Implementation science communications最新文献

Background: Critically ill children tend to receive fluid volumes exceeding physiologic requirements despite evidence demonstrating harm with increasing net positive fluid balance. However, interventions aimed at optimizing fluid balance have yet to demonstrate significant clinical benefit, likely because there are multiple drivers of this complex problem. In this study, we used qualitative inquiry to describe the current practice at a community pediatric intensive care unit and discover potential barriers and facilitators to clinical practice change.

Methods: We designed a semi-structured interview guide informed by the consolidated framework in implementation research (CFIR) and conducted interviews with attending physicians, dietitians, nurses, nurse practitioners, pharmacists, and physician assistants. We coded interview transcripts according to a deductive coding framework based on the CFIR with additional inductive codes as pertinent to the clinical problems described. Referencing Braun and Clarke's six steps to thematic analysis, we analyzed the coded data and developed themes to synthesize findings and draw meaningful insights for clinical practice.

Results: We interviewed 20 participants who practiced in 5 distinct healthcare roles. Clinical priorities and suggestions for improvement differed among healthcare roles, but four key themes guiding fluid optimization emerged: "Positive Self-Perceptions of Fluid Optimization," "Delegation and Autonomy in Fluid Prescribing," "The Influence of EHR Design on Clinical Practice," and "Clinical Uncertainty and Predictive Support." We mapped each of the themes with key CFIR domains and constructs as well as potential barriers and facilitators to development and implementation of a clinical innovation to fluid optimization.

Conclusions: Interview participants recognized the problem of fluid overload but offered mixed perspectives on how to change clinical practice. Recognizing the multidisciplinary nature of caring for critically ill children with potential variations in viewpoints, we used the CFIR as a solution rooted in complexity to improve understanding of the problem, identify existing barriers, and leverage facilitators before designing a contextualized and practical strategy to optimize fluid balance.

Background: Healthcare team communication is essential to high-quality childhood cancer care, especially during high-acuity events such as clinical deterioration and in resource-variable settings, where supportive interventions to resolve deterioration are less available. Communication quality has traditionally been understudied in these settings, and there is a notable lack of communication interventions that are appropriate and feasible in settings across resource levels. We propose addressing this challenge in this study protocol, which will co-develop and pilot a multi-level intervention to improve communication and outcomes for children receiving cancer treatment.

Methods/design: This study leverages systems and implementation science methodologies to evaluate and improve communication quality in the care of hospitalized children with cancer. We will use a newly developed reliable and multilingual measure of communication quality during clinical deterioration (CritCom). In this study, we will: 1) evaluate the relationship between healthcare team communication structures (using social network analysis) and quality (using CritCom) in the care of children with cancer, with a specific focus on the impact of hierarchy and modifiable communication determinants. We will then: 2) co-develop a multilevel intervention to address challenges in communication quality across variably resourced settings, using semi-structured interviews among clinicians working in these settings and intervention mapping with a global expert panel. Finally, we will 3) test the feasibility, acceptability, appropriateness, and preliminary efficacy of this novel intervention using a cluster-randomized wait list control pilot trial in eight resource-variable hospitals providing childhood cancer care with poor team communication quality.

Discussion: This project identifies modifiable determinants of communication before co-developing and testing interventions with clinicians. When completed, this study will produce an evidence-informed, multilevel intervention to improve healthcare team communication during clinical deterioration, advancing the science of team communication during cancer care, and ultimately improving survival for children with cancer.

Trial registration: ClinicalTrials.gov Record NCT07083674.

Background: Depression is highly prevalent in people living with HIV (PWH), affecting their daily life and HIV outcomes. Following a successful pilot study to treat depression in PWH with Group Interpersonal Therapy, we examined its implementation potential. Despite a strong willingness for its adoption routine practice, formal integration of mental health services into HIV care remained challenging. Using Implementation Mapping, we aimed to select and specify a set of implementation strategies to integrate depression services into Senegalese HIV care.

Methods: For each step of depression services (i.e. screening, diagnostic confirmation/referral, and treatment), we selected potential implementation strategies using the Expert Recommendations for Implementing Change (ERIC). During a 3-day workshop, 14 different stakeholders, including doctors, social workers, community health workers, a psychiatrist, a socio-anthropologist and local health officials, reviewed and discussed strategies selected for each implementation step. Each participant also voted on the importance and feasibility of each strategy, using a Likert scale from 1 to 5 (5 = very high importance or feasibility). Scores were then plotted on a 'go-zone' graph. Details of strategies ranked as important and feasible were then specified by stakeholders.

