scholarly journals Strategies Used by Clinical Champions to De-Implement a Low-Value Care Service

2021 ◽  
Author(s):  
Michael L Parchman ◽  
Lorella G Palazzo ◽  
Jessica M Mogk ◽  
Janna C Webbon ◽  
Lauren D Demosthenes ◽  
...  
Keyword(s):  
Care Service ◽  
Structured Interview ◽  
Fellowship Training ◽  
Practice Change ◽  
Local Context ◽  
Training Experience ◽  
Implementation Project ◽  
Modified Delphi ◽  
Use Of Data ◽  
Future Work

Abstract Background: Clinical champions are front-line clinicians who advocate for and influence practice change in their local context. The strategies they use when leading efforts to de-implement the use of a low-value service have not been well described. The purpose of this study is to identify and describe important strategies used by six clinical champions who launched a de-implementation project as part of a fellowship training experience.Methods: Fellows participated in a two-round modified Delphi survey to identify the key strategies they used during their de-implementation project. In the second round the fellows were asked to identify one important strategy they would be willing to discuss in an interview. A 30-minute semi-structured interview was conducted with each fellow, transcribed and thematically analyzed.Results: The six strategies were: build a coalition, conduct a local needs assessment, develop a formal implementation blueprint, conduct educational meetings, use facilitation, and develop clinical reminders. Additional common strategies that emerged across the interviews were the use of data to engage clinicians in conversations, including the patient’s perspective in designing the interventions, and investing the time upfront to plan and launch the initiative because of the inherent challenges of relinquishing a service. Conclusions: Clinical champions identified multiple strategies as important when de-implementing a low-value service. Many were used to engage in conversations with stakeholders, including leadership, providers, and patients, to increase buy-in and support, challenge beliefs, promote behavior change, and gather insights about next steps in their effort to support de-implementing their chosen low-value service. Future work is needed to better understand how prepare clinicians for this role and to understand the mechanisms through which these strategies might be effective.

Nutrition in Primary Health Care: Using a Delphi Process To Design New Interdisciplinary Services

2006 ◽  
Vol 67 (S1) ◽  
pp. S14-S29 ◽  
Author(s):  
Paula Brauer ◽  
Linda Dietrich ◽  
Bridget Davidson ◽  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Providers ◽  
Administrative Support ◽  
Care Service ◽  
Delphi Process ◽  
Care Providers ◽  
Modified Delphi ◽  
Nutrition Services ◽  
Key Features

Purpose: A modified Delphi process was used to identify key features of interdisciplinary nutrition services, including provider roles and responsibilities for Ontario Family Health Networks (FHNs), a family physician-based type of primary care. Methods: Twenty-three representatives from interested professional organizations, including three FHN demonstration sites, completed a modified Delphi process. Participants reviewed evidence from a systematic literature review, a patient survey, a costing analysis, and key informant interview results before undertaking the Delphi process. Statements describing various options for services were developed at an in-person meeting, which was followed by two rounds of e-mail questionnaires. Teleconference discussions were held between rounds. Results: An interdisciplinary model with differing and complementary roles for health care providers emerged from the process. Additional key features addressing screening for nutrition problems, health promotion and disease prevention, team collaboration, planning and evaluation, administrative support, access to care, and medical directives/delegated acts were identified. Under the proposed model, the registered dietitian is the team member responsible for managing all aspects of nutrition services, from needs assessment to program delivery, as well as for supporting all providers’ nutrition services. Conclusions: The proposed interdisciplinary nutrition services model merits evaluation of cost, effectiveness, applicability, and sustainability in team-based primary care service settings.

scholarly journals How clinical teaching teams deal with educational change: ‘we just do it’

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
L. Bank ◽  
M. Jippes ◽  
T. R. van Rossum ◽  
C. den Rooyen ◽  
A. J. J. A. Scherpbier ◽  
...  
Keyword(s):  
Educational Change ◽  
Curriculum Change ◽  
Clinical Teaching ◽  
Postgraduate Medical Education ◽  
Structured Interview ◽  
Program Director ◽  
Local Context ◽  
Team Members ◽  
Teaching Teams ◽  
Medical Education Program

