scholarly journals De-implementing wisely: developing the evidence base to reduce low-value care

2020 ◽  
Vol 29 (5) ◽  
pp. 409-417 ◽  
Author(s):  
Jeremy M Grimshaw ◽  
Andrea M Patey ◽  
Kyle R Kirkham ◽  
Amanda Hall ◽  
Shawn K Dowling ◽  
...  
Keyword(s):  
Large Scale ◽  
Phase 1 ◽  
Evidence Base ◽  
Choosing Wisely ◽  
Community Settings ◽  
Implementation Framework ◽  
Worked Example ◽  
Phase 0 ◽  
Five Phases ◽  
Implementation Programme

Choosing Wisely (CW) campaigns globally have focused attention on the need to reduce low-value care, which can represent up to 30% of the costs of healthcare. Despite early enthusiasm for the CW initiative, few large-scale changes in rates of low-value care have been reported since the launch of these campaigns. Recent commentaries suggest that the focus of the campaign should be on implementation of evidence-based strategies to effectively reduce low-value care. This paper describes the Choosing Wisely De-Implementation Framework (CWDIF), a novel framework that builds on previous work in the field of implementation science and proposes a comprehensive approach to systematically reduce low-value care in both hospital and community settings and advance the science of de-implementation.The CWDIF consists of five phases: Phase 0, identification of potential areas of low-value healthcare; Phase 1, identification of local priorities for implementation of CW recommendations; Phase 2, identification of barriers to implementing CW recommendations and potential interventions to overcome these; Phase 3, rigorous evaluations of CW implementation programmes; Phase 4, spread of effective CW implementation programmes. We provide a worked example of applying the CWDIF to develop and evaluate an implementation programme to reduce unnecessary preoperative testing in healthy patients undergoing low-risk surgeries and to further develop the evidence base to reduce low-value care.

scholarly journals Resilience Testing of Health Systems: How Can It Be Done?

2021 ◽  
Vol 18 (9) ◽  
pp. 4742
Author(s):  
Heather L. Rogers ◽  
Pedro Pita Barros ◽  
Jan De Maeseneer ◽  
Lasse Lehtonen ◽  
Christos Lionis ◽  
...  
Keyword(s):  
Health System ◽  
Health Systems ◽  
Phase 1 ◽  
Action Planning ◽  
Health System Strengthening ◽  
System Transformation ◽  
Traffic Light ◽  
Phase 0 ◽  
Five Phases ◽  
Quantitative Indicators

The resilience of health systems has received considerable attention as of late, yet little is known about what a resilience test might look like. We develop a resilience test concept and methodology. We describe key components of a toolkit and a 5-phased approach to implementation of resilience testing that can be adapted to individual health systems. We develop a methodology for a test that is balanced in terms of standardization and system-specific characteristics/needs. We specify how to work with diverse stakeholders from the health ecosystem via participatory processes to assess and identify recommendations for health system strengthening. The proposed resilience test toolkit consists of “what if” adverse scenarios, a menu of health system performance elements and indicators based on an input-output-outcomes framework, a discussion guide for each adverse scenario, and a traffic light scorecard template. The five phases of implementation include Phase 0, a preparatory phase to adapt the toolkit materials; Phase 1: facilitated discussion groups with stakeholders regarding the adverse scenarios; Phase 2: supplemental data collection of relevant quantitative indicators; Phase 3: summarization of results; Phase 4: action planning and health system transformation. The toolkit and 5-phased approach can support countries to test resilience of health systems, and provides a concrete roadmap to its implementation.

Implementation Science of Mindfulness in Intellectual and Developmental Disabilities

2020 ◽  
Vol 125 (5) ◽  
pp. 345-348
Author(s):  
Nirbhay N. Singh
Keyword(s):  
Developmental Disabilities ◽  
Implementation Science ◽  
Large Scale ◽  
Evidence Base ◽  
Intellectual And Developmental Disabilities ◽  
Community Settings ◽  
Behavior Support ◽  
Care Facilities ◽  
Effectiveness Studies

Abstract Implementation science deals with the translation of evidence-based knowledge into practice in the real world. Mindfulness-based programs for people with intellectual and developmental disabilities (IDD) emerged about 20 years ago. Efficacy and effectiveness studies provide the evidence-base for these programs and the field of IDD is moving towards large scale implementation of these programs. This article presents a model for implementing mindfulness-based programs in community settings, including family and group homes, schools, vocational settings, and congregate care facilities. The model is based on the 3-tier positive behavior support (PBS) system commonly used in school, family, and agency settings. Specific mindfulness-based programs can be linked to each of the three tiers to improve the quality of life of people with IDD.

