Implementation Science

2020 ◽  
Author(s):  
Suzanne Heurtin-Roberts ◽  
Heather Schacht Reisinger
Keyword(s):  
Human Health ◽  
Implementation Science ◽  
Real World ◽  
Quantitative Methods ◽  
Care Delivery ◽  
Well Being ◽  
Local Context ◽  
Evidence Based ◽  
Forthcoming Article ◽  
Qualitative And Quantitative Methods

This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Anthropology. Please check back later for the full article. Research has produced a substantial body of knowledge that has the significant possibility to improve human health and well-being. Much of that knowledge is published, yet read only by other researchers. Alternatively, this research becomes “evidence-based practice,” (EBP) knowledge obtained under specific controlled conditions that is meant to improve some aspect of human health or wellbeing. The world where humans live their everyday lives tends to be complex and messy. These EBP’s, when employed in the scientifically uncontrolled world, are frequently ineffective. Implementation science (IS) is a relatively new but rapidly growing field intended to remedy this situation. IS was established to study the most effective strategies to integrate evidence-based interventions into public and community health and health care delivery. IS asks whether an intervention can be effectively delivered in a specific local context, that is, “under what conditions and in what contexts can any change-oriented action be effective in the real world?” Anthropology has contributed significantly to implementation science, yet it can contribute much more. Well-equipped to answer many of the questions posed by IS, anthropology’s theory and methods allow us to understand and broker both emic and etic perspectives and to represent the richness, fluidity, and complexity of context. Both anthropology and IS recognize the importance of context and locality, are real-world oriented, and embrace complexity and non-linearity. Both are comfortable with the emergent nature of research-produced knowledge, and both employ both qualitative and quantitative methods. Beyond these congruencies in perspectives and approaches, the rationale for having more anthropology in implementation science is not only because it’s a good fit. Anthropology attends to power structures and differentials, phenomena that, while sometimes included in IS, are not frequently critiqued. Anthropology can furnish a questioning, critical perspective of the object of study and how it’s studied, a perspective that is lacking in much IS work. Indeed, this is something that anthropology does best, and it is integral to anthropology’s conceptual orientation.

scholarly journals Evidence-Based Landscape Architecture for Human Health and Well-Being

2020 ◽  
Vol 12 (4) ◽  
pp. 1360 ◽  
Author(s):  
Robert D. Brown ◽  
Robert C. Corry
Keyword(s):  
Human Health ◽  
Architectural Design ◽  
Landscape Architecture ◽  
Well Being ◽  
Evidence Based ◽  
Natural Environments ◽  
The People ◽  
Outdoor Environments ◽  
The Usa ◽  
Health And Well Being

More than 80% of the people in the USA and Canada live in cities. Urban development replaces natural environments with built environments resulting in limited access to outdoor environments which are critical to human health and well-being. In addition, many urban open spaces are unused because of poor design. This paper describes case studies where traditional landscape architectural design approaches would have compromised design success, while evidence-based landscape architecture (EBLA) resulted in a successful product. Examples range from school-yard design that provides safe levels of solar radiation for children, to neighborhood parks and sidewalks that encourage people to walk and enjoy nearby nature. Common characteristics for integrating EBLA into private, public, and academic landscape architecture practice are outlined along with a discussion of some of the opportunities and barriers to implementation.

scholarly journals Evidence-Based Design in Architectural Education: Designing the First Maggie’s Centre in Israel

2021 ◽  
pp. 193758672110079
Author(s):  
Nirit Putievsky Pilosof ◽  
Yasha Jacob Grobman
Keyword(s):  
Literature Review ◽  
Architectural Design ◽  
Early Stage ◽  
Scientific Research ◽  
Well Being ◽  
Architectural Education ◽  
Local Context ◽  
Evidence Based ◽  
Architecture Education ◽  
The Impact

Objective The study examines the integration of the Evidence-based Design (EBD) approach in healthcare architecture education in the context of an academic design studio. Background Previous research addressed the gap between scientific research and architectural practice and the lack of research on the use of the EBD approach in architectural education. Methods The research examines an undergraduate architectural studio to design a Maggie’s Centre for cancer care in Israel and evaluates the impact of the EBD approach on the design process and design outcomes. The research investigates the impact of the integration of three predesign tasks: (1) literature review of healing architecture research, (2) analysis and comparison of existing Maggie’s Centres, and (3) analysis of the context of the design project. Results The literature review of scientific research supported the conceptual design and development of the projects. The analysis of existing Maggie’s centers, which demonstrated the interpretation of the evidence by different architects, developed the students’ ability to evaluate EBD in practice critically, and the study of the projects’ local context led the students to define the relevance of the evidence to support their vision for the project. Conclusions The research demonstrates the advantages of practicing EBD at an early stage in healthcare architectural education to enhance awareness of the impact of architectural design on the users’ health and well-being and the potential to support creativity and innovative design. More studies in design studios are needed to assess the full impact of integrating EBD in architectural education.