Results: Forty-eight strategies were identified. Among them, 62,5% were considered as highly important and feasible, 31,3% as important but with concerns about feasibility, 6,2% as not very important or feasible. A total of 46 distinct implementation strategies, derived from 21 ERIC strategies and corresponding to 8 ERIC thematic clusters, were selected for the final implementation plan. Materials needed to implement and monitor implementation (i.e. registers, decision tree, patient's record) were validated during the workshop. Finally, a summary of the implementation plan for integrating depression management into HIV care services in Senegal was elaborated.

Conclusions: A systematic approach was used to collaboratively develop an implementation plan to integrate depression management into HIV care in Senegal. Informed by various stakeholders, this work can facilitate a national dissemination of the integration program and may offer a useful reference for developing similar programs for PWH in other settings.

Introduction: While the importance of a more holistic approach to implementation science, recognizing the interconnection among implementation determinants and the heterogeneity of context and care professionals (CPs), has long been acknowledged, recent research has increasingly focused on these issues. Despite this growing attention, the practical application of these insights within implementation research remains limited. In this study, we aimed to identify distinctive subgroups of CPs based on their profiles of implementation determinants concerning the Childcheck, a guideline facilitating early identification of child abuse based on parental characteristics. We also explored the influence of organization type on subgroups of CPs with specific implementation characteristics (subgroup membership) and assessed their relationship to CPs implementation level.

Methods: A total of 562 Dutch CPs in Mental Health Care (aMHC) and Forensic Care settings completed a self-reported questionnaire on Childcheck implementation determinants. We conducted Latent Profile Analysis to identify subgroups of CPs. The influence of organization type on subgroup membership was examined using Chi-Squared test and we explored the impact of subgroup membership on implementation levels using a one-way ANOVA.

Results: We identified five distinct subgroups. Subgroup A (Reporting Center for Child Abuse and Neglect (RCCAN) collaboration issues, 11.7%) faced issues related to the external organization, such as feedback and collaboration issues. Subgroup B (RCCAN collaboration and organizational issues, 5.0%) encountered challenges with both the external and internal organization, including issues with financial resources and formal agreements, resulting in the lowest implementation level. Subgroup C (Limited implementation issues, 9.4%) demonstrated relatively high ratings across determinants, achieving the highest implementation level. CPs in subgroup D (CP-client interaction issues, 37.7%) encountered challenges in CP-client interaction. CPs in subgroup E (Indifferent attitudes towards implementation, 36.1%) expressed low to average retings, were mainly from aMHC settings, and reported a low to average implementation level.

Conclusions: This study highlights the importance of tailored implementation plans to address each subgroup's specific needs and challenges, instead of employing a one-size-fits-all approach. Latent Profile Analysis successfully revealed the variations in implementation determinants among CPs in aMHC and Forensic Care settings. Tailoring implementation strategies for these subgroups is key to successful guideline implementation and enhancing the well-being of vulnerable children and families.

Background: Despite many older individuals in Norway experiencing fulfilling lives, the effectiveness of local solutions for quality aging in place is inconsistent across different municipalities. To address this, White Paper No. 15, A Quality Reform for Older Adults, was introduced in Norway in 2019, targeting the challenges associated with aging in place and maintaining quality of life, irrespective of health status or location. The reform was based on recommendations from stakeholders: staff, older adults, relatives, volunteers, researchers, and leaders. This study explored how barriers, facilitators, and context interact in implementing a national aging-in-place reform and how these dynamics can inform actionable strategies for successful and context-sensitive implementation as experienced by municipal employees.

Methods: This qualitative study, utilizing a process evaluation design and the Consolidated Framework of Implementation Research (CFIR), forms part of a larger reform evaluation. This study focuses on six Norwegian municipalities of varying sizes, from three counties in central, south, and north Norway, selected due to their focus on institutional or home care and their demographics. Data was collected through focus group discussions with municipal employees (N = 36), who represent a wide range of professional backgrounds and experiences.

Results: The final analysis resulted in five main themes, structured in line with the CFIR framework: i) Policy Translation: Making Sense of the Reform in Local Context, ii) National Framing: Navigating Through Pandemic and Diversity, iii) Local Governance: The Need for a Common Implementation Platform, iv) Stakeholder Dynamics: The Importance of Interplay of Different Actors, and v) Sustainability Uncertainty: Lack of Clear Reform Responsibility. The themes provide an overview of facilitators and barriers during the reform implementation.

Conclusions: The study found that despite municipalities' diverse engagement with the reform's focus areas, there is potential for more effective implementation. Municipal employees agreed with the reform's ideas but struggled with its innovative aspects, indicating a need for clearer guidelines through top-down strategies. Facilitators were identified, but barriers such as the COVID-19 pandemic, municipal diversity, and funding issues created challenges. Insufficient leadership and inter-sector collaboration were primary obstacles. These findings are crucial for future reform implementation and service quality improvement.

