Implementation Challenges With Evidence-Based Practice Within Inpatient Rehabilitation to Incorporate Task-Specific Training

2021 ◽  
Vol 75 (Supplement_2) ◽  
pp. 7512510266p1-7512510266p1
Author(s):  
Eron Bozec ◽  
Namrata Grampurohit ◽  
Jaime Gorska
Keyword(s):  
Implementation Research ◽  
Inpatient Rehabilitation ◽  
Barriers And Facilitators ◽  
Training Manual ◽  
Evidence Based ◽  
Specific Training ◽  
Implementation Barriers ◽  
Study Objective ◽  
Implementation Challenges ◽  
Primary Author

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The study objective was to examine the implementation barriers and facilitators after a year of training and use of a task-specific training manual in inpatient rehabilitation. The Consolidated Framework for Implementation Research provided structure for the survey of OTs. Stakeholders reported confidence in evidence incorporation, and the barriers related to ease of selection and use of this intervention need to be addressed. Primary Author and Speaker: Eron Bozec Additional Authors and Speakers: Namrata Grampurohit Contributing Authors: Namrata Grampurohit, Jaime Gorska

806 Barriers to screening and diagnosis of obstructive sleep apnea during inpatient traumatic brain injury rehabilitation

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A314-A315
Author(s):  
Bridget Cotner ◽  
Risa Nakase-Richardson ◽  
Becky Gius ◽  
Lauren Fournier ◽  
Alexa Watach ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Obstructive Sleep Apnea ◽  
Brain Injury ◽  
Sleep Apnea ◽  
Inpatient Rehabilitation ◽  
Screening Tools ◽  
Diagnostic Tools ◽  
Evidence Based ◽  
Implementation Barriers ◽  
Obstructive Sleep

Abstract Introduction Obstructive Sleep Apnea (OSA) is prevalent after moderate to severe traumatic brain injury (TBI) and may diminish recovery when left untreated. Despite the demonstrated importance of treating OSA following TBI, assessment for OSA during or soon after inpatient rehabilitation for TBI is limited. Little is known about barriers to implementing OSA screening and early diagnosis during inpatient rehabilitation thus hindering the translation of evidence-based OSA assessment procedures into clinical practice and potentially delaying necessary OSA treatment. The current analysis explored facilitators and barriers to implementing OSA screening tools in an inpatient rehabilitation setting from the perspectives of end user stakeholders. Methods Patients, families, industry, clinical providers and administrators participated in a two-day meeting following completion of a diagnostic clinical trial of OSA screening and diagnostic tools during inpatient rehabilitation. Stakeholders were provided with open ended questions generated by study investigators and given the opportunity to respond on paper or a “graffiti wall” (i.e., white board). Example questions include “What are the greatest needs of the healthcare system related to sleep apnea and TBI?” and “What are the key things we need to consider to move results into real-world practice?” Qualitative content analyses using a rapid matrix approach were conducted from stakeholder feedback obtained during the two-day meeting, which included a guided review of emerging OSA research and discussion of potential implementation barriers of OSA assessment during inpatient rehabilitation. Results Improved screening and treatment practices for OSA were the greatest needs identified. To meet these needs, stakeholders identified the importance of improving patient, family, and staff understanding of OSA (e.g., health literacy) and other sleep disorders through education; inpatient rehabilitation access to resources (technology; sleep providers); and reimbursement for additional inpatient procedures. Conclusion Although treatment of OSA is crucial for recovery during inpatient rehabilitation following TBI, barriers to earlier recognition, diagnosis, and treatment of OSA exists across several different domains, including education, resources, and funding policies. Findings support future implementation efforts to translate evidence-based care into practice to improve patient outcomes. Support (if any) PCORI-NCT03033901

Exemplars Illustrating De-implementation of Tradition-Based Practices

2019 ◽  
Vol 39 (6) ◽  
pp. 64-69 ◽  
Author(s):  
Michele J. Upvall ◽  
Annette M. Bourgault ◽  
Cody Pigon ◽  
Christine A. Swartzman
Keyword(s):  
Internal Medicine ◽  
Critical Care ◽  
Clinical Practice ◽  
Cognitive Dissonance ◽  
Implementation Process ◽  
Barriers And Facilitators ◽  
Evidence Based ◽  
Implementation Barriers ◽  
Complex Process ◽  
Psychological Bias

Clinical practice must be based on evidence. When evidence suggests that a certain practice may be ineffective or even harmful, that practice should be discontinued. The Choosing Wisely campaign, an initiative of the ABIM (American Board of Internal Medicine) Foundation, is intended to bring attention to tradition-based practices, or “sacred cows,” which lack evidence to support their ongoing use. The complex process of discontinuing or reducing the use of tradition-based practices is known as “de-implementation.” Recognizing the importance of de-implementation is necessary to fully understand evidence-based practice. This article explores the de-implementation process, examining its barriers and facilitators. Three critical care exemplars of tradition-based practices are presented and examined through the lens of de-implementation. Barriers and facilitators related to de-implementing these tradition-based practices are described, with an emphasis on the roles of various stakeholders and the need to overcome cognitive dissonance and psychological bias.

