scholarly journals THE IMPACT OF ALIVIADO DEMENTIA CARE HOSPICE EDITION TRAINING PROGRAM ON HOSPICE STAFF’S DEMENTIA SYMPTOM KNOWLEDGE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S851-S851
Author(s):  
Catherine E Schneider ◽  
Alycia A Bristol ◽  
Ariel Ford ◽  
Shih-Yin Lin ◽  
Abraham A Brody
Keyword(s):  
Psychological Symptoms ◽  
Daily Practice ◽  
Dementia Care ◽  
Interdisciplinary Teams ◽  
Practice Change ◽  
P Value ◽  
Evidence Based ◽  
Improvement Program ◽  
Team Members ◽  
The Impact

Abstract A lack of high quality dementia training for healthcare workers is a key barrier to effective care for persons with dementia (PWD), a vulnerable and increasing population across the care continuum. Hospice agencies in particular are underprepared to care for this population, although annually about 17% of hospice patients have a primary diagnosis of dementia and an additional 28% as a comorbidity. Aliviado Dementia Care-Hospice Edition is an interdisciplinary, evidence-based quality improvement program developed to assist hospice interdisciplinary teams in caring for PWD and their caregivers. Interdisciplinary hospice team members in two agencies were enrolled in online training modules, which addressed multiple areas including pain, behavioral and psychological symptoms of dementia (BPSD), and working with caregivers. They were also provided a toolkit to integrate training in daily practice. Changes in knowledge, confidence and attitudes were tested before and after training and paired t-tests were utilized to evaluate the program’s effect. Thirty-five individuals completed the program and pre/post tests. Paired t-tests showed clinically and statistically significant increases in knowledge, attitudes and confidence in five of 10 domains including depression knowledge and confidence and BPSD knowledge, confidence and interventions. The greatest increase was in using BPSD interventions (18.5% increase, p-value: 0.0002), depression confidence (15.9% increase, p-value: 0.006) and BPSD confidence (12.6% increase, p-value: 0.02). Aliviado is an evidence-based, systems-level intervention shown to improve clinical knowledge, attitudes and confidence in treating pain and BPSD in PWD. This training could be used to produce systems-level practice change for hospice interdisciplinary team members serving PWD.

scholarly journals Older and Wiser? The Need to Reexamine the Impact of Health Professionals Age and Experience on Competency-Based Practices

2021 ◽  
Vol 7 ◽  
pp. 237796082110290
Author(s):  
Jing Xu ◽  
Kristen Hicks-Roof ◽  
Chloe E. Bailey ◽  
Hanadi Y. Hamadi
Keyword(s):  
Health Professionals ◽  
Online Survey ◽  
Evidence Based Practice ◽  
Core Competencies ◽  
Healthcare Services ◽  
Interdisciplinary Teams ◽  
Evidence Based ◽  
Health Providers ◽  
Cross Sectional ◽  
The Impact

Introduction Delivery of healthcare services makes up a complex system and it requires providers to be competent and to be able to integrate each of the institute of medicine’s (IOM) 5 core competencies into practice. However, healthcare providers are challenged with the task to be able to understand and apply the IOM core competencies into practice. Objective The purpose of the study was to examine the factors that influence health professional’s likelihood of accomplishing the IOM core competencies. Methods A cross-sectional study design was used to administer a validated online survey to health providers. This survey was distributed to physicians, nursing professionals, specialists, and allied healthcare professionals. The final sample included 3,940 participants who completed the survey. Results The study findings show that younger health professionals more consistently practice daily competencies than their older counterparts, especially in the use of evidence-based practice, informatics, and working in interdisciplinary teams. Less experienced health professionals more consistently applied quality improvement methods but less consistently used evidence-based practice compared to their more experienced counterparts. Conclusion There is a need to understand how health professionals’ age and experience impact their engagement with IOM’s core competencies. This study highlights the need for educational resources on the competencies to be tailored to health providers’ age and experience.

