scholarly journals Implementation Science Translation: Program Sustainment for Managing Distress Behavior in Dementia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 537-538
Author(s):  
Kim Curyto ◽  
Ann Kolanowski
Keyword(s):  
Nursing Home ◽  
Usual Care ◽  
Implementation Science ◽  
Implementation Strategies ◽  
Care Practice ◽  
Evidence Based ◽  
Effective Management ◽  
Clinical Practices ◽  
Science Concepts ◽  
Evidence Based Programs

Abstract Distress behaviors in dementia (DBD) are common in nursing home settings, are distressing, and result in poorer outcomes for residents and staff. We present on the implementation of STAR-VA, an interdisciplinary intervention for effective management of DBD in Veterans Health Administration (VA) nursing home settings, called Community Living Centers (CLCs). A primary focus of this symposium is the use of implementation science concepts to improve and sustain evidence-based programs through tailored implementation strategies and key partnerships. Key implementation science concepts from conceptual frameworks, including the Consolidated Framework for Implementation Research (CFIR) and the use of organizational Knowledge Reservoirs (KR) for sustaining new clinical practices, formed the basis of this work. Their application in health care practice will be discussed using STAR-VA as an exemplar. Interdisciplinary CLC staff feedback during STAR-VA implementation and sustainment is presented, including feedback regarding barriers to integrating new program interventions into usual care processes. Mapping key implementation strategies onto reported barriers informed development of implementation tools and strategies designed to guide adaptions tailored to the needs of the residents and frontline staff, increasing the chances of successful sustainment. Finally, we highlight the importance of key leadership partnerships in implementation of evidence-based programs to improve care of residents with DBD and present strategies for developing these partnerships. Discussion will include the importance of using implementation science to implement evidence-based interventions for effective management of DBD and strategies for sustainment of these effective practices into usual care.

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.

scholarly journals Application of an antiracism lens in the field of implementation science (IS): Recommendations for reframing implementation research with a focus on justice and racial equity

2021 ◽  
Vol 2 ◽  
pp. 263348952110494
Author(s):  
Rachel C. Shelton ◽  
Prajakta Adsul ◽  
April Oh ◽  
Nathalie Moise ◽  
Derek M. Griffith
Keyword(s):  
Implementation Science ◽  
Health Equity ◽  
Implementation Research ◽  
Implementation Strategies ◽  
Health Inequities ◽  
Evidence Based ◽  
Racial Equity ◽  
Structural Racism ◽  
Core Elements ◽  
Evaluation Approaches

Background Despite the promise of implementation science (IS) to reduce health inequities, critical gaps and opportunities remain in the field to promote health equity. Prioritizing racial equity and antiracism approaches is critical in these efforts, so that IS does not inadvertently exacerbate disparities based on the selection of frameworks, methods, interventions, and strategies that do not reflect consideration of structural racism and its impacts. Methods Grounded in extant research on structural racism and antiracism, we discuss the importance of advancing understanding of how structural racism as a system shapes racial health inequities and inequitable implementation of evidence-based interventions among racially and ethnically diverse communities. We outline recommendations for explicitly applying an antiracism lens to address structural racism and its manifests through IS. An anti-racism lens provides a framework to guide efforts to confront, address, and eradicate racism and racial privilege by helping people identify racism as a root cause of health inequities and critically examine how it is embedded in policies, structures, and systems that differentially affect racially and ethnically diverse populations. Results We provide guidance for the application of an antiracism lens in the field of IS, focusing on select core elements in implementation research, including: (1) stakeholder engagement; (2) conceptual frameworks and models; (3) development, selection, adaptation of EBIs; (4) evaluation approaches; and (5) implementation strategies. We highlight the need for foundational grounding in antiracism frameworks among implementation scientists to facilitate ongoing self-reflection, accountability, and attention to racial equity, and provide questions to guide such reflection and consideration. Conclusion We conclude with a reflection on how this is a critical time for IS to prioritize focus on justice, racial equity, and real-world equitable impact. Moving IS towards making consideration of health equity and an antiracism lens foundational is central to strengthening the field and enhancing its impact. Plain language abstract There are important gaps and opportunities that exist in promoting health equity through implementation science. Historically, the commonly used frameworks, measures, interventions, strategies, and approaches in the field have not been explicitly focused on equity, nor do they consider the role of structural racism in shaping health and inequitable delivery of evidence-based practices/programs. This work seeks to build off of the long history of research on structural racism and health, and seeks to provide guidance on how to apply an antiracism lens to select core elements of implementation research. We highlight important opportunities for the field to reflect and consider applying an antiracism approach in: 1) stakeholder/community engagement; 2) use of conceptual frameworks; 3) development, selection and adaptation of evidence-based interventions; 4) evaluation approaches; 5) implementation strategies (e.g., how to deliver evidence-based practices, programs, policies); and 6) how researchers conduct their research, with a focus on racial equity. This is an important time for the field of implementation science to prioritize a foundational focus on justice, equity, and real-world impact through the application of an anti-racism lens in their work.

