scholarly journals A Strategy Matching Tool for Boosting Implementation of Geriatric Telehealth Services in Rural CBOCs

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 120-120
Author(s):  
Laura Kernan ◽  
Eileen Dryden ◽  
Camilla Pimentel ◽  
Kathryn Nearing ◽  
Lauren Moo
Keyword(s):  
Change Implementation ◽  
Outpatient Clinics ◽  
Veterans Administration ◽  
Community Based ◽  
Hub And Spoke ◽  
Implementing Change ◽  
Medical Centers ◽  
Implementation Approach ◽  
Facilitators And Barriers ◽  
Expert Recommendations

Abstract Fifteen Veterans Administration Medical Centers (VAMCs) offer geriatric specialty care telehealth services through a hub and spoke model to patients at affiliated community-based outpatient clinics (CBOCs). These services are not used to the extent they could be. Through interviews with 50 staff and providers at rural CBOCs we identified several implementation facilitators and barriers. CBOC-level barriers included space constraints, low staffing, internet connection issues, and limited knowledge of services available and referral processes. Patient-level barriers included discomfort with technology, cognitive decline, and inability to travel to the CBOC. We found that champions within the CBOC and iterative, targeted outreach from the hub helped facilitate uptake of services. We entered the identified barriers into the CFIR-ERIC (Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change) Implementation Strategy Matching Tool to help generate targeted strategies that will be used to refine each hub’s implementation approach.

scholarly journals Providing Specialty Telehealth Care to Older, Rural Patients: Voices From Field

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 118-119
Author(s):  
Eileen Dryden ◽  
Lauren Moo
Keyword(s):  
Rural Areas ◽  
Specialty Care ◽  
Older Patient ◽  
Viable Option ◽  
Urban Centers ◽  
Community Based ◽  
Hub And Spoke ◽  
Medical Centers ◽  
Facilitators And Barriers ◽  
Rural Patients

Abstract Older, rural adults have limited access to quality geriatric specialty care for several reasons including relatively few geriatric specialists in rural areas and lack of transportation options or patient ability to travel to more urban centers. GRECC Connect is a promising telehealth-hub and spoke model that provides rural patients access to teams of multidisciplinary geriatric specialists in more urban medical centers primarily by video connection with affiliated community-based outpatient clinics (CBOCs). This model provides a viable option for increasing access to geriatric specialty care for rural patients but is not used to the extent it could be. To date, much of our understanding of this model has come from the experts at the hub medical centers. To learn more about the experience of this model from the field we interviewed CBOC staff and providers as well as Veterans and their caregivers about geriatric specialty telehealth services. In this symposium we will discuss facilitators and barriers to implementing this model from the perspective of the field and then explore more deeply both the context of the CBOC environment and the older patient population served by rural CBOCs to further understand the challenges that are faced in attempting to connect older patients with telehealth services. Finally, we will share the perceived value of the service and alignment with local needs. This deeper understanding of the experience of the ‘spoke’ may help enhance access to much needed geriatric specialty care for rural veterans.

scholarly journals Qualitative Evaluation: GRECC Connect as a Method of Delivering Health Care to Rural Older Veterans

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 119-119
Author(s):  
Lauren Moo ◽  
William Hung ◽  
Eileen Dryden ◽  
Camilla Pimentel ◽  
Laura Kernan ◽  
...  
Keyword(s):  
Health Care ◽  
Social Workers ◽  
Family Caregivers ◽  
Rural Health ◽  
Qualitative Evaluation ◽  
Outpatient Clinics ◽  
Multiple Perspectives ◽  
Community Based ◽  
Stakeholder Groups ◽  
Medical Centers

