NICE LESSONS TO BE LEARNED

2001 ◽  
Vol 17 (2) ◽  
pp. 222-235 ◽  
Author(s):  
Jane Farmer ◽  
Rosemary Chesson
Keyword(s):  
Cost Effectiveness ◽  
Implementation Strategies ◽  
Relevant Information ◽  
Policy Implications ◽  
Health Board ◽  
Evidence Based ◽  
Apparent Lack ◽  
Information Centre ◽  
Two Stages ◽  
The Impact

Objectives: This study examined users' perceptions of the role and value of the Scottish Health Purchasing Information Centre (SHPIC) from 1995 to 1998.Methods: Questionnaires and interviews were used to gather data from Scottish GP fundholders and health board managers at two stages.Results: Initially, purchasers sought help in identifying the most relevant information. By 1997, while some appreciated the clinical and cost-effectiveness information produced, others were critical of lack of timely production and apparent lack of cooperation between agencies.Conclusions: New U.K. agencies can learn from SHPIC's problems, specifically in producing clear, coordinated, timely, independent, and well-marketed information with implementation strategies.Policy Implications: It is important to evaluate the impact of agencies to produce and disseminate evidence-based information, even if this has to be done pragmatically rather than as an outcomes-based assessment. Evidence from evaluations can inform direction and strategy for existing and new agencies.

Are Home Care Programs Cost-Effective? A Systematic Review of the Literature

2003 ◽  
Vol 4 (4) ◽  
pp. 198-201 ◽  
Author(s):  
Kimberly D. Fraser
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Cost Effectiveness ◽  
Home Care ◽  
Home Health Care ◽  
Research Question ◽  
Policy Implications ◽  
Evidence Based ◽  
The Cost ◽  
Evidence Based Decision Making

The cost-effectiveness of home care programs and services is an important area of health care research given the recent growth and continuing trend in home health care, the current state of health care reform in Canada, and changing demographics in Canada. Home care programs often proceed with little evidence-based decision-making. Increased demand for evidence-based decision-making is apparent in not only clinical settings, but also in policy environments thus creating a need for more research in this area. There are presently very few rigorous studies on the cost-effectiveness of home care programs. This systematic literature review addresses the research question, “What is the relationship between cost-consequence evidence and policy implications within the home care context?” The findings are not surprising. They include mixed results and indicate that cost-effectiveness of home care programs is an important area to study in spite of the many challenges. The challenges presented must be acknowledged and addressed in order to produce better research designs in future studies.

scholarly journals The Effectiveness of Two Implementation Strategies for Improving Teachers’ Delivery of an Evidenced-based HIV Prevention Program

2020 ◽  
Author(s):  
Bo Wang ◽  
Lynette Deveaux ◽  
Lesley Cottrell ◽  
Xiaoming Li ◽  
Richard Adderley ◽  
...  
Keyword(s):  
Sex Education ◽  
Self Efficacy ◽  
Implementation Strategies ◽  
Implementation Fidelity ◽  
Evidence Based ◽  
Principal Support ◽  
Hiv Intervention ◽  
Evidenced Based ◽  
Intervention Curriculum ◽  
The Impact

Abstract Background: Effective implementation strategies are needed to enhance the success of evidence-based prevention programs. The current study evaluates the effects of two implementation strategies on teachers’ implementation of an evidenced-based HIV intervention.Methods: Using our 7-item Pre-Implementation School Screening tool, we identified teachers who were at-risk for not implementing the Focus on Youth HIV-risk reduction intervention curriculum which targets middle and high school youth. After completing a two-day curriculum workshop, 84 low- and moderate-performing teachers were randomly assigned to one of four experimental conditions and were asked to teach the intervention curriculum for nearly two months. This optimization trial examines the impact of two implementation strategies including biweekly monitoring/feedbacks (BMF) and site-based assistance/mentorship (SAM). The primary outcome is implementation fidelity defined as number of core activities taught. General linear model was used to examine the association of the implementation strategies with implementation fidelity.Results: BMF and SAM were significantly associated with teachers’ implementation fidelity. Teachers who received both BFM and SAM taught the greatest numbers of core activities, followed by teachers who received either BMF or SAM. Teachers who did not receive BMF or SAM taught the lowest numbers of core activities (15.0 vs. 7.9 vs. 6.9 vs. 4.1, p< 0.001). Teachers’ confidence in implementing five core activities, attitudes towards sex education in schools, and perceived principal support were significantly related to increased self-efficacy, which in turn was related to teachers’ fidelity of implementation. Teacher full attendance at the training workshop and teachers’ sustained implementation of FOYC in the prior school year were related to increased implementation fidelity. Conclusion: BMF and SAM are effective in promoting teachers’ implementation of youth evidence-based interventions. Researchers and future program implementers should consider teacher training, teachers’ attitudes towards sex education, perceived principal support and self-efficacy when attempting to maintain the effects of teacher-delivered interventions in schools.

