMB of MgSO₄ for the prevention of cerebral palsy in preterm births was obtained from the literature. The INMB of sub-optimal implementation over time was estimated as the difference between optimal and actual uptake over time in each country. We estimated the cost-effectiveness of a hypothetical future QI programme based on different scenarios of implementation effectiveness and costs.

Results: The optimal uptake of MgSO₄ was 95%. The INMB forgone associated with sub-optimal MgSO₄ uptake has reduced over time, as uptake has increased. However, in 2022, the societal lifetime INMB forgone was still £18.2 m in England, £3.7 m in Scotland, and £1.0 m in Wales. A future QI programme across all three countries achieving a 5% increase in MgSO₄ uptake over one year, and costing £987,500 to implement, would be cost-effective; generating £7.5 m in INMB. Future implementation initiatives are likely to be cost-effective within a range of different implementation effectiveness and costs.

Conclusions: The case of MgSO₄ treatment for preterm birth illustrates how sub-optimal implementation of evidence-based interventions can be associated with high opportunity costs measured as INMB forgone. This approach provides valuable quantification of the value for money of future QI programmes to improve the implementation of these interventions.

Background: Patient safety-related adverse events continue to pose a serious threat in healthcare, frequently arising from excessive job demands on frontline staff. It is particularly critical to understand how work overload affects nursing interns, a group vulnerable due to limited clinical experience.

Purpose: This study examines the relationship between work overload and patient safety behaviours among nursing interns in Nigerian public hospitals. It also investigates whether perceived supervisor and coworker support moderate that relationship, guided by the Job Demands-Resources (JD-R) model.

Methods: A cross-sectional survey was administered to nursing interns during clinical placements in government teaching hospitals located in the Southwest region of Nigeria, measuring self-reported work overload, perceived supervisor and coworker support, and medical error incidence.

Results: Higher levels of reported work overload were found to significantly predict a higher incidence of self-reported patient safety errors. However, both perceived supervisor support and coworker support significantly moderated this association, helping to buffer the negative impact of work overload on the occurrence of patient safety errors.

Conclusions: Social support from supervisors and colleagues serves as a protective resource in high-stress clinical environments. Health institutions should therefore promote supportive supervisory practices and team cohesion to mitigate patient safety-related adverse events and enhance the well-being and performance of early-career nurses.

Introduction: As in-demand, specialty service providers, neuropsychologists and dementia evaluation teams in the Veterans Health Administration often face significant patient backlogs, many of which worsened during the COVID-19 pandemic. As long waitlists can result in delayed care, effective methods for reducing waitlists are essential. The purpose of this clinical quality improvement (QI) project was to increase clinical efficiency by implementing comprehensive criteria to streamline consult management in an interdisciplinary memory disorder clinic within the Central Arkansas VA healthcare system.

Methods: This project used a combination of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and the practical, robust implementation and sustainability model (PRISM) primarily for implementation purposes. Consult management criteria were developed and chart reviews utilizing these criteria were performed on all referrals to determine if patient needs could be best addressed though the memory clinic or other departments.

Results: A total of 195 consults were reviewed between August 2023 and April 2024, with approximately 40% of referrals triaged to other services to appropriately address their needs. Increased administrative support and educating referring providers were also implemented. Consult tracking showed waitlist reduction from approximately 6 months to less than a month with consistent implementation and has been maintained at that level.

Conclusions: Overall, implementation of our team's consult management criteria greatly improved efficiency, by reducing the clinic's wait list by prioritizing patients whose needs could be best served by our clinic while providing alternative referrals for patients whose care could be better and more expediently addressed by other services.

Background: Improving patient experience is a prominent theme of the National Health Service (NHS) 10-Year Health Plan for England including the need to improve patient experience of clinical negligence claims. Understanding the factors that shape patient choices in bringing a claim for clinical negligence is an important aspect of patient experience that has the potential to provide crucial insight that could inform the future reform of the clinical negligence process in England. This scoping review aimed to identify the key concepts within the limited research exploring the factors that shape patient choices in bringing a claim for clinical negligence against the NHS in England and identify where gaps in the research may exist.