Abstract The VA Office of Rural Health-funded GRECC Connect program uses telehealth modalities to provide geriatric specialty care to rural older veterans and education to clinicians in VA Community-based outpatient clinics (CBOCs). Qualitative evaluation of GRECC Connect has included interviews with three stakeholder groups: geriatrics specialty teams at 15 hub medical centers, rural CBOC staff, and patients/family caregivers. CBOC staff interviews included 50 individuals from 13 different CBOCs. Staff roles included clinic managers, social workers, psychologists, physicians, nurses, and telehealth technicians. Older veterans who had recently been involved in a GRECC Connect video visit were also invited to share their views on the visit. By including multiple perspectives on the program, we are better positioned to increase reach, access, and improve care for older rural veterans.

scholarly journals Facilitators and barriers to the utilization of the ACT SMART Implementation Toolkit in community-based organizations: a qualitative study

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Aksheya Sridhar ◽  
Amy Drahota ◽  
Kiersten Walsworth
Keyword(s):  
Technology Acceptance ◽  
Technology Acceptance Model ◽  
Autism Spectrum ◽  
Ease Of Use ◽  
Science Literature ◽  
Community Based ◽  
Web Based ◽  
Community Based Organizations ◽  
Facilitators And Barriers ◽  
Acceptance Model

Abstract Background Evidence-based practices (EBPs) have been shown to improve behavioral and mental health outcomes for children diagnosed with autism spectrum disorder (ASD). Research suggests that the use of these practices in community-based organizations is varied; however, the utilization of implementation guides may bridge the gap between research and practice. The Autism Community Toolkit: Systems to Measure and Adopt Research-Based Treatments (ACT SMART) Implementation Toolkit is a web-based implementation toolkit developed to guide organization-based implementation teams through EBP identification, adoption, implementation, and sustainment in ASD community-based organizations. Methods This study examined the facilitators and barriers (collectively termed “determinants”) to the utilization of this toolkit, based on the perspectives of implementation teams at six ASD community-based organizations. Two independent coders utilized the adapted EPIS framework and the Technology Acceptance Model 3 to guide qualitative thematic analyses of semi-structured interviews with implementation teams. Results Salient facilitators (e.g., facilitation teams, facilitation meetings, phase-specific activities) and barriers (e.g., website issues, perceived lack of ease of use of the website, perceived lack of resources, inner context factors) were identified, highlighting key determinants to the utilization of this toolkit. Additionally, frequent determinants and determinants that differed across adapted EPIS phases of the toolkit were noted. Finally, analyses highlighted two themes: (a) Inner Context Determinants to use of the toolkit (e.g., funding) and (b) Innovation Determinants (e.g., all website-related factors), indicating an interaction between the two models utilized to guide study analyses. Conclusions Findings highlighted several factors that facilitated the utilization of this implementation guide. Additionally, findings identified key areas for improvement for future iterations of the ACT SMART Implementation Toolkit. Importantly, these results may inform the development, refinement, and utilization of implementation guides with the aim of increasing the uptake of EBPs in community-based organizations providing services to children with ASD and their families. Finally, these findings contribute to the implementation science literature by illustrating the joint use of the EPIS framework and Technology Acceptance Model 3 to evaluate the implementation of a web-based toolkit within community-based organizations.

scholarly journals Enabling Sustainable Organizational Change: A Case of Cognitive Diversity in the Automotive Industry

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Tonja Blom ◽  
Yvonne du Plessis ◽  
Hamid H Kazeroony
Keyword(s):  
Organizational Change ◽  
Single Case ◽  
Research Question ◽  
Diversity Management ◽  
Change Implementation ◽  
Cognitive Diversity ◽  
Single Case Study ◽  
Niche Theory ◽  
Implementing Change

In diverse societies such as South Africa, organizations continue to face inclusion challenges when implementing change. This study proposes a different method and new dimension of diversity management within the cognitive diversity construct, namely human niche theory, to tackle the diversity dilemma of exclusivity. The research question asked whether human niche theory, as a defined concept within cognitive diversity, could be utilized by managers to enable inclusion and promote sustainable organizational change implementation. Conceptually, this paper relates human niche theory to seven themes in the change process, namely, communication, training, motivation, resources, control, monitoring, and feedback. An exploratory single case study in a multicultural South African automotive organization that implemented a company-wide technology change project was used as a unit of analysis. The single case study revealed a new understanding of change implementation processes using the human niche theoretical framework related to radical technological change implementation. Data collection included in-depth interviews, focus group sessions, solicited company data, field notes, and observations. Content and comparative data analysis were used to present findings. This research showed that managers’ awareness of human niche theory in terms of cognitive diversity could assist in managing diversity, enabling inclusion, and change effectiveness in the organization, while minimizing emotional exclusion.