Abstract Background In postgraduate medical education, program directors are in the lead of educational change within clinical teaching teams. As change is part of a social process, it is important to not only focus on the program director but take their other team members into account. The purpose of this study is to provide an in-depth insight into how clinical teaching teams manage and organize curriculum change processes, and implement curriculum change in daily practice. Methods An explorative qualitative semi-structured interview study was conducted between October 2016 and March 2017. A total of six clinical teaching teams (n = 6) participated in this study, i.e. one program director, one clinical staff member, and one trainee from each clinical teaching team (n = 18). Data were analysed and structured by means of thematic analysis. Results The analysis yielded to five factors that positively impact change: shared commitment, reinvention, ownership, supportive structure and open culture. Factors that negatively impact change were: resistance, behaviour change, balance between different tasks, lack of involvement, lack of consensus, and unsafe culture and hierarchy. Overall, no clear change strategy could be recognized. Conclusions Insight was gathered in factors facilitating and hindering the implementation of change. It seems particularly important for clinical teaching teams to be able to create a sense of ownership among all team members by making a proposed change valuable for their local context as well as to be capable of working together as a team. Cultural factors seem to be particularly relevant in a team’s ability to accomplish this.

scholarly journals Exploring the Relationship between Locational and Household Characteristics and E-Commerce Home Delivery Demand

Logistics ◽  
2021 ◽  
Vol 5 (2) ◽  
pp. 29
Author(s):  
Cheng Cheng ◽  
Takanori Sakai ◽  
André Alho ◽  
Lynette Cheah ◽  
Moshe Ben-Akiva
Keyword(s):  
Online Shopping ◽  
Household Survey ◽  
Past Research ◽  
Home Delivery ◽  
Local Context ◽  
Household Characteristics ◽  
Use Of Data ◽  
Research Findings ◽  
Individual Household ◽  
Parcel Deliveries

The rapid growth in online shopping and associated parcel deliveries prompts investigation of the factors that contribute to parcel delivery demand. In this study, we evaluated the influence of locational and household characteristics on e-commerce home delivery demand. While past research has largely focused on the impacts of the adoption of online shopping using individual/household survey data, we made use of data from an e-commerce carrier. A linear regression model was estimated considering factors such as degree of urbanization, transit and shopping accessibility, and household attributes. The results both confirm and contradict prior research findings, highlighting the potential for a non-negligible influence of the local context on demand for parcel deliveries.

scholarly journals Nutritional status of multiple sclerosis (MS) patients attending Kasr Alainy MS unit: an exploratory cross-sectional study

2021 ◽  
Vol 96 (1) ◽  
Author(s):  
Zeinab E. Afifi ◽  
Rania I. Shehata ◽  
Asmaa F. El Sayed ◽  
El Sayed M. Hammad ◽  
Marwa R. Salem
Keyword(s):  
Multiple Sclerosis ◽  
Nutritional Status ◽  
Dietary Habits ◽  
Care Service ◽  
Structured Interview ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Level Measurement ◽  
Impact Scale

Abstract Background Nutrition was claimed to be a factor in MS causation, course, complications, and management. Several studies were conducted to assess the nutritional status of MS patients; however, few studies were conducted to assess this problem in Egypt. Therefore, the purpose of the current study was to assess the nutritional status of a sample of MS patients. Methods The researchers conducted an exploratory cross-sectional study among 76 relapsing-remitting MS (RRMS) patients attending Kasr Alainy Multiple Sclerosis Unit (KAMSU) from October 2018 to January 2019 to assess the nutritional status of a sample of MS patients. Data were collected using a structured interview questionnaire including an inquiry about the socioeconomic status, and nutritional status using anthropometric measurements, patient-generated subjective global assessment (PG-SGA), semi-quantitative food frequency questionnaires (SQFFQ), and hemoglobin level measurement. Assessment of fatigue was done using the Modified Fatigue Impact Scale 5-items version. Results The mean age of the study participants was 30 ± 6 years. The disease duration ranged from 2 to 264 months. Malnutrition was prevalent among 67.1% (27.6 % overweight, 36.8% obese, and 2.6% underweight). Half of the investigated patients were anemic. According to the PG-SGA, more than half of the studied patients (53.9%) were classified as moderately or suspected malnourished. The unhealthy dietary habits such as taking only a few meals, junk food intake and skipping breakfast were observed in considerable proportions of the group. The SQFFQ revealed overconsumption of energy and fat, and less than acceptable consumption of dietary fibers by most of the studied patients. Conclusions Overweight, obesity, anemia, and unhealthy dietary habits were prevalent among the RRMS patients attending the KAMSU. Nutrition care service is extremely needed for this group of patients.

