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Designing strategies to support Implementation of iNtensive Therapy for Early Reach through PLAY (INTERPLAY) for young children with cerebral palsy: a study protocol. 设计策略以支持针对脑瘫幼儿的 "通过游戏实现早期康复的强化治疗"(INTERPLAY)的实施:研究方案。
Pub Date : 2024-06-18 DOI: 10.1186/s43058-024-00602-y
Alicia Hilderley, Christine Cassidy, Sandra Reist-Asencio, Chelsea Tao, Stephen Tao, Susan McCoy, Divya Vurrabindi, Kathleen O'Grady, Mia Herrero, Liz Cambridge, Eleanor Leverington, Victoria Micek, John Andersen, Darcy Fehlings, Adam Kirton

Background: Intensive manual therapy is important for improving lifelong upper limb motor outcomes for infants and toddlers with cerebral palsy. This play-based therapy is delivered by caregivers who are coached by occupational therapists. However, access to this therapy is very limited for Canadian children with cerebral palsy younger than two years old. This project aims to first identify barriers and facilitators and then design implementation strategies to support early intensive manual therapy delivery for infants and toddlers with cerebral palsy across Canada.

Methods: A mixed-methods sequential explanatory design will be used with four consecutive phases. The updated Consolidated Framework for Implementation Research will guide the study. Quantitative data will be collected from a survey in Phase One. Participants will be recruited from three groups: (1) Caregivers of children with cerebral palsy six years old and younger who are eligible for manual therapy; (2) occupational therapists who treat children with cerebral palsy; and (3) healthcare administrators or people responsible for managing pediatric occupational therapy programs. In Phase Two, quantitative data from the survey will be used to map to implementation strategies known to be effective at addressing the identified modifiable barriers and facilitators. Phase Three will collect qualitative data from semi-structured interviews for the purpose of explaining Phase One quantitative findings in greater depth, and for understanding the appropriateness of strategies identified in Phase Two. The participant recruitment strategy and interview guide content for Phase Three will be informed by results of Phase One. Phase Four will use a modified nominal group technique to refine and prioritize an implementation strategy toolbox. Results will be widely disseminated to knowledge users to provide them with tailorable strategies to increase delivery of early intensive manual interventions.

Discussion: This study will provide a comprehensive understanding of the barriers and facilitators to implementation of early intensive manual therapy for young children with cerebral palsy in Canada. A toolbox of evidence-based and tailorable implementation strategies will be disseminated nationally to support uptake of early intensive manual therapy into clinical practice for young children with cerebral palsy.

背景:强化徒手疗法对于改善脑瘫婴幼儿上肢运动的终生效果非常重要。这种以游戏为基础的疗法由护理人员在职业治疗师的指导下进行。然而,加拿大两岁以下的脑瘫儿童获得这种疗法的机会非常有限。本项目旨在首先确定障碍和促进因素,然后设计实施策略,以支持在加拿大各地为患有脑瘫的婴幼儿提供早期强化手工治疗:方法:将采用混合方法顺序解释设计,分为四个连续阶段。最新的实施研究综合框架将为本研究提供指导。第一阶段将通过调查收集定量数据。参与者将从三类人群中招募:(1)符合人工疗法条件的六岁及以下脑瘫儿童的照顾者;(2)治疗脑瘫儿童的职业治疗师;以及(3)医疗保健管理人员或负责管理儿科职业治疗项目的人员。在第二阶段,来自调查的定量数据将被用于绘制已知能有效解决已确定的可修改障碍和促进因素的实施策略图。第三阶段将通过半结构式访谈收集定性数据,以便更深入地解释第一阶段的定量调查结果,并了解第二阶段确定的策略是否合适。第三阶段的参与者招募策略和访谈指南内容将参考第一阶段的结果。第四阶段将使用修改后的名义小组技术来完善实施战略工具箱并确定优先次序。研究结果将广泛传播给知识使用者,为他们提供量身定制的策略,以增加早期强化人工干预的实施:讨论:本研究将为加拿大脑瘫幼儿早期强化手法治疗的实施障碍和促进因素提供一个全面的了解。我们将在全国范围内推广以证据为基础、可量身定制的实施策略工具箱,以支持将早期强化手法治疗纳入脑瘫幼儿的临床实践中。
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引用次数: 0
Development of a method for Making Optimal Decisions for Intervention Flexibility during Implementation (MODIFI): a modified Delphi study. 制定一种在实施过程中为灵活干预做出最佳决策的方法(MODIFI):一项经修改的德尔菲研究。
Pub Date : 2024-06-17 DOI: 10.1186/s43058-024-00592-x
Stephanie K Brewer, Catherine M Corbin, Ana A Baumann, Shannon Wiltsey Stirman, Janine M Jones, Michael D Pullmann, Aaron R Lyon

Background: Intervention adaptation is often necessary to improve the fit between evidence-based practices/programs and implementation contexts. Existing frameworks describe intervention adaptation processes but do not provide detailed steps for prospectively designing adaptations, are designed for researchers, and require substantial time and resources to complete. A pragmatic approach to guide implementers through developing and assessing adaptations in local contexts is needed. The goal of this project was to develop Making Optimal Decisions for Intervention Flexibility during Implementation (MODIFI), a method for intervention adaptation that leverages human centered design methods and is tailored to the needs of intervention implementers working in applied settings with limited time and resources.

Method: MODIFI was iteratively developed via a mixed-methods modified Delphi process. Feedback was collected from 43 implementation research and practice experts. Two rounds of data collection gathered quantitative ratings of acceptability and inclusion (Round 1) and feasibility (Round 2), as well as qualitative feedback regarding MODIFI revisions analyzed using conventional content analysis.

