Tailored interventions to support the implementation of the German national guideline on screening, diagnosis and treatment of alcohol-related disorders: a project protocol

2019 ◽  
Vol 65 (6) ◽  
pp. 373-381 ◽  
Author(s):  
Bernd Schulte ◽  
Christina Lindemann ◽  
Angela Buchholz ◽  
Anke Rosahl ◽  
Martin Härter ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Guideline Implementation ◽  
Implementation Strategies ◽  
Organizational Factors ◽  
Diagnosis And Treatment ◽  
Primary Data ◽  
Routine Practice ◽  
Evidence Based ◽  
Advisory Boards ◽  
Prevention And Treatment

Abstract. Background: The German Guideline on Screening, Diagnosis and Treatment of Alcohol Use Disorders aims to increase the uptake of evidence-based interventions for the early identification, diagnosis, prevention and treatment of alcohol-related disorders in relevant healthcare settings. To date, dissemination has not been accompanied by a guideline implementation strategy. The aim of this study is to develop tailored guideline implementation strategies and to field-test these in relevant medical and psycho-social settings in the city of Bremen, Germany. Methods: The study will conduct an impact and needs assessment of healthcare provision for alcohol use orders in Bremen, drawing on a range of secondary and primary data to: evaluate existing healthcare services; model the potential impact of improved care on public health outcomes; and identify potential barriers and facilitators to implementing evidence-based guidelines. Community advisory boards will be established for the selection of single-component or multi-faceted guideline implementation strategies. The tailoring approach considers guideline, provider and organizational factors shaping implementation. In field tests quality outcome indicators of the delivery of evidence-based interventions will be evaluated accompanied by a process evaluation to examine patient, provider and organizational factors. Outlook: This project will support the translation of guideline recommendations for the identification, prevention and treatment of AUD in routine practice and therefore contributes to the reduction of alcohol-related burden in Germany. The project is running since October 2017 and will provide its main outcomes by end of 2020. Project results will be published in scientific journals and presented at national and international conferences.

scholarly journals Multifaceted guideline implementation strategies improve early identification and management of osteoporosis

2009 ◽  
Vol 33 (3) ◽  
pp. 423 ◽  
Author(s):  
Cheryl M Kimber ◽  
Karen A Grimmer-Somers
Keyword(s):  
Early Identification ◽  
Best Practice ◽  
Guideline Implementation ◽  
Implementation Strategies ◽  
Fragility Fractures ◽  
Management Approach ◽  
Routine Practice ◽  
Patient Records ◽  
Fracture Management ◽  
Metropolitan Hospital

Background: Osteoporosis contributes significantly to fractures, subsequent disability and premature mortality in Australia. Better detection and management of osteoporosis will reduce unnecessary health expenditure. Objective: To evaluate, in one large tertiary metropolitan hospital, the orthopaedic health care team?s approach to osteoporosis guideline implementation to improve early identification and management of osteoporosis. Methods: This paper describes the implementation of multifaceted strategies to improve healthpromoting behaviours and the uptake of osteoporosis guidelines by staff in the orthopaedic outpatient clinic at one metropolitan hospital, reflecting organisational and individual commitment to embedding guideline recommendations into routine practice. Implementation strategies were aimed at the requirements and perspectives of different stakeholder groups. Five audit datasets were compared: 62 patient records in two baseline audits, and three post-implementation audits of 31 patient records, collected over the following 3-month periods (August 2006 to April 2007). All audits used the same criteria to assess compliance with clinical guidelines, and outcomes of implementation strategies. Results: There was consistent improvement in compliance with osteoporosis guidelines over the audit periods. Comparing baseline and immediate post-implementation data, there was a significant improvement (P < 0.05) in the percentage of patients with likely fragility fractures who were identified with an osteoporotic fracture. The percentage of patients who had a likely fragility fracture, with whom staff communicated about their problems and how to deal with them, increased consistently over all post-implementation audit periods. For patients with established osteoporosis who presented with fragility fractures, there was sustained improvement over the audit periods in the percentage provided with guideline-based care. Conclusion: This study highlights that appropriate and targeted intervention strategies can be effective if modelled on best practice guideline implementation approaches with the use of a coordinated post-fracture management approach to osteoporosis.

scholarly journals Implementing IG Best Practices in Community-Based Settings: A Pre-Implementation Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 733-733
Author(s):  
Lisa Juckett ◽  
Shannon Jarrott ◽  
Jill Naar ◽  
Rachel Scivano ◽  
Alicia Bunger
Keyword(s):  
Best Practices ◽  
Implementation Strategies ◽  
Routine Practice ◽  
Evidence Based ◽  
Valuable Insight ◽  
Small Community ◽  
Community Settings ◽  
Intergenerational Program ◽  
Specific Implementation ◽  
Intergenerational Programming