Evidence-Based Interventions in Schools: Developers’ Views of Implementation Barriers and Facilitators

2008 ◽  
Vol 1 (1) ◽  
pp. 26-36 ◽  
Author(s):  
Susan G. Forman ◽  
S. Serene Olin ◽  
Kimberly Eaton Hoagwood ◽  
Maura Crowe ◽  
Noa Saka
Keyword(s):  
Barriers And Facilitators ◽  
Evidence Based ◽  
Implementation Barriers

scholarly journals Identifying actionable strategies: using Consolidated Framework for Implementation Research (CFIR)-informed interviews to evaluate the implementation of a multilevel intervention to improve colorectal cancer screening

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Helen Lam ◽  
Michael Quinn ◽  
Toni Cipriano-Steffens ◽  
Manasi Jayaprakash ◽  
Emily Koebnick ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Implementation Research ◽  
Formative Evaluation ◽  
Peer Pressure ◽  
Barriers And Facilitators ◽  
Structured Interviews ◽  
Implementation Barriers ◽  
Time Data ◽  
Crc Screening ◽  
Report Quality

Abstract Background Many evidence-based interventions (EBIs) found to be effective in research studies often fail to translate into meaningful patient outcomes in practice. The purpose of this study was to identify facilitators and barriers that affect the implementation of three EBIs to improve colorectal cancer (CRC) screening in an urban federally qualified health center (FQHC) and offer actionable recommendations to improve future implementation efforts. Methods We conducted 16 semi-structured interviews guided by the Consolidation Framework for Implementation Research (CFIR) to describe diverse stakeholders’ implementation experience. The interviews were conducted in the participant’s clinic, audio-taped, and professionally transcribed for analysis. Results We used the five CFIR domains and 39 constructs and subconstructs as a coding template to conduct a template analysis. Based on experiences with the implementation of three EBIs, stakeholders described barriers and facilitators related to the intervention characteristics, outer setting, and inner setting. Implementation barriers included (1) perceived burden and provider fatigue with EHR (Electronic Health Record) provider reminders, (2) unreliable and ineffectual EHR provider reminders, (3) challenges to providing health care services to diverse patient populations, (4) lack of awareness about CRC screening among patients, (5) absence of CRC screening goals, (6) poor communication on goals and performance, and (7) absence of printed materials for frontline implementers to educate patients. Implementation facilitators included (1) quarterly provider assessment and feedback reports provided real-time data to motivate change, (2) integration with workflow processes, (3) pressure from funding requirement to report quality measures, (4) peer pressure to achieve high performance, and (5) a culture of teamwork and patient-centered mentality. Conclusions The CFIR can be used to conduct a post-implementation formative evaluation to identify barriers and facilitators that influenced the implementation. Furthermore, the CFIR can provide a template to organize research data and synthesize findings. With its clear terminology and meta-theoretical framework, the CFIR has the potential to promote knowledge-building for implementation. By identifying the contextual determinants, we can then determine implementation strategies to facilitate adoption and move EBIs to daily practice.

scholarly journals Tracking the Randomized Rollout of a Veterans Affairs Opioid Risk Management Tool: A Multi-method Implementation Evaluation Using the Consolidated Framework for Implementation Research

2021 ◽  
Author(s):  
Sharon McCarthy ◽  
Matthew Chinman ◽  
Shari Rogal ◽  
Gloria Klima ◽  
Leslie Hausmann ◽  
...  
Keyword(s):  
Implementation Research ◽  
Structured Interview ◽  
Barriers And Facilitators ◽  
Management Tool ◽  
Opioid Overdose ◽  
Veterans Health ◽  
Health Administration ◽  
Implementation Barriers ◽  
Implementation Climate ◽  
The Mean