Results: In Round 1, most participants rated all proposed components as essential but identified important avenues for revision which were incorporated into MODIFI prior to Round 2. Round 2 emphasized feasibility, where ratings were generally high and fewer substantive revisions were recommended. Round 2 changes largely surrounded operationalization of terms/processes and sequencing of content. Results include a detailed presentation of the final version of the three-step MODIFI method (Step 1: Learn about the users, local context, and intervention; Step 2: Adapt the intervention; Step 3: Evaluate the adaptation) along with a case example of its application.

Discussion: MODIFI is a pragmatic method that was developed to extend the contributions of other research-based adaptation theories, models, and frameworks while integrating methods that are tailored to the needs of intervention implementers. Guiding teams to tailor evidence-based interventions to their local context may extend for whom, where, and under what conditions an intervention can be effective.

背景:为了改善循证实践/计划与实施环境之间的契合度,通常需要对干预措施进行调整。现有的框架描述了干预适应过程,但没有提供前瞻性设计适应的详细步骤,这些框架是为研究人员设计的,需要大量的时间和资源才能完成。我们需要一种务实的方法来指导实施者根据当地情况制定和评估调整措施。本项目的目标是开发 "在实施过程中为干预灵活性做出最优决策"(MODIFI),这是一种干预适应性方法,它利用了以人为本的设计方法,适合在时间和资源有限的应用环境中工作的干预实施者的需要:方法:MODIFI 是通过改良德尔菲混合方法迭代开发的。从 43 位实施研究和实践专家那里收集了反馈意见。两轮数据收集收集了对可接受性和包容性(第 1 轮)以及可行性(第 2 轮)的定量评分,以及有关 MODIFI 修订的定性反馈,并使用传统内容分析法进行了分析:结果:在第一轮中,大多数参与者将所有建议内容评为必要,但指出了重要的修改途径,并在第二轮之前将其纳入 MODIFI。第二轮强调了可行性,与会者的评分普遍较高,建议进行的实质性修订也较少。第二轮修改主要围绕术语/过程的操作化和内容的排序。结果包括对 MODIFI 三步法(第一步:了解用户、当地情况和干预措施;第二步:调整干预措施;第三步:评估调整措施)最终版本的详细介绍以及一个应用案例:MODIFI 是一种务实的方法,旨在扩展其他基于研究的适应理论、模型和框架的贡献,同时整合适合干预实施者需求的方法。指导团队根据当地情况调整基于证据的干预措施,可以扩大干预措施在哪些人、哪些地方、哪些条件下有效。
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引用次数: 0
A streamlined approach to classifying and tailoring implementation strategies: recommendations to speed the translation of research to practice. 对实施战略进行分类和量身定制的简化方法:加快将研究成果转化为实践的建议。
Pub Date : 2024-06-17 DOI: 10.1186/s43058-024-00606-8
Jennifer Leeman, Catherine Rohweder, Jennifer Elston Lafata, Mary Wangen, Renee Ferrari, Christopher M Shea, Alison Brenner, Isabel Roth, Oscar Fleming, Mark Toles

Background: Implementation science emerged from the recognized need to speed the translation of effective interventions into practice. In the US, the science has evolved to place an ever-increasing focus on implementation strategies. The long list of implementation strategies, terminology used to name strategies, and time required to tailor strategies all may contribute to delays in translating evidence-based interventions (EBIs) into practice. To speed EBI translation, we propose a streamlined approach to classifying and tailoring implementation strategies.

Main text: A multidisciplinary team of eight scholars conducted an exercise to sort the Expert Recommendations for Implementing Change (ERIC) strategies into three classes: implementation processes (n = 25), capacity-building strategies (n = 20), and integration strategies (n = 28). Implementation processes comprise best practices that apply across EBIs and throughout the phases of implementation from exploration through sustainment (e.g., conduct local needs assessment). Capacity-building strategies target either general or EBI-specific knowledge and skills (e.g., conduct educational meetings). Integration strategies include "methods and techniques" that target barriers or facilitators to implementation of a specific EBI beyond those targeted by capacity building. Building on these three classes, the team collaboratively developed recommendations for a pragmatic, five-step approach that begins with the implementation processes and capacity-building strategies practice-settings are already using prior to tailoring integration strategies. A case study is provided to illustrate use of the five-step approach to tailor the strategies needed to implement a transitional care intervention in skilled nursing facilities.

Conclusions: Our proposed approach streamlines the formative work required prior to implementing an EBI by building on practice partner preferences, expertise, and infrastructure while also making the most of prior research findings.

背景:实施科学的产生源于人们认识到需要加快将有效干预措施转化为实践。在美国,科学的发展越来越注重实施策略。长长的实施策略清单、用于命名策略的术语以及定制策略所需的时间都可能导致循证干预措施(EBIs)转化为实践的延误。为了加快循证干预的转化,我们提出了一种简化的方法来对实施策略进行分类和定制:一个由八位学者组成的多学科团队开展了一项工作,将 "专家建议实施变革(ERIC)"策略分为三类:实施过程(25 项)、能力建设策略(20 项)和整合策略(28 项)。实施过程包括适用于所有 EBI 以及从探索到维持的整个实施阶段的最佳做法(例如,进行当地需求评估)。能力建设战略针对的是一般的或针对 EBI 的知识和技能(例如,举行教育会议)。整合战略包括 "方法和技巧",这些方法和技巧针对的是能力建设所针对的障碍或实施特定 EBI 的促进因素。在这三个类别的基础上,该团队合作制定了实用的五步方法建议,在定制整合策略之前,先从实践机构已经在使用的实施流程和能力建设策略开始。我们提供了一个案例研究,说明如何使用五步方法来定制在专业护理机构中实施过渡性护理干预所需的策略:我们提出的方法以实践合作伙伴的偏好、专业知识和基础设施为基础,同时充分利用先前的研究成果,从而简化了实施 EBI 之前所需的形成性工作。
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引用次数: 0
How context links to best practice use in long-term care homes: a mixed methods study. 环境如何与长期护理院使用最佳实践联系起来:一项混合方法研究。
Pub Date : 2024-06-07 DOI: 10.1186/s43058-024-00600-0
Yinfei Duan, Jing Wang, Holly J Lanham, Whitney Berta, Stephanie A Chamberlain, Matthias Hoben, Katharina Choroschun, Alba Iaconi, Yuting Song, Janelle Santos Perez, Shovana Shrestha, Anna Beeber, Ruth A Anderson, Leslie Hayduk, Greta G Cummings, Peter G Norton, Carole A Estabrooks