Abstract Programs that intentionally engage unrelated young and old persons often lead to mutual benefits; however, specific implementation strategies that support the use of evidence-based intergenerational programming in community settings are understudied. With strong demand for training resources among intergenerational program providers, this pilot study examined how a multifaceted training strategy facilitated the implementation of 14 distinct evidence-based intergenerational best practices. Intergenerational programming was implemented with nine staff from two small community sites using three implementation strategies including educational meetings, ongoing consultation, and routine practice reminders. Observational analysis of video recorded intergenerational program sessions indicated that staff adopted an average of 81.7% of intergenerational best practices suggesting the feasibility of implementing IG in community settings. Findings yield valuable insight that can inform training refinements, and selection of strategies for improving implementation. Next steps include aligning specific practices with participant outcomes.

The increasing role of breast cancer lymphedema screening, diagnosis, and management as part of evidence-based breast cancer survivorship.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 145-145
Author(s):  
Chirag Shah ◽  
Frank A. Vicini
Keyword(s):  
Breast Cancer ◽  
Cancer Survivorship ◽  
Diagnosis And Treatment ◽  
Detection Methods ◽  
Current Evidence ◽  
Routine Practice ◽  
Evidence Based ◽  
Breast Cancer Survivorship ◽  
Cancer Management ◽  
Evidence Based Guidelines

145 Background: With improved outcomes across all stages, breast cancer survivorship represents an increasingly significant oncologic issue. One major facet of breast cancer survivorship is assessment and management of sequelae of treatment including breast cancer related lymphedema (BCRL) which has an incidence of 5-40% depending on locoregional and systemic treatment. BCRL represents a complication associated with physical changes as well as reduction in quality of life and continues to increase in prevalence with new diagnostics (ex. L-Dex, perometry) increasing the sensitivity for detection. Methods: Review of current evidence based guidelines from the National Comprehensive Cancer Network (NCCN), American Society of Clinical Oncology (ASCO), and the American Cancer Society. Results: Evidence based treatment guidelines for breast cancer have evolved in 2015. For the first time, the NCCN guidelines include a reference to BCRL as part of routine treatment stating “to educate, monitor, and refer for lymphedema management” represents a standard component of breast cancer treatment and survivorship and allows for the early diagnosis and treatment of BCRL. At this time, neither the ASCO Breast Cancer nor ASCO survivorship guidelines incorporate BCRL management into routine practice. At this time, BCRL management is not part of ACS survivorship protocols. Conclusions: At this time, due to increasing data on BCRL diagnosis and treatment, evidence based guidelines are beginning to incorporate BCRL education, diagnosis, and treatment into standard breast cancer management plans. With increasing focus on survivorship, prospective BCRL programs are being developed that begin evaluation prior to treatment with screening in place and early intervention to help prevent progression by using diagnostics with increased sensitivity (ex. L-Dex, perometry).

scholarly journals A Cross-Site Partnership to Examine Implementation and Sustainability of a School-Based Trauma Program

2018 ◽  
Vol 28 (Supp) ◽  
pp. 427-436 ◽  
Author(s):  
Pamela Vona ◽  
Shilpa Baweja ◽  
Catherine DeCarlo Santiago ◽  
Gillian Pears ◽  
Audra Langley ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Services ◽  
School Setting ◽  
Implementation Strategies ◽  
Organizational Factors ◽  
The United States ◽  
School Level ◽  
Evidence Based ◽  
School Based ◽  
School Stakeholders

Objectives: Schools have been identified as an ideal setting for increasing access to mental health services particularly for underserved minority youth. The emerging field of implementation science has begun to systematically investigate strategies for more efficiently integrating evidence-based practices into community settings. Signifi­cantly less translational research has focused specifically on the school setting. To address this need, we examined the implementa­tion of a school-based trauma intervention across three distinct regions.Design: We conducted key informant interviews guided by Mendel’s Frame­work of Dissemination in Health Services Intervention Research with multiple school stakeholders to examine what school organizational characteristics influence the adoption and implementation process and sustainability of Cognitive Behavioral Intervention for Trauma in Schools (CBITS). Participants were selected from schools in three geographic regions in the United States: Western, Midwestern, and Southern.Results: Our findings reveal that while sites had some common organizational factors that appeared to facilitate implementation, regions differed in how they compensated for less robust implementation domains. Across all regions, school stakeholders recognized the need for services to sup­port students impacted by trauma. In the Western region, there was no centralized district policy for implementation; therefore, implementation was facilitated by school-level change agents and supervision support from the district mental health unit. In the Midwestern region, centralized district policies drove implementation. In both the Midwestern and Southern regions, imple­mentation was facilitated by collaboration with a local mental health agency.Conclusions: This study contributes to the paucity of empirical information on the organizational factors that influence the implementation of evidence-based mental health interventions in schools. Our find­ings reveal that different implementation strategies across policies, structures, and resources can result in implementation of a school-based intervention. Frameworks such as Mendel’s can be helpful in identify­ing areas of strength and improvement of implementation within a school organiza­tion.Ethn Dis. 2018; 28(Suppl 2): 427-436; doi:10.18865/ed.28.S2.427

