scholarly journals Application of theory to enhance audit and feedback interventions to increase the uptake of evidence-based transfusion practice: an intervention development protocol

2014 ◽  
Vol 9 (1) ◽  
Author(s):  
Natalie J Gould ◽  
Fabiana Lorencatto ◽  
Simon J Stanworth ◽  
Susan Michie ◽  
Maria E Prior ◽  
...  
Keyword(s):  
Intervention Development ◽  
Transfusion Practice ◽  
Audit And Feedback ◽  
Evidence Based ◽  
Feedback Interventions

scholarly journals How well do critical care audit and feedback interventions adhere to best practice? Development and application of the REFLECT-52 evaluation tool

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Madison Foster ◽  
Justin Presseau ◽  
Eyal Podolsky ◽  
Lauralyn McIntyre ◽  
Maria Papoulias ◽  
...  
Keyword(s):  
Critical Care ◽  
Best Practices ◽  
Best Practice ◽  
Effective Means ◽  
Intervention Development ◽  
Audit And Feedback ◽  
Evaluation Tool ◽  
Feedback Intervention ◽  
Feedback Display ◽  
Feedback Interventions

Abstract Background Healthcare Audit and Feedback (A&F) interventions have been shown to be an effective means of changing healthcare professional behavior, but work is required to optimize them, as evidence suggests that A&F interventions are not improving over time. Recent published guidance has suggested an initial set of best practices that may help to increase intervention effectiveness, which focus on the “Nature of the desired action,” “Nature of the data available for feedback,” “Feedback display,” and “Delivering the feedback intervention.” We aimed to develop a generalizable evaluation tool that can be used to assess whether A&F interventions conform to these suggestions for best practice and conducted initial testing of the tool through application to a sample of critical care A&F interventions. Methods We used a consensus-based approach to develop an evaluation tool from published guidance and subsequently applied the tool to conduct a secondary analysis of A&F interventions. To start, the 15 suggestions for improved feedback interventions published by Brehaut et al. were deconstructed into rateable items. Items were developed through iterative consensus meetings among researchers. These items were then piloted on 12 A&F studies (two reviewers met for consensus each time after independently applying the tool to four A&F intervention studies). After each consensus meeting, items were modified to improve clarity and specificity, and to help increase the reliability between coders. We then assessed the conformity to best practices of 17 critical care A&F interventions, sourced from a systematic review of A&F interventions on provider ordering of laboratory tests and transfusions in the critical care setting. Data for each criteria item was extracted by one coder and confirmed by a second; results were then aggregated and presented graphically or in a table and described narratively. Results In total, 52 criteria items were developed (38 ratable items and 14 descriptive items). Eight studies targeted lab test ordering behaviors, and 10 studies targeted blood transfusion ordering. Items focused on specifying the “Nature of the Desired Action” were adhered to most commonly—feedback was often presented in the context of an external priority (13/17), showed or described a discrepancy in performance (14/17), and in all cases it was reasonable for the recipients to be responsible for the change in behavior (17/17). Items focused on the “Nature of the Data Available for Feedback” were adhered to less often—only some interventions provided individual (5/17) or patient-level data (5/17), and few included aspirational comparators (2/17), or justifications for specificity of feedback (4/17), choice of comparator (0/9) or the interval between reports (3/13). Items focused on the “Nature of the Feedback Display” were reported poorly—just under half of interventions reported providing feedback in more than one way (8/17) and interventions rarely included pilot-testing of the feedback (1/17 unclear) or presentation of a visual display and summary message in close proximity of each other (1/13). Items focused on “Delivering the Feedback Intervention” were also poorly reported—feedback rarely reported use of barrier/enabler assessments (0/17), involved target members in the development of the feedback (0/17), or involved explicit design to be received and discussed in a social context (3/17); however, most interventions clearly indicated who was providing the feedback (11/17), involved a facilitator (8/12) or involved engaging in self-assessment around the target behavior prior to receipt of feedback (12/17). Conclusions Many of the theory-informed best practice items were not consistently applied in critical care and can suggest clear ways to improve interventions. Standardized reporting of detailed intervention descriptions and feedback templates may also help to further advance research in this field. The 52-item tool can serve as a basis for reliably assessing concordance with best practice guidance in existing A&F interventions trialed in other healthcare settings, and could be used to inform future A&F intervention development. Trial registration Not applicable.