scholarly journals Implementing Interventions with Varying Marginal Cost-Effectiveness: An Application in Precision Medicine

2020 ◽  
Vol 40 (7) ◽  
pp. 924-938
Author(s):  
Stuart J. Wright ◽  
Mike Paulden ◽  
Katherine Payne
Keyword(s):  
Cost Effectiveness ◽  
Precision Medicine ◽  
Implementation Strategies ◽  
Recurrence Score ◽  
Cost Effective ◽  
Decision Analytic Model ◽  
Costs And Benefits ◽  
Marginal Costs ◽  
The Impact

Purpose. A range of barriers may constrain the effective implementation of strategies to deliver precision medicine. If the marginal costs and consequences of precision medicine vary at different levels of implementation, then such variation will have an impact on relative cost-effectiveness. This study aimed to illustrate the importance and quantify the impact of varying marginal costs and benefits on the value of implementation for a case study in precision medicine. Methods. An existing method to calculate the value of implementation was adapted to allow marginal costs and consequences of introducing precision medicine into practice to vary across differing levels of implementation. This illustrative analysis used a case study based on a published decision-analytic model-based cost-effectiveness analysis of a 70-gene recurrence score (MammaPrint) for breast cancer. The impact of allowing for varying costs and benefits for the value of the precision medicine and of implementation strategies was illustrated graphically and numerically in both static and dynamic forms. Results. The increasing returns to scale exhibited by introducing this specific example of precision medicine mean that a minimum level of implementation (51%) is required for using the 70-gene recurrence score to be cost-effective at a defined threshold of €20,000 per quality-adjusted life year. The observed variation in net monetary benefit implies that the value of implementation strategies was dependent on the initial and ending levels of implementation in addition to the magnitude of the increase in patients receiving the 70-gene recurrence score. In dynamic models, incremental losses caused by low implementation accrue over time unless implementation is improved. Conclusions. Poor implementation of approaches to deliver precision medicine, identified to be cost-effective using decision-analytic model-based cost-effectiveness analysis, can have a significant economic impact on health systems. Developing and evaluating the economic impact of strategies to improve the implementation of precision medicine will potentially realize the more cost-effective use of health care budgets.

scholarly journals Looking into mechanisms of change: Evaluation of a multifaceted implementation strategy to change pain management behavior of care workers

2020 ◽  
Author(s):  
Thekla Brunkert ◽  
Michael Simon ◽  
Franziska Zúñiga
Keyword(s):  
Pain Management ◽  
Nursing Homes ◽  
Pain Assessment ◽  
Self Efficacy ◽  
Implementation Strategies ◽  
Mechanisms Of Change ◽  
Evidence Based ◽  
Mixed Effect ◽  
Care Workers ◽  
The Impact

Abstract BackgroundUnderutilization of evidence-based pain management in nursing homes is common. Evidence towards effective approaches to improve adoption of evidence-based practices in nursing homes is limited. To get a better understanding of the impact of our multi-faceted implementation strategies, care worker training workshops and the introduction of trained pain champions, this study explored the underlying mechanisms of the implementation strategies using behavioral theory.MethodsWe conducted a mixed-methods evaluation alongside an implementation- effectiveness study in four Swiss nursing homes. Based on an a priori contextual analysis in the participating homes implementation strategies were developed. Furthermore, we developed a conceptual framework describing hypotheses concerning determinants of implementation and mechanisms of change underlying our implementation strategies.Care workers’ questionnaire surveys were conducted at baseline (n=136), after three (n= 99) and six months (n=83) to assess self-efficacy in pain management and self-reported guideline adoption. We computed linear mixed-effect models to assess changes over time in self-efficacy and logistic regressions to assess associations between self-efficacy and guideline adoption. Concurrently, we conducted focus groups with care workers (n=8) to explore their response to the implementation strategies and to gain a deeper understanding of the potential mechanisms. After transcription, interview data was analyzed using content analysis.ResultsOverall, there was a significant increase in self-efficacy after three and six months (p<0.001). Self-reported adoption of guideline components ranged between 44% and 73% depending on the component. We found significant associations between self-efficacy and adoption of two guideline components, i.e. performing a comprehensive pain assessment and using an observational pain assessment tool in cognitively impaired residents.Qualitative findings showed that the training workshops and pain champions were received positively by care workers. Focus group participants reported to be more attentive to residents` pain experience and to assess and document pain more frequently and with more detail than before.ConclusionsOur findings highlight the importance of continuous commitment of an implementation facilitator, e.g., a pain champion, within an organization. Regarding persistent implementation challenges, a theory-based conceptual model contributes to the overall understanding.Trial registrationClinicalTrials.gov (NCT03471390)

scholarly journals Policies for Improving PM2.5 Particles and GHGs Emissions in a Maritime Port of Taiwan: Evidence Based on the INDC and GGRMA Regulations