Abstract BackgroundThe Veterans Health Administration (VHA) developed the Stratification Tool for Opioid Risk Mitigation (STORM) dashboard to assist VHA clinicians in identifying Veterans at risk for adverse opioid overdose or suicide-related events. In 2018, a national policy was implemented requiring providers at all VHA facilities to complete case reviews of Veterans identified by STORM as very high risk for adverse events. Nationally, facilities were randomized by the type of oversight required when sufficient case reviews were not completed and also by the timing of an increase in the number of required case reviews. As part of a comprehensive assessment of this policy intervention, we aimed to 1) identify barriers and facilitators to implementing case reviews as required in the policy; 2) assess variation across the four arms of the study; and 3) evaluate associations between facility characteristics and implementation barriers and facilitators.MethodsUsing the Consolidated Framework for Implementation Research (CFIR), we developed a semi-structured interview guide to examine barriers to and facilitators of implementing the STORM policy. Staff from 40 purposefully selected facilities who were involved in implementation were invited to participate in telephone interviews. Interview transcripts were coded and then organized into memos, which were numerically rated using the -2 to +2 CFIR rating system for each construct. Descriptive statistics were used to evaluate the mean ratings on each CFIR construct, the associations between ratings and study arm, and three facility characteristics (size, rurality, and level of academic detailing) associated with CFIR ratings. We used the mean CFIR rating for each site to determine which constructs differed between the sites with highest and lowest overall CFIR scores, and these constructs were described in detail. ResultsInterviews with 78 staff at 39 VHA facilities identified a slightly positive (+0.2) overall mean CFIR rating. CFIR ratings were not significantly different between the four study arms, nor associated with facility characteristics. Overall, two important barriers to implementation were CFIR constructs Access to knowledge and information and Evaluating and reflecting. Having time to complete the reviews was a pervasive barrier. Sites with higher overall CFIR scores showed three important facilitators: Leadership engagement, Engaging, and Implementation climate. ConclusionAlthough there was variability in implementation barriers and facilitators across facilities, these were unrelated to study arms and facility characteristics. Leadership, resources, and overall implementation climate were the strongest facilitators of policy implementation.

scholarly journals Implementation Strategies and Outcomes for Occupational Therapy in Adult Stroke Rehabilitation: A Scoping Review

2021 ◽  
Author(s):  
J. Edward Murrell ◽  
Janell L. Pisegna ◽  
Lisa A. Juckett
Keyword(s):  
Occupational Therapy ◽  
Scoping Review ◽  
Stroke Rehabilitation ◽  
Implementation Strategies ◽  
Stroke Care ◽  
Barriers And Facilitators ◽  
Educational Outreach ◽  
Evidence Based ◽  
Implementation Barriers ◽  
Implementation Outcomes

Abstract BackgroundEvery year, millions of people worldwide experience a stroke. Given the degree of physical, cognitive, visual, and behavioral impairments post-stroke, stroke survivors often encounter occupational therapy practitioners in the rehabilitation practice settings. Although evidence-based occupational therapy practices have been well-established in the stroke literature, it remains unclear what strategies have been used to promote these practices' effective implementation in the real-world context. The present review identifies these strategies and the extent to which researchers have measured implementation outcomes. MethodsA scoping review protocol was developed to assess the breadth and depth of occupational therapy literature examining implementation strategies and outcomes in the stroke rehabilitation field. Four electronic databases and two peer-reviewed implementation science journals were searched to identify studies meeting inclusion criteria. Two reviewers applied the inclusion parameters and consulted with a third reviewer, as needed, to achieve consensus. The Expert Change guided synthesis of review findings for Implementing Change project and the Implementation Outcomes Framework. ResultsThe initial search yielded 1219 studies, and 26 were included in the final review. A total of 48 out of 73 discrete implementation strategies were deployed in the included studies. The most used implementation strategies were “distribute educational materials,” “assess for readiness and identify barriers and facilitators,” and “conduct educational outreach visits.” “Adoption” was the most frequently measured implementation outcome, while “cost” was not measured in any included studies. Eleven studies reported findings to support the effectiveness of their implementation strategy or strategies; eleven studies reported inconclusive findings, and four studies found that their strategies did not lead to improved implementation outcomes. ConclusionsThis scoping review identified occupational therapy literature examining implementation strategies and outcomes in the context of stroke rehabilitation. With the growth of the stroke survivor population, the occupational therapy profession must identify effective strategies that promote the uptake of evidence-based practices into routine stroke care. Occupational therapy researchers and practitioners are encouraged to collaborate to develop and deploy implementation strategies responsive to known implementation barriers and facilitators in the stroke rehabilitation setting.

scholarly journals Self-perceived evidence-based practice competencies: a survey of faculty and students at a chiropractic institution*

2019 ◽  
Author(s):  
Anjum S. Odhwani ◽  
Pradip K. Sarkar ◽  
Gene F. Giggleman ◽  
Michelle M. Holmes ◽  
Kathrine A. Pohlman
Keyword(s):  
Student Satisfaction ◽  
Evidence Based Practice ◽  
Cross Sectional Study ◽  
Faculty Members ◽  
The Self ◽  
Barriers And Facilitators ◽  
Evidence Based ◽  
Implementation Barriers ◽  
Cross Sectional ◽  
Ebp Implementation