scholarly journals Informing the research agenda for optimizing audit and feedback interventions: results of a prioritization exercise

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Heather L. Colquhoun ◽  
Kelly Carroll ◽  
Kevin W. Eva ◽  
Jeremy M. Grimshaw ◽  
Noah Ivers ◽  
...  
Keyword(s):  
Research Agenda ◽  
Audit And Feedback ◽  
Evidence Based ◽  
Design Development ◽  
Evidence Based Practices ◽  
Web Based ◽  
Current Survey ◽  
Feedback Interventions ◽  
Key Barrier ◽  
The Individual

Abstract Background Audit and feedback (A&F) interventions are one of the most common approaches for implementing evidence-based practices. A key barrier to more effective A&F interventions is the lack of a theory-guided approach to the accumulation of evidence. Recent interviews with theory experts identified 313 theory-informed hypotheses, spread across 30 themes, about how to create more effective A&F interventions. In the current survey, we sought to elicit from stakeholders which hypotheses were most likely to advance the field if studied further. Methods From the list of 313, three members of the research team identified 216 that were clear and distinguishable enough for prioritization. A web-based survey was then sent to 211 A&F intervention stakeholders asking them to choose up to 50 ‘priority’ hypotheses following the header “A&F interventions will be more effective if…”. Analyses included frequencies of endorsement of the individual hypotheses and themes into which they were grouped. Results 68 of the 211 invited participants responded to the survey. Seven hypotheses were chosen by > 50% of respondents, including A&F interventions will be more effective… “if feedback is provided by a trusted source”; “if recipients are involved in the design/development of the feedback intervention”; “if recommendations related to the feedback are based on good quality evidence”; “if the behaviour is under the control of the recipient”; “if it addresses barriers and facilitators (drivers) to behaviour change”; “if it suggests clear action plans”; and “if target/goal/optimal rates are clear and explicit”. The most endorsed theme was Recipient Priorities (four hypotheses were chosen 92 times as a ‘priority’ hypotheses). Conclusions This work determined a set of hypotheses thought by respondents to be to be most likely to advance the field through future A&F intervention research. This work can inform a coordinated research agenda that may more efficiently lead to more effective A&F interventions.

scholarly journals Results of the CHlorhexidine Gluconate Bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections Study (CHanGing BathS): a stepped wedge cluster randomized trial

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Staci S. Reynolds ◽  
Patricia Woltz ◽  
Edward Keating ◽  
Janice Neff ◽  
Jennifer Elliott ◽  
...  
Keyword(s):  
Implementation Strategies ◽  
Bloodstream Infections ◽  
Central Line ◽  
Audit And Feedback ◽  
Educational Outreach ◽  
Evidence Based ◽  
Intervention Effect ◽  
Cluster Randomized ◽  
Outreach Visits ◽  
Educational Outreach Visits

Abstract Background Central line-associated bloodstream infections (CLABSIs) result in approximately 28,000 deaths and approximately $2.3 billion in added costs to the U.S. healthcare system each year, and yet, many of these infections are preventable. At two large health systems in the southeast United States, CLABSIs continue to be an area of opportunity. Despite strong evidence for interventions to prevent CLABSI and reduce associated patient harm, such as use of chlorhexidine gluconate (CHG) bathing, the adoption of these interventions in practice is poor. The primary objective of this study was to assess the effect of a tailored, multifaceted implementation program on nursing staff’s compliance with the CHG bathing process and electronic health record (EHR) documentation in critically ill patients. The secondary objectives were to examine the (1) moderating effect of unit characteristics and cultural context, (2) intervention effect on nursing staff’s knowledge and perceptions of CHG bathing, and (3) intervention effect on CLABSI rates. Methods A stepped wedged cluster-randomized design was used with units clustered into 4 sequences; each sequence consecutively began the intervention over the course of 4 months. The Grol and Wensing Model of Implementation helped guide selection of the implementation strategies, which included educational outreach visits and audit and feedback. Compliance with the appropriate CHG bathing process and daily CHG bathing documentation were assessed. Outcomes were assessed 12 months after the intervention to assess for sustainability. Results Among the 14 clinical units participating, 8 were in a university hospital setting and 6 were in community hospital settings. CHG bathing process compliance and nursing staff’s knowledge and perceptions of CHG bathing significantly improved after the intervention (p = .009, p = .002, and p = .01, respectively). CHG bathing documentation compliance and CLABSI rates did not significantly improve; however, there was a clinically significant 27.4% decrease in CLABSI rates. Conclusions Using educational outreach visits and audit and feedback implementation strategies can improve adoption of evidence-based CHG bathing practices. Trial registration ClinicalTrials.gov, NCT03898115, Registered 28 March 2019.