scholarly journals Building a neuroinfectious disease consensus curriculum

Neurology ◽  
2019 ◽  
Vol 93 (5) ◽  
pp. 208-216
Author(s):  
Arun Venkatesan ◽  
Felicia C. Chow ◽  
Allen Aksamit ◽  
Russell Bartt ◽  
Thomas P. Bleck ◽  
...  
Keyword(s):  
American Academy ◽  
Delphi Technique ◽  
Fellowship Training ◽  
Consensus Process ◽  
Diverse Range ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Modified Delphi Technique ◽  
Comprehensive Curriculum ◽  
American Academy Of Neurology

ObjectiveTo delineate a comprehensive curriculum for fellowship training in neuroinfectious diseases, we conducted a modified Delphi approach to reach consensus among 11 experts in the field.MethodsThe authors invited a diverse range of experts from the American Academy of Neurology Neuro-Infectious Diseases (AAN Neuro-ID) Section to participate in a consensus process using a modified Delphi technique.ResultsA comprehensive list of topics was generated with 101 initial items. Through 3 rounds of voting and discussion, a curriculum with 83 items reached consensus.ConclusionsThe modified Delphi technique provides an efficient and rigorous means to reach consensus on topics requiring expert opinion. The AAN Neuro-ID section provided the pool of diverse experts, the infrastructure, and the community through which to accomplish the consensus project successfully. This process could be applied to other subspecialties and sections at the AAN.

Adapting services to the needs of children and families with complex migration experiences: The Toulouse University Hospital’s intercultural consultation

2017 ◽  
Vol 54 (4) ◽  
pp. 445-465 ◽  
Author(s):  
Gesine Sturm ◽  
Zohra Guerraoui ◽  
Sylvie Bonnet ◽  
Françoise Gouzvinski ◽  
Jean-Philippe Raynaud
Keyword(s):  
Health Care ◽  
Psychological Health ◽  
Service Providers ◽  
Care Service ◽  
Health Care Service ◽  
University Hospital ◽  
Local Context ◽  
Children And Families ◽  
The University ◽  
Migration Experiences

This article presents the recently created intercultural consultation at the Medical and Psychological Health Care Service (CMP) of the University Hospital la Grave at Toulouse. The approach of the intercultural consultation was elaborated in response to the increasing diversity of children and families using the service in Toulouse. It is also based on local research that indicates the difficulties service providers encounter when trying to establish a solid therapeutic alliance with families with complex migration backgrounds who accumulate different disadvantaging factors. The intercultural consultation adapts existing models of culture-sensitive consultations in child mental health care in France and Canada to the local context in Toulouse. We describe the underlying principles of the intercultural consultation work, the therapeutic and mediation techniques used, and the way the work is integrated into the global service provision of the CMP. The process is illustrated with a case study followed by a discussion of the innovations.

scholarly journals Key Components for the Delivery of Palliative and End-of-Life Care in Care Homes in Hong Kong: A Modified Delphi Study

2022 ◽  
Vol 19 (2) ◽  
pp. 667
Author(s):  
Helen Yue-Lai Chan ◽  
Cecilia Nim-Chee Chan ◽  
Chui-Wah Man ◽  
Alice Dik-Wah Chiu ◽  
Faith Chun-Fong Liu ◽  
...  
Keyword(s):  
Palliative Care ◽  
Hong Kong ◽  
End Of Life ◽  
Delphi Study ◽  
End Of Life Care ◽  
Care Home ◽  
Local Context ◽  
Life Care ◽  
Home Setting ◽  
Modified Delphi

Integrating the palliative care approach into care home service to address the complex care needs of older adults with frailty or advanced diseases has been increasingly recognized. However, such a service is underdeveloped in Hong Kong owing to socio-cultural and legal concerns. We adopted a modified Delphi study design to identify the key components for the delivery of palliative and end-of-life care in care home settings for the local context. It was an iterative staged method to assimilate views of experts in aged care, palliative care, and care home management. A multidisciplinary expert panel of 18 members consented to participate in the study. They rated their level of agreement with 61 candidate statements identified through a scoping review in two rounds of anonymous surveys. The steering group revised the statements in light of the survey findings. Eventually, the finalized list included 28 key statements concerning structure and process of care in seven domains, namely policy and infrastructure, education, assessment, symptom management, communication, care for dying patients, and family support. The findings of this study underscored concerns regarding the feasibility of statements devised at different levels of palliative care development. This list would be instrumental for regions where the development of palliative and end-of-life care services in care home setting is at an initial stage.