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.

Implementation Science

2020 ◽  
Author(s):  
Enola Proctor ◽  
Alicia Bunger
Keyword(s):  
Social Work ◽  
Implementation Science ◽  
Implementation Strategies ◽  
Work Practice ◽  
Social Work Practice ◽  
Research Translation ◽  
Evidence Based ◽  
Implementation Studies ◽  
Specific Implementation ◽  
Key Terms

Implementation science seeks to inform how to deliver evidence-based interventions, programs, and policies in real-world settings so their benefits can be realized and sustained. The aim of implementation science is building a base of evidence about the most effective processes and strategies for improving service delivery. Implementation research builds upon effectiveness research and then seeks to discover how to use specific implementation strategies and to move interventions into specific settings, extending their availability, reach, and benefits to clients and communities. This article provides an overview of implementation science as a component of research translation with an emphasis on traditional social work practice settings. The article begins by defining key terms, including implementation and evidence-based interventions. To inform conceptualization of implementation studies, the article continues with an overview of guiding implementation theories, models, and frameworks that explain the role of the multi-level practice context for implementation. Next, the article defines implementation strategies, identifies sources of implementation strategies, and provides recommendations for specifying and describing strategies that allow for replication. The article then describes methodological issues, including variable measurement, research design, and stakeholder engagement. Given the importance of designing implementation studies that optimize both internal and external validity, there is special attention to creative alternatives to traditional randomized controlled trials, and the potential for participatory and systems approaches. Finally, the article concludes with a discussion of future directions for implementation science in social work.

scholarly journals Using Implementation Science Strategy Mapping on the Age-Friendly Health System's 4Ms Journey

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 365-365
Author(s):  
Mary Dolansky ◽  
Anne Pohnert ◽  
Sherry Greenberg
Keyword(s):  
Implementation Science ◽  
Scale Up ◽  
Implementation Strategies ◽  
Mapping Method ◽  
Evidence Based ◽  
Systematic Process ◽  
Implementing Change ◽  
Implementation Outcomes ◽  
Adoption And Implementation ◽  
And Performance

Abstract Background Implementation science is the study of methods to promote the adoption and integration of evidence-based practices into routine health care to improve the quality of care. The purpose of this study was to use Implementation Mapping to guide the implementation of The John A. Hartford evidence-based Age-Friendly Health Systems (AFHS) 4Ms Framework: What Matters, Medications, Mentation, and Mobility. Methods Implementation Mapping, a systematic process for planning implementation strategies, guided the 9-month integration of the 4Ms Framework in the 1,100 MinuteClinics across the US. Implementation Mapping includes five tasks: (1) conduct an implementation needs assessment and identify program adopters and implementers; (2) state adoption and implementation outcomes and performance objectives, identify determinants, and create matrices of change objectives; (3) choose theoretical methods (mechanisms of change) and select or design implementation strategies; (4) produce implementation protocols and materials; and (5) evaluate implementation outcomes. Results The implementation plan, developed by the implementation mapping method, was carried out over 9-months. Seven implementation strategies were identified from the Expert Recommendations for Implementing Change (ERIC) project including the provision of education, electronic health record integration, internal champion facilitation, cues to action, and a dashboard to monitor progress. To date, the implementation mapping has resulted in the adoption of the 4Ms by 1145 providers (37%). Monitoring of the adoption of the 4Ms Framework and consideration of future implementation strategies is ongoing. Conclusions Implementation Mapping provided a systematic process to develop strategies to improve the adoption, implementation, sustainment, and scale-up of the evidence-based 4Ms Framework.

Excellent multi-stakeholder acceptability and reimbursable costs in a pilot pragmatic trial of an evidence-based physical activity counseling intervention for patients with type 2 diabetes

2020 ◽  
Author(s):  
Amy G. Huebschmann ◽  
Russell E Glasgow ◽  
Ian M Leavitt ◽  
Kristi Chapman ◽  
John D Rice ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Usual Care ◽  
Physical Function ◽  
Pragmatic Trial ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Multi Level