Best practice for chronic oedema in community settings: what can we learn?

2020 ◽  
Vol 25 (12) ◽  
pp. 610-614
Author(s):  
Garry Cooper-Stanton
Keyword(s):  
Service Provision ◽  
Best Practice ◽  
Evidence Base ◽  
Community Services ◽  
Guidance Document ◽  
Community Settings ◽  
Tissue Viability ◽  
Delivery Of Care ◽  
Specialist Nurses ◽  
The Uk

There are various opportunities and challenges in the delivery of care to those diagnosed with chronic oedema/lymphoedema. Service provision is not consistent within the UK, and non-specialist nurses and other health professionals may be called on to fill the gaps in this area. The latest best practice guidance on chronic oedema is directed at community services that care for people within their own homes in primary care. This guide was developed in order to increase awareness, knowledge and access to an evidence base. Those involved in its creation cross specialist fields (lymphoedema and tissue viability), resulting in the document covering a number of areas, including an explanation of chronic oedema, its assessment and management and the association between chronic oedema and wet legs. The document complements existing frameworks on the condition and its management and also increases the available tools within chronic oedema management in the community. The present article provides an overview of the guidance document and discusses its salient features.

Translational Research Principles of an Effectiveness Trial for Diabetes Care in an Urban African American Population

2005 ◽  
Vol 31 (6) ◽  
pp. 880-889 ◽  
Author(s):  
Tiffany L. Gary ◽  
Felicia Hill-Briggs ◽  
Marian Batts-Turner ◽  
Frederick L. Brancati
Keyword(s):  
African American ◽  
African Americans ◽  
Diabetes Care ◽  
Large Scale ◽  
Health Workers ◽  
Controlled Trial ◽  
Phase 1 ◽  
Community Setting ◽  
Minority Community ◽  
Effectiveness Trials

Purpose Large-scale effectiveness trials designed to translate evidence-based diabetes care to community settings are few. Studies describing these methods among high-risk minority populations are particularly limited. Methods The authors describe Project Sugar, a randomized controlled trial conducted in 2 phases: Project Sugar 1 (1994-1999), which piloted a 4-arm clinic and homebased intervention using nurse case management and community health workers in 186 urban African Americans with type 2 diabetes, and Project Sugar 2 (2000-2005), which examined effectiveness of this intervention among 542 diabetic, urban African Americans. Results and Conclusions Project Sugar had success with regard to recruitment and retention, both in phase 1 (80% rate at 24 months) and phase 2 (>90% at 24 months). Using the RE-AIM framework, planning and research design for Project Sugar 2 is described in detail for elements that contributed to the reach, effectiveness, adoption, implementation, and maintenance of this study within a minority community setting. In addition to successful strategies, challenges to conducting effectiveness trials in an inner-city African American community are identified.

scholarly journals Evaluating the national multisite implementation of dialectical behaviour therapy in a community setting: A mixed methods approach

2019 ◽  
Author(s):  
Daniel Flynn ◽  
Mary Joyce ◽  
Conall Gillespie ◽  
Mary Kells ◽  
Michaela Swales ◽  
...  
Keyword(s):  
Mixed Methods ◽  
National Level ◽  
Team Leader ◽  
Barriers And Facilitators ◽  
Future Research ◽  
Evidence Based ◽  
Community Settings ◽  
Team Leaders ◽  
Implementation Framework ◽  
Mixed Methods Approach