Methods: To address this knowledge gap, a methodological framework for conducting scoping reviews was applied. Search strategies were developed using selected keywords and index terms. Relevant published literature was identified by applying the search strategy to the peer-reviewed databases MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Westlaw. Reference lists of relevant publications were searched to identify relevant research and academic policy. All studies identified were charted, and the results were presented as a narrative synthesis.

Results: Two main themes were identified from the 17 included records. These themes were 'experience of harm' and 'accessibility of compensation for clinical negligence'.

Conclusion: How an NHS organisation responds to harm can shape patient choices in bringing a claim for clinical negligence. However, this scoping review identified the limited consideration given to how current law and policy, organisational cultures, social determinants of health and health inequalities may shape patient choices in bringing a claim for clinical negligence. Furthermore, this scoping review has identified that empirical research has given no consideration to the role of social media or Artificial Intelligence (AI) in shaping patient choices in bringing a claim for clinical negligence. Research considering these factors is vital to improve patient experience of the clinical negligence process in England and has the potential to play an important role in informing the future reform of the clinical negligence process in England.

Systematic review registration: https://doi.org/10.17605/OSF.I0/6BP2N.

Introduction: The prevalence of cardiovascular diseases (CVD) and CVD risk factors such as Type 2 Diabetes Mellitus (T2DM), hypertension and hypercholesterolemia has increased steadily worldwide. Population health screening is a common effort that promotes early detection, better prognosis and reduces disease burden. However, despite nationwide efforts, screening uptake for CVD risk factors in Singapore has remained moderately low (60.2%). Profiles of individuals who do not screen remain largely unknown, making them harder to reach via mainstream screening efforts. Existing literature has yet to organise factors systematically influencing CVD screening uptake, making it difficult to select a set of robust strategies to promote CVD screening uptake. This study aims to identify determinants of screening uptake for T2DM, hypertension and hypercholesterolemia in eligible adults residing in Western Singapore, and develop an implementation strategy toolkit to enhance screening uptake in this population.

Methods: Prospective, theory-informed, two-phased, multi-method study design. Phase 1: rapid umbrella review, document review and qualitative interviews (n = 20-40) to examine existing evidence about behavioural factors influencing CVD risk factors and strategies implemented to increase uptake. Phase 2: identified determinants mapped onto strategies, its feasibility and acceptability. Strategies ranked high will be specified to clarify who will implement them, what actions are required and how they will be implemented in specific settings. The strategies are organised into an actionable toolkit, where the Implementation Research Logic Model technique will be adopted to articulate the interrelationships between determinants, hypothesised causal mechanisms and strategies. Both phases will be guided by established implementation science frameworks and co-design approach.

Clinical trial registration: identifier [CRD42024566701].

Background: The goal of personalized medicine (PM) is to provide tailored diagnostics and therapies for individual patients, primarily in oncology. However, significant regional disparities exist in its implementation. The Deutsches Netzwerk für Personalisierte Medizin (DNPM; German Network for Personalized Medicine) project aims to harmonize and network the implementation of PM in Germany.

Methods: The DNPM project is evaluated as a Hybrid Type 3 implementation study using a non-randomized, modified stepped-wedge design. Twenty-one university hospital sites across Germany will transition from standard, non-harmonized care to a harmonized personalized medicine intervention at different time points, based on administrative readiness indicated by certification. The primary outcome is change in patient management due to molecular tumor board (MTB) decisions, assessed on three tiers using prospectively collected primary data entered by clinical staff: (1) number of patients with access to an MTB, (2) proportion with revised diagnostic or therapeutic recommendations, and (3) proportion with implemented changes. Therefore, the study aims to include 4,807 patients (intervention group: 3.507). A mixed-methods approach is employed to evaluate further aspects of the implementation process including patient and staff satisfaction, perceived quality of care, and the degree of harmonization and collaboration within the network. Health economic outcomes include health-related quality of life, healthcare utilization costs, and intervention-related costs.

