scholarly journals Tracking Adaptation and Fidelity When Embedding COPE, Evidence-Based Dementia Care, in PACE Sites

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 176-176
Author(s):  
Laura Gitlin ◽  
Nancy Hodgson
Keyword(s):  
Program Implementation ◽  
Implementation Strategies ◽  
Care Program ◽  
Dementia Care ◽  
Theory Of Change ◽  
Evidence Based ◽  
Delivery Methods ◽  
Implementing Change ◽  
Essential Question ◽  
Core Components

Abstract One essential question in moving dementia care interventions to practice is, “What is the optimal balance between fidelity to, and adaptation of, a proven program in “real world” settings?" We present a protocol for measuring the adaptation/fidelity and implementation of an evidence-based dementia care program (Care of Persons in their Environment, COPE) in PACE settings. During pre-implementation, science-based elements of COPE were documented including the theory of change, logic model and core components. Possible adaptations to COPE in its delivery were identified and included program structure (sequence of sessions), content (assessments), and delivery methods (online). During implementation, documentation of implementation strategies is captured using an evidence-informed checklist derived from the Expert Recommendations for Implementing Change (ERIC) workgroup. Ongoing documentation of fidelity/adaptation aspects of program implementation is conducted using the FRAME framework. Understanding methods and measures deployed in adaptation and implementation of evidence-based dementia programs can help guide future translation efforts.

scholarly journals Strategies to Integrate Genomic Medicine into Clinical Care: Evidence from the IGNITE Network

2021 ◽  
Vol 11 (7) ◽  
pp. 647
Author(s):  
Nina R. Sperber ◽  
Olivia M. Dong ◽  
Megan C. Roberts ◽  
Paul Dexter ◽  
Amanda R. Elsey ◽  
...  
Keyword(s):  
Precision Medicine ◽  
Program Implementation ◽  
Clinical Care ◽  
Genomic Medicine ◽  
Implementation Strategies ◽  
Clinical Decision ◽  
Implementing Change ◽  
Implementation Outcomes ◽  
Planning Framework

The complexity of genomic medicine can be streamlined by implementing some form of clinical decision support (CDS) to guide clinicians in how to use and interpret personalized data; however, it is not yet clear which strategies are best suited for this purpose. In this study, we used implementation science to identify common strategies for applying provider-based CDS interventions across six genomic medicine clinical research projects funded by an NIH consortium. Each project’s strategies were elicited via a structured survey derived from a typology of implementation strategies, the Expert Recommendations for Implementing Change (ERIC), and follow-up interviews guided by both implementation strategy reporting criteria and a planning framework, RE-AIM, to obtain more detail about implementation strategies and desired outcomes. We found that, on average, the three pharmacogenomics implementation projects used more strategies than the disease-focused projects. Overall, projects had four implementation strategies in common; however, operationalization of each differed in accordance with each study’s implementation outcomes. These four common strategies may be important for precision medicine program implementation, and pharmacogenomics may require more integration into clinical care. Understanding how and why these strategies were successfully employed could be useful for others implementing genomic or precision medicine programs in different contexts.

scholarly journals Implementing an evidence‐based dementia care program in the Australian health context: A cost–benefit analysis

2020 ◽  
Vol 28 (6) ◽  
pp. 2013-2024
Author(s):  
Miia Rahja ◽  
Kim‐Huong Nguyen ◽  
Kate Laver ◽  
Lindy Clemson ◽  
Maria Crotty ◽  
...  
Keyword(s):  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Care Program ◽  
Dementia Care ◽  
Evidence Based ◽  
Benefit Analysis ◽  
Australian Health

Toward an evidence-based implementation model and checklist for personalized dementia care in the community

2015 ◽  
Vol 28 (5) ◽  
pp. 801-813 ◽  
Author(s):  
L. D. Van Mierlo ◽  
F. J. M. Meiland ◽  
H. P. J. Van Hout ◽  
R. M. Dröes
Keyword(s):  
Psychosocial Care ◽  
Personal Characteristics ◽  
Dementia Care ◽  
Evidence Based ◽  
Policy Makers ◽  
Personalized Care ◽  
Implementation Model ◽  
Individualized Care ◽  
Core Components ◽  
Evidence Based Model

ABSTRACTBackground:The aim was to develop an evidence-based model that focuses specifically on factors that enable the provision of personalized care to facilitate and promote the implementation of community-based personalized dementia care interventions. The model is based on our previous research and additional literature.Methods:The theoretical model of adaptive implementation was used as a framework to structure our model. Facilitators and barriers considered relevant for personalized care were extracted from our studies and additional literature, and were synthesized into the new evidence-based implementation model and checklist for personalized dementia care in the community.Results:Extraction of data led to a composition of an evidence-based model for the implementation of personalized psychosocial care interventions that incorporates core components of personalized care. The model addresses several issues, e.g. how personalized care interventions should be offered and to whom; whether these are able to adapt to personal characteristics and needs of clients and informal caregivers; and whether both organizational management and staff that provide the intervention support personalized care and are able to focus on providing individualized care.Conclusions:Our model provides a checklist for researchers, professional caregivers, and policy-makers who wish to develop, evaluate, or implement personalized care interventions.