Evidence-Based and Clinical Outcome Scores to Facilitate Audit and Feedback for Colorectal Cancer Care

2009 ◽  
Vol 52 (4) ◽  
pp. 616-622 ◽  
Author(s):  
Miriam R. Habib ◽  
Michael J. Solomon ◽  
Jane M. Young ◽  
Bruce K. Armstrong ◽  
Dianne O'Connell ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Clinical Outcome ◽  
Cancer Care ◽  
Audit And Feedback ◽  
Evidence Based ◽  
Outcome Scores

scholarly journals Interactive Participatory Audit and Feedback (IPAF): Theory-based development and multi-site implementation outcomes with specialty clinic staff

2020 ◽  
Author(s):  
Edmond Ramly ◽  
Diane Lauver ◽  
Andrea Gilmore-Bykovskyi ◽  
Christie M Bartels
Keyword(s):  
Risk Reduction ◽  
Self Regulation ◽  
Self Determination Theory ◽  
Self Determination ◽  
Audit And Feedback ◽  
Evidence Based ◽  
Cvd Risk ◽  
Frontline Staff ◽  
Target Behaviors ◽  
Implementation Outcomes

Abstract Background: Theory-based implementation strategies, such as audit and feedback (A&F), can improve adoption of evidence-based practices. However, few strategies have been developed and tested to meet the needs of specialty clinics. In particular, frontline staff can execute CVD risk-reduction protocols, but A&F strategies to support them have not been well examined. Our objective was to develop and evaluate a novel A&F strategy, Interactive Participatory A&F (IPAF). Methods: We developed IPAF by combining theories to inform staff goals (Self-Regulation Theory) and address their psychological needs for relatedness, autonomy, and confidence (Self-Determination Theory). We facilitated IPAF fidelity by developing a theory-based facilitation tool: a semi-structured worksheet to guide flexible discussion of target behaviors, perceived barriers, goals, and action plans. We evaluated IPAF in the context of eight quasi-experimental implementations in specialty clinics across two health systems. Following a Hybrid Type 2 effectiveness-implementation design, we reported intervention outcomes for CVD risk-reduction elsewhere. This paper reports implementation outcomes associated with IPAF, focusing on feasibility, acceptability, fidelity, and adoption. We evaluated implementation outcomes using mixed-methods data including Electronic Health Records (EHR) data, team records, IPAF worksheets, and staff questionnaire responses. Results: Eighteen staff participated in 99 monthly, individual, synchronous (face-to-face or by phone) IPAF sessions during the first six months of implementation. Subsequently, we provided over 375 monthly feedback emails. Feasibility data revealed high staff attendance (90-93%) and engagement in IPAF sessions. Staff rated questionnaire items about acceptability of IPAF highly. IPAF records and staff responses demonstrated fidelity of delivery and receipt of IPAF. Adoption of target behaviors increased significantly (all P-values < 0.05) and was maintained for over 24 months. Conclusions: We developed and evaluated an interactive participatory A&F strategy with frontline staff in specialty clinics to improve implementation of evidence-based interventions. The IPAF toolkit combines two complementary theories: Self-Regulation Theory and Self-Determination Theory. Findings support feasibility, acceptability, and fidelity of IPAF, and staff adoption and maintenance of target behaviors. By evaluating multi-site implementation outcomes, we have extended prior research on clinic protocols and A&F beyond primary care settings and providers.

scholarly journals A Framework for Designing and Evaluating Internet Interventions to Improve Tinnitus Care

2019 ◽  
pp. 121-160
Author(s):  
Eldré W. Beukes ◽  
Gerhard Andersson ◽  
Vinaya Manchaiah ◽  
Peter M. Allen ◽  
David M. Baguley
Keyword(s):  
Service Delivery ◽  
Intervention Development ◽  
Cost Effective ◽  
Evidence Based ◽  
Service Delivery Models ◽  
Internet Interventions ◽  
Intervention Models ◽  
Related Symptom ◽  
Delivery Models ◽  
Internet Based Intervention

Tinnitus can be a debilitating hearing-related symptom. Access to evidence-based tinnitus interventions remain limited. Tele-audiology can assist by providing a clinically and cost-effective tinnitus management route. This chapter highlights how this is made possible by focusing on one form of tele-audiology, namely an internet-based intervention. Guidelines are provided for the development of such interventions. A framework outlining the various processes involved in evaluating newly developed interventions is also provided. The chapter closes by discussing factors that may facilitate or hamper the dissemination of new interventions into existing service delivery models. This well-defined outline for intervention development and evaluation can be applied and used to guide innovative intervention models by stakeholders.