2021 ◽  
Vol 9 (12) ◽  
pp. 1315
Author(s):  
Ching-Chih Chang ◽  
Yi-An Tsai
Keyword(s):  
Pollution Reduction ◽  
Evidence Based ◽  
Second Stage ◽  
Reduce Emissions ◽  
Set Up ◽  
Liquid Natural Gas ◽  
Two Stages ◽  
The Impact ◽  
Policy Proposals ◽  
Port Of Kaohsiung

The impact of possible emission reduction policies designed to reduce port emissions in the Port of Kaohsiung in Taiwan was analyzed, focusing on ways to reduce air pollution from CO2, CH4, N2O, PM10, PM2.5, NOx, and SOx generated by vessels, cranes, and truck tractors in the port. This paper was set up in two stages to determine how pollution reduction policies could reach the 2030 and in 2050 goals. The results showed that emissions of CO2, CH4, N2O, PM10, PM2.5, NOx, and SOx could be reduced by 46%, 26%, 25%, 77%, 77%, 76%, and 68%, respectively, in the first stage (in 2030, INDC), and by 57%, 59%, 53%, 79%, 79%, 80%, and 69%, respectively, in the second stage (in 2050, GGGRMA), as compared to 2005 data. This paper concludes as follows: (1) for vessels, the use of liquid natural gas is the best way to reduce GHGs when navigating by water; (2) for bridge cranes, electrification is the better policy during operation; (3) in the case of truck tractors, the generation of battery-electric power is the best way to reduce emissions. These policy proposals for improving air quality can be applied to all ports in Taiwan.

scholarly journals Exploring the impact of workforce turnover on the sustainability of evidence-based programs: A scoping review

2021 ◽  
Vol 2 ◽  
pp. 263348952110345
Author(s):  
Kelley M Pascoe ◽  
Miruna Petrescu-Prahova ◽  
Lesley Steinman ◽  
Jennifer Bacci ◽  
Siobhan Mahorter ◽  
...  
Keyword(s):  
Scoping Review ◽  
Relevant Information ◽  
Evidence Based ◽  
Program Sustainability ◽  
Data Abstraction ◽  
Organizational Goals ◽  
Workforce Turnover ◽  
The Individual ◽  
Evidence Based Programs ◽  
The Impact

Background Evidence-based programs (EBPs) are used across disciplines to integrate research into practice and improve outcomes at the individual and/or community level. Despite widespread development and implementation of EBPs, many programs are not sustained beyond the initial implementation period due to many factors, including workforce turnover. This scoping review summarizes research on the impact of workforce turnover on the sustainability of EBPs and recommendations for mitigating these impacts. Methods We searched 10 databases for articles that focused on an EBP and described an association between workforce turnover and the sustainment or sustainability of the program. We created a data abstraction tool to extract relevant information from each article and applied the data abstraction tool to all included articles to create the dataset. Data were mapped and analyzed using the program sustainability framework (PSF). Results and Discussion A total of 30 articles were included in this scoping review and mapped to the PSF. Twenty-nine articles described impacts of workforce turnover and 18 articles proposed recommendations to address the impacts. The most frequent impacts of workforce turnover included increased need for training, loss of organizational knowledge, lack of EBP fidelity, and financial stress. Recommendations to address the impact of workforce turnover included affordable and alternative training modalities, the use of champions or volunteers, increasing program alignment with organizational goals, and generating diverse funding portfolios. Conclusion The sustainment of EBPs is critical to ensure and maintain the short- and long-term benefits of the EBP for all participants and communities. Understanding the impacts of workforce turnover, a determinant of sustainability, can create awareness among EBP-implementing organizations and allow for proactive planning to increase the likelihood of program sustainability.

scholarly journals Use of Human-Centered Design to Improve Implementation of Evidence-Based Psychotherapies in Low-Resource Communities: Protocol for Studies Applying a Framework to Assess Usability