A Generative Sequential Mixed Methods Approach Using Quantitative Measures to Enhance Social Constructionist Inquiry

2021 ◽  
pp. 155868982098627
Author(s):  
Diego Romaioli
Keyword(s):  
Mixed Methods ◽  
Mixed Methods Research ◽  
Quantitative Methods ◽  
Maslach Burnout Inventory ◽  
Well Being ◽  
Social Constructionist ◽  
Social Scientists ◽  
Mixed Methods Approach ◽  
Qualitative And Quantitative Methods ◽  
Sequential Mixed Methods

In order to enhance core mixed methods research designs, social scientists need an approach that incorporates developments in the social constructionist perspective. This work describes a study that aimed to promote occupational well-being in hospital departments where employees are at risk of burnout, based on a constructionist inquiry developed starting from the Maslach Burnout Inventory. Taking this study as an example, we define a “generative sequential mixed methods approach” as a process that involves consulting quantitative studies to identify criticalities on which to conduct focused, transformative investigations. The article contributes by envisaging ways to mix qualitative and quantitative methods that consider a “generative” and “future-forming” orientation to research, in line with recent shifts in social psychology.

scholarly journals Implementation Science in Pediatric Psychology: The Example of Type 1 Diabetes

2019 ◽  
Vol 44 (9) ◽  
pp. 1068-1073 ◽  
Author(s):  
Julia Price ◽  
Rinad S Beidas ◽  
Courtney Benjamin Wolk ◽  
Kimberly Genuario ◽  
Anne E Kazak
Keyword(s):  
Type 1 Diabetes ◽  
Implementation Science ◽  
Psychosocial Care ◽  
Implementation Strategies ◽  
Well Being ◽  
Pediatric Psychology ◽  
Evidence Based ◽  
Children And Families ◽  
Integration Of Care

Abstract Objective Evidence-based screening, assessment, and intervention practices for youth with type 1 diabetes (T1D) are underutilized. Implementation science (IS) offers theoretical models and frameworks to guide rigorous mixed methods research to advance comprehensive care for children and families. Methods We conducted a targeted review of applications of IS to T1D. Results Pediatric T1D research offers initial, but still limited studies on implementation of evidence-based psychosocial care. IS designates approaches to understanding multi-level factors that influence implementation, ways to alter these factors, and methods to evaluate strategies to improve implementation. Conclusions IS is promising for advancing the translation of pediatric psychology approaches into clinical care. Following the science of implementation, further documentation of the reach of evidence-based care and establishing practice guidelines are important initial steps. Examining the barriers and facilitators of evidence-based psychosocial care can guide the development of testable implementation strategies to improve integration of care. Successful strategies can be evaluated through multi-site controlled implementation trials to explore their effectiveness. These lines of inquiry can be considered within pediatric populations, but may also be used to examine similarities and differences in effectiveness of implementation strategies across populations and settings. Such research has the potential to improve the health and well-being of children and families.

scholarly journals Evolution of Cancer Care Delivery Research in the NCI Community Oncology Research Program

2019 ◽  
Vol 112 (6) ◽  
pp. 557-561 ◽  
Author(s):  
Ann M Geiger ◽  
Ann M O’Mara ◽  
Worta J McCaskill-Stevens ◽  
Brenda Adjei ◽  
Priyanga Tuovenin ◽  
...  
Keyword(s):  
Research Program ◽  
National Cancer Institute ◽  
Cancer Care ◽  
Care Delivery ◽  
Well Being ◽  
Practice Change ◽  
Evidence Based ◽  
Oncology Research ◽  
Community Oncology ◽  
Robust Portfolio

Abstract Research seeking to improve patient engagement with decision-making, use of evidence-based guidelines, and coordination of multi-specialty care has made important contributions to the decades-long effort to improve cancer care. The National Cancer Institute expanded support for these efforts by including cancer care delivery research in the 2014 formation of the National Cancer Institute Community Oncology Research Program (NCORP). Cancer care delivery research is a multi-disciplinary effort to generate evidence-based practice change that improves clinical outcomes and patient well-being. NCORP scientists and community-based clinicians and organizations rapidly embraced the addition of this type of research into the network, resulting in a robust portfolio of observational studies and intervention studies within the first 5 years of funding. This commentary describes the initial considerations in conducting this type of research in a network previously focused on cancer prevention, control, and treatment studies; characterizes the protocols developed to date; and outlines future directions for cancer care delivery research in the second round of NCORP funding.