scholarly journals Building capacity for implementation—the KT Challenge

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Agnes T. Black ◽  
Marla Steinberg ◽  
Amanda E. Chisholm ◽  
Kristi Coldwell ◽  
Alison M. Hoens ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Health Care Professionals ◽  
Qualitative Data ◽  
Practice Change ◽  
Evidence Based ◽  
Science Literature ◽  
Health Care Settings ◽  
Improvement Programs ◽  
The Impact

Abstract Background The KT Challenge program supports health care professionals to effectively implement evidence-based practices. Unlike other knowledge translation (KT) programs, this program is grounded in capacity building, focuses on health care professionals (HCPs), and uses a multi-component intervention. This study presents the evaluation of the KT Challenge program to assess the impact on uptake, KT capacity, and practice change. Methods The evaluation used a mixed-methods retrospective pre-post design involving surveys and review of documents such as teams’ final reports. Online surveys collecting both quantitative and qualitative data were deployed at four time points (after both workshops, 6 months into implementation, and at the end of the 2-year funded projects) to measure KT capacity (knowledge, skills, and confidence) and impact on practice change. Qualitative data was analyzed using a general inductive approach and quantitative data was analyzed using non-parametric statistics. Results Participants reported statistically significant increases in knowledge and confidence across both workshops, at the 6-month mark of their projects, and at the end of their projects. In addition, at the 6-month check-in, practitioners reported statistically significant improvements in their ability to implement practice changes. In the first cohort of the program, of the teams who were able to complete their projects, half were able to show demonstrable practice changes. Conclusions The KT Challenge was successful in improving the capacity of HCPs to implement evidence-based practice changes and has begun to show demonstrable improvements in a number of practice areas. The program is relevant to a variety of HCPs working in diverse practice settings and is relatively inexpensive to implement. Like all practice improvement programs in health care settings, a number of challenges emerged stemming from the high turnover of staff and the limited capacity of some practitioners to take on anything beyond direct patient care. Efforts to address these challenges have been added to subsequent cohorts of the program and ongoing evaluation will examine if they are successful. The KT Challenge program has continued to garner great interest among practitioners, even in the midst of dealing with the COVID-19 pandemic, and shows promise for organizations looking for better ways to mobilize knowledge to improve patient care and empower staff. This study contributes to the implementation science literature by providing a description and evaluation of a new model for embedding KT practice skills in health care settings.

scholarly journals Building Capacity for Implementation – The KT Challenge

2020 ◽  
Author(s):  
Agnes Black ◽  
Marla Steinberg ◽  
Amanda Chisholm ◽  
Kristi Coldwell ◽  
Alison Hoens ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Health Care Professionals ◽  
Qualitative Data ◽  
Practice Change ◽  
Evidence Based ◽  
Science Literature ◽  
Health Care Settings ◽  
Improvement Programs ◽  
The Impact

Abstract Background The KT Challenge program supports health care professionals to effectively implement evidence-based practices. Unlike other knowledge translation (KT) programs, this program is grounded in capacity building, focuses on health care professionals (HCPs), and uses a multi-component intervention. This study presents the evaluation of the KT Challenge program to assess the impact on uptake, KT capacity and practice change. MethodsThe evaluation used a mixed-methods, time-series design involving surveys and review of documents such as teams’ final reports. Online surveys collecting both quantitative and qualitative data were deployed at four time points (after both workshops, six months into implementation, and at the end of the two-year funded projects) to measure KT capacity ( knowledge, skills and confidence), and impact on practice change. Qualitative data was analyzed using a general inductive approach and quantitative data was analysed using non-parametric statistics. ResultsParticipants reported statistically significant increases in knowledge and confidence across both workshops, at the 6-month mark of their projects, and at the end of their projects. In addition, at the 6-month check-in, practitioners reported statistically significant improvements in their ability to implement practice changes. In the first cohort of the program, of the teams who were able to complete their projects, half were able to show demonstrable practice changes. ConclusionsThe KT Challenge was successful in improving the capacity of HCPs to implement evidence-based practice changes and has begun to show demonstrable improvements in a number of practice areas. The program is relevant to a variety of HCPs working in diverse practice settings and is relatively inexpensive to implement. Like all practice improvement programs in health care settings, a number of challenges emerged stemming from the high turnover of staff and the limited capacity of some practitioners to take on anything beyond direct patient care. Efforts to address these challenges have been added to subsequent cohorts of the KT Challenge program and ongoing evaluation will examine if they are successful. The KT Challenge program has continued to garner great interest among practitioners, even in the midst of dealing with the COVID-19 pandemic, and shows promise for organizations looking for better ways to mobilize knowledge to improve patient care and empower staff. This study contributes to the implementation science literature by providing a description and evaluation of a new model for embedding KT practice skills in health care settings.