Abstract Background The implementation of evidence-based interventions for borderline personality disorder in community settings is important given that individuals with this diagnosis are often extensive users of both inpatient and outpatient mental health services. Although work in this area is limited, previous studies have identified facilitators and barriers to successful DBT implementation. This study seeks to expand on previous work by evaluating a coordinated implementation of DBT in community settings at a national level. The Consolidated Framework for Implementation Research (CFIR) [1] provided structural guidance for this national level coordinated implementation.Methods A mixed methods approach was utilised to explore the national multi-site implementation of DBT from the perspective of team leaders and therapists who participated in the coordinated training and subsequent implementation of DBT. Qualitative interviews with DBT team leaders ( n = 8) explored their experiences of implementing DBT in their local service and was analysed using content analysis. Quantitative surveys from DBT therapists ( n = 74) examined their experience of multiple aspects of the implementation process including orienting the system, and preparations and support for implementation. Frequencies of responses were calculated. Written qualitative feedback was analysed using content analysis.Results Five themes were identified from the interview data: team formation, implementation preparation, client selection, service level challenges and team leader role. Participants identified team size and support for the team leader as key points for consideration in DBT implementation. Key challenges encountered were the lack of system support to facilitate phone coaching and a lack of allocated time to focus on DBT. Implementation facilitators included having dedicated team members and support from management.Conclusions The barriers and facilitators identified in this study are broadly similar to those reported in previous research. Barriers and facilitators were identified across several domains of the CFIR and are consistent with a recently published DBT implementation Framework [2]. Future research should pay particular attention to the domain of characteristics of individuals involved in DBT implementation. The results highlight the importance of a mandated service plan for the coordinated implementation of an evidence-based treatment in a public health service.

scholarly journals Risk and Opportunity—The Leadership Challenge in a World of Uncertainty—Learnings from Research into the Implementation of the Australian National Disability Insurance Scheme

2021 ◽  
Vol 14 (8) ◽  
pp. 383
Author(s):  
David Rosenbaum ◽  
Elizabeth More
Keyword(s):  
Large Scale ◽  
Service Providers ◽  
Implementation Process ◽  
Disability Insurance ◽  
Framework Analysis ◽  
Insurance Scheme ◽  
Implementation Framework ◽  
Non Profit ◽  
Leadership Challenges ◽  
Implementation Challenges

This paper considers the risks and opportunities inherent in a major national change process through a descriptive approach to the implementation challenges for Australian non-profit disability service providers as they grapple with the implementation of the transformational National Disability Insurance Scheme (NDIS). It highlights the leadership challenges associated with the newly developed NDIS Implementation Framework and, in doing so, recognises the risk and opportunity issues contained with that implementation process. The research used grounded theory coupled with framework analysis in a qualitative study that, in part, sought to identify leadership characteristics deemed necessary to minimize risks, capitalize on opportunities, and support positive change outcomes leading to successful NDIS implementations amongst several participating organisations, each with differing demographics and at different stages in the implementation process. The findings, which have been grouped into phases, suggest a range of leadership attributes at key phases of the NDIS implementation that are necessary to minimise implementation risks and maximise opportunities associated with the NDIS. These phases have been identified as: (i) An input phase where the emphasis must be on internal change preparedness and external environmental impacts and drivers; (ii) A process phase where the emphasis is on direct implementation issues; and (iii) An outcomes phase where active consideration needs to be on organisational mission sustainability, as well as the risk and opportunity challenge. The study is crucial in revealing leadership challenges and lessons for large scale change and risk management in the non-profit sector, within and beyond the specific case of Australia’s NDIS implementation, useful for both scholars and practitioners.

scholarly journals What role should randomized control trials play in providing the evidence base for conservation?

Oryx ◽  
2019 ◽  
pp. 1-10 ◽  
Author(s):  
Edwin L. Pynegar ◽  
James M. Gibbons ◽  
Nigel M. Asquith ◽  
Julia P. G. Jones
Keyword(s):  
Large Scale ◽  
Relevant Literature ◽  
Evidence Base ◽  
Randomized Control Trials ◽  
High Quality ◽  
Bolivian Andes ◽  
Behavioural Effects ◽  
Randomized Control ◽  
The Impact ◽  
Conservation Interventions

AbstractThe effectiveness of many widely used conservation interventions is poorly understood because of a lack of high-quality impact evaluations. Randomized control trials (RCTs), in which experimental units are randomly allocated to treatment or control groups, offer an intuitive way to calculate the impact of an intervention by establishing a reliable counterfactual scenario. As many conservation interventions depend on changing people's behaviour, conservation impact evaluation can learn a great deal from RCTs in fields such as development economics, where RCTs have become widely used but are controversial. We build on relevant literature from other fields to discuss how RCTs, despite their potential, are just one of a number of ways to evaluate impact, are not feasible in all circumstances, and how factors such as spillover between units and behavioural effects must be considered in their design. We offer guidance and a set of criteria for deciding when RCTs may be an appropriate approach for evaluating conservation interventions, and factors to consider to ensure an RCT is of high quality. We illustrate this with examples from one of the few concluded RCTs of a large-scale conservation intervention: an incentive-based conservation programme in the Bolivian Andes. We argue that conservation should aim to avoid a rerun of the polarized debate surrounding the use of RCTs in other fields. Randomized control trials will not be feasible or appropriate in many circumstances, but if used carefully they can be useful and could become a more widely used tool for the evaluation of conservation impact.