Quality improvement and implementation science in cancer care: Identifying areas of synergy and opportunities for further integration.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 29-29
Author(s):  
Devon Check ◽  
Leah L. Zullig ◽  
Melinda Davis ◽  
Angela M. Stover ◽  
Louise Davies ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Implementation Science ◽  
Cancer Care ◽  
Performance Monitoring ◽  
Care Delivery ◽  
Evidence Based ◽  
Theoretical Frameworks ◽  
Randomized Design ◽  
Stakeholder Input ◽  
The Impact

29 Background: Efforts to improve cancer care delivery have been driven by two approaches: quality improvement (QI) and implementation science (IS). QI and IS have developed independently but have potential for synergy. To inform efforts to better align these fields, we examined 20 cancer-related QI and IS articles to identify differences and areas of commonality. Methods: We searched PubMed for cancer care studies that used IS or QI methods and were published in the past 5 years in one of 17 leading journals. Through consensus-based discussions, we categorized studies as QI if they evaluated efforts to improve the quality, value, or safety of care, or IS if they evaluated efforts to promote the adoption of evidence-based interventions into practice. We identified the 10 most frequently cited studies from each category (20 total studies), characterizing and comparing their objectives, methods – including use of theoretical frameworks involvement of stakeholders – and terminology. Results: All IS studies (10/10) and half (5/10) of QI studies addressed barriers to uptake of evidence-based practices. The remaining five QI studies sought to improve clinical outcomes, reduce costs, and/or address logistical issues. QI and IS studies employed common approaches to change provider and/or organizational practice (e.g., training, performance monitoring/feedback, decision support). However, the terminology used to describe these approaches was inconsistent within and between IS and QI studies. Fewer than half (8/20) of studies (4 from each category) used a theoretical or conceptual framework and only 4/20 (2 from each category) consulted key stakeholders in developing their approach. Most studies (10/10 IS and 6/10 QI) were multi-site, and most were observational, with only 4/20 studies (2 from each category) using a randomized design to evaluate their approach. Conclusions: Cancer-related QI and IS studies had overlapping objectives and used similar approaches but used inconsistent terminology. The impact of IS and QI on cancer care delivery could be enhanced by greater harmonization of language and by promoting rigor through the use of conceptual frameworks and stakeholder input.

scholarly journals PLACE MATTERS: HOW LOCATION AT DEATH INFLUENCES CAREGIVER WELL-BEING IN BEREAVEMENT

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S136-S136
Author(s):  
Deborah P Waldrop ◽  
Jacqueline M McGinley
Keyword(s):  
Older Adults ◽  
Quantitative Methods ◽  
Hospice Care ◽  
Well Being ◽  
Care Recipient ◽  
Categorical Variables ◽  
Qualitative And Quantitative Methods ◽  
Care Recipients ◽  
Location Of Death ◽  
Actual Location

Abstract Most older adults express the preference to die at home, but the desire for home death may go unfulfilled when the dying process become burdensome. Little is known about the congruence between older adults’ and their caregivers’ desired locations at death. The purpose of this study was to explore how the congruence between caregiver-care recipients desired and actual location at death influenced well-being in bereavement. This exploratory study utilized simultaneous qualitative and quantitative methods. Interviews were conducted with 108 bereaved caregivers about 4 months after the care recipient died while receiving hospice care. Care recipients’ ages ranged from 43-101 (M=79.6); caregivers from 32-88 (M=61.5). Quantitative data included categorical variables about demographics, advance care planning and location at death. The Core Bereavement Items and CDC HRQOL–14 "Healthy Days Measure" scales were used. Qualitative data involved open-ended questions about the illness trajectory, desired location and perceptions of care at life’s end. Quantitative analysis included comparison of group differences using both Independent Samples t-tests and One-way ANOVA. Of the 92 care recipients who had an advance directive, N=49 (45%) were in the location they desired and for N=49 (45%) there was caregiver/care recipient congruence about location. Caregivers who experienced incongruence reported poorer physical and emotional well-being and higher, more intense bereavement symptoms. Three overarching themes illuminated caregivers’ experiences: (1) Caregiver-recipient congruence; (2) Caregiver-recipient incongruence; (3) Incongruence-influenced bereavement. Results suggest that incongruence between desired and actual location of death affects well-being in bereavement. Implications: Communication about location at death is an essential consideration.