scholarly journals Building Capacity for Implementation – The KT Challenge

2021 ◽  
Author(s):  
Agnes Black ◽  
Marla Steinberg ◽  
Amanda Chisholm ◽  
Kristi Coldwell ◽  
Alison Hoens ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Health Care Professionals ◽  
Qualitative Data ◽  
Practice Change ◽  
Evidence Based ◽  
Science Literature ◽  
Health Care Settings ◽  
Improvement Programs ◽  
The Impact

Abstract Background The KT Challenge program supports health care professionals to effectively implement evidence-based practices. Unlike other knowledge translation (KT) programs, this program is grounded in capacity building, focuses on health care professionals (HCPs), and uses a multi-component intervention. This study presents the evaluation of the KT Challenge program to assess the impact on uptake, KT capacity and practice change. MethodsThe evaluation used a mixed-methods, time-series design involving surveys and review of documents such as teams’ final reports. Online surveys collecting both quantitative and qualitative data were deployed at four time points (after both workshops, six months into implementation, and at the end of the two-year funded projects) to measure KT capacity ( knowledge, skills and confidence), and impact on practice change. Qualitative data was analyzed using a general inductive approach and quantitative data was analysed using non-parametric statistics. ResultsParticipants reported statistically significant increases in knowledge and confidence across both workshops, at the 6-month mark of their projects, and at the end of their projects. In addition, at the 6-month check-in, practitioners reported statistically significant improvements in their ability to implement practice changes. In the first cohort of the program, of the teams who were able to complete their projects, half were able to show demonstrable practice changes. ConclusionsThe KT Challenge was successful in improving the capacity of HCPs to implement evidence-based practice changes and has begun to show demonstrable improvements in a number of practice areas. The program is relevant to a variety of HCPs working in diverse practice settings and is relatively inexpensive to implement. Like all practice improvement programs in health care settings, a number of challenges emerged stemming from the high turnover of staff and the limited capacity of some practitioners to take on anything beyond direct patient care. Efforts to address these challenges have been added to subsequent cohorts of the program and ongoing evaluation will examine if they are successful. The KT Challenge program has continued to garner great interest among practitioners, even in the midst of dealing with the COVID-19 pandemic, and shows promise for organizations looking for better ways to mobilize knowledge to improve patient care and empower staff. This study contributes to the implementation science literature by providing a description and evaluation of a new model for embedding KT practice skills in health care settings.

scholarly journals Evaluating the impact of clinical librarians on clinical questions during inpatient rounds

2018 ◽  
Vol 106 (2) ◽  
Author(s):  
Riley Brian ◽  
Nicola Orlov ◽  
Debra Werner ◽  
Shannon K. Martin ◽  
Vineet M. Arora ◽  
...  
Keyword(s):  
Evidence Based Medicine ◽  
Effective Means ◽  
Median Number ◽  
Evidence Based ◽  
Test Quality ◽  
Team Members ◽  
Fresno Test ◽  
Attending Rounds ◽  
Based Medicine ◽  
The Impact

