MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Implementation Science' source. Wed, 17 Mar 2010 16:10:17 +0100 http://www.medworm.com/index.php?rid=3310401&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F5%2F1%2F20 Conclusions: We recommend sensitivity and positive predictive value as statistics to assess agreement of direct and proxy measures of individual clinical actions. Summary measures should be reliable, repeatable, capture a single underlying aspect of behaviour, and map that construct onto a valid measurement scale. The relationship between the direct and proxy measures should be evaluated over the entire range of the direct measure and describe not only the mean of the proxy measure for any specific value of the direct measure, but also the range of variability of the proxy measure. The evidence about the relationship between direct and proxy methods of assessing clinical behaviour is weak. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=3310401 Fri, 26 Feb 2010 00:00:00 +0100 3310401 http://www.medworm.com/index.php?rid=3310402&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F5%2F1%2F19 Conclusions: This study showed that the perceived need for tailoring standard change ideas to local contexts and the complexity of aligning interests of involved departments hampered the use of the QIC method for process redesign. We cannot determine whether the QIC method would have been appropriate for process redesign. Peer stimulus was non-optimal as a result of the selection process for participation of project teams by the external change agent. In conclusion, project teams felt that necessary preconditions for successful use of the QIC method were lacking. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=3310402 Thu, 25 Feb 2010 00:00:00 +0100 3310402 http://www.medworm.com/index.php?rid=3301013&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F5%2F1%2F18 DiscussionThe BRIDGE Study includes clinicians and African-American patients in under-resourced community-based practices who have not been well-represented in clinical trials to improve depression care. The patient-centered and culturally targeted approach to depression care is a relatively new one that has not been tested in most previous studies. The study will provide evidence about whether patient-centered accommodations improve quality of care and outcomes to a greater extent than standard quality improvement strategies for African Americans with depression.Trial RegistrationClinicalTrials.gov NCT00243425 (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=3301013 Tue, 23 Feb 2010 00:00:00 +0100 3301013 http://www.medworm.com/index.php?rid=3275062&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F5%2F1%2F17 Conclusions: General practitioners judged the effectiveness of medical interventions by considering two broad dimensions: the extent to which interventions involve patient effort, and the size of their impact. The latter is informed by trial evidence, but the patient effort required to achieve effectiveness seems to be based on clinical judgement. Some of the failure of evidence-based medicine to be implemented may be more explicable if both dimensions were attended to. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=3275062 Tue, 16 Feb 2010 00:00:00 +0100 3275062 http://www.medworm.com/index.php?rid=3261804&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F5%2F1%2F15 Conclusions: The NPM provides a useful structure for both guiding and analysing the process by which an intervention is optimized for testing in a larger scale trial or for subsequent full-scale implementation. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=3261804 Wed, 10 Feb 2010 00:00:00 +0100 3261804 http://www.medworm.com/index.php?rid=3253562&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F5%2F1%2F13 Conclusions: The framework presented offers researchers an explicit path to composite indicator development. Without a scientifically robust and comprehensive approach to measurement of the quality of healthcare, performance measurement will ultimately fail to achieve its quality improvement goals. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=3253562 Tue, 09 Feb 2010 00:00:00 +0100 3253562 http://www.medworm.com/index.php?rid=3253561&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F5%2F1%2F14 Conclusions: There was poor justification of choice of intervention and use of theory in implementation research in the identified studies until at least 1998. Future research should explicitly identify the justification for the interventions. Greater use of explicit theory to understand barriers, design interventions and explore mediating pathways and moderators is needed to advance the science of implementation research. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=3253561 Tue, 09 Feb 2010 00:00:00 +0100 3253561 http://www.medworm.com/index.php?rid=3242759&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F5%2F1%2F12 Conclusion: A decision-maker-researcher partnership provides a model for systematic reviews that may foster knowledge translation and uptake. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=3242759 Fri, 05 Feb 2010 00:00:00 +0100 3242759 http://www.medworm.com/index.php?rid=3234662&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F5%2F1%2F11 Conclusions: We evaluated research publications for nine evidence-practice gaps, and identified small numbers of well-designed intervention trials and low rates of physician participation in these trials. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=3234662 Wed, 03 Feb 2010 00:00:00 +0100 3234662 http://www.medworm.com/index.php?rid=3230462&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F5%2F1%2F10 This study is not about patient participation in guideline development, a closely related and important issue that does not however substitute for, or guarantee individual patient involvement in clinical decisions. The study results will provide the needed background for recommendations about potential effective and feasible strategies to ensure greater responsiveness of clinical practice guidelines to individual patient's preferences in clinical decision-making. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=3230462 Tue, 02 Feb 2010 00:00:00 +0100 3230462 http://www.medworm.com/index.php?rid=3230463&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F5%2F1%2F9 DiscussionStakeholders adopt and use knowledge that has perceived utility, such as a solution to a problem. Achieving a technology-based solution involves three methods that generate knowledge in three states, analogous to the three classic states of matter. Research activity generates discoveries that are intangible and highly malleable like a gas; development activity transforms discoveries into inventions that are moderately tangible yet still malleable like a liquid; and production activity transforms inventions into innovations that are tangible and immutable like a solid. The paper demonstrates how the KTA model can accommodate all three types of activity and address all three states of knowledge. Linking the three activities in one model also illustrates the importance of engaging t... Implementation Science journals http://www.medworm.com/rss/comments.php?id=3230463 Mon, 01 Feb 2010 00:00:00 +0100 3230463 http://www.medworm.com/index.php?rid=3219395&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F5%2F1%2F7 Conclusions: The formative evaluation approach and attention to normalisation process theory allowed the training team to make adjustments to content and delivery and ensure appropriate staff attended each session. The content of the course was simplified and focussed more clearly on operationalising the WISE approach. The patient arm of the approach was strengthened by raising expectations of a change in approach to self-care support by their practice. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=3219395 Fri, 29 Jan 2010 00:00:00 +0100 3219395 http://www.medworm.com/index.php?rid=3215438&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F5%2F1%2F6 DiscussionThe results of this study will help determine the most effective way and the costs of improving the recognition of individuals at an increased familial CRC risk. It will provide insight into the experiences of both patients and clinicians with these strategies.The knowledge gathered in this study can be used to improve the recognition of familial and hereditary CRC at national and international level and serve as an example to improve care for patients and their relatives worldwide. Our results may also be useful in improving health care in other diseases.Trial registration: ClinicalTrials.gov NCT00929097 (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=3215438 Thu, 28 Jan 2010 00:00:00 +0100 3215438 http://www.medworm.com/index.php?rid=3207543&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F5%2F1%2F4 Conclusions: Compliance to the guidelines increased after active implementation and was sustained over the two-year follow-up. These results indicate that active local implementation of clinical guidelines involving clinicians can change behaviour and maintain compliance. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=3207543 Tue, 26 Jan 2010 00:00:00 +0100 3207543 http://www.medworm.com/index.php?rid=3207542&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F5%2F1%2F5 Background: Rewarding provider performance has been recommended by the Institute of Medicine as an approach to improve the quality of treatment, yet little empirical research currently exists that has examined the effectiveness and cost-effectiveness of such approaches.Aim: To test the effectiveness and cost-effectiveness of providing monetary incentives directly to therapists as a method to improve substance abuse treatment service delivery and subsequent client treatment outcomes.DesignUsing a cluster randomized design substance abuse treatment therapists from across 29 sites were assigned by site to either an implementation as usual (IAU) or pay-for-performance (P4P) condition.Participants: Substance abuse treatment therapists participating in a large dissemination and implementation in... Implementation Science journals http://www.medworm.com/rss/comments.php?id=3207542 Tue, 26 Jan 2010 00:00:00 +0100 3207542 http://www.medworm.com/index.php?rid=3199757&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F5%2F1%2F3 Conclusions: Further research is needed to refine the measure of information networks and to test theimpact of network characteristics on the uptake of innovations. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=3199757 Fri, 22 Jan 2010 00:00:00 +0100 3199757 http://www.medworm.com/index.php?rid=3178089&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F5%2F1%2F2 Conclusions: The scoping review methodology has permitted us to characterize and catalogue the extensive body of literature pertaining to health system report cards. The resulting literature repository that our review has created can be of use to researchers and health system stakeholders interested in the topic of health system quality measurement and reporting. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=3178089 Fri, 15 Jan 2010 00:00:00 +0100 3178089 http://www.medworm.com/index.php?rid=3138546&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F5%2F1%2F1 Conclusion: A blended learning approach was not superior to a QCs approach for improving knowledge about dementia management. However, a subgroup of GPs who were motivated to actually use the online modules had a gain in knowledge. Trial registration: Current Controlled Trials ISRCTN36550981. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=3138546 Mon, 04 Jan 2010 00:00:00 +0100 3138546 http://www.medworm.com/index.php?rid=3132906&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F84 Conclusions: The primary care practices in the network that we surveyed are at differing stages in their organization and implementation of evidence-based depression management. Practical surveys such as this may serve to better direct implementation of these quality improvement strategies for depression by improving understanding of the organizational barriers and facilitators that exist within both practices and practice networks. In addition, survey information can inform efforts of individual primary care practices in customizing intervention strategies to improve depression management. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=3132906 Thu, 31 Dec 2009 00:00:00 +0100 3132906 http://www.medworm.com/index.php?rid=3128375&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F82 Conclusions: There is little evidence at the moment for the effectiveness of an increasingly used and commercialised instrument such as electronic multidimensional guidelines. After more than a decade of development of numerous electronic systems, research on the most effective implementation strategy for this kind of guideline-based decision support systems is still lacking. This conclusion implies a considerable risk towards inappropriate investments in ineffective implementation interventions and in suboptimal care. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=3128375 Wed, 30 Dec 2009 00:00:00 +0100 3128375 http://www.medworm.com/index.php?rid=3084192&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F80 Conclusions: The data set constructed for this analysis is unique. It revealed that practitioners not only exercise their agency within interventions, they do so systematically, that is, according to a pattern. The typology is the first of its kind and, if verified through replication, may have value for anticipating intervention dynamics and explaining implementation variation in community interventions. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=3084192 Mon, 14 Dec 2009 00:00:00 +0100 3084192 http://www.medworm.com/index.php?rid=3043444&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F78 Conclusion: Our findings provide evidence of some of the key contextual elements that may require attention if institutionalization of EBP is to be realized. They also suggest the need for an integrated set of receptive contextual elements to achieve EBP institutionalization; and they further support the importance of specific interactions among these elements, including ways in which leadership affects other contextual elements positively or negatively. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=3043444 Mon, 30 Nov 2009 00:00:00 +0100 3043444 http://www.medworm.com/index.php?rid=3032975&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F77 This study aimed to investigate whether a multiple goal-directed behaviour perspective might inform implementation research beyond single-behaviour approaches. Methods: We conducted theory-based semi-structured interviews with 12 general medical practitioners (GPs) in Scotland on their views regarding two focal clinical behaviours--providing physical activity (PA) advice and prescribing to reduce blood pressure (BP) to (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=3032975 Thu, 26 Nov 2009 00:00:00 +0100 3032975 http://www.medworm.com/index.php?rid=3022120&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F76 Conclusions: Staff reported modifying and reinventing interventions when translating HIV prevention programs into practice. Targeted technical assistance for formative evaluation should be focused on the pre-implementation phase during which frequent modifications occur. Continuous or repeated measurements of fidelity are recommended. Increased technical assistance and guidance are needed to ensure that reinventions are evaluated and consistent with the aims of the original interventions. Providing strategic technical assistance and written guidance can facilitate effective HIV prevention technology transfer of evidence-based interventions. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=3022120 Mon, 23 Nov 2009 00:00:00 +0100 3022120 http://www.medworm.com/index.php?rid=3002695&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F75 DiscussionPreference-sensitive decisions are defined by equipoise: situations where options need to be deliberated. Moreover, where both healthcare professionals and patients agree that equipoise exists, situations may be regarded as having 'dual equipoise'. Such conditions are ideal for shared decision making. However, there are many situations in medicine where dual equipoise does not exist, where health professionals hold the view that scientific evidence for benefit strongly outweighs harm. This is often the case where people suffer from chronic conditions, and where behaviour change is recommended to improve outcomes. However, some patients, are either ambivalent or find it difficult to sustain optimal behaviours, i.e., patients will be in varying degrees of equipoise. Therefore, situ... Implementation Science journals http://www.medworm.com/rss/comments.php?id=3002695 Wed, 18 Nov 2009 00:00:00 +0100 3002695 http://www.medworm.com/index.php?rid=2998568&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F74 The objective of the current study is to learn more about relations between relevant conditions for successful implementation of QICs, applied changes, perceived successes, and actual outcomes. Methods: Twenty-four Dutch hospitals participated in a dissemination programme based on QICs. A questionnaire was sent to 237 leaders of teams who joined 18 different QICs to measure changes in working methods and activities, overall perceived success, team organisation, and supportive conditions. Actual outcomes were extracted from a database