The Primary Physician and the Death of a Child in a Specialized Hospital Setting

PEDIATRICS ◽  
1983 ◽  
Vol 71 (3) ◽  
pp. 443-445
Author(s):  
MORRIS A. WESSEL
Keyword(s):  
Social Workers ◽  
Hospital Setting ◽  
Infants And Children ◽  
Hospital Service ◽  
Community Based ◽  
Medical Centers ◽  
Primary Physician ◽  
Hospital Physicians ◽  
Death Of A Child ◽  
Specialized Hospital

Pediatricians offer ongoing comprehensive and coordinate care for children. Community-based primary pediatricians assume a large proportion of this repsonsibility, referring a few patients to collegues with specialized skills for consultation and treatment. These consultants, who are often fulltime members of university or other medical centers, provide care extending the lives of many children suffering illnesses that formerly were fatal early in the course of the disease. Some infants and children unfortunately do die after many months or years of treatment at a specialized clinic or hospital service. When this tragedy occurs, parents and siblings have the difficult task of relinquishing their relationship to hospital physicians, nurses, and social workers who have sustained them for many months or years.

scholarly journals Understanding the Most Important Facilitators and Barriers for Online Education during COVID-19 through Online Photovoice Methodology

2020 ◽  
Vol 10 (1) ◽  
pp. 166
Author(s):  
İbrahim Doyumğaç ◽  
Ahmet Tanhan ◽  
Mustafa Said Kiymaz
Keyword(s):  
Distance Education ◽  
Online Education ◽  
Interpretative Phenomenological Analysis ◽  
Community Based Participatory Research ◽  
Learning Opportunities ◽  
Economic Resources ◽  
Community Based ◽  
Main Research ◽  
Institutional Review ◽  
Facilitators And Barriers

There are three main research goals in this study including (a) understanding the most important facilitators (support, strength) and complicators (barrier, concern, issues, problems) for online or distance education during COVID-19 from the unique perspective of college students, academicians, and teachers through Online Photovoice (OPV); (b) advocating with the volunteer participants and partners as allies to share the results with the key people and institutions through online avenues to enhance facilitators and address complicators; and finally, (c) investigating participants’ attribution of facilitators and complicators based on Ecological Systems Theory (EST) levels. The researchers utilized the adapted Turkish version of OPV to collect and used Online Interpretative Phenomenological Analysis (OIPA) to analyze the data. Community-Based Participatory Research (CBPR) grounded in EST constructed the theoretical framework for the research. In total, 115 participants completed and consented for the study. Sixteen main facilitator-related themes emerged, and the five most expressed were having technology (n = 31, 35%), internet (n = 28, 32%), communication (n =18, 20%), emotions (n = 17, 19%), and economic resources (n = 16, %18). Thirteen main complicators-related themes emerged, and the five most reported barriers were lacks of technological resources (n = 41, 47%), internet (n = 40, 46%), appropriate learning environments, learning opportunities (n = 32, 36%) appropriate resources for online or distance education (n = 18, 20%), and interaction (n = 14, 16%). Participants attributed the facilitator and complicators to EST levels respectively as follows: individual/intrapsychic factors (84%; 69%), microsystem (45%; 59%), exosystem (36%; 43%), and macrosystem (34%; 44%). The researchers provided practical recommendations. The researchers obtained an institutional review board approval for this study.

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