Background: Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based approach to identify and initiate treatment for alcohol and substance use in primary care settings. Among 22 public hospitals incentivized to implement SBIRT as part of a value-based Medicaid waiver program over five years, this study examined trajectories, strategies, and challenges in standardizing SBIRT within primary care.

Methods: This study utilized data from narrative reports completed by hospital leadership, obtained from the evaluation of the Public Hospital Redesign and Incentives in Medi-Cal (PRIME) program in California. Following the Multi-Level Health Outcomes Framework, template analysis was used to characterize SBIRT implementation. Content analysis was used to catalogue implementation strategies using the Expert Recommendations for Implementing Change Framework. To assess trajectories (i.e., longitudinal implementation outcomes) of SBIRT implementation, we categorized standardized adoption of sequential SBIRT processes (screening only; screening and brief intervention; screening, brief intervention, and referral to treatment) and reach (limited vs. full primary care population).

Results: Hospitals used a wide variety of measures, personnel, platforms, and workflows in screening for substance use within primary care settings. Brief intervention was conducted by primary care or behavioral health care team members who had received targeted training. Hospitals implemented a wide range of treatment options to address substance use, including referral to co-located or contracted/partnered behavioral health providers. By the end of the first implementation year, only one hospital had standardized screening processes, and none had standardized brief intervention or referral. At the end of the fifth year, 20 of 22 hospitals had standardized screening, 15 had standardized brief intervention, and 12 had standardized referral among their full primary care populations. Strategies and challenges in planning, education, and restructuring processes (e.g., integration of screening processes within electronic health records and clinical workflows) were particularly influential in facilitating implementation.

Conclusions: This study highlighted significant progress made by public hospitals in implementing standardized SBIRT processes among their primary care populations within a value-based program. However, hospitals experienced delays and challenges, highlighting key areas in which additional support or investment may be needed to sustain and promote long-term progress in SBIRT implementation.

Background: Many technologies have been developed to aid in surgical instrument counting, but wide adoption is rare. A technology that has been widely adopted around 20 years ago is the weighing scale. Lessons can be extracted from its sustainment and fidelity, and applied to the development and implementation of new laboursaving technologies in healthcare.

Methods: We conducted semi-structured interviews with experienced staff in four hospitals that use weighing systems in their surgical instrument cycle, which we analysed according to the Matrixed Multiple Case Study (MMCS) methodology. Hospitals were designated a low, medium, or high sustainment and fidelity score, after which influencing factors were identified. These factors were categorised according to the i-PARIHS domains of Innovation, Recipient, Context, and Facilitation. Within-site analysis and cross-site analysis was performed to identify influencing factors associated with a high or low level of sustainment or fidelity.

Results: All hospitals showed a high sustainment. Two hospitals showed low fidelity, and two showed high fidelity. Twenty-one total influencing factors were identified, divided among all i-PARIHS domains. All hospitals experienced similar limitations of the technology, and all hospitals showed signs of facilitation efforts during the implementation phase. In low-fidelity hospitals, interdepartmental coordination and trust in technology were limited, in contrast to high-fidelity hospitals. A large and/or complex surgical instrument inventory hindered fidelity of the weighing system.

Conclusions: 20 years after implementation, there is varying success concerning the fidelity of weighing systems for surgical instrument counting. All participating hospitals have adapted their workflow to the limitations of the technology in different ways. Given the relative straight-forwardness of weighing scales as a technology, our findings underline the complexity of implementation processes, regardless of the complexity of the innovation.

Background: Incarcerated individuals have high rates of chronic disease, which will likely increase as the prison population ages. Despite this, prison healthcare services primarily focus on infectious diseases, mental illness, and substance abuse, largely neglecting chronic physical health conditions. The Chronic Disease Self-Management Program (CDSMP) is an evidence-based program that supports self-management for people with chronic illnesses. Although numerous pilot studies of CDSMP have been conducted in correctional settings, there has been little research into efficient and effective strategies for scaling up the intervention within state corrections systems. The purpose of this project is to evaluate and develop an implementation approach to maximize the scalability of CDSMP among older adults in state correctional systems.

Methods: Guided by the Scaling up Management Framework, we will use a mixed-methods approach to assess scalability, utilizing both quantitative survey data and qualitative interviews. Study participants will include external agency leaders (n = 20), prison staff (n = 20), and incarcerated individuals (n = 20) who have been involved in CDSMP implementation within a U.S. state prison system. Data from this study will be used to develop a scale-up manual to be tested in a subsequent randomized trial. This study does not meet the World Health Organization (WHO) definition of a clinical trial.