with team performance indicator data. Multi-level analyses were conducted to test a number of hypothesised relations within the cross-classified hierarchical structure in which teams are nested within QICs and hospitals. Results: Organisational and external ch... Implementation Science journals http://www.medworm.com/rss/comments.php?id=2998568 Tue, 17 Nov 2009 00:00:00 +0100 2998568 http://www.medworm.com/index.php?rid=2987967&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F73 We describe how Fishbein's Integrative Model (IM) of behavior can be applied to the development and evaluation of DESIs. There are several ways in which the IM could be used in research on the behavioral effects of DESIs. An investigator could measure the effects of an intervention on the central constructs of the IM - attitudes, normative pressure, self-efficacy, and intentions related to communication behaviors relevant to shared decision-making. However, if one were interested in the determinants of these domains, formative qualitative research would be necessary to elicit the salient beliefs underlying each of the central constructs. Formative research can help identify potential targets for a theory-based intervention to maximize the likelihood that it will influence the behavior of i... Implementation Science journals http://www.medworm.com/rss/comments.php?id=2987967 Thu, 12 Nov 2009 00:00:00 +0100 2987967 http://www.medworm.com/index.php?rid=2983997&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F72 DiscussionThis paper describes one of the nine Collaborations, that of Leicestershire, Northamptonshire and Rutland. Drawing a distinction between translation as an organising principle for health care providers and implementation as a discrete activity, this Collaboration is built on a substantial programme of applied research intended to create both research generation and research use capacity in provider organisations. The Collaboration in Leicestershire, Northamptonshire and Rutland has potential to provide evidence on how partnerships between practitioners, patients and researchers can improve the transfer of evidence into practice. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2983997 Thu, 12 Nov 2009 00:00:00 +0100 2983997 http://www.medworm.com/index.php?rid=2942475&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F71 Conclusion: Provider acceptance of CPGs depends on the type of implementation strategies used. Implementation effectiveness can be improved by using both workflow-focused as well as provider-focused strategies. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2942475 Thu, 29 Oct 2009 00:00:00 +0100 2942475 http://www.medworm.com/index.php?rid=2922642&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F70 Background: Blood transfusion is an essential part of healthcare and can improve patient outcomes. However, like most therapies, it is also associated with significant clinical risks. In addition, there is some evidence of over-use. Understanding the potential barriers and enablers to reduced prescribing of blood products will facilitate the selection of intervention components likely to be effective, thereby reducing the number of costly trials evaluating different implementation strategies. Using a theoretical basis to understand behaviours targeted for change will contribute to a "basic science" relating to determinants of professional behaviour and how these inform the selection of techniques for changing behaviour. However, it is not clear which theories of behaviour are relevant to c... Implementation Science journals http://www.medworm.com/rss/comments.php?id=2922642 Fri, 23 Oct 2009 23:00:00 +0100 2922642 http://www.medworm.com/index.php?rid=2919019&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F69 DiscussionWe summarize key elements of participatory action research, with particular attention to its collaborative, reflective approach. Elements of participatory action research and randomized controlled trial study designs are discussed and contrasted, with a complex adaptive systems approach used to frame their integration.SummaryThe integration of participatory action research and randomized controlled trial design results in a new approach that reflects not only the complex nature of healthcare organizations, but also the need to obtain generalizeable knowledge regarding the implementation process. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2919019 Thu, 22 Oct 2009 23:00:00 +0100 2919019 http://www.medworm.com/index.php?rid=2907713&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F68 Conclusion: This study showed low acceptance rates of the offer of access to the on-line resource when there was an associated requirement of response to a short on-line questionnaire and non-obtrusive monitoring of GP behaviour in terms of accessing the resource. If we are to improve care and encourage evidence based practice we need to find effective ways of motivating doctors and other health professionals to take part in research that can inform our implementation efforts. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2907713 Mon, 19 Oct 2009 23:00:00 +0100 2907713 http://www.medworm.com/index.php?rid=2904245&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F67 DiscussionOrganizational readiness for change is a multi-level, multi-faceted construct. As an organization-level construct, readiness for change refers to organizational members' shared resolve to implement a change (change commitment) and shared belief in their collective capability to do so (change efficacy). Organizational readiness for change varies as a function of how much organizational value the change and how favorably they appraise three key determinants of implementation capability: task demands, resource availability, and situational factors. When organizational readiness for change is high, organizational members are more likely to initiate change, exert greater effort, exhibit greater persistence, and display more cooperative behavior. The result is more effective implementa... Implementation Science journals http://www.medworm.com/rss/comments.php?id=2904245 Sun, 18 Oct 2009 23:00:00 +0100 2904245 http://www.medworm.com/index.php?rid=2889471&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F65 Conclusions: Potential barriers and supports to implementation have been identified that will help EDs adopt MDI/spacer use. Future interventions intended to increase MDI/spacer use in PEDs will need to be sensitive to the barriers identified in this study. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2889471 Mon, 12 Oct 2009 23:00:00 +0100 2889471 http://www.medworm.com/index.php?rid=2889470&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F66 Conclusions: The model extends previous research by outlining a process by which clinicians' perceptions shape implementation of lifestyle risk factor management in routine practice. This provides new insights to inform the development of effective strategies to improve such practices. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2889470 Mon, 12 Oct 2009 23:00:00 +0100 2889470 http://www.medworm.com/index.php?rid=2957928&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F64 Discussion and conclusionDevelopment, execution and evaluation of the TIDES marketing effort shows that social marketing is a promising approach for promoting implementation of evidence-based interventions in integrated healthcare systems. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2957928 Mon, 28 Sep 2009 00:00:00 +0100 2957928 http://www.medworm.com/index.php?rid=2823012&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F61 Background: Significant resources and time are invested in the production of research knowledge. The primary objective of this randomized controlled trial was to evaluate the effectiveness of three knowledge translation and exchange strategies in the incorporation of research evidence into public health policies and programs. Methods: This trial was conducted with a national sample of public health departments in Canada from 2004 to 2006. The three interventions, implemented over one year in 2005, included access to an online registry of research evidence; tailored messaging; and a knowledge broker. The primary outcome assessed the extent to which research evidence was used in a recent program decision, and the secondary outcome measured the change in the sum of evidence-informed healthy b... Implementation Science journals http://www.medworm.com/rss/comments.php?id=2823012 Tue, 22 Sep 2009 23:00:00 +0100 2823012 http://www.medworm.com/index.php?rid=2823013&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F60 Approximately one quarter of all Canadian children will seek emergency care in any given year, with the two most common medical problems affecting children in the ED being acute respiratory illness and injury. Treatment for some medical conditions in the ED remains controversial due to a lack of strong supporting evidence.The purpose of this paper is to describe a multi-centre Team Grant in Pediatric Emergency Medicine (PEM) that has been recently funded by the Canadian Institutes of Health Research (CIHR). This program of research integrates clinical research (in the areas of acute respiratory illness and injury) and knowledge translation (KT). This initiative includes seven distinct projects that address the objective to generate new evidence for clinical care and KT in the pediatric eme... Implementation Science journals http://www.medworm.com/rss/comments.php?id=2823013 Mon, 21 Sep 2009 23:00:00 +0100 2823013 http://www.medworm.com/index.php?rid=2813938&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F59 Conclusions: Residency programs teach different aspects of CPGs to varying degrees, and the majority uses educational strategies not supported by research evidence. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2813938 Sun, 20 Sep 2009 23:00:00 +0100 2813938 http://www.medworm.com/index.php?rid=2773993&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F57 Conclusions: There are differences in attitudes to prioritising contrasting interventions for optimising LRTI management among GPs with and without experience of using the interventions, although GPs in both groups recognised the importance of both approaches to optimise management of acute cough. GPs' experiences with and attitudes towards interventions need to be taken into account when planning rollout of interventions aimed at changing clinical practice. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2773993 Mon, 07 Sep 2009 23:00:00 +0100 2773993 http://www.medworm.com/index.php?rid=2760956&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F56 This study was designed to support two purposes. The first purpose was to test the effectiveness of a universal classroom-based intervention, the Whole Day First Grade Program (WD), aimed at two early antecedents of drug abuse and other problem behaviors, namely aggressive, disruptive behavior and poor academic achievement. The second purpose was to examine the utility of a multilevel structure to support high levels of implementation during the effectiveness trial, to sustain WD practices across additional years, and to train additional teachers in WD practices. Methods: The WD intervention integrated three components, each previously tested separately: classroom behavior management; instruction, specifically reading; and family-classroom partnerships around behavior and learning. Teacher... Implementation Science journals http://www.medworm.com/rss/comments.php?id=2760956 Tue, 01 Sep 2009 23:00:00 +0100 2760956 http://www.medworm.com/index.php?rid=2711200&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F55 DiscussionThese findings could be used by universities, research institutes, funding agencies and professional organizations in Canada and elsewhere to develop, implement and evaluate mentorship for KT research and practice. This research will establish a theoretical basis upon which we and others can compare the cost-effectiveness of interventions that enhance KT mentorship. If successful this program of research may increase knowledge about, confidence in, and greater utilization of KT processes, and the quality and quantity of KT research, perhaps ultimately leading to better implementation and adoption of recommended health care services. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2711200 Tue, 18 Aug 2009 23:00:00 +0100 2711200 http://www.medworm.com/index.php?rid=2690599&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F52 This study protocol describes the details of a multi-level -- including provinces, regions, facilities, units within facilities, and individuals who receive care (residents) or work (staff) in facilities -- and longitudinal (five-year) research project. A stratified random sample of 36 residential long-term care facilities (30 urban and 6 rural) from the Canadian Prairie Provinces will comprise the sample. Caregivers and care managers within these facilities will be asked to complete the TREC survey -- a suite of survey instruments designed to assess organizational context and related factors hypothesized to be important to successful knowledge translation and to achieving better resident, staff, and system outcomes. Facility and unit level data will be collected using standardized data co... Implementation Science journals http://www.medworm.com/rss/comments.php?id=2690599 Mon, 10 Aug 2009 23:00:00 +0100 2690599 http://www.medworm.com/index.php?rid=2690598&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F53 Background: The organizational context in which healthcare is delivered is thought to play an important role in mediating the use of knowledge in practice. Additionally, a number of potentially modifiable contextual factors have been shown to make an organizational context more amenable to change. However, understanding of how these factors operate to influence organizational context and knowledge use remains limited. In particular, research to understand knowledge translation in the long-term care setting is scarce. Further research is therefore required to provide robust explanations of the characteristics of organizational context in relation to knowledge use.AimTo develop a robust explanation of the way organizational context mediates the use of knowledge in practice in long-term care ... Implementation Science journals http://www.medworm.com/rss/comments.php?id=2690598 Mon, 10 Aug 2009 23:00:00 +0100 2690598 http://www.medworm.com/index.php?rid=2687459&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F51 Background: The knowledge translation field is undermined by two interrelated gaps -- underdevelopment of the science and limited use of research in health services and health systems decision making. The importance of context in theory development and successful translation of knowledge has been identified in past research. Additionally, examination of knowledge translation in the long-term care (LTC) sector has been seriously neglected, despite the fact that aging is increasingly identified as a priority area in health and health services research.AimsThe aims of this study are: to build knowledge translation theory about the role of organizational context in influencing knowledge use in LTC settings and among regulated and unregulated caregivers, to pilot knowledge translation intervent... Implementation Science journals http://www.medworm.com/rss/comments.php?id=2687459 Sun, 09 Aug 2009 23:00:00 +0100 2687459 http://www.medworm.com/index.php?rid=2673590&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F49 Conclusions: Given that guideline development processes have improved in some areas over the past 12 years yet not in others, ongoing monitoring of guideline quality is required. Guidelines produced more recently in Canada are less likely to be based on a review of the evidence and only about half discuss levels of evidence underlying recommendations. Guideline dissemination and implementation activities have actually decreased. Unfortunately, the potential positive impact on patient health outcomes will not be realized until the recommendations are adopted and acted upon. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2673590 Tue, 04 Aug 2009 23:00:00 +0100 2673590 http://www.medworm.com/index.php?rid=2669992&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F48 Conclusions: This method is currently being applied to study the meetings of three of NICE GDGs. These cover topics in acute physical health, mental health and public health, and comprise a total of 45 full-day meetings. The method offers potential for application to other health care and decision-making groups. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2669992 Tue, 04 Aug 2009 23:00:00 +0100 2669992 http://www.medworm.com/index.php?rid=2666452&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F47 Conclusions: Policy documents and plans of action aiming to promote physical activity and healthy eating habits among schoolchildren aged six to 16 in municipalities and town districts in Stockholm County did not seem to have an impact on the local level of measures. Demographic and socio-economic characteristics of the municipalities and town districts were on the other hand associated with local health-promoting measures. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2666452 Sun, 02 Aug 2009 23:00:00 +0100 2666452 http://www.medworm.com/index.php?rid=2633291&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F42 Conclusions: The effectiveness of interventions delivered at hospital level over periods realistically required to achieve change may be influenced by a wide variety of factors at national and local levels. We have demonstrated how dynamic such contexts are, and therefore the need to consider context when interpreting an intervention's effectiveness. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2633291 Wed, 22 Jul 2009 23:00:00 +0100 2633291 http://www.medworm.com/index.php?rid=2633290&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F43 Conclusions: Motivation is likely to influence powerfully any attempts to change or improve health worker and hospital practices. Some factors influencing motivation may themselves be influenced by the processes chosen to implement change. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2633290 Wed, 22 Jul 2009 23:00:00 +0100 2633290 http://www.medworm.com/index.php?rid=2633289&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F44 Conclusions: While the barriers identified are broadly similar in theme to those reported from high-income settings, their specific nature often differs. For example, at an institutional level there is an almost complete lack of systems to introduce or reinforce guidelines, poor teamwork across different cadres of health worker, and failure to confront poor practice. At an individual level, lack of interest in the evidence supporting guidelines, feelings that they erode professionalism, and expectations that people should be paid to change practice threaten successful implementation. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2633289 Wed, 22 Jul 2009 23:00:00 +0100 2633289 http://www.medworm.com/index.php?rid=2633288&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F45 Conclusions: The actual content of an intervention and how it is implemented and received may be critical determinants of whether it achieves its aims. We have carefully described our intervention approach to facilitate appraisal of the quantitative results of the intervention's effect on quality of care. Our findings suggest ongoing training, external supportive supervision, open feedback, and local facilitation may be valuable additions to more typical in-service training approaches, and may be feasible. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2633288 Wed, 22 Jul 2009 23:00:00 +0100 2633288 http://www.medworm.com/index.php?rid=2633287&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F46 Conclusions: The tool can serve as a catalyst for an important discussion about research use at the organizational level; such a discussion, in and of itself, demonstrates potential as an intervention to encourage processes and supports for research translation. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2633287 Wed, 22 Jul 2009 23:00:00 +0100 2633287 http://www.medworm.com/index.php?rid=2629170&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F41 Conclusions: Qualitative research nested in an experimental trial may clarify the improvements that a QIP may bring about in a general practice, provide insight into GPs' approach to diabetes care and reveal the program's limits. Implementation of a QIP encounters an array of cognitive, motivational and relational obstacles that are embedded in a patient-health care provider relationship. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2629170 Tue, 21 Jul 2009 23:00:00 +0100 2629170 http://www.medworm.com/index.php?rid=2609972&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F40 Complex behaviour change interventions are not well described; when they are described, the terminology used is inconsistent. This constrains scientific replication, and limits the subsequent introduction of successful interventions. Implementation Science is introducing a policy of initially encouraging and subsequently requiring the scientific reporting of complex behaviour change interventions. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2609972 Wed, 15 Jul 2009 23:00:00 +0100 2609972 http://www.medworm.com/index.php?rid=2597282&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F38 Conclusions: We find general support for the reliability and factor structure of the ORCA. Discrepant results included poor reliability among measures of evidence, and factor analysis results for measures of general resources and clinical champion role did not conform to the PARIHS framework. Additional validation is needed, including criterion validation. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2597282 Mon, 13 Jul 2009 23:00:00 +0100 2597282 http://www.medworm.com/index.php?rid=2597281&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F39 This study aims to test whether quality improvement interventions improve primary care management of elevated BP in CKD, reduce cardiovascular risk, and slow renal disease progressionDesignCluster randomised controlled trial (CRT) Methods: This three-armed CRT compares two well-established quality improvement interventions with usual practice. The two interventions comprise: provision of clinical practice guidelines with prompts and audit-based education.The study population will be all individuals with CKD from general practices in eight localities across England. Randomisation will take place at the level of the general practices. The intended sample (three arms of 25 practices) powers the study to detect a 3 mmHg difference in systolic BP between the different quality improvement interv... Implementation Science journals http://www.medworm.com/rss/comments.php?id=2597281 Mon, 13 Jul 2009 23:00:00 +0100 2597281 http://www.medworm.com/index.php?rid=2568242&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F37 Conclusions: Valid measures of clinical behaviour are of fundamental importance to accurately identify gaps in care delivery, improve quality of care, and ultimately to improve patient care. However, the evidence base for three commonly used proxy measures of clinicians' behaviour is very limited. Further research is needed to better establish the methods of development, application, and analysis for a range of both direct and proxy measures of behaviour. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2568242 Thu, 02 Jul 2009 23:00:00 +0100 2568242 http://www.medworm.com/index.php?rid=2568243&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F36 DiscussionPrevious research examined guideline implementation by measuring rates of compliance with recommendations or associated outcomes but this produced little insight on how the products themselves, or their implementation could be improved. This research will establish a theoretical basis upon which to conduct experimental studies to compare the cost-effectiveness of interventions that enhance guideline development and implementation capacity. Such studies could first examine short-term outcomes predictive of guideline utilization such as recall, attitude to, confidence in, and adoption intention. If successful, then long-term objective outcomes reflecting the adoption of processes and associated patient care outcomes could be evaluated. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2568243 Wed, 01 Jul 2009 23:00:00 +0100 2568243 http://www.medworm.com/index.php?rid=2500938&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F33 Conclusion: National and international KT organizations, research institutions, and funding agencies are encouraged to consider replicating the training model employed here, as investment into KT personnel will foster the advancement of the field within and beyond local borders.'To the individual who devotes his/her life to science, nothing can give more happiness than when the results immediately find practical application. There are not two sciences. There is science and the application of science, and these two are linked as the fruit is to the tree.' – Louis Pasteur, 1871 (from presentation by Ian Graham, 2008 CIHR Knowledge Translation Summer Institute) (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2500938 Thu, 11 Jun 2009 23:00:00 +0100 2500938 http://www.medworm.com/index.php?rid=2467265&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F32 Conclusions: We developed a simple tool designed to gather data from senior hospital administrators on factors likely to affect the success of a hospital patient flow improvement intervention. A minimization algorithm will ensure balanced allocation of the intervention with respect to these factors in study hospitals. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2467265 Mon, 08 Jun 2009 04:00:00 +0100 2467265 http://www.medworm.com/index.php?rid=2454645&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F31 Conclusions: Considerable resources are devoted to encouraging clinicians to implement evidence-based practice using interventions with erratic success records, or no known applicability to a specific clinical behaviour, selected mainly by means of researchers' intuition or optimism. The methodology used to develop this implementation intervention is not limited to decontamination nor to a single segment of primary care. It also accords with the preliminary stages of the framework for evaluating complex interventions suggested by the medical research council. The next phases of this work are to test the intervention feasibility and evaluate its effectiveness in a randomised control trial. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2454645 Fri, 05 Jun 2009 04:00:00 +0100 2454645 http://www.medworm.com/index.php?rid=2500939&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com Conclusions: Considerable resources are devoted to encouraging clinicians to implement evidence-based practice using interventions with erratic success records, or no known applicability to a specific clinical behaviour, selected mainly by means of researchers' intuition or optimism. The methodology used to develop this implementation intervention is not limited to decontamination nor to a single segment of primary care. It also accords with the preliminary stages of the framework for evaluating complex interventions suggested by the medical research council. The next phases of this work are to test the intervention feasibility and evaluate its effectiveness in a randomised control trial. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2500939 Thu, 04 Jun 2009 23:00:00 +0100 2500939 http://www.medworm.com/index.php?rid=2454646&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F30 This study aims at identifying what it is about PPIP that works, in which contexts are PPIP most likely to be effective, and how are PPIP assumed to lead to better CPGs development and implementation. Methods: A knowledge synthesis will be conducted in four phases. In phase one, literature on PPIP in CPGs development will be searched through bibliographic databases. A call for bibliographic references and unpublished reports will also be sent via the mailing lists of relevant organizations. Eligible publications will include original qualitative, quantitative, or mixed methods study designs reporting on a PPIP pertaining to CPGs development or implementation. They will also include documents produced by CPGs organizations to describe their PPIP. In phase two, grounded in the program's logi... Implementation Science journals http://www.medworm.com/rss/comments.php?id=2454646 Thu, 04 Jun 2009 04:00:00 +0100 2454646 http://www.medworm.com/index.php?rid=2431462&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F29 Conclusion: Normalization Process Theory has been developed through procedures that were properly sceptical and critical, and which were opened to review at each stage of development. The theory has been shown to be sufficiently robust to merit formal testing. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2431462 Thu, 21 May 2009 04:00:00 +0100 2431462 http://www.medworm.com/index.php?rid=2421869&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F27 Conclusions: There is no dominant trend in how the CoP concept is operationalized in the business and health sectors; hence it is challenging to define the parameters of CoP groups. This may be one of the reasons for the lack of studies on the effectiveness of CoPs in the health sector. In order to improve the usefulness of the CoP concept in the development of groups and teams, further research will be needed to clarify the extent to which the four characteristics of CoPs are present in the mature and emergent groups, the expectations of facilitators and other participants, and the power relationship within CoPs. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2421869 Sun, 17 May 2009 04:00:00 +0100 2421869 http://www.medworm.com/index.php?rid=2411803&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F26 Conclusions: Study findings suggest the relevance of principles and foci from the field of process evaluation related to intervention implementation, further illuminating KT as a structuration process facilitated by evolving transformative leadership in an active and integrated context. The model provides guidance for proactively constructing a 'fit' between content, context, and facilitation in the translation of evidence informing professional craft knowledge. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2411803 Thu, 14 May 2009 04:00:00 +0100 2411803 http://www.medworm.com/index.php?rid=2401986&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F25 Conclusion: The identification and examination of health care organizations that demonstrate positive deviance provides an opportunity to characterize and disseminate strategies for improving quality. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2401986 Fri, 08 May 2009 04:00:00 +0100 2401986 http://www.medworm.com/index.php?rid=2395823&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F24 Conclusions: These approaches to aggregating individually-administered measures may be a methodological advance of theoretical importance. Using simple means of individual-level measures to explain team-level behaviours is neither theoretically plausible nor empirically supported; the highest intention was both predictive and plausible. In studies aiming to understand the behaviours of teams of healthcare professionals in managing chronic diseases, some sort of aggregation of measures from individuals is necessary. This is not simply a methodological point, but a necessary step in advancing the theoretical and practical understanding of the processes that lead to implementation of clinical behaviours within healthcare teams. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2395823 Tue, 05 May 2009 04:00:00 +0100 2395823 http://www.medworm.com/index.php?rid=2373543&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F22 Background: Type 2 diabetes is an increasingly prevalent chronic illness and is an important cause of avoidable mortality. Patients are managed by the integrated activities of clinical and non-clinical members of the primary care team. Studies of the quality of care for patients with diabetes suggest less than optimum care in a number of areas. Aim The aim of this study is to improve the quality of care for patients with diabetes cared for in primary care in the UK. by identifying individual, team and organisational factors that predict the implementation of best practice. DesignParticipants will be clinical and non-clinical staff within 100 general practices sampled from practices who are members of the MRC General Practice Research Framework. Self-completion questionnaires will be devel... Implementation Science journals http://www.medworm.com/rss/comments.php?id=2373543 Mon, 27 Apr 2009 04:00:00 +0100 2373543 http://www.medworm.com/index.php?rid=2373542&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F23 Conclusion: As the knowledge broker role developed during this study, central themes that emerged as particularly important included relationship development, on-going support, customized approaches, and opportunities for individual and organizational capacity development. The novelty of the knowledge broker role in public health provides a unique opportunity to assess the need for and reaction to the role and its associated activities. Future research should include studies to evaluate the effectiveness of knowledge brokers in different settings and among different health care professionals; explore the optimal preparation and training of knowledge brokers, as well as the identification of the personality characteristics most closely associated with knowledge broker effectiveness. Studies... Implementation Science journals http://www.medworm.com/rss/comments.php?id=2373542 Mon, 27 Apr 2009 04:00:00 +0100 2373542 http://www.medworm.com/index.php?rid=2352595&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F21 Conclusions: This article reports on an in-depth pre-intervention study that led to the design and development of an intervention in partnership with local healthcare professionals and managers. The stepwise approach represents an innovative strategy for developing tailored interventions, particularly in complex domains such as chronic care. It highlights the usefulness of seeking out the insight of healthcare professionals and managers and emphasizes the need to intervene at different levels. Further research will be needed in order to develop a more thorough understanding of the impacts of such strategies on the final outcomes of intervention implementations. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2352595 Tue, 21 Apr 2009 04:00:00 +0100 2352595 http://www.medworm.com/index.php?rid=2320963&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F20 DiscussionGiven the imminence of an interoperable EHR in Canada, knowledge and evidence are urgently needed to prepare this major shift in our healthcare system and to oversee the factors that could affect its adoption and integration by all its potential users. This synthesis will be the first to systematically summarize the barriers and facilitators to EHR adoption perceived by different groups and to consider the local contexts in order to ensure the applicability of this knowledge to the particular realities of various Canadian jurisdictions. This comprehensive and rigorous strategy could be replicated in other settings. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2320963 Thu, 09 Apr 2009 04:00:00 +0100 2320963 http://www.medworm.com/index.php?rid=2320969&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F18 In October 2006, the Chief Medical Officer (CMO) of England asked Professor Sir John Tooke to chair a High Level Group on Clinical Effectiveness in response to the chapter 'Waste not, want not' in the CMOs 2005 annual report 'On the State of the Public Health'. The high level group made recommendations to the CMO to address possible ways forward to improve clinical effectiveness in the UK National Health Service (NHS) and promote clinical engagement to deliver this. The report contained a short section on research needs that emerged from the process of writing the report, but in order to more fully identify the relevant research agenda Professor Sir John Tooke asked Professor Martin Eccles to convene an expert group -- the Clinical Effectiveness Research Agenda Group (CERAG) -- to define t... Implementation Science journals http://www.medworm.com/rss/comments.php?id=2320969 Tue, 07 Apr 2009 04:00:00 +0100 2320969 http://www.medworm.com/index.php?rid=2320966&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F19 We describe the design and implementation of MHealthy: Focus on Diabetes (FOD), a prospective, controlled trial of targeted co-payment reductions for high value, underutilized therapies for individuals with diabetes. Methods: The FOD trial includes 2,507 employees and dependents with diabetes insured by one large employer. Approximately 81% are enrolled in a single independent-practice association model health maintenance organization. The control group includes 8,637 patients with diabetes covered by other employers and enrolled in the same managed care organization. Both groups received written materials about the importance of adherence to secondary prevention therapies, while only the intervention group received targeted co-payment reductions for glycemic agents, antihypertensives, lip... Implementation Science journals http://www.medworm.com/rss/comments.php?id=2320966 Tue, 07 Apr 2009 04:00:00 +0100 2320966 http://www.medworm.com/index.php?rid=2320972&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F17 Conclusions: The process of forming of academic-public partnerships is challenging and time consuming, yet crucial for the development and implementation of state-of-the-art approaches to assessment and interventions to improve the functioning and quality of life for persons with serious mental illnesses. These partnerships provide necessary organizational support to facilitate the translation of clinical research into community practice benefiting consumers, researchers, and providers. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2320972 Tue, 31 Mar 2009 04:00:00 +0100 2320972 http://www.medworm.com/index.php?rid=2272162&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F16 DiscussionThis is a unique study of research transfer in acute stroke. Providing optimal inpatient care during the admission phase is essential if we are to combat the rising incidence of debilitating stroke. Our CRCT will also allow us to test interventions focussed on multidisciplinary ASU teams rather than individual disciplines, an imperative of modern hospital services. Trial Registration: Australia New Zealand Clinical Trial Registry (ANZCTR) No: ACTRN12608000563369 (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2272162 Mon, 16 Mar 2009 04:00:00 +0100 2272162 http://www.medworm.com/index.php?rid=2255841&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F10 Conclusion: The results of our DCE and traditional questionnaire would probably lead to different implementation strategies. Although there is no 'gold standard' for prioritising potential barriers and facilitators to the implementation of change, theoretically, DCE would be the method of choice. However, the feasibility of using DCE was less favourable. Further empirical applications should investigate whether DCE can really make a valuable contribution to the implementation science. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2255841 Sun, 01 Mar 2009 05:00:00 +0100 2255841 http://www.medworm.com/index.php?rid=2226802&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F10 Conclusions: The results of our DCE and traditional questionnaire would probably lead to different implementation strategies. Although there is no 'gold standard' for prioritising potential barriers and facilitators to the implementation of change, theoretically, DCE would be the method of choice. However, the feasibility of using DCE was less favourable. Further empirical applications should investigate whether DCE can really make a valuable contribution to the implementation science. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2226802 Sun, 01 Mar 2009 05:00:00 +0100 2226802 http://www.medworm.com/index.php?rid=2226803&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F9 The U.S. Veterans Health Administration (VHA) may have a very different structure and function from the organizations and practices that provide medical care to most Americans, but those organizations and practices could learn a lot from the VHA's Quality Enhancement Research Initiative (QUERI). There are at least six topics of increasing importance for implementation research where QUERI experience should be of value to other non-VHA organizations, both within and external to the United States: 1) Researcher-clinical leader partnerships for care improvement; 2) Attention to culture, capacity, leadership, and a supportive infrastructure; 3) Practical economic evaluation of quality implementation efforts; 4) Human subject protection problems; 5) Sustainability of improvements; and 6) Scale-... Implementation Science journals http://www.medworm.com/rss/comments.php?id=2226803 Thu, 26 Feb 2009 05:00:00 +0100 2226803 http://www.medworm.com/index.php?rid=2221997&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F8 The Quality Enhancement Research Initiative (QUERI) is a unique quality improvement program designed to connect health services researchers to Veterans Health Administration (VHA) management and operations, as well as to provide the science and initiative for making change. Through this process, QUERI stakeholders have learned that success and impact in improving healthcare quality and outcomes largely depends on coordination and collaboration among numerous VHA programs and organizations working to develop and implement evidence-based clinical policies, practices, and quality improvement strategies. This Commentary discusses some of these collaborative efforts and perceived successes in achieving common goals from the viewpoints of two closely involved VHA Operations/Support stakeholders.... Implementation Science journals http://www.medworm.com/rss/comments.php?id=2221997 Thu, 26 Feb 2009 05:00:00 +0100 2221997 http://www.medworm.com/index.php?rid=2221996&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F9 The U.S. Veterans Health Administration (VHA) may have a very different structure and function from the organizations and practices that provide medical care to most Americans, but those organizations and practices could learn a lot from the VHA's Quality Enhancement Research Initiative (QUERI). There are at least six topics of increasing importance for implementation research where QUERI experience should be of value to other non-VHA organizations, both within and external to the United States: 1) Researcher-clinical leader partnerships for care improvement; 2) Attention to culture, capacity, leadership, and a supportive infrastructure; 3) Practical economic evaluation of quality implementation efforts; 4) Human subject protection problems; 5) Sustainability of improvements; and 6) Scale-... Implementation Science journals http://www.medworm.com/rss/comments.php?id=2221996 Thu, 26 Feb 2009 05:00:00 +0100 2221996 http://www.medworm.com/index.php?rid=2199794&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F7 Conclusion: The Triple P study will provide new knowledge about how to improve patient adherence, quality of care, and cardiovascular outcomes and how to reduce disparities in care and outcomes of ethnic minority and poor persons with hypertension. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2199794 Thu, 19 Feb 2009 05:00:00 +0100 2199794 http://www.medworm.com/index.php?rid=2177287&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F4 Conclusions: CCs and SUs perceive similar value in early warning signs interventions to prevent relapse and these have particular benefits to them. If this perceived value is maintained, CCs and SUs in routine practice may use ERP long-term. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2177287 Mon, 09 Feb 2009 05:00:00 +0100 2177287 http://www.medworm.com/index.php?rid=2086673&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F4%2F1%2F3 This study aims to provide internationally comparative data on cardiovascular risk management provided in primary care and on health-related lifestyles of patients in Europe. The study will also explore the views of doctors and patients on innovative preventive services for CVDs. Design and methods An observational cross-sectional study is planned. In 10 European countries, stratified samples of 36 practices per country will be recruited. In each practice, three samples of 15 patients each will be sampled: patients with coronary heart disease, patients at high risk for CVD, and healthy adult patients. The quality of cardiovascular risk management has been specified in terms of 44 performance indicators that resulted from an international Delphi-procedure with general practitioners. Most in... Implementation Science journals http://www.medworm.com/rss/comments.php?id=2086673 Wed, 07 Jan 2009 05:00:00 +0100 2086673 http://www.medworm.com/index.php?rid=2073327&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F57 Conclusions: The model successfully provided a framework for helping to identify factors that promote and inhibit the implementation of DSTs in healthcare and gave us insights into factors influencing the introduction of new technologies into contexts where negotiations are characterized by asymmetries of power and knowledge. Future research and development on the deployment of DSTs needs to take a more holistic approach and give emphasis to the structural conditions and social norms in which these technologies are enacted. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2073327 Wed, 31 Dec 2008 05:00:00 +0100 2073327 http://www.medworm.com/index.php?rid=2073326&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F58 Conclusion: This preliminary experience suggests that successful change in clinical processes and organizational culture can be accomplished through multidisciplinary collaboration. A randomized trial of PREDICT consent, leveraging the accumulated knowledge from this first experience, is needed to further evaluate its impact on medical decision-making, patient compliance, and clinical outcomes. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2073326 Wed, 31 Dec 2008 05:00:00 +0100 2073326 http://www.medworm.com/index.php?rid=2073325&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F59 Conclusions: MH-QUERI has partnered with VA organizational leaders to develop a focused yet flexible plan to address key factors to prepare for national dissemination and implementation of collaborative care for depression. Early indications suggest that the plan is laying an important foundation that will enhance the likelihood of successful implementation and spread across the VA healthcare system. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=2073325 Wed, 31 Dec 2008 05:00:00 +0100 2073325 http://www.medworm.com/index.php?rid=1974527&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F50 This study used TPB to explore the observed effects in a pragmatic cluster randomised controlled trial of a structured recall and prompting intervention to increase evidence-based diabetes care that was conducted in three Primary Care Trusts in England. Methods: All general practitioners and nurses in practices involved in the trial were sent a postal questionnaire at the end of the intervention period, based on the TPB (predictor variables: attitude; subjective norm; perceived behavioural control, or PBC). It focussed on three clinical behaviours recommended in diabetes care: measuring blood pressure; inspecting feet; and prescribing statins. Multivariate analyses of variance and multiple regression analyses were used to explore changes in cognitions and thereby better understand trial ef... Implementation Science journals http://www.medworm.com/rss/comments.php?id=1974527 Wed, 19 Nov 2008 05:00:00 +0100 1974527 http://www.medworm.com/index.php?rid=1968254&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F47 Conclusion: Findings suggest that establishing strong norms and values may influence employee participation in a change program in a group setting. Supervisory level was also significant with greater responsibility being associated with greater participation. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1968254 Sun, 02 Nov 2008 04:00:00 +0100 1968254 http://www.medworm.com/index.php?rid=1920766&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F46 In 2004 a UK charity, The Health Foundation, established the 'Engaging with Quality Initiative' to explore and evaluate the benefits of engaging clinicians in quality improvement in healthcare. Eight projects run by professional bodies or specialist societies were commissioned in various areas of acute care. A developmental approach to the initiative was adopted, accompanied by a two level evaluation: eight project self-evaluations and a related external evaluation. This paper describes how the protocol for the external evaluation was developed. The challenges faced included large variation between and within the projects (in approach, scope and context, and in understanding of quality improvement), the need to support the project teams in their self-evaluations while retaining a necessary... Implementation Science journals http://www.medworm.com/rss/comments.php?id=1920766 Thu, 30 Oct 2008 04:00:00 +0100 1920766 http://www.medworm.com/index.php?rid=1914165&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F44 Conclusion: People with chronic conditions need support from providers in both supply and engagement with information, in a way which gives legitimacy to the person's own self-management strategies and possible alternatives. Thus, a link could usefully be made between information offered, as well as patients' past experiences of self-management and engagement with services for their condition. The timeliness of the information should be considered, both in terms of the illness career and the type of condition (i.e., before depression gets too bad or time to reflect on existing knowledge about a condition and how it is to be managed) and in terms of the pre-existing relationship with services (i.e., options explored and tried).More considered use of information (how it is provided, by whom,... Implementation Science journals http://www.medworm.com/rss/comments.php?id=1914165 Mon, 13 Oct 2008 04:00:00 +0100 1914165 http://www.medworm.com/index.php?rid=1905275&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F43 Conclusion: This study has systematically employed the AGREE instrument for the critical assessment of guidelines produced in a LMIC. Guideline development and diffusion in Argentina from 1994 to 2004 shows a constant increment, although quality of reporting did not improve; moreover, in some aspects it seemed to decline. Much room for improvement of the guideline development process was found at all levels of the health system. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1905275 Mon, 13 Oct 2008 04:00:00 +0100 1905275 http://www.medworm.com/index.php?rid=1872810&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F43 Conclusions: This study has systematically employed the AGREE instrument for the critical assessment of guidelines produced in a LMIC. Guideline development and diffusion in Argentina from 1994 to 2004 shows a constant increment, although quality of reporting did not improve; moreover, in some aspects it seemed to decline. Much room for improvement of the guideline development process was found at all levels of the health system. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1872810 Mon, 13 Oct 2008 04:00:00 +0100 1872810 http://www.medworm.com/index.php?rid=1872809&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F44 Conclusions: People with chronic conditions need support from providers in both supply and engagement with information, in a way which gives legitimacy to the person's own self-management strategies and possible alternatives. Thus, a link could usefully be made between information offered and patients' past experiences of self-management and engagement with services for their condition. The timeliness of the information should be considered, both in terms of the