10.2196/14990 ◽  
2019 ◽  
Vol 8 (10) ◽  
pp. e14990 ◽  
Author(s):  
Aaron R Lyon ◽  
Sean A Munson ◽  
Brenna N Renn ◽  
David C Atkins ◽  
Michael D Pullmann ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Implementation Strategy ◽  
Relative Effectiveness ◽  
Implementation Strategies ◽  
Psychosocial Interventions ◽  
Evidence Based ◽  
Human Centered Design ◽  
Patient Reported ◽  
The Impact

Background This paper presents the protocol for the National Institute of Mental Health (NIMH)–funded University of Washington’s ALACRITY (Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness) Center (UWAC), which uses human-centered design (HCD) methods to improve the implementation of evidence-based psychosocial interventions (EBPIs). We propose that usability—the degree to which interventions and implementation strategies can be used with ease, efficiency, effectiveness, and satisfaction—is a fundamental, yet poorly understood determinant of implementation. Objective We present a novel Discover, Design/Build, and Test (DDBT) framework to study usability as an implementation determinant. DDBT will be applied across Center projects to develop scalable and efficient implementation strategies (eg, training tools), modify existing EBPIs to enhance usability, and create usable and nonburdensome decision support tools for quality delivery of EBPIs. Methods Stakeholder participants will be implementation practitioners/intermediaries, mental health clinicians, and patients with mental illness in nonspecialty mental health settings in underresourced communities. Three preplanned projects and 12 pilot studies will employ the DDBT model to (1) identify usability challenges in implementing EBPIs in underresourced settings; (2) iteratively design solutions to overcome these challenges; and (3) compare the solution to the original version of the EPBI or implementation strategy on usability, quality of care, and patient-reported outcomes. The final products from the center will be a streamlined modification and redesign model that will improve the usability of EBPIs and implementation strategies (eg, tools to support EBPI education and decision making); a matrix of modification targets (ie, usability issues) that are both common and unique to EBPIs, strategies, settings, and patient populations; and a compilation of redesign strategies and the relative effectiveness of the redesigned solution compared to the original EBPI or strategy. Results The UWAC received institutional review board approval for the three separate studies in March 2018 and was funded in May 2018. Conclusions The outcomes from this center will inform the implementation of EBPIs by identifying cross-cutting features of EBPIs and implementation strategies that influence the use and acceptability of these interventions, actively involving stakeholder clinicians and implementation practitioners in the design of the EBPI modification or implementation strategy solution and identifying the impact of HCD-informed modifications and solutions on intervention effectiveness and quality. Trial Registration ClinicalTrials.gov NCT03515226 (https://clinicaltrials.gov/ct2/show/NCT03515226), NCT03514394 (https://clinicaltrials.gov/ct2/show/NCT03514394), and NCT03516513 (https://clinicaltrials.gov/ct2/show/NCT03516513). International Registered Report Identifier (IRRID) DERR1-10.2196/14990

scholarly journals Ending the HIV Epidemic Among Persons Who Inject Drugs: A Cost-Effectiveness Analysis in Six US Cities

2020 ◽  
Vol 222 (Supplement_5) ◽  
pp. S301-S311 ◽  
Author(s):  
Emanuel Krebs ◽  
Xiao Zang ◽  
Benjamin Enns ◽  
Jeong E Min ◽  
Czarina N Behrends ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Los Angeles ◽  
Implementation Strategies ◽  
Transmission Model ◽  
Evidence Based ◽  
Hiv Incidence ◽  
Persons Who Inject Drugs ◽  
Hiv Epidemic ◽  
Life Years ◽  
Us Cities

Abstract Background Persons who inject drugs (PWID) are at a disproportionately high risk of HIV infection. We aimed to determine the highest-valued combination implementation strategies to reduce the burden of HIV among PWID in 6 US cities. Methods Using a dynamic HIV transmission model calibrated for Atlanta, Baltimore, Los Angeles, Miami, New York City, and Seattle, we assessed the value of implementing combinations of evidence-based interventions at optimistic (drawn from best available evidence) or ideal (90% coverage) scale-up. We estimated reduction in HIV incidence among PWID, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) for each city (10-year implementation; 20-year horizon; 2018 $ US). Results Combinations that maximized health benefits contained between 6 (Atlanta and Seattle) and 12 (Miami) interventions with ICER values ranging from $94 069/QALY in Los Angeles to $146 256/QALY in Miami. These strategies reduced HIV incidence by 8.1% (credible interval [CI], 2.8%–13.2%) in Seattle and 54.4% (CI, 37.6%–73.9%) in Miami. Incidence reduction reached 16.1%–75.5% at ideal scale. Conclusions Evidence-based interventions targeted to PWID can deliver considerable value; however, ending the HIV epidemic among PWID will require innovative implementation strategies and supporting programs to reduce social and structural barriers to care.

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