The Clinical Practice Model for Persons with Dementia: Application to Music Therapy

2021 ◽  
Author(s):  
Alaine E Reschke-Hernández
Keyword(s):  
Clinical Practice ◽  
Music Therapy ◽  
Behavioral Interventions ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Intervention Development ◽  
Well Being ◽  
Future Research ◽  
Evidence Based ◽  
Practice Model

Abstract Currently, no drug can cure or effectively mitigate symptoms for the growing number of individuals who live with Alzheimer’s disease and related dementias. As they experience declines in memory, communication, and thinking—symptoms that undermine social initiative, autonomy, and well-being—these individuals become increasingly dependent on others. Evidence regarding the benefits of music therapy for persons with dementia is growing. Nonetheless, limitations in existing research have hindered knowledge regarding the use and appropriate application of music as a form of treatment with this population. This article describes the development of The Clinical Practice Model for Persons with Dementia, which provides a theoretical framework to inform evidence-based practice, illustrated here in application to music therapy. Specifically, the model is intended to prompt purposeful application of strategies documented within a broad literature base within 6 thematic areas (Cognition, Attention, Familiarity, Audibility, Structure, and Autonomy); facilitate clinical decision-making and intervention development, including music interventions; and encourage discourse regarding relationships between characteristics of the intervention, the therapist, the person with dementia, and their response to intervention. The model comprises a set of testable assumptions to provide direction for future research and to facilitate the description and investigation of mechanisms underlying behavioral interventions with this population. Although the model is likely to evolve as knowledge is gained, it offers a foundation for holistically considering an individual’s needs and strengths, guidance for applying music and nonmusic strategies in evidence-based practice, and direction for future research.

Section 2: Evidence implementation projects using an evidence-based audit and feedback approach: the JBI Implementation Framework

2019 ◽  
Author(s):  
Zachary Munn ◽  
Alexa McArthur ◽  
Kylie Porritt ◽  
Lucylynn Lizarondo ◽  
Sandeep Moola ◽  
...  
Keyword(s):  
Audit And Feedback ◽  
Evidence Based ◽  
Implementation Framework

scholarly journals Supplementing Substance Use Prevention With Sexual Health Education: A Partner-Informed Approach to Intervention Development

2020 ◽  
pp. 152483992094768
Author(s):  
Terrinieka W. Powell ◽  
Meghan Jo ◽  
Anne D. Smith ◽  
Beth D. Marshall ◽  
Santha Thigpen ◽  
...  
Keyword(s):  
Substance Use ◽  
Health Education ◽  
Sexual Health ◽  
Intervention Development ◽  
Lessons Learned ◽  
Evidence Based ◽  
Substance Use Prevention ◽  
Sexual Health Education ◽  
Multiple Sources ◽  
Wide Range

Supplementing substance use prevention with sexual health education would allow educators to address the risk and protective factors that influence both health issues. This streamlined approach may minimize the inefficiencies of multisession, single-purpose interventions. Our team developed a supplemental sexual and reproductive health (SRH) unit to align with an existing evidence-based intervention, LifeSkills Training (LST). This goal of this article is to describe our process, final product, lessons learned, and future directions. Our partner-informed approach took place across three key phases: (1) formative insights, (2) unit development, and (3) pilot implementation. The final supplemental SRH unit is ten, 45-minute sessions offered to seventh- and eighth-grade students and includes a set of learning objectives that are aligned with individual sessions. The supplemental SRH unit also mirrors existing LST modules in length, flow, layout, facilitator instructions, focus on prevention, and utilization of a student workbook. Lessons learned include strategies to effectively incorporate a wide range of ongoing feedback from multiple sources and quickly respond to staff turnover. This partnership approach serves as a model for researchers and practitioners aiming to extend the reach of existing evidence-based programs.

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