scholarly journals Protocol for conducting scoping reviews to map implementation strategies in different care settings: focusing on evidence-based interventions for preselected phenomena in people with dementia

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e051611
Author(s):  
Christina Manietta ◽  
Tina Quasdorf ◽  
Mike Rommerskirch-Manietta ◽  
Jana Isabelle Braunwarth ◽  
Daniel Purwins ◽  
...  
Keyword(s):  
Complex Interventions ◽  
Implementation Strategies ◽  
Routine Care ◽  
Dementia Care ◽  
Evidence Based ◽  
Care Needs ◽  
Term Care ◽  
People With Dementia ◽  
Scoping Reviews ◽  
Analytical Approaches

IntroductionVarious evidence-based interventions are available to improve the care of people with dementia in different care settings, many of which are not or are only partially implemented in routine care. Different implementation strategies have been developed to support the implementation of interventions in routine care; however, the implementation of complex interventions remains challenging. The aim of our reviews is to identify promising strategies for, significant facilitators of and barriers to the implementation of evidence-based interventions for very common dementia care phenomena: (A) behaviour that challenges supporting a person with dementia in long-term care, (B) delirium in acute care and (C) the postacute care needs of people with dementia.Methods and analysisWe will conduct one scoping review for each preselected dementia care phenomenon (A, B and C). For this, three literature searches will be carried out in the following electronic databases: MEDLINE (via PubMed), CINAHL (via EBSCO) and PsycINFO (via EBSCO). Additionally, we will perform backward and forward citation tracking via reference lists and Google Scholar. Identified records will be independently screened by two reviewers (title/abstract and full text) using the defined inclusion criteria. We will include all study designs and publications in the German or English language. For the data analyses, we will conduct a deductive content analysis using two different analytical approaches: Expert Recommendations for Implementation Change and the Consolidated Framework for Implementation Research.Ethics and disseminationDue to the nature of a review, ethical clearing is not required. We will disseminate our results in peer-reviewed journals, workshops with stakeholders, and (inter)national conferences.

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.

scholarly journals Time Investment for Program Implementation to Manage Neuropsychiatric Symptoms: An Observational Longitudinal Study in In-Home and Residential Care Settings

2020 ◽  
Vol 4 (1) ◽  
pp. 441-453
Author(s):  
Miharu Nakanishi ◽  
Junko Niimura ◽  
Canan Ziylan ◽  
Ton TJEM Bakker ◽  
Eva Granvik ◽  
...  
Keyword(s):  
Home Care ◽  
Residential Care ◽  
Program Implementation ◽  
Care Management ◽  
Service Providers ◽  
Neuropsychiatric Symptoms ◽  
Care Program ◽  
Group Homes ◽  
Dementia Care ◽  
Time Investment

Background: There are no studies on how the same psychosocial dementia care program is adapted to both in-home and residential care settings. Objective: To evaluate the time investment required by professionals to implement a psychosocial dementia care program to manage neuropsychiatric symptoms. Methods: A prospective observational study design was used. The program consisted of 1) a one-day training course, 2) three interdisciplinary discussion meetings in five months, and 3) a web-based tool for the continued assessment of neuropsychiatric symptoms. Care professionals implemented the intervention in in-home (19 in-home care management agencies and 14 multiple in-home service providers) and residential care settings (19 group homes and eight nursing homes) in Japan from October 2019 to February 2020. The level of neuropsychiatric symptoms for the participants was evaluated using the Neuropsychiatric Inventory (NPI: 0–144). The time investment was reported by participating professionals. A total of 125 persons with dementia were included at baseline. Results: Neuropsychiatric symptoms were significantly decreased at the final follow-up in all types of providers (Cohen’s drm = 0.44–0.61). The mean (SD) time required for the five-month implementation was 417.9 (219.8) minutes. There was a mean (SD) decrease of 8.6 (14.0) points in the total NPI score among the 103 persons with completed interventions. The time investment was significantly lower in in-home care management agencies than in group homes, and lower in follow-ups than at baseline assessment. Conclusion: The program implementation may incur a substantial time investment regardless of setting. An additional benefit scheme to reward the time investment would be helpful to encourage implementation until the follow-ups.

scholarly journals Descriptive Evaluation of SBIRT Adoption, Implementation, and Delivery across a Health System