Objective: The investigation sought to determine the effects of a clinical librarian (CL) on inpatient team clinical questioning quality and quantity, learner self-reported literature searching skills, and use of evidence-based medicine (EBM).Methods: Clinical questioning was observed over 50 days of inpatient pediatric and internal medicine attending rounds. A CL was present for 25 days and absent for 25 days. Questioning was compared between groups. Question quality was assessed by a blinded evaluator, who used a rubric adapted from the Fresno Test of Competence in Evidence-Based Medicine. Team members were surveyed to assess perceived impacts of the CL on rounds.Results: Rounds with a CL (CLR) were associated with significantly increased median number of questions asked (5 questions CLR vs. 3 NCLR; p<0.01) and answered (3 CLR vs. 2 NCLR; p<0.01) compared to rounds without a CL (NCLR). CLR were also associated with increased mean time spent asking (1.39 minutes CLR vs. 0.52 NCLR; p<0.01) and answering (2.15 minutes CLR vs. 1.05 NCLR; p=0.02) questions. Rounding time per patient was not significantly different between CLR and NCLR. Questions during CLR were 2 times higher in adapted Fresno Test quality than during NCLR (p<0.01). Select participants described how the CL’s presence improved their EBM skills and care decisions.Conclusions: Inpatient CLR were associated with more and improved clinical questioning and subjectively perceived to improve clinicians’ EBM skills. CLs may directly affect patient care; further study is required to assess this. CLs on inpatient rounds may be an effective means for clinicians to learn and use EBM skills.

Adaptation and Piloting for Hospice Social Workers of Aliviado Dementia Care, a Dementia Symptom Management Program

2020 ◽  
pp. 104990912096245
Author(s):  
Tessa M. Jones ◽  
Abraham A. Brody
Keyword(s):  
Social Workers ◽  
Symptom Management ◽  
Repeated Measures ◽  
Psychological Symptoms ◽  
The United States ◽  
Management Program ◽  
Dementia Care ◽  
Home Healthcare ◽  
Behavioral Symptoms ◽  
Improvement Program

Background: Forty-five percent of hospice patients currently have a primary or secondary diagnosis of Alzheimer’s disease or related disorders. However, few programs have focused specifically on assisting hospices in providing evidence-based symptom management to persons living with dementia (PLWD). Objective: To adapt and pilot the training component of Aliviado Dementia Care, a dementia symptom management quality improvement program originally developed for home healthcare, for use by social workers as part of the hospice interdisciplinary team. Design: A prospective pre-post design was utilized, measuring knowledge, confidence, and attitudes at baseline, and immediately and 1-month post-training. Analysis was performed using paired t-tests and repeated measures ANOVA. Subjects: Hospice social workers currently practicing in the United States with at least 1 year of experience. Measurements: The Dementia Symptom Knowledge Assessment and a post-training continuing education evaluation form. Results: Forty-six subjects were enrolled, of whom 26 completed the first post-test and 23 both post-tests. There was a poor baseline level of knowledge and confidence in caring for PLWD. Significant improvements occurred following training, particularly in implementing non-pharmacologic interventions for behavioral and psychological symptoms of dementia (BPSD) (16.64% increase, p < .0001) and confidence in managing behavioral symptoms (16.86%, p = .01) and depression (25.18%, p < .0001). Changes were maintained over time. All respondents were either very satisfied or satisfied with the quality and content of the program. Conclusions: The training modules of Aliviado Dementia Care were successfully tailored for use by hospice social workers, showing significant improvement in knowledge and confidence in caring for behavioral symptoms in PLWD. Future work will examine whether the larger program, including this training, can subsequently improve patient outcomes in hospice.

scholarly journals Using Gemba Boards to Facilitate Evidence-Based Practice in Critical Care

2018 ◽  
Vol 38 (3) ◽  
pp. e1-e7 ◽  
Author(s):  
Annette M. Bourgault ◽  
Michele J. Upvall ◽  
Alison Graham
Keyword(s):  
Critical Care ◽  
Evidence Based Practice ◽  
Secondary Analysis ◽  
Outcome Data ◽  
Practice Change ◽  
Future Research ◽  
Evidence Based ◽  
Management Tools ◽  
Team Members ◽  
Real Place