Discussion: The study's wide range of outcome parameters and mixed-methods approach yield robust results for implementation insights. A limitation of the study design is the lack of a clear cutoff for transitioning from the control to the intervention group and the lack of randomization. Additionally, the health economic evaluation is limited by the absence of health insurance claims data, as no insurance company is involved in the project.

Trial registration: This trial is registered with the German Clinical Trials Register (DRKS) under the trial number DRKS00031622 (registration date: 23 May 2023).

[This corrects the article DOI: 10.3389/frhs.2025.1638587.].

Introduction: Inpatient falls are serious adverse events that contribute to functional decline and adverse outcomes. Overconfidence in mobility, and reluctance to seek assistance, are often difficult for staff to detect in the absence of a structured tool. The Multidimensional Falls Efficacy Scale (MdFES) was developed to assess patients' confidence across fall prevention, recovery, and self-protection domains. This pilot implementation feasibility study evaluated the early adoption of the MdFES in a community hospital, using the Proctor Implementation Outcomes framework to examine patient and nurse perspectives.

Methods: A mixed-methods pilot was conducted in Singapore community hospitals involving 90 patients and 32 nurses. Quantitative data were collected across multiple implementation outcomes-including acceptability, appropriateness, feasibility, cost, and fidelity-using structured questionnaires, with results reported as mean ± SD. Qualitative data from open-ended responses were thematically analysed to identify barriers and facilitators to MdFES implementation.

Results: Patients reported high acceptability [Acceptability of Intervention Measure (AIM)] = 17.48 ± 2.66) and appropriateness [Intervention Appropriateness Measure (IAM)] = 17.54 ± 2.75), with 80% agreeing with their MdFES results and an average completion time of 3.12 ± 2.23 min, indicating low perceived burden. In contrast, nurses reported moderate acceptability (AIM = 12.72 ± 2.11), appropriateness (IAM = 13.19 ± 3.17), and feasibility [Feasibility of Intervention Measure (FIM)] = 13.47 ± 2.66), citing language barriers, cognitive limitations, and workflow constraints as key challenges. Fidelity was affected, with frequent rewording and translation required. Qualitative themes highlighted the need for translated versions, simplified wording, and workflow integration.

Conclusion: This pilot feasibility study demonstrates that the MdFES is acceptable and meaningful to patients, while revealing modifiable feasibility challenges for nurses. These early findings provide essential insights to guide workflow adaptations, stakeholder engagement, and contextual modifications required before proceeding to a larger-scale, multi-centre implementation study.

In many rural communities, traditional and biomedical health systems operate side by side, yet the comparative roles of traditional birth attendants and community health workers in perinatal care remain poorly understood. This study examines the variations in the influence of Accredited Social Health Activists (ASHAs) and traditional birth attendants (locally known as Dais) on maternal and newborn health behaviors in rural Bihar, India. We employed a mixed-methods design. Qualitative data included 40 focus group discussions, 50 key informant interviews, and six weeks of focused ethnographic observation of both ASHAs and Dais guided by rapid ethnography principles. Quantitative data were collected through a multi-stage cluster random survey of 1,166 recent mothers and 400 ASHAs, designed to ensure representation across Bihar's major linguistic regions. Logistic regression with backward selection (validated through sensitivity analyses and alternate specifications) estimated the influence of each provider on perinatal behaviors, with multicollinearity assessed using variance inflation factors. Findings revealed distinct temporal and functional roles: ASHAs were most active during pregnancy and labor, significantly increasing the odds of antenatal visits and institutional delivery, while Dais exerted greater influence postpartum, promoting traditional practices such as newborn massage. Synergistic effects emerged in breastfeeding initiation when both providers were involved, while conflicting guidance appeared in cord care. Families often created hybrid care models that blended biomedical recommendations with ritual practices. Overall, the coexistence of ASHAs and Dais suggests complementarity rather than simple competition, though patterns varied across settings. The study focuses on behaviors rather than health outcomes, and we acknowledge that this scope, along with ethical considerations of working with overlapping provider systems, shapes interpretation. Tailored strategies that foster respectful collaboration-such as joint training and coordinated outreach-may improve the uptake and cultural acceptability of maternal and newborn health programs in rural contexts.