2020 ◽  
Author(s):  
Alyson Keen ◽  
Kelli M Thoele ◽  
Ukamaka Oruche ◽  
Robin Newhouse
Keyword(s):  
Health System ◽  
Implementation Strategies ◽  
Structured Interview ◽  
Evidence Based ◽  
Positive Health ◽  
Sustaining Change ◽  
Implementing Change ◽  
Implementation Studies ◽  
Common Framework

Abstract Background: Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based intervention used to enhance reductions in alcohol and illicit drug use. SBIRT use has resulted in positive health and social outcomes. However, SBIRT implementation remains low. Research on implementation of evidence-based interventions, such as SBIRT, lacks information about challenges and successes related to implementation. The Expert Recommendations for Implementing Change (ERIC) provides a framework that improves the comprehension, clarity, and relevance of strategies available for implementation research. This framework was applied to structure findings from analyses of qualitative interview data gathered from local champions leading SBIRT implementation. The purpose of this study was to understand site coordinators’ (SCs) perceptions of SBIRT implementation and employed strategies. Study aims included (1) describe SCs’ perceptions of barriers, facilitators, and outcomes related to SBIRT implementation, and (2) describe strategies perceived as most effective to implement SBIRT. Methods: This was a descriptive study conducted with 14 SCs, representing 14 medical surgical units within a large healthcare system. A semi-structured interview guide was developed by the study team to capture barriers, facilitators, and outcomes related to SBIRT implementation. A follow-up survey, based on 14 commonly identified ERIC strategies during SC interviews, was administered to determine the SC’s perceptions of the most helpful (i.e. effective) implementation strategies on a scale of 1 (least helpful) to 5 (most helpful).Results: All site coordinators participated in the SBIRT implementation interview, and 11 of 14 (79%) responded to the follow-up survey. Within the categories of barriers, facilitators, and outcomes, 25 subthemes emerged. The most highly rated effective ERIC implementation strategies were purposely reexamining the implementation (M=4.38; n=8), providing ongoing consultation (M=4.13; n=8), auditing and providing feedback (M=4.1; n=10), developing education materials (M=4.1; n=10), identifying and preparing champions (M=4; n=7), and tailoring strategies (M=4; n=7). Conclusion: This study applied a common framework (ERIC) to implementation lessons within a large health system that can be replicated in other implementation studies and quality improvement efforts. Adapting and sustaining change are challenging in healthcare settings. However, understanding and using the most helpful implementations strategies may support healthcare teams to adopt and sustain interventions such as SBIRT.

Strategies used to implement Hospital at Home: a description of an approach to scaling a complex healthcare intervention

2019 ◽  
Author(s):  
Robert M. Zimbroff ◽  
Albert Siu ◽  
Linda V. DeCherrie ◽  
Ania Wajnberg ◽  
Barbara Morano ◽  
...  
Keyword(s):  
Program Implementation ◽  
Implementation Strategies ◽  
Healthcare Intervention ◽  
Program Leaders ◽  
Health Care Intervention ◽  
Implementing Change ◽  
Modified Delphi ◽  
Hospital At Home ◽  
External Vendors ◽  
At Home

Abstract Background Advances have been made in recent years to characterize facilitators and barriers to implementation of complex health care intervention and to classify the implementation strategies available to address these determinants. We study the implementation of a Hospital at Home (HaH) intervention in a multi-hospital health system to understand the selection and use of implementation strategies in its launch, sustainment, and scaling. Methods We report on the implementation portion of an effectiveness-implementation study of the hybrid type 1 design. First, we retrospectively identified determinants of practice most relevant to the HaH intervention using of the Integrated Checklist of Determinants (TICD) assisted by review of archived documents. We also identified implementation strategies using the listing created by the Expert Recommendations for Implementing Change (ERIC) that could potentially address each determinant. Second, we then identified which of the ERIC strategies were actually employed using a modified Delphi process to obtain consensus among HaH program leaders involved in the program implementation. Program leaders also rated the importance and effort expended on each strategy on 1-9 Likert scales. The most relevant implementation strategies identified through these steps were detailed with respect to actors, targets, dosing and justification, and associated with prospectively collected implementation outcomes. Results The majority of ERIC implementation strategies (57 of 73, 78%) were utilized; 7 strategies (10%) were not used. On the remaining 9 strategies (12%), program leaders did not reach consensus regarding utilization. For used strategies, mean importance was 6.87 and mean effort expended was 6.22. Implementation strategies rated most important by program leaders had a broad target of actions that included clinical staff, patients, leadership, external vendors, health plans, and government officials. The strategies varied in temporality and dosing. Over the course of the implementation, adoption, acceptance, and penetration increased over time, while measures of fidelity remained stable. Conclusions Considerable effort and multiple strategies were required to implement Hospital at Home. While potentially daunting, use of existing implementation frameworks can help focus limited efforts and resources by targeting strategies that address the key barriers and enablers to implementation of complex healthcare interventions.

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.

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.

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