Abstract Background: Physical activity (PA) improves important health outcomes for patients with type 2 diabetes mellitus (T2D), including physical function. We iteratively adapted the implementation strategies of pragmatic and evidence-based PA counseling programs to meet primary care stakeholders’ needs, resulting in the “Be ACTIVE” program. In a pilot randomized pragmatic trial, we evaluated the feasibility, acceptability and effectiveness of Be ACTIVE. Methods: Formative activities involved engaging multi-level stakeholders (patients, clinicians, coaches) to tailor implementation strategies for Be ACTIVE to the primary care context, while taking care to preserve the core “functions” of Be ACTIVE. Be ACTIVE included: a PA tracker (FitBit©), six theory-informed PA counseling phone calls, and three in-person clinician visits. Sedentary patients with T2D from two academic primary care clinics were randomized to Be ACTIVE vs. enhanced usual care. We used mixed methods to assess implementation outcomes of feasibility and acceptability among multi-level stakeholders, including costs. Objective effectiveness outcomes included PA (primary outcome, steps/week), physical function (secondary outcomes, including Short Physical Performance Battery (SPPB)), and behavioral PA predictors. Results: Multi-level stakeholders were engaged in formative activities to design a feasible pragmatic intervention. Fifty patients were randomized to Be ACTIVE or enhanced usual care. Acceptability was >90% for patients and clinic staff. In-person visits were fully reimbursed, and counseling costs of ~$90/patient would be reimbursable by Medicare. Pre-post PA increased by ~11% absolute in the Be ACTIVE group and by ~6% in controls (group difference: 1574 ± 4391 steps/week, p = 0.72) — less than the clinically important threshold of 4200 steps/week. Be ACTIVE participants’ physical function improved more than controls (SPPB: +0.9 ± 0.3 versus -0.1 ± 0.3, p = 0.01, changes >0.5 points are clinically important for preventing falls), and for PA predictors of self-efficacy (p=0.02) and social-environmental support (p<0.01). Conclusions: In this pilot trial, Be ACTIVE was feasible and highly acceptable to stakeholders and yielded significant improvements in objective physical function consistent with lower fall risk, while changes in PA were less than anticipated. Be ACTIVE may need adaptation or longer duration to clinically improve PA outcomes. Further optimizing the implementation strategies for sustainability is also needed.

scholarly journals The Importance of Mental Models in Implementation Science

2020 ◽  
Author(s):  
Jodi Summers Holtrop ◽  
Laura Scherer ◽  
Daniel Matlock ◽  
Russell E Glasgow ◽  
Lee A Green
Keyword(s):  
Mental Models ◽  
Implementation Science ◽  
Cognitive Task ◽  
Implementation Strategies ◽  
Successful Implementation ◽  
Evidence Based ◽  
Structured Interviews ◽  
Implementation Challenges ◽  
The World ◽  
The Way

Abstract Background: Implementation science is concerned with the study of adoption, implementation and maintenance of evidence-based interventions and use of implementation strategies to facilitate translation into practice. Ways to conceptualize and overcome challenges to implementing evidence-based practice may enhance the field of implementation science. The concept of mental models may be one way to view such challenges and to guide selection, use and adaptation of implementation strategies. Methods: A mental model is an interrelated set of beliefs that shape how a person forms expectations for the future and understands the way the world works. Mental models can shape how an individual thinks about or understands how something or someone does, can, or should function in the world. We review the concepts of mental models and illustrate how they pertain to implementation of an example intervention, shared decision making. A range of methods to elicit and analyze mental models are reviewed, including formal methods developed specifically for a given project. Results: Mental models may be sparse or detailed, may be shared among actors in implementation or not, and may be substantially tacit, i.e., of limited accessibility to introspection. Actors’ mental models can determine what information they are willing to accept and what changes they are willing to consider. We describe and illustrate multiple methods for eliciting and analyzing mental models including semi-structured interviews, cognitive task analyses and Delphi methods. Conclusions: Understanding the mental models of actors in implementation can provide crucial information for understanding, anticipating, and overcoming implementation challenges. Successful implementation often requires changing actors’ mental models or the way in which interventions or implementation strategies are presented or implemented. Accurate elicitation and understanding can guide strategies for doing so.

scholarly journals Transforming Mental Health Delivery Through Behavioral Economics and Implementation Science: Protocol for Three Exploratory Projects (Preprint)

2018 ◽  
Author(s):  
Rinad S Beidas ◽  
Kevin G Volpp ◽  
Alison N Buttenheim ◽  
Steven C Marcus ◽  
Mark Olfson ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Data Collection ◽  
Behavioral Economics ◽  
Psychiatric Disorders ◽  
Implementation Science ◽  
Participatory Design ◽  
Implementation Strategies ◽  
Successful Implementation ◽  
Evidence Based