Background: Context (work environment) plays a crucial role in implementing evidence-based best practices within health care settings. Context is multi-faceted and its complex relationship with best practice use by care aides in long-term care (LTC) homes are understudied. This study used an innovative approach to investigate how context elements interrelate and influence best practice use by LTC care aides.

Methods: In this secondary analysis study, we combined coincidence analysis (a configurational comparative method) and qualitative analysis to examine data collected through the Translating Research in Elder Care (TREC) program. Coincidence analysis of clinical microsystem (care unit)-level data aggregated from a survey of 1,506 care aides across 36 Canadian LTC homes identified configurations (paths) of context elements linked consistently to care aides' best practices use, measured with a scale of conceptual research use (CRU). Qualitative analysis of ethnographic case study data from 3 LTC homes (co-occurring with the survey) further informed interpretation of the configurations.

Results: Three paths led to very high CRU at the care unit level: very high leadership; frequent use of educational materials; or a combination of very high social capital (teamwork) and frequent communication between care aides and clinical educators or specialists. Conversely, 2 paths led to very low CRU, consisting of 3 context elements related to unfavorable conditions in relationships, resources, and formal learning opportunities. Our qualitative analysis provided insights into how specific context elements served as facilitators or barriers for best practices. This qualitative exploration was especially helpful in understanding 2 of the paths, illustrating the pivotal role of leadership and the function of teamwork in mitigating the negative impact of time constraints.

Conclusions: Our study deepens understanding of the complex interrelationships between context elements and their impact on the implementation of best practices in LTC homes. The findings underscore that there is no singular, universal bundle of context-related elements that enhance or hinder best practice use in LTC homes.

背景:情境(工作环境)在医疗机构实施循证最佳实践中起着至关重要的作用。情境是多方面的,它与长期护理(LTC)机构中护理助理使用最佳实践的复杂关系尚未得到充分研究。本研究采用了一种创新方法来调查环境因素是如何相互关联并影响长期护理院护理助手使用最佳实践的:在这项二次分析研究中,我们结合了巧合分析(一种配置比较方法)和定性分析,对通过老年护理转化研究(TREC)项目收集到的数据进行了研究。通过对加拿大 36 家 LTC 养老院的 1,506 名护理人员进行调查,对临床微观系统(护理单元)层面的数据进行了巧合分析,确定了与护理人员使用最佳实践相关的环境要素配置(路径),并用概念研究使用(CRU)量表进行了测量。对来自 3 家 LTC 养老院的人种学案例研究数据(与调查同时进行)进行的定性分析,为解释这些配置提供了进一步的信息:在护理单元层面,有三条路径导致了极高的 CRU:极高的领导力;频繁使用教育材料;或结合极高的社会资本(团队合作)以及护理助手与临床教育者或专家之间的频繁沟通。与此相反,有 2 种途径导致 CRU 非常低,其中包括与人际关系、资源和正规学习机会等不利条件相关的 3 个环境要素。通过定性分析,我们深入了解了特定环境因素是如何成为最佳实践的促进因素或障碍的。这种定性探索尤其有助于理解其中的两条路径,说明了领导力的关键作用和团队合作在减轻时间限制的负面影响方面的作用:我们的研究加深了人们对环境因素之间复杂的相互关系及其对在长者照护中心实施最佳实践的影响的理解。研究结果强调,并不存在单一的、普遍的、能促进或阻碍最佳实践在长者照护中心应用的环境因素。
{"title":"How context links to best practice use in long-term care homes: a mixed methods study.","authors":"Yinfei Duan, Jing Wang, Holly J Lanham, Whitney Berta, Stephanie A Chamberlain, Matthias Hoben, Katharina Choroschun, Alba Iaconi, Yuting Song, Janelle Santos Perez, Shovana Shrestha, Anna Beeber, Ruth A Anderson, Leslie Hayduk, Greta G Cummings, Peter G Norton, Carole A Estabrooks","doi":"10.1186/s43058-024-00600-0","DOIUrl":"10.1186/s43058-024-00600-0","url":null,"abstract":"<p><strong>Background: </strong>Context (work environment) plays a crucial role in implementing evidence-based best practices within health care settings. Context is multi-faceted and its complex relationship with best practice use by care aides in long-term care (LTC) homes are understudied. This study used an innovative approach to investigate how context elements interrelate and influence best practice use by LTC care aides.</p><p><strong>Methods: </strong>In this secondary analysis study, we combined coincidence analysis (a configurational comparative method) and qualitative analysis to examine data collected through the Translating Research in Elder Care (TREC) program. Coincidence analysis of clinical microsystem (care unit)-level data aggregated from a survey of 1,506 care aides across 36 Canadian LTC homes identified configurations (paths) of context elements linked consistently to care aides' best practices use, measured with a scale of conceptual research use (CRU). Qualitative analysis of ethnographic case study data from 3 LTC homes (co-occurring with the survey) further informed interpretation of the configurations.</p><p><strong>Results: </strong>Three paths led to very high CRU at the care unit level: very high leadership; frequent use of educational materials; or a combination of very high social capital (teamwork) and frequent communication between care aides and clinical educators or specialists. Conversely, 2 paths led to very low CRU, consisting of 3 context elements related to unfavorable conditions in relationships, resources, and formal learning opportunities. Our qualitative analysis provided insights into how specific context elements served as facilitators or barriers for best practices. This qualitative exploration was especially helpful in understanding 2 of the paths, illustrating the pivotal role of leadership and the function of teamwork in mitigating the negative impact of time constraints.</p><p><strong>Conclusions: </strong>Our study deepens understanding of the complex interrelationships between context elements and their impact on the implementation of best practices in LTC homes. The findings underscore that there is no singular, universal bundle of context-related elements that enhance or hinder best practice use in LTC homes.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"5 1","pages":"63"},"PeriodicalIF":0.0,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11157780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141289018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Dissemination and implementation research coordination and training to improve cardiovascular health in people living with HIV in sub-Saharan Africa: the research coordinating center of the HLB-SIMPLe Alliance. 传播和实施研究协调与培训,以改善撒哈拉以南非洲艾滋病毒感染者的心血管健康:HLB-SIMPLe 联盟研究协调中心。
Pub Date : 2024-06-06 DOI: 10.1186/s43058-024-00599-4
Emmanuel K Tetteh, William Effah, Lisa de las Fuentes, Karen Steger-May, Charles W Goss, David W Dowdy, Mark D Huffman, Makeda J Williams, Veronica Tonwe, Geetha P Bansal, Elvin H Geng, Victor G Dávila-Román, Treva Rice, Kenneth B Schechtman