Discussion: As the prison population continues to age, the burden of chronic disease within correctional systems will continue to increase, which contributes to skyrocketing correctional costs. Understanding how to expand evidence-based chronic disease programs within correctional systems is crucial for reducing disease-related morbidity and mortality among incarcerated individuals and for reducing costs. This line of research will identify and test scale-up strategies for chronic disease management in prisons.

Background: Police officers are exposed to potentially psychological traumatic events and are at high risk of developing post-traumatic stress injuries (PTSI). Development and wide implementation of best practices for managing PTSI are needed. The psychological first aid (PFA) framework encompasses trauma-informed knowledge to guide the development of best practices. Based on the framework and on a pilot performed among Canadian police officers, we propose a PFA program including: 1) PTSI awareness e-learning; 2) PFA training provided by local trainers; and, 3) peer-to-peer PFA intervention to mitigate PTSI in police officers. The study was designed to evaluate the feasibility and effectiveness of a large-scale PFA program implementation among Canadian police officers.

Methods: A multi-phase mixed-methods participatory action research study is being performed in five phases according to the PFA implementation and the dynamic sustainability frameworks. The program 1) was adapted to environmental needs; 2) is progressively deployed; and, to be evaluated for 3) feasibility; 4) effectiveness; and, 5) sustainability. Local trainers (N = 10) were trained to then train PFA providers (N = 322 police officers) who could then administer the intervention to police officers as needed (i.e., PFA recipients). The e-learning is being co-developed and will be disseminated. Program feasibility (i.e., acceptability, demand, practicality, implementation) will be assessed through interviews with trainers (n = 10), providers (n = 30), and recipients (n = 20). The program effectiveness will be assessed by tracking changes in PTSI literacy and stigma among officers who complete the e-learning (n = 5700) using pre-post e-learning questionnaires. Pre-post training questionnaires with participating providers (n = 175) will track perceived competence to provide the intervention. Pre-post intervention questionnaires with recipients (n = 64) will track changes in putative protective factors (i.e., professional quality of life, work safety, coping, sense of efficacy, sense of hope) and symptoms of PTSI (i.e., anxiety-, depressive-, and post-traumatic stress disorder symptoms).

Discussion: The PFA program is designed to help officers to recognize PTSI, promote self-care strategies and help-seeking, enhance organizational support, and expand psychological support. The study could provide trauma-informed guidelines for implementation and evaluation practices in high-risk and interdependent organizations and inform future directions for policy decisions.

Trial registration: The study was pre-registered on OSF ( https://osf.io/7khgs/?view_only=33260c704ffc46ffb75a704320283ccf ).

Background: The field of implementation research has recently seen much interest in equity, with a strong emphasis on recognising and responding to disparities in care. Recent studies highlight the role of macro-level processes that translate meso-level institutional behaviours to micro-level healthcare practices, and that are generative of health and care inequities. They emphasise challenges patient-centredness and underscore the need for justice-oriented intervention design to address disparities and promote equitable care.

Aim: To develop a patient-centred and justice-informed approach to the design of complex healthcare interventions and innovations in service delivery.

Method: Patient-centred Equity Design was developed in five stages. Sociological, public health, and implementation science theories explaining the generation of modifiable inequities were identified, and relevant explanatory constructs were extracted from them and organised into a determinant framework. Framework elements were then translated into (a) process models characterizing causal mechanisms of systemic inequities; (b) generative principles to guide equity- and patient-centred interventions and services; and (c) critical design questions to appraise the ways that inequities are embedded in healthcare interventions and services.

Results: Development work led to a determinant framework linking macro-level processes to meso- and micro-level healthcare inequities, and these were visualized in process models. The framework informed principles for the promotion of equitable, patient-centred interventions: fostering civility and dependability, ensuring clarity and continuity, and reducing workload and complexity. Four critical questions address relational inequalities, participation barriers, role expectations, and restitution for inequities. These were translated into proposed content for a simple appraisal tool to support the equitable design and evaluation of healthcare interventions and services.

Conclusion: Patient-centred Equity Design integrates sociology, social justice, and implementation science to create equity-focused healthcare interventions. It offers a determinant framework, process models, generative principles, and critical questions to guide design. While not a validated tool, it enhances intervention development and service delivery, with potential for future Medical Research Council Framework integration. Patient- centred Equity Design provides actionable generative design principles to centre patient and caregiver experiences within intervention development, emphasizing restitution for inequities.