Background Tradition-based practices lack supporting research evidence and may be harmful or ineffective. Engagement of key stakeholders is a critical step toward facilitating evidence-based practice change. Gemba, derived from Japanese, refers to the real place where work is done. Gemba boards (visual management tools) appear to be an innovative method to engage stakeholders and facilitate evidence-based practice. Objectives To explore the use of gemba boards and gemba huddles to facilitate practice change. Methods Twenty-two critical care nurses participated in interviews in this qualitative, descriptive study. Thematic analysis was used to code and categorize interview data. Two researchers reached consensus on coding and derived themes. Data were managed with qualitative analysis software. Results The code gemba occurred most frequently; a secondary analysis was performed to explore its impact on practice change. Four themes were derived from the gemba code: (1) facilitation of staff, leadership, and interdisciplinary communication, (2) transparency of outcome data, (3) solicitation of staff ideas and feedback, and (4) dissemination of practice changes. Gemba boards and gemba huddles became part of the organizational culture for promoting and disseminating evidence-based practices. Conclusions Unit-based, publicly located gemba boards and huddles have become key components of evidence-based practice culture. Gemba is both a tool and a process to engage team members and the public to generate clinical questions and to plan, implement, and evaluate practice changes. Future research on the effectiveness of gemba boards to facilitate evidence-based practice is warranted.

Abstract WP333: The Impact of External Facilitation on Implementation: Findings From the Protocol-Guided Rapid Evaluation of Veterans PREVENT Quality Improvement Program

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Teresa M Damush ◽  
Barbara Homoya ◽  
Lauren Penney ◽  
Edward Miech ◽  
Nicholas Rattray ◽  
...  
Keyword(s):  
Implementation Process ◽  
Team Cohesion ◽  
Veterans Administration ◽  
Improvement Program ◽  
Team Members ◽  
Education Planning ◽  
Medical Facilities ◽  
Facility Level ◽  
The Impact ◽  
External Facilitation

Background and Aims: In the Veterans Administration, we found an absence of acute TIA care protocols and broad clinician uncertainty. To address these gaps, the PREVENT program was implemented in a stepped-wedge trial involving 6 medical facilities. To promote local adaptation, we employed external facilitation (EF) delivered by nurse as a key implementation strategy. The specific aim of this evaluation was to examine the effect of EF strategy on PREVENT implementation. Methods: We adapted an EF tracking template to prospectively monitor facilitation type, dose and temporality. We defined 17 apriori facilitation EF activity codes based upon the PREVENT protocol, and Consolidated Framework for Implementation Research (CFIR). We evaluated the EF activities delivered at each site over a 1 year and how the EF dose corresponded to the number of implementation activities completed and the level of team cohesion (beginning, developing, basic, intermediate, advanced) for providing and improving TIA care. Results: A total of 1209 EF activities delivered were delivered to QI teams and most frequently to the clinical champions; with a mean number of 242 EF activities per facility (range 182-295). Facility-level clinical champions were most likely to participate in EF activities compared to other team members. The most common EF activities delivered were: education (mean=34.3); planning (mean=27.8); overcoming barriers (mean=22.2) and ongoing quality process monitoring (mean=32.3). Teams with high initial team cohesion, &gt intermediate level, used EF early in the implementation process while teams that gradually developed cohesion over time, developing to basic levels of team cohesion, utilized EF later. QI teams with greater success in implementation activities had far more implementation activities completed (IA= 29-39) than EF activities related to barriers (B=18-28). However, QI teams with the least success in implementation activities (IA=11-25) had similar levels of EF activities related to barriers or higher (B=18-25). Conclusions: EF impacts real-world implementation by facilitating team education; planning; navigating the barriers; and enhancing the champions' skills. Early team cohesion was related to greater implementation success.