As global adoption of antiretroviral therapy extends the lifespan of People Living with HIV (PLHIV) through viral suppression, the risk of comorbid conditions such as hypertension has risen, creating a need for effective, scalable interventions to manage comorbidities in PLHIV. The Heart, Lung, and Blood Co-morbiditieS Implementation Models in People Living with HIV (HLB-SIMPLe) Alliance has been funded by the National Heart, Lung, and Blood Institute (NHLBI) and the Fogarty International Center (FIC) since September 2020. The Alliance was created to conduct late-stage implementation research to contextualize, implement, and evaluate evidence-based strategies to integrate the diagnosis, treatment, and control of cardiovascular diseases, particularly hypertension, in PLHIV in low- and middle-income countries (LMICs).The Alliance consists of six individually-funded clinical trial cooperative agreement research projects based in Botswana, Mozambique, Nigeria, South Africa, Uganda, and Zambia; the Research Coordinating Center; and personnel from NIH, NHLBI, and FIC (the Federal Team). The Federal Team works together with the members of the seven cooperative agreements which comprise the alliance. The Federal Team includes program officials, project scientists, grant management officials and clinical trial specialists. This Alliance of research scientists, trainees, and administrators works collaboratively to provide and support venues for ongoing information sharing within and across the clinical trials, training and capacity building in research methods, publications, data harmonization, and community engagement. The goal is to leverage shared learning to achieve collective success, where the resulting science and training are greater with an Alliance structure rather than what would be expected from isolated and unconnected individual research projects.In this manuscript, we describe how the Research Coordinating Center performs the role of providing organizational efficiencies, scientific technical assistance, research capacity building, operational coordination, and leadership to support research and training activities in this multi-project cooperative research Alliance. We outline challenges and opportunities during the initial phases of coordinating research and training in the HLB-SIMPLe Alliance, including those most relevant to dissemination and implementation researchers.

随着抗逆转录病毒疗法在全球的应用,艾滋病病毒感染者(PLHIV)的寿命因病毒抑制而延长,高血压等合并症的风险也随之上升,因此需要有效、可扩展的干预措施来控制艾滋病病毒感染者的合并症。自 2020 年 9 月起,美国国家心肺血液研究所(NHLBI)和福加提国际中心(FIC)开始资助心肺血液合并症艾滋病感染者实施模式(HLB-SIMPLe)联盟。该联盟由博茨瓦纳、莫桑比克、尼日利亚、南非、乌干达和赞比亚的六个单独资助的临床试验合作协议研究项目、研究协调中心以及来自美国国立卫生研究院、国家心肺和血液研究所和福格蒂国际中心的人员(联邦团队)组成。联邦小组与组成联盟的七个合作协议的成员一起工作。联邦小组成员包括项目官员、项目科学家、拨款管理官员和临床试验专家。这个由研究科学家、受训人员和管理人员组成的联盟通力合作,为临床试验内部和临床试验之间的持续信息共享、研究方法的培训和能力建设、出版物、数据协调和社区参与提供场所和支持。在本手稿中,我们介绍了研究协调中心如何发挥提供组织效率、科学技术援助、研究能力建设、业务协调和领导力的作用,以支持这个多项目合作研究联盟的研究和培训活动。我们概述了在 HLB-SIMPLe 联盟中协调研究和培训的初始阶段所面临的挑战和机遇,包括那些与传播和实施研究人员最相关的挑战和机遇。
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引用次数: 0
Evaluating a multifaceted implementation strategy and package of evidence-based interventions based on WHO PEN for people living with HIV and cardiometabolic conditions in Lusaka, Zambia: protocol for the TASKPEN hybrid effectiveness-implementation stepped wedge cluster randomized trial. 在赞比亚卢萨卡评估基于世界卫生组织 PEN 的针对艾滋病病毒感染者和心脏代谢疾病患者的多方面实施策略和循证干预一揽子方案:TASKPEN 混合效果-实施阶梯式楔形分组随机试验方案。
Pub Date : 2024-06-06 DOI: 10.1186/s43058-024-00601-z
Michael E Herce, Samuel Bosomprah, Felix Masiye, Oliver Mweemba, Jessie K Edwards, Chomba Mandyata, Mmamulatelo Siame, Chilambwe Mwila, Tulani Matenga, Christiana Frimpong, Anchindika Mugala, Peter Mbewe, Perfect Shankalala, Pendasambo Sichone, Blessings Kasenge, Luanaledi Chunga, Rupert Adams, Brian Banda, Daniel Mwamba, Namwinga Nachalwe, Mansi Agarwal, Makeda J Williams, Veronica Tonwe, Jake M Pry, Maurice Musheke, Michael Vinikoor, Wilbroad Mutale