scholarly journals A Study for the Development of Automated Essay Scoring (AES) in Malaysian English Test Environment

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Wee Sian Wong ◽  
Chih How Bong
Keyword(s):  
Reliability And Validity ◽  
Theoretical Aspect ◽  
Local Context ◽  
Test Environment ◽  
Automated Essay Scoring ◽  
Scoring Rubrics ◽  
Essay Scoring ◽  
Assessment Environment ◽  
Future Work ◽  
Assessment Context

Automated Essay Scoring (AES) is the use of specialized computer programs to assign grades to essays written in an educational assessment context. It is developed to overcome time, cost, and reliability issues in writing assessment. Most of the contemporary AES are “western” proprietary product, designed for native English speakers, where the source code is not made available to public and the assessment criteria may tend to be associated with the scoring rubrics of a particular English test context. Therefore, such AES may not be appropriate to be directly adopted in Malaysia context. There is no actual software development work found in building an AES for Malaysian English test environment. As such, this work is carried out as the study for formulating the requirement of a local AES, targeted for Malaysia's essay assessment environment. In our work, we assessed a well-known AES called LightSide for determining its suitability in our local context. We use various Machine Learning technique provided by LightSide to predict the score of Malaysian University English Test (MUET) essays; and compare its performance, i.e. the percentage of exact agreement of LightSide with the human score of the essays. Besides, we review and discuss the theoretical aspect of the AES, i.e. its state-of-the-art, reliability and validity requirement. The finding in this paper will be used as the basis of our future work in developing a local AES, namely Intelligent Essay Grader (IEG), for Malaysian English test environment.

scholarly journals How senior paramedics decide to cease resuscitation in pulseless electrical activity out of hospital cardiac arrest: a mixed methods study

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Ali Coppola ◽  
Sarah Black ◽  
Ruth Endacott
Keyword(s):  
Cardiac Arrest ◽  
Electrical Activity ◽  
Pulseless Electrical Activity ◽  
Structured Interview ◽  
Ambulance Service ◽  
Local Context ◽  
Clinical Judgement ◽  
Framework Analysis ◽  
Senior Clinician ◽  
The Impact

Abstract Background Evidenced-based guidelines on when to cease resuscitation for pulseless electrical activity are limited and support for paramedics typically defaults to the senior clinician. Senior clinicians include paramedics employed to work beyond the scope of clinical guidelines as there may be a point at which it is reasonable to cease resuscitation. To support these decisions, one ambulance service has applied a locally derived cessation of resuscitation checklist. This study aimed to describe the patient, clinical and system factors and examine senior clinician experiences when ceasing resuscitation for pulseless electrical activity. Design and methods An explanatory sequential mixed method study was conducted in one ambulance service in the South West of England. A consecutive sample of checklist data for adult pulseless electrical activity were retrieved from 1st December 2015 to 31st December 2018. Unexpected results which required exploration were identified and developed into semi-structured interview questions. A purposive sample of senior clinicians who ceased resuscitation and applied the checklist were interviewed. Content framework analysis was applied to the qualitative findings. Results Senior clinicians ceased resuscitation for 50 patients in the presence of factors known to optimise survival: Witnessed cardiac arrest (n = 37, 74%), bystander resuscitation (n = 30, 60%), defibrillation (n = 22, 44%), return of spontaneous circulation (n = 8, 16%). Significant association was found between witnessed cardiac arrest and bystander resuscitation (p = .00). Six senior clinicians were interviewed, and analysis resulted in four themes: defining resuscitation futility, the impact of ceasing resuscitation, conflicting views and clinical decision tools. In the local context, senior clinicians applied their clinical judgement to balance survivability. Multiple factors were considered as the decision to cease resuscitation was not always clear. Senior clinicians deviated from the checklist when the patient was perceived as non-survivable. Conclusion Senior clinicians applied clinical judgement to assess patients as non-survivable or when continued resuscitation was considered harmful with no patient benefit. Senior clinicians perceived pre-existing factors with duration of resuscitation and clinical factors known to optimise patient survival. Future practice could look beyond a set criteria in which to cease resuscitation, however, it would be helpful to investigate the value or threshold of factors associated with patient outcome.

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