Objective To assess the self-perceived importance, skills, and utilization of evidence-based practice (EBP) among faculty and students at a chiropractic institution without a structured EBP program. The survey also evaluated EBP satisfaction among students and EBP implementation barriers/facilitators among the faculty. Methods In this cross-sectional study, a set of organized questionnaires to assess the importance of EBP and self-perceived skills, utilization, barriers, and facilitators for faculty members, and student satisfaction was administered to the students and faculty of a chiropractic institution in February–March 2016. Descriptive statistics were used to evaluate responses. Results A total of 417 (60.1%) students and 27 (60.0%) faculty members completed the survey. Faculty members' and students' EBP importance values were similar (8.4 and 8.3 out of 10, respectively), but faculty members self-reported their EBP skills (7.3/10) at a higher level than the student self-reported skill level (6.1/10). For utilization, students reported a higher utilization of EBP than that reported by the responding faculty members. Perceived student satisfaction on the quality and content of research-related experiences decreased from the first year to the third (final) year. Conclusion This study found variance in the self-perceived EBP skills, utilization, barriers, and facilitators and that these skills are lagging at our doctor of chiropractic program, which does not have a structured EBP program. Faculty members and students identified the importance for EBP. Similar observations have been found at other chiropractic institutions prior to their implementation of a systematic EBP program. Those developing an EBP curriculum might use these findings to better design, implement, and assess a structured program.

Application of the Non-adoption, Abandonment, Scale-up, Spread and, Sustainability (NASSS) Framework to evaluate the role of technology in the Pathways to Comorbidity Care (PCC) implementation project to improve management of comorbid substance use and mental disorders

2020 ◽  
Author(s):  
MariaGabriela Uribe Guajardo ◽  
Andrew James Baillie ◽  
Eva Louie ◽  
Vicki Giannopoulos ◽  
Katie Wood ◽  
...  
Keyword(s):  
Substance Use ◽  
Clinical Supervision ◽  
Mental Health Problems ◽  
Scale Up ◽  
Structured Interview ◽  
Barriers And Facilitators ◽  
Self Report ◽  
Evidence Based ◽  
Face To Face ◽  
Drug And Alcohol

Abstract (250 words)In substance use treatment settings, there is a high prevalence of comorbid mental health problems. Yet an integrated approach for managing comorbidity, implementation of evidence-based intervention in drug and alcohol settings remains problematic. Technology can help the adoption of evidence-based practice and successfully implement effective treatment health care pathways. This study sought to examine aspects of electronic resources utilisation (barriers and facilitators) by clinicians participating in the PCC training. MethodA self-report questionnaire and a semi-structured interview was designed to measure overall satisfaction with the PCC portal and e-resources available throughout the 9-month intervention for participating clinicians. An adapted version of the ‘Non-adoption, Abandonment, Scale-up, Spread and, Sustainability’ (NASSS) framework was used to facilitate discussion in regards to the study findings. ResultsA total of 20 clinicians from drug and alcohol services responded to all the measures. Facilitators of portal use included: i. clinician acceptance of the PCC portal; ii. guidance from the clinical supervisor or clinical champion that encouraged the use of e-resources. Some of the barriers included: i. complexity of the illness (condition), ii. clinicians’ preference (adopter system) for face-to-face resources and training modes (e.g. clinical supervision, clinical champion workshops), and iii. lack of face-to-face training on how to use the portal (technology and organisation).ConclusionBased on the NASSS framework, we were able to identify several barriers and facilitators including such as the complexity of the illness, lack of face-to-face training and clinician preference for training mediums. Recommendations include ongoing consultation of clinicians to assist in the development of tailored e-health resources and offering in-house training on how to operate and effectively utilise these resources.

A Process Evaluation of San Francisco’s Law Enforcement Assisted Diversion Program

2021 ◽  
pp. 088740342110333
Author(s):  
Erica Jovanna Magaña ◽  
Dina Perrone ◽  
Aili Malm
Keyword(s):  
Law Enforcement ◽  
San Francisco ◽  
Program Implementation ◽  
Relationship Building ◽  
Barriers And Facilitators ◽  
Implementation Barriers ◽  
Diversion Program ◽  
Drug Laws ◽  
Point Of Entry ◽  
Reducing Recidivism

In 2016, San Francisco (SF) implemented the Law Enforcement Assisted Diversion (LEAD) program, a harm reduction–based pre-booking diversion system for people who violate drug laws and/or are engaged in sex work. LEAD is set apart from existing diversion programs, as it uses police as point of entry. Prior LEAD studies indicate some success in reducing recidivism and improving life outcomes. However, less is known about program implementation, including barriers and facilitators. Relying on policy documents, interviews, and focus groups, this study describes the LEAD SF’s development, operations, adaptations, and challenges. It also identifies the unique context of LEAD SF that led to implementation barriers and facilitators. Results show that SF experienced success in collaboration, relationship building, and client connections to services but experienced challenges in securing and maintaining police officer buy-in and keeping clear and open lines of communication regarding LEAD goals, objectives, policies, and procedures. This led to the termination of LEAD SF in 2020.

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