Background: Despite increasing morbidity and mortality from non-communicable diseases (NCD) globally, health systems in low- and middle-income countries (LMICs) have limited capacity to address these chronic conditions, particularly in sub-Saharan Africa (SSA). There is an urgent need, therefore, to respond to NCDs in SSA, beginning by applying lessons learned from the first global response to any chronic disease-HIV-to tackle the leading cardiometabolic killers of people living with HIV (PLHIV). We have developed a feasible and acceptable package of evidence-based interventions and a multi-faceted implementation strategy, known as "TASKPEN," that has been adapted to the Zambian setting to address hypertension, diabetes, and dyslipidemia. The TASKPEN multifaceted implementation strategy focuses on reorganizing service delivery for integrated HIV-NCD care and features task-shifting, practice facilitation, and leveraging HIV platforms for NCD care. We propose a hybrid type II effectiveness-implementation stepped-wedge cluster randomized trial to evaluate the effects of TASKPEN on clinical and implementation outcomes, including dual control of HIV and cardiometabolic NCDs, as well as quality of life, intervention reach, and cost-effectiveness.

Methods: The trial will be conducted in 12 urban health facilities in Lusaka, Zambia over a 30-month period. Clinical outcomes will be assessed via surveys with PLHIV accessing routine HIV services, and a prospective cohort of PLHIV with cardiometabolic comorbidities nested within the larger trial. We will also collect data using mixed methods, including in-depth interviews, questionnaires, focus group discussions, and structured observations, and estimate cost-effectiveness through time-and-motion studies and other costing methods, to understand implementation outcomes according to Proctor's Outcomes for Implementation Research, the Consolidated Framework for Implementation Research, and selected dimensions of RE-AIM.

Discussion: Findings from this study will be used to make discrete, actionable, and context-specific recommendations in Zambia and the region for integrating cardiometabolic NCD care into national HIV treatment programs. While the TASKPEN study focuses on cardiometabolic NCDs in PLHIV, the multifaceted implementation strategy studied will be relevant to other NCDs and to people without HIV. It is expected that the trial will generate new insights that enable delivery of high-quality integrated HIV-NCD care, which may improve cardiovascular morbidity and viral suppression for PLHIV in SSA. This study was registered at ClinicalTrials.gov (NCT05950919).

背景:尽管全球非传染性疾病 (NCD) 的发病率和死亡率不断上升,但中低收入国家(LMICs)的卫生系统应对这些慢性疾病的能力有限,尤其是在撒哈拉以南非洲地区(SSA)。因此,撒哈拉以南非洲地区迫切需要应对非传染性疾病,首先要从全球首次应对任何慢性病--艾滋病毒--的行动中吸取经验教训,解决艾滋病毒感染者(PLHIV)的主要心脏代谢杀手问题。我们制定了一套可行且可接受的循证干预措施和多方面的实施策略,即 "TASKPEN",并根据赞比亚的情况进行了调整,以解决高血压、糖尿病和血脂异常问题。TASKPEN 多方面实施策略的重点是重组服务提供,以实现 HIV-NCD 综合护理,其特点是任务转移、促进实践以及利用 HIV 平台促进 NCD 护理。我们提议开展一项混合型 II 效能-实施阶梯式楔形群组随机试验,以评估 TASKPEN 对临床和实施结果的影响,包括艾滋病和心脏代谢性非传染性疾病的双重控制,以及生活质量、干预范围和成本效益:试验将在赞比亚卢萨卡的 12 个城市医疗机构进行,为期 30 个月。临床结果将通过对接受常规艾滋病服务的艾滋病毒感染者进行调查,以及对嵌套在大型试验中的患有心脏代谢合并症的艾滋病毒感染者进行前瞻性队列评估。我们还将采用混合方法收集数据,包括深度访谈、问卷调查、焦点小组讨论和结构化观察,并通过时间与运动研究和其他成本计算方法估算成本效益,以便根据 Proctor 的实施研究成果、实施研究综合框架和 RE-AIM 的选定维度了解实施成果:本研究的结果将用于在赞比亚和该地区提出离散的、可操作的和针对具体情况的建议,以便将心脏代谢性非传染性疾病护理纳入国家艾滋病治疗计划。虽然 TASKPEN 研究的重点是艾滋病毒感染者的心脏代谢性非传染性疾病,但所研究的多方面实施策略将适用于其他非传染性疾病和未感染艾滋病毒的人群。预计该试验将产生新的见解,有助于提供高质量的 HIV-NCD 综合护理,从而改善 SSA 地区 PLHIV 的心血管发病率和病毒抑制率。该研究已在 ClinicalTrials.gov 注册(NCT05950919)。
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引用次数: 0
Supporting ColoREctal Equitable Navigation (SCREEN): a protocol for a stepped-wedge cluster randomized trial for patient navigation in primary care. 支持结肠直肠公平导航(SCREEN):基层医疗患者导航阶梯式楔形分组随机试验方案。
Pub Date : 2024-06-03 DOI: 10.1186/s43058-024-00598-5
Jessica N Rivera Rivera, Katarina E AuBuchon, Laura C Schubel, Claire Starling, Jennifer Tran, Marjorie Locke, Melanie Grady, Mihriye Mete, H Joseph Blumenthal, Jessica E Galarraga, Hannah Arem

Background: Black individuals in the United States (US) have a higher incidence of and mortality from colorectal cancer (CRC) compared to other racial groups, and CRC is the second leading cause of death among Hispanic/Latino populations in the US. Patient navigation is an evidence-based approach to narrow inequities in cancer screening among Black and Hispanic/Latino patients. Despite this, limited healthcare systems have implemented patient navigation for screening at scale.