Four distinct patient-reported outcome (PRO) trajectories in longitudinal responses collected before, during, and after chemotherapy.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2012-2012
Author(s):  
Douglas W. Blayney ◽  
Amee Azad ◽  
Melih Yilmaz ◽  
Selen Bozkurt ◽  
James D. Brooks ◽  
...  
Keyword(s):  
At Risk ◽  
Real World ◽  
Care Delivery ◽  
Global Mental Health ◽  
Well Being ◽  
Patient Reported Outcome ◽  
Post Treatment ◽  
Measurement Information ◽  
Patient Reported ◽  
Pre Treatment

2012 Background: Cancer chemotherapy, whether given with curative or palliative intent, is toxic. Toxicity is routinely captured in clinical trials by investigator observation and increasingly by PRO. The ability to capture PRO in the routine treatment workflow has been standard at Stanford since 2015 (Roy et al ASCO 2020). Analysis of longitudinally captured, real world PRO and prospectively identifying patients (pts) whose quality of life (QOL) is at risk of deteriorating either permanently or temporarily is needed. Routine serial PRO measurement should enhance precision care delivery, precision toxicity detection and management. Methods: We identified patients undergoing chemotherapy at Stanford and analyzed PROMIS (PRO Measurement Information System) responses. Pts with PROMIS survey information at three intervals—pre-treatment, during chemotherapy and post chemotherapy—were identified. We evaluated global physical health (GPH) and global mental health (GMH). Pts with a clinically significant decrease (CSD) in GPH or GMH scores were identified. A k-median cluster analysis was used to identify patient trajectory clusters and a machine-learning model was applied to identify risk factors for CSD and predict CSD. Results: We identified 670 adult oncology patients undergoing chemotherapy who completed at least one PROMIS survey in each interval. GPH scores were 48.4 ± 9.1 before, 47.1 ± 8.5 during, and 48.5 ± 8.9 after chemotherapy and GMH scores were 50.5 ± 8.2, 49.1 ± 8.5, and 50.7 ± 9.0, respectively. The majority of patients did not have a CSD in GPH or GMH post treatment compared to pretreatment scores. Pretreatment scores were the strongest predictor of a CSD in GPH and GMH. Trajectory clustering identified four distinct trajectories: Temporary Improver, Temporary Deteriorator, Improver, Inexorable Deteriorators. We were not able to predict any cluster based on pre-treatment features. Conclusions: Using routinely collected PROMIS surveys in a real-world setting, we are able to predict patients with post-treatment decreases in their physical and mental well-being. We further defined four novel patient trajectories during chemotherapy, which could guide personalized supportive interventions to improve patient’s chemotherapy experience. Identification of patients at risk for deterioration and the patterns of deterioration could help guide efficient deployment of toxicity mitigating and supportive care interventions to patients most in need.

Abstract 400: Novel Training In Implementation Science To Accelerate Evidence Into Practice

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Stacy Farr ◽  
Carole J Decker ◽  
Anne Sales ◽  
John Spertus
Keyword(s):  
Implementation Science ◽  
Real World ◽  
Care Delivery ◽  
Unmet Need ◽  
Likert Scale ◽  
Dissemination And Implementation ◽  
Practical Training ◽  
Certificate Program ◽  
Local Public Health ◽  
State And Local

Research Objective: Translating evidence into practice and communities is a complex process that often takes years. The shifting healthcare landscape from volume- to value-based demands learning health systems shift to more rapid uptake of evidence. The field of dissemination and implementation (D&I) science seeks to inform how evidence-based interventions can be successfully adopted, implemented and maintained in health care delivery and community settings. A significant challenge in implementing evidence into practice is finding researchers and the health workforce trained and equipped with the skills to do so in real world settings. This challenge is compounded by the fact that there are limited and highly competitive opportunities for training in D&I. Thus, a curriculum and certificate program, Training in Implementation: Actionable Research Approaches (TIARA) was developed and implemented to provide researchers and providers with skills in D&I. Study Design: Two projects are being implemented regionally across multiple hospitals. Prior to the projects' implementation, TIARA was launched. TIARA consists of four components: 1) completing four training module sessions by a national leader; 2) a pre- and post-knowledge assessment, 3) participation at four community forums on healthcare topics, and 4) compiling a Project Summary assignment. Population Studied: Study participants came from 14 regional hospitals, 4 healthcare payer organizations, 2 state hospital associations, 4 state and local public health departments, and 9 community based organizations, and 3 regional academic institutions. Over 120 individuals participated in the four TIARA training modules. Principal Findings: In late 2019, 16 individuals completed the requirements for, and received, TIARA Certificates. Over 60 percent of participants said their level of D&I expertise increased after taking part in the training. Across all eight competencies in implementation science, participants increased an average of 4 points on a 1-10 point Likert scale. Evaluations of TIARA demonstrated high levels of satisfaction with the program, relevance, and helpfulness of the program for their profession (average of 4.2 on a 1-5 Likert scale). Participants also showed high levels of satisfaction with the content of each of the sessions and frequency of communication (average of 4.6 on 1-5 Likert scale). The TIARA Certificate program contributed to 6 grant submissions, 4 real-world implementation projects, and 4 publications and/or presentations. Conclusions: There is a significant unmet need to expand skills, through both theoretical and practical training, to multiple organizations to reach a broader workforce of researchers, providers, and administrators. TIARA is one promising program to train, support, and encourage these stakeholders.

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