Implementation of evidence-based, non-pharmacological interventions addressing behavior and psychological symptoms of dementia: a systematic review focused on implementation strategies

2020 ◽  
pp. 1-29
Author(s):  
Sally Bennett ◽  
Kate Laver ◽  
Margaret MacAndrew ◽  
Elizabeth Beattie ◽  
Lindy Clemson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quantitative Methods ◽  
Psychological Symptoms ◽  
Implementation Strategies ◽  
Practice Change ◽  
Evidence Based ◽  
Pharmacological Interventions ◽  
People With Dementia ◽  
Implementation Studies ◽  
Behavioral And Psychological Symptoms

ABSTRACT Objective This study aimed to identify the nature and effects of implementation strategies to increase the use of evidence-based, non-pharmacological interventions designed to reduce the frequency and/or severity of behavioral and psychological symptoms associated with dementia, for people living in the community. Design This was a systematic review of implementation studies. We searched six databases (in January 2019) and hand-searched reference lists of reports. Studies were included if they used quantitative methods evaluating the use of implementation strategies to increase the use of non-pharmacological interventions. These interventions had to have been tested in a randomized controlled trial (RCT) and found to reduce behavioral and psychological symptoms of dementia, for those living in the community. Studies needed to report the effect of the implementation on clinical practice, for example, a change in practice or the adoption of the intervention in community settings. Results Twelve studies were included: 11 one-group pre-post design studies and 1 cluster RCT. All studies reported practice change – the majority implementing a new intervention, with six different types of interventions implemented. All studies reported including using partnerships, new funding, educational strategies, and ongoing support and consultation. Seven implementation studies reported positive outcomes for clients on some aspect of behavior or depression for the person with dementia. Conclusions Implementation studies using multiple implementation strategies to increase the use of non-pharmacological interventions have demonstrated improvements in behavioral and psychological symptoms common in people with dementia, when provided by clinicians as part of their everyday work routines.

Racial Disparities in Outcomes of Reconstructive Breast Surgery: An Analysis of 51,362 Patients from the ACS-NSQIP

2020 ◽  
Vol 36 (08) ◽  
pp. 592-599
Author(s):  
Louise L. Blankensteijn ◽  
Sebastian Sparenberg ◽  
Dustin T. Crystal ◽  
Ahmed M.S. Ibrahim ◽  
Bernard T. Lee ◽  
...  
Keyword(s):  
African American ◽  
Racial Disparities ◽  
Surgical Outcomes ◽  
Breast Surgery ◽  
P Value ◽  
Improvement Program ◽  
Reconstructive Procedures ◽  
Different Types ◽  
The Impact ◽  
White Patients

Abstract Background In various surgical specialties, racial disparities in postoperative complications are widely reported. It is assumed that the effect of race can also be found in plastic surgical outcomes, although this remains largely undefined in literature. This study aims to provide data on the impact of race on outcomes of reconstructive breast surgery. Methods Data were collected using the NSQIP (National Surgical Quality Improvement Program) database (2008–2016). Outcomes of the reconstructive breast surgery of White patients were compared with those of African American, Asian, or other races. Logistic regression was performed to control for variations between all groups. Analysis of racial disparities was further sub-stratified according to four different types of breast reconstruction: delayed or immediate autologous, and delayed or immediate prosthesis-based reconstruction. Results In total, this study included 51,362 patients of which 43,864 were Caucasian, 5,135 African American, 2,057 Asian, and 332 of other races. When compared with White patients, patients of African American race had larger body mass indices (31.3 ± 7.0 vs. 27.6 ± 6.3, p-value < 0.001) in addition to higher rates of diabetes (12.3 vs 4.6%, p-value < 0.001) and hypertension (44.7 vs. 23.4%, p-value < 0.001). Both multivariate analysis and the sub-stratified analysis of different types of reconstruction showed no differences in overall complication rate. Conclusion Among the four types of reconstructive procedures, differences in surgical outcomes do not appear to be based on race and therefore seem to be less evident in reconstructive breast surgery compared with the current literature within other surgical specialties.

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