Methods: We are conducting a stepped-wedge cluster randomized trial of 15 primary care clinics with six steps of six-month duration to scale a patient navigation program to improve screening rates among Black and Hispanic/Latino patients. After six months of baseline data collection with no intervention we will randomize clinics, whereby three clinics will join the intervention arm every six months until all clinics cross over to intervention. During the intervention roll out we will conduct training and education for clinics, change infrastructure in the electronic health record, create stakeholder relationships, assess readiness, and deliver iterative feedback. Framed by the Practical, Robust Implementation Sustainment Model (PRISM) we will focus on effectiveness, reach, provider adoption, and implementation. We will document adaptations to both the patient navigation intervention and to implementation strategies. To address health equity, we will engage multilevel stakeholder voices through interviews and a community advisory board to plan, deliver, adapt, measure, and disseminate study progress. Provider-level feedback will include updates on disparities in screening orders and completions.

Discussion: Primary care clinics are poised to close disparity gaps in CRC screening completion but may lack an understanding of the magnitude of these gaps and how to address them. We aim to understand how to tailor a patient navigation program for CRC screening to patients and providers across diverse clinics with wide variation in baseline screening rates, payor mix, proximity to specialty care, and patient volume. Findings from this study will inform other primary care practices and health systems on effective and sustainable strategies to deliver patient navigation for CRC screening among racial and ethnic minorities.

Trial registration: NCT06401174.

背景:与其他种族群体相比,美国黑人的结直肠癌(CRC)发病率和死亡率较高,而在美国的西班牙裔/拉美裔人群中,CRC 是第二大死因。患者指导是一种基于证据的方法,可缩小黑人和西班牙裔/拉美裔患者在癌症筛查方面的不平等。尽管如此,在大规模筛查中实施患者指导的医疗保健系统仍然有限:方法:我们正在 15 家初级保健诊所开展一项阶梯式楔形分组随机试验,该试验分为六个步骤,为期六个月,目的是扩大患者指导计划的规模,以提高黑人和西班牙裔/拉丁裔患者的筛查率。在不采取干预措施的情况下,经过六个月的基线数据收集后,我们将对诊所进行随机分组,每六个月将有三家诊所加入干预组,直至所有诊所都加入干预组。在干预推广期间,我们将对诊所进行培训和教育,改变电子健康记录中的基础设施,建立利益相关者关系,评估准备情况,并提供迭代反馈。在 "实用、稳健的持续实施模式"(PRISM)的框架下,我们将重点关注有效性、覆盖范围、提供者采用率和实施情况。我们将记录患者导航干预和实施策略的调整情况。为了解决健康公平问题,我们将通过访谈和社区咨询委员会,听取多层次利益相关者的意见,以规划、实施、调整、衡量和传播研究进展。提供者层面的反馈将包括筛查订单和完成率差异的最新情况:讨论:初级保健诊所已准备好缩小在完成 CRC 筛查方面的差距,但可能对这些差距的严重程度以及如何缩小差距缺乏了解。我们的目标是了解如何为不同诊所的患者和医疗服务提供者量身定制 CRC 筛查患者指导计划,这些诊所在基线筛查率、支付方组合、专科医疗就近性和患者数量方面存在很大差异。这项研究的结果将为其他初级医疗实践和医疗系统提供信息,帮助他们制定有效且可持续的策略,为少数种族和少数民族的 CRC 筛查提供患者指导:试验注册:NCT06401174。
{"title":"Supporting ColoREctal Equitable Navigation (SCREEN): a protocol for a stepped-wedge cluster randomized trial for patient navigation in primary care.","authors":"Jessica N Rivera Rivera, Katarina E AuBuchon, Laura C Schubel, Claire Starling, Jennifer Tran, Marjorie Locke, Melanie Grady, Mihriye Mete, H Joseph Blumenthal, Jessica E Galarraga, Hannah Arem","doi":"10.1186/s43058-024-00598-5","DOIUrl":"10.1186/s43058-024-00598-5","url":null,"abstract":"<p><strong>Background: </strong>Black individuals in the United States (US) have a higher incidence of and mortality from colorectal cancer (CRC) compared to other racial groups, and CRC is the second leading cause of death among Hispanic/Latino populations in the US. Patient navigation is an evidence-based approach to narrow inequities in cancer screening among Black and Hispanic/Latino patients. Despite this, limited healthcare systems have implemented patient navigation for screening at scale.</p><p><strong>Methods: </strong>We are conducting a stepped-wedge cluster randomized trial of 15 primary care clinics with six steps of six-month duration to scale a patient navigation program to improve screening rates among Black and Hispanic/Latino patients. After six months of baseline data collection with no intervention we will randomize clinics, whereby three clinics will join the intervention arm every six months until all clinics cross over to intervention. During the intervention roll out we will conduct training and education for clinics, change infrastructure in the electronic health record, create stakeholder relationships, assess readiness, and deliver iterative feedback. Framed by the Practical, Robust Implementation Sustainment Model (PRISM) we will focus on effectiveness, reach, provider adoption, and implementation. We will document adaptations to both the patient navigation intervention and to implementation strategies. To address health equity, we will engage multilevel stakeholder voices through interviews and a community advisory board to plan, deliver, adapt, measure, and disseminate study progress. Provider-level feedback will include updates on disparities in screening orders and completions.</p><p><strong>Discussion: </strong>Primary care clinics are poised to close disparity gaps in CRC screening completion but may lack an understanding of the magnitude of these gaps and how to address them. We aim to understand how to tailor a patient navigation program for CRC screening to patients and providers across diverse clinics with wide variation in baseline screening rates, payor mix, proximity to specialty care, and patient volume. Findings from this study will inform other primary care practices and health systems on effective and sustainable strategies to deliver patient navigation for CRC screening among racial and ethnic minorities.</p><p><strong>Trial registration: </strong>NCT06401174.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"5 1","pages":"60"},"PeriodicalIF":0.0,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Determinants of implementation for group medical visits for patients with chronic pain: a systematic review. 慢性疼痛患者集体就医实施的决定因素:系统综述。
Pub Date : 2024-05-23 DOI: 10.1186/s43058-024-00595-8
Isabel Roth, Malik Tiedt, Carrie Brintz, Ariana Thompson-Lastad, Gayla Ferguson, Erum Agha, Jennifer Holcomb, Paula Gardiner, Jennifer Leeman