Implementation Strategies

2017 ◽  
Author(s):  
JoAnn E. Kirchner ◽  
Thomas J. Waltz ◽  
Byron J. Powell ◽  
Jeffrey L. Smith ◽  
Enola K. Proctor
Keyword(s):  
Implementation Science ◽  
Comparative Effectiveness ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Efficient Manner

As the field of implementation science moves beyond studying barriers to and facilitators of implementation to the comparative effectiveness of different strategies, it is essential that we create a common taxonomy to define the strategies that we study. Similarly, we must clearly document the implementation strategies that are applied, the factors that influence their selection, and any adaptation of the strategy during the course of implementation and sustainment of the innovation being implemented. By incorporating this type of rigor into our work we will be able to not only advance the science of implementation but also our ability to place evidence-based innovations into the hands of practitioners in a timely and efficient manner.

The Role of Organizational Processes in Dissemination and Implementation Research

2017 ◽  
Author(s):  
Gregory A. Aarons ◽  
Joanna C. Moullin ◽  
Mark G. Ehrhart
Keyword(s):  
Health Care ◽  
Organizational Development ◽  
Organizational Factors ◽  
Dissemination And Implementation ◽  
Evidence Based ◽  
Organizational Strategies ◽  
Evidence Based Practices ◽  
Effective Dissemination ◽  
Dissemination And Implementation Research ◽  
Ebp Implementation

Both organizational characteristics and specific organizational strategies are important for the effective dissemination and implementation of evidence-based practices (EBPs) in health and allied health care settings, as well as mental health, alcohol/drug treatment, and social service settings. One of the primary goals of this chapter is to support implementers and leaders within organizations in attending to and shaping the context in which implementation takes place in order to increase the likelihood of implementation success and long-term sustainment. The chapter summarizes some of the most critical organizational factors and strategies likely to impact successful evidence-based practice implementation. There are myriad approaches to supporting organizational development and change—this chapter focuses on issues supported by relevant scientific literatures, particularly those germane to EBP implementation in health care and related settings.

scholarly journals Results of the CHlorhexidine Gluconate Bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections Study (CHanGing BathS): a stepped wedge cluster randomized trial

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Staci S. Reynolds ◽  
Patricia Woltz ◽  
Edward Keating ◽  
Janice Neff ◽  
Jennifer Elliott ◽  
...  
Keyword(s):  
Implementation Strategies ◽  
Bloodstream Infections ◽  
Central Line ◽  
Audit And Feedback ◽  
Educational Outreach ◽  
Evidence Based ◽  
Intervention Effect ◽  
Cluster Randomized ◽  
Outreach Visits ◽  
Educational Outreach Visits

Abstract Background Central line-associated bloodstream infections (CLABSIs) result in approximately 28,000 deaths and approximately $2.3 billion in added costs to the U.S. healthcare system each year, and yet, many of these infections are preventable. At two large health systems in the southeast United States, CLABSIs continue to be an area of opportunity. Despite strong evidence for interventions to prevent CLABSI and reduce associated patient harm, such as use of chlorhexidine gluconate (CHG) bathing, the adoption of these interventions in practice is poor. The primary objective of this study was to assess the effect of a tailored, multifaceted implementation program on nursing staff’s compliance with the CHG bathing process and electronic health record (EHR) documentation in critically ill patients. The secondary objectives were to examine the (1) moderating effect of unit characteristics and cultural context, (2) intervention effect on nursing staff’s knowledge and perceptions of CHG bathing, and (3) intervention effect on CLABSI rates. Methods A stepped wedged cluster-randomized design was used with units clustered into 4 sequences; each sequence consecutively began the intervention over the course of 4 months. The Grol and Wensing Model of Implementation helped guide selection of the implementation strategies, which included educational outreach visits and audit and feedback. Compliance with the appropriate CHG bathing process and daily CHG bathing documentation were assessed. Outcomes were assessed 12 months after the intervention to assess for sustainability. Results Among the 14 clinical units participating, 8 were in a university hospital setting and 6 were in community hospital settings. CHG bathing process compliance and nursing staff’s knowledge and perceptions of CHG bathing significantly improved after the intervention (p = .009, p = .002, and p = .01, respectively). CHG bathing documentation compliance and CLABSI rates did not significantly improve; however, there was a clinically significant 27.4% decrease in CLABSI rates. Conclusions Using educational outreach visits and audit and feedback implementation strategies can improve adoption of evidence-based CHG bathing practices. Trial registration ClinicalTrials.gov, NCT03898115, Registered 28 March 2019.

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