scholarly journals Observation of ENSO linked changes in the tropical Atlantic cloud vertical distribution using 14 years of MODIS observations

2019 ◽  
Author(s):  
Nils Madenach ◽  
Cintia Carbajal Henken ◽  
René Preusker ◽  
Odran Sourdeval ◽  
Jürgen Fischer
Keyword(s):  
Vertical Distribution ◽  
El Niño ◽  
Large Scale ◽  
El Nino ◽  
Phase 1 ◽  
Tropical Atlantic ◽  
Phase 2 ◽  
High Cloud ◽  
La Nina ◽  
Linear Decrease

Abstract. 14 years (September 2002 to September 2016) of Aqua Moderate Resolution Imaging Spectroradiometer (MODIS) monthly mean cloud data is analyzed to identify possible changes of the cloud vertical distribution over the Tropical Atlantic Ocean (TAO). For the analysis multiple linear regression techniques are used. Within the investigated period, no significant trend in the domain-averaged cloud vertical distribution was found. In terms of linear changes, two major phases (before and after November 2011) in the time-series of the TAO domain-average Cloud Top Height (CTH) and High Cloud Fraction (HCF) can be distinguished. While phase 1 is dominated by a significant linear increase, phase 2 is characterized by a strong, significant linear decrease. The observed trends were mainly caused by the El Niño Southern Oscillation (ENSO). The increase in CTH and HCF in phase 1, was attributed to the transition from El Niño (2002) to La Niña (2011) conditions. The strong decrease in phase 2, was caused by the opposite transition from a La Niña (2011) to a major El Niño event (2016). A comparison with the large scale vertical motion ω at 500 hPa obtained from ERA-Interim ECMWF Re-Analyses and the Nino3.4-Index indicates that the changes in HCF are induced by ENSO linked changes in the large scale vertical upward movements over regions with strong large scale ascent. A first comparison with the DARDAR data set, which combines CloudSat radar and CALIPSO lidar measurements, shows qualitatively good agreements for the interannual variability of the high cloud amount and its linear decrease in phase 2.

scholarly journals A RCT for assessment of active human-centred learning finds teacher-centric non-human teaching of evolution optimal

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Loredana Buchan ◽  
Momna Hejmadi ◽  
Liam Abrahams ◽  
Laurence D. Hurst
Keyword(s):  
Large Scale ◽  
Evidence Base ◽  
School Curriculum ◽  
Deep Time ◽  
Effective Pedagogy ◽  
Primary School Curriculum ◽  
In Series ◽  
Lower Ability ◽  
The Uk

AbstractCurrent educational discourse holds that effective pedagogy requires engagement through active student participation with subject matter relating to them. The lack of testing of lessons in series is recognized as a potential weakness in the evidence base, not least because standard parallel designs cannot capture serial interaction effects (cf. drug interactions). However, logistic issues make large-scale replicated in situ assessment of serial designs challenging. The recent introduction of evolution into the UK primary school curriculum presents a rare opportunity to overcome this. We implemented a randomised control 2 × 2 design with four inexpensive schemes of work, comparable to drug interaction trials. This involved an initial test phase (N = 1152) with replication (N = 1505), delivered by teachers, after training, in their classrooms with quantitative before-after-retention testing. Utilising the “genetics-first” approach, the schemes comprised four lessons taught in the same order. Lessons 1 (variation) and 3 (deep-time) were invariant. Lesson 2 (selection) was either student-centred or teacher-centred, with subject organism constant, while lesson 4 (homology) was either human-centred or not, with learning mode constant. All four schemes were effective in replicate, even for lower ability students. Unexpectedly, the teacher-focused/non-human centred scheme was the most successful in both test and replicate, in part owing to a replicable interaction effect but also because it enabled engagement. These results highlight the importance of testing lessons in sequence and indicate that there are many routes to effective engagement with no “one-size fits all” solution in education.

Sign in / Sign up

Export Citation Format

Share Document