Background: Despite the critical need for comprehensive and effective chronic pain care, delivery of such care remains challenging. Group medical visits (GMVs) offer an innovative and efficient model for providing comprehensive care for patients with chronic pain. The purpose of this systematic review was to identify barriers and facilitators (determinants) to implementing GMVs for adult patients with chronic pain.

Methods: The review included peer-reviewed studies reporting findings on implementation of GMVs for chronic pain, inclusive of all study designs. Pubmed, EMBASE, Web of Science, and Cochrane Library were searched. Studies of individual appointments or group therapy were excluded. The Mixed Methods Appraisal Tool was used to determine risk of bias. Data related to implementation determinants were extracted independently by two reviewers. Data synthesis was guided by the updated Consolidated Framework for Implementation Research.

Results: Thirty-three articles reporting on 25 studies met criteria for inclusion and included qualitative observational (n = 8), randomized controlled trial (n = 6), quantitative non-randomized (n = 9), quantitative descriptive (n = 3), and mixed methods designs (n = 7). The studies included in this review included a total of 2364 participants. Quality ratings were mixed, with qualitative articles receiving the highest quality ratings. Common multi-level determinants included the relative advantage of GMVs for chronic pain over other available models, the capability and motivation of clinicians, the cost of GMVs to patients and the health system, the need and opportunity of patients, the availability of resources and relational connections supporting recruitment and referral to GMVs within the clinic setting, and financing and policies within the outer setting.

Conclusions: Multi-level factors determine the implementation of GMVs for chronic pain. Future research is needed to investigate these determinants more thoroughly and to develop and test implementation strategies addressing these determinants to promote the scale-up of GMVs for patients with chronic pain.

Trial registration: This systematic review was registered with PROSPERO 2021 CRD42021231310 .

背景:尽管迫切需要全面有效的慢性疼痛护理,但提供此类护理仍具有挑战性。集体就诊(GMVs)为慢性疼痛患者提供了一种创新而高效的综合治疗模式。本系统性综述的目的是确定对成年慢性疼痛患者实施团体医疗访问的障碍和促进因素(决定因素):方法:综述包括同行评审的研究,这些研究报告了针对慢性疼痛实施 GMVs 的结果,包括所有研究设计。检索了 Pubmed、EMBASE、Web of Science 和 Cochrane Library。个人预约或团体治疗的研究未包括在内。使用混合方法评估工具确定偏倚风险。与实施决定因素相关的数据由两名审稿人独立提取。数据综合以最新的实施研究综合框架为指导:报告 25 项研究的 33 篇文章符合纳入标准,包括定性观察(8 篇)、随机对照试验(6 篇)、定量非随机(9 篇)、定量描述性(3 篇)和混合方法设计(7 篇)。纳入本综述的研究共有 2364 名参与者。质量评分参差不齐,定性文章的质量评分最高。常见的多层次决定因素包括:GMV 对慢性疼痛的治疗相对于其他可用模式的优势、临床医生的能力和动机、GMV 对患者和医疗系统的成本、患者的需求和机会、诊所内支持招募和转诊到 GMV 的资源和关系网的可用性,以及外部环境中的融资和政策:多层次因素决定了慢性疼痛全球监测志愿服务的实施。未来的研究需要对这些决定因素进行更深入的调查,并针对这些决定因素制定和测试实施策略,以促进慢性疼痛患者GMVs的推广:本系统综述已在 PROSPERO 2021 CRD42021231310 注册。
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引用次数: 0
Do no harm: the impact of implementing cancer prevention strategies on other preventive health measures. 不造成伤害:实施癌症预防战略对其他预防保健措施的影响。
Pub Date : 2024-05-22 DOI: 10.1186/s43058-024-00597-6
Karen M Emmons, Leslie Pelton-Cairns, Daniel A Gundersen, Jennifer L Cruz, Lynette Mascioli, Gina R Kruse

Background: Translational efforts to increase uptake of evidence-based practices typically look at those outcomes in isolation of their impact on other aspects of care delivery. If we are in fact to "do no harm", we must consider the possible negative impact of improving use of one practice on other quality measures. Alternatively, a focus on one practice could lead to spread of effective strategies to other practices, which would be highly beneficial. We studied the impact of a colorectal cancer (CRC) screening initiative on delivery of other preventive care measures.

Methods: We used an interrupted time series design with implementation year as the interruption point. The initiative was conducted between 2015 and 2020, with three staggered cohorts. Main outcomes were quality measures for colorectal cancer screening, cervical cancer screening, hypertension management, diabetes management, weight screening and follow-up, tobacco use screening and cessation treatment, and depression screening and follow-up.

Results: The initiative was associated with an increase in CRC screening (OR = 1.67, p ≤ 0.01; average marginal effect = 12.2% points), and did not reduce performance on other quality measures in the year of CRC program implementation or a change in their respective secular trends.

