Multi-Level Stakeholder Perspectives on Determinants of Point of Care Ultrasound Implementation in a US Academic Medical Center

There is growing interest from multiple specialties, including internal medicine, to incorporate diagnostic point of care ultrasound (POCUS) into standard clinical care. However, few internists currently use POCUS. The objective of this study was to understand the current determinants of POCUS adoption at both the health system and clinician level at a U.S. academic medical center from the perspective of multi-level stakeholders. We performed semi-structured interviews of multi-level stakeholders including hospitalists, subspecialists, and hospital leaders at an academic medical center in the U.S. Questions regarding the determinants of POCUS adoption were asked of study participants. Using the framework method, team-based analysis of interview transcripts were guided by the contextual domains of the Practical Robust Implementation and Sustainability Model (PRISM). Thirty-one stakeholders with diverse roles in POCUS adoption were interviewed. Analysis of interviews revealed three overarching themes that stakeholders considered important to adoption by clinicians and health systems: clinical impact, efficiency and cost. Subthemes included two that were deemed essential to high-fidelity implementation: the development of credentialing policies and robust quality assurance processes. These findings identify potential determinants of system and clinician level adoption that may be leveraged to achieve high-fidelity implementation of POCUS applications that result in improved patient outcomes.

A random-walk benchmark for single-electron circuits

Mesoscopic integrated circuits aim for precise control over elementary quantum systems. However, as fidelities improve, the increasingly rare errors and component crosstalk pose a challenge for validating error models and quantifying accuracy of circuit performance. Here we propose and implement a circuit-level benchmark that models fidelity as a random walk of an error syndrome, detected by an accumulating probe. Additionally, contributions of correlated noise, induced environmentally or by memory, are revealed as limits of achievable fidelity by statistical consistency analysis of the full distribution of error counts. Applying this methodology to a high-fidelity implementation of on-demand transfer of electrons in quantum dots we are able to utilize the high precision of charge counting to robustly estimate the error rate of the full circuit and its variability due to noise in the environment. As the clock frequency of the circuit is increased, the random walk reveals a memory effect. This benchmark contributes towards a rigorous metrology of quantum circuits.

A Mixed-Methods Approach for Embedding Cost Analysis Within Fidelity Assessment in School-Based Programs

This mixed-methods study describes a framework for conducting cost analyses of school-based programs leveraging fidelity data and applying the ingredients method. We illustrate this approach by applying it to Positive Behavioral Interventions and Supports (PBIS), drawing on multiple sources of data from a sample of 77 schools that were trained in PBIS. We concluded that the average per school cost of PBIS was US$53,216.00 (median = US$36,698), with an average per-pupil cost of US$90.00 (median = US$58.00), which is considerably less than other school-based prevention models. The cost did, however, differ by implementation level, such that high-fidelity implementation tended to cost more than low-fidelity implementation. We provide a case illustration to elucidate some of the cost drivers of PBIS implementation. Specifically, these data highlight the variability in the amount of training and coaching by the specific evidence-based program implemented within the tiered PBIS framework. Through this case illustration, we demonstrate the utility of tracking costs of school-based program within the context of fidelity data collection. The findings also suggest the potential cost savings of PBIS, both when compared with other evidence-based interventions as well as the known costs of negative school outcomes like dropout.

Achievement of Students With IEPs and Associated Relationships With an Inclusive MTSS Framework

The present study investigated the effectiveness of an equity-based inclusive school reform model nested within a multitiered system of support (MTSS) framework on the improvement of math and reading performance of students with Individualized Education Programs (IEPs). Descriptive statistics revealed that math state assessment scores of students with IEPs increased over the implementation period. Results of multilevel modeling demonstrated that the model’s fidelity of implementation scores positively and significantly predicted state assessment math scores. A further analysis examining the effectiveness of the model in three schools that implemented with adequate fidelity compared with nonimplementing schools indicated students with IEPs in implementing schools increased their math scores at a greater rate than their peers in comparison schools; however, effects on reading scores were equivocal. Findings are discussed in the context of inclusion and efforts to support high fidelity implementation of MTSS.

Assessing key stakeholders' knowledge, needs, and preferences for cancer survivorship care plans.

30 Background: Survivorship care plans (SCPs) are individualized documents that summarize cancer treatment received and provide guidelines for monitoring and maintaining survivors’ health. While SCPs are intended to facilitate care coordination, they are rarely used in the primary care setting. We aimed to understand the informational needs and delivery preferences of PCPs, cancer survivors, cancer specialists, and nurses related to SCPs. Methods: We conducted semi-structured interviews with a purposeful sample of PCPs (n = 10), cancer specialists (n = 5), nurses (n = 5), and cancer survivors (n = 5). After reviewing a sample SCP based on the published ASCO template, participants were asked about acceptability, appropriateness, feasibility, fidelity, implementation, and sustainability. De-identified transcripts were qualitatively analyzed using NVivo software. Results: 25 interviews were completed (RR 45%). Emergent themes included informational needs and delivery preferences. Informational needs include clarifying roles and responsibilities of allied professionals; the roles of the PCP for follow-up care should be clear, outlined and with content summarizing their responsibilities regarding screening, and surveillance. Additionally, SCPs should emphasize side and late effects of cancer treatment for the benefit of patients and providers. Delivery preferences include using sustainable and accessible electronic formats to improve provider communication and streamlining documentation for the intended audience. Electronic SCPs could be frequently updated with pertinent information about patient needs and care over time. Conclusions: Understanding the needs and preferences of PCPs may address current limitations of SCPs in coordinating survivor care. Future SCPs may be electronic and accessible, with content and guidance targeted to the PCP’s role.

Evaluating Implementation

The objective of this chapter is to describe the evaluation methods, techniques, and tools involved in measuring implementation fidelity. Implementation fidelity is defined and the distinction between process evaluation and formative evaluation is described. The body of knowledge known as implementation research is introduced, and the National Implementation Research Network’s Implementation Drivers Framework and implementation stages are presented. The use of manuals, protocols, checklists, and practice profiles to support high-fidelity practitioner behaviors are illustrated. Research-validated tools for assessing implementation fidelity within a multi-tiered system of support initiative are highlighted. This chapter concludes with a discussion regarding the use of established criterion for judging implementation fidelity and the critical importance of measuring implementation fidelity linked to intended student outcomes.

The Roles of Individual Differences and Innovation Properties in Multiple Forms of Innovation Implementation

We departed from research strategies suggested in prior studies in which binary outcomes of implementation, such as use or acceptance and nonuse or resistance, have been used, and we proposed the examination of diverse patterns of implementation behavior, including mechanical implementation, learning, reinvention, and mutual adaptation. These implementation patterns can be explained by innovation-related individual differences, innovation properties, and their interactions. We collected longitudinal data from 141 employees of a large steel company in Korea. Results showed that when employees participated in innovation-related training and when the innovation was compatible with the company's existing values and practices, the employees implemented the innovation as designed. In contrast, when employees had sufficient experience with the innovation and perceived it as flexible and adaptable to the local needs, they reinvented the innovation by customizing it to the local context. Employees' innovation competence was positively related to high-fidelity implementation only when compatibility of the innovation was high and flexibility of the innovation was low.