BACKGROUND Efficacious psychiatric treatments are not consistently deployed in community practice, and clinical outcomes are attenuated compared with those achieved in clinical trials. A major focus for mental health services research is to develop effective and cost-effective strategies that increase the use of evidence-based assessment, prevention, and treatment approaches in community settings. OBJECTIVE The goal of this program of research is to apply insights from behavioral economics and participatory design to advance the science and practice of implementing evidence-based practice (EBP) for individuals with psychiatric disorders across the life span. METHODS Project 1 (Assisting Depressed Adults in Primary care Treatment [ADAPT]) is patient-focused and leverages decision-making heuristics to compare ways to incentivize adherence to antidepressant medications in the first 6 weeks of treatment among adults newly diagnosed with depression. Project 2 (App for Strengthening Services In Specialized Therapeutic Support [ASSISTS]) is provider-focused and utilizes normative pressure and social status to increase data collection among community mental health workers treating children with autism. Project 3 (Motivating Outpatient Therapists to Implement: Valuing a Team Effort [MOTIVATE]) explores how participatory design can be used to design organizational-level implementation strategies to increase clinician use of EBPs. The projects are supported by a Methods Core that provides expertise in implementation science, behavioral economics, participatory design, measurement, and associated statistical approaches. RESULTS Enrollment for project ADAPT started in 2018; results are expected in 2020. Enrollment for project ASSISTS will begin in 2019; results are expected in 2021. Enrollment for project MOTIVATE started in 2018; results are expected in 2019. Data collection had begun for ADAPT and MOTIVATE when this protocol was submitted. CONCLUSIONS This research will advance the science of implementation through efforts to improve implementation strategy design, measurement, and statistical methods. First, we will test and refine approaches to collaboratively design implementation strategies with stakeholders (eg, discrete choice experiments and innovation tournaments). Second, we will refine the measurement of mechanisms related to heuristics used in decision making. Third, we will develop new ways to test mechanisms in multilevel implementation trials. This trifecta, coupled with findings from our 3 exploratory projects, will lead to improvements in our knowledge of what causes successful implementation, what variables moderate and mediate the effects of those causal factors, and how best to leverage this knowledge to increase the quality of care for people with psychiatric disorders. CLINICALTRIAL ClinicalTrials.gov NCT03441399; https://www.clinicaltrials.gov/ct2/show/NCT03441399 (Archived by WebCite at http://www.webcitation.org/74dRbonBD) INTERNATIONAL REGISTERED REPOR DERR1-10.2196/12121

scholarly journals Implementation Science and Implementation Science Communications: a refreshed description of the journals’ scope and expectations

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Michel Wensing ◽  
Anne Sales ◽  
Paul Wilson ◽  
Rebecca Armstrong ◽  
Roman Kislov ◽  
...  
Keyword(s):  
Implementation Science ◽  
Professional Education ◽  
Financial Incentives ◽  
Empirical Studies ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Organizational Changes ◽  
Evidence Based Practices ◽  
Central Interest ◽  
Time Reading

AbstractThis editorial provides a comprehensive consolidated overview of the scope and expectations of Implementation Science and Implementation Science Communications. We remain most interested in rigorous empirical studies of the implementation of evidence-based healthcare practices (including interventions, technologies, and policies) and the de-implementation of practices that are demonstrated to be of low or no benefit. Implementation strategies (e.g., continuing professional education, organizational changes, and financial incentives to enhance the uptake of evidence-based practices) are of central interest to the journals. We see the field as large and complex, with a wide literature that is published in many venues. We urge people for whom it is new to spend some time reading the existing literature, and learning the scope of the work that has already been done, and published, in our journals and in an increasing number of other journals in the field.

scholarly journals Implementation Strategies for Widespread Scaling of Effective Programs into Healthcare systems

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 50-50
Author(s):  
Jaime Hughes
Keyword(s):  
Older Adults ◽  
Technical Assistance ◽  
Implementation Strategies ◽  
Consumer Involvement ◽  
Evidence Based ◽  
Health Promotion Programs ◽  
Or Practice ◽  
Clinical Program ◽  
Evidence Based Programs ◽  
And Training

Abstract Translation of effective evidence-based programs into practice is critical to promoting and preserving older adults’ function and independence. This presentation will provide an introduction to implementation strategies, defined as the “methods or techniques used to enhance the adoption, implementation, and sustainability of a clinical program or practice.” Some examples of implementation strategies include education and training, stakeholder engagement, patient and/or consumer involvement, adaptation, and technical assistance. Application of these implementation strategies will be illustrated using examples from local and national scale out of evidence-based health promotion programs for older adults within the VA Healthcare System. This presentation will close with guidance on how to select, track, and evaluate implementation strategies.

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