Conclusions: The initiative led to a clinically meaningful increase in CRC screening and was not associated with reductions in delivery of six other preventive services. Quality improvement (QI) initiatives typically approach implementation with an eye towards reducing unintended impact and leveraging existing staff and resources. Implementation research studies may benefit from considering how QI initiatives factor in the local context in implementation efforts.

背景:为提高循证实践的采用率而开展的转化工作通常是孤立地看待这些成果对医疗服务其他方面的影响。如果我们确实要做到 "不造成伤害",我们就必须考虑改进一种实践的使用对其他质量衡量标准可能产生的负面影响。反之,如果只关注一种做法,可能会将有效的策略推广到其他做法中,这将是非常有益的。我们研究了大肠癌(CRC)筛查措施对其他预防性护理措施的影响:我们采用了中断时间序列设计,以实施年份作为中断点。该计划于 2015 年至 2020 年间实施,分为三个错开的队列。主要结果是结直肠癌筛查、宫颈癌筛查、高血压管理、糖尿病管理、体重筛查和随访、烟草使用筛查和戒烟治疗以及抑郁症筛查和随访的质量测量:该倡议与 CRC 筛查的增加有关(OR = 1.67,p ≤ 0.01;平均边际效应 = 12.2% 点),并且在实施 CRC 计划的当年没有降低其他质量指标的绩效,也没有改变其各自的长期趋势:结论:该计划提高了 CRC 筛查的临床意义,并且与其他六项预防服务的减少无关。质量改进(QI)计划的实施通常着眼于减少意外影响和充分利用现有人员和资源。实施研究可能会受益于考虑 QI 计划如何在实施工作中考虑当地环境因素。
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引用次数: 0
IMplementation of the Preterm Birth Surveillance PAthway: a RealisT evaluation (The IMPART Study). 早产监测途径的实施:真实评估(IMPART 研究)。
Pub Date : 2024-05-21 DOI: 10.1186/s43058-024-00594-9
Naomi Carlisle, Sonia Dalkin, Andrew H Shennan, Jane Sandall

Background: In the UK, 7.6% of babies are born preterm, which the Department of Health aims to decrease to 6% by 2025. To advance this, NHS England released Saving Babies Lives Care Bundle Version 2 Element 5, recommending the Preterm Birth Pathway for women at risk of preterm birth. The success of this new pathway depends on its implementation. The IMPART (IMplementation of the Preterm Birth Surveillance PAthway: a RealisT evaluation) study aimed to research how, why, for whom, to what extent and in what contexts the prediction and prevention aspects of Preterm Birth Surveillance Pathway is implemented through a realist evaluation. Realist implementation studies are growing in popularity.

Methods: Initial programme theories were developed through a realist informed literature scope, interviews with developers of the NHS England guidance, and a national questionnaire of current practice. Implementation theory was utilised in developing the programme theories. Data (interviews and observations with staff and women) were undertaken in 3 case sites in England to 'test' the programme theories. Substantive theory was utilised during data analysis to interpret and refine the theories on how implementation could be improved.

Results: Three explanatory areas were developed: risk assessing and referral; the preterm birth surveillance clinic; and women centred care. Explanatory area 1 dealt with the problems in correct risk assessment and referral to a preterm clinic. Explanatory area 2 focused on how once a correct referral has been made to a preterm clinic, knowledgeable and supported clinicians can deliver a well-functioning clinic. Explanatory area 3 concentrated on how the pathway delivers appropriate care to women.

Conclusions: The IMPART study provides several areas where implementation could be improved. These include educating clinicians on knowledge of risk factors and the purpose of the preterm clinic, having a multidisciplinary preterm team (including a preterm midwife) with specialist preterm knowledge and skills (including transvaginal cervical scanning skills), and sites actively working with their local network. This multidisciplinary preterm team are placed to deliver continuity of care for women at high-risk of preterm birth, being attentive to their history but also ensuring they are not defined by their risk status.

Trial registration: ISRCTN57127874.

背景:在英国,早产儿的比例为 7.6%,卫生部的目标是到 2025 年将这一比例降至 6%。为推动这一目标的实现,英国国家医疗服务体系发布了《挽救婴儿生命护理包》第 2 版第 5 要素,建议为有早产风险的妇女提供早产路径。这一新路径的成功取决于其实施情况。IMPART(早产监测途径的实施:现实主义评估)研究旨在通过现实主义评估,研究早产监测途径的预测和预防方面如何实施、为何实施、为谁实施、实施程度如何以及在何种情况下实施。现实主义实施研究越来越受欢迎:方法:通过现实主义文献范围、对英格兰国家医疗服务体系指南制定者的访谈以及对当前实践的全国性问卷调查,形成了初步的计划理论。在制定计划理论时采用了实施理论。在英格兰的 3 个案例地点收集数据(与工作人员和妇女进行访谈和观察),以 "检验 "计划理论。在数据分析过程中,利用了实质性理论来解释和完善如何改进实施的理论:提出了三个解释领域:风险评估和转诊、早产监测诊所和以妇女为中心的护理。解释领域 1 涉及正确的风险评估和转介到早产诊所的问题。解释性说明 2 的重点是,一旦正确转介到早产儿诊所,有知识和有支持的临床医生如何能够提供一个运作良好的诊所。解释性领域 3 集中于该路径如何为妇女提供适当的护理:IMPART 研究提供了几个可以改进实施的领域。这些方面包括:对临床医生进行风险因素和早产门诊目的方面的知识教育,建立一支具备专业早产知识和技能(包括经阴道宫颈扫描技能)的多学科早产团队(包括一名早产助产士),以及各医疗点积极与当地网络合作。这支多学科早产团队将为早产高危妇女提供连续性护理,关注她们的病史,但也确保她们不会被其风险状况所界定:试验注册:ISRCTN57127874。
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引用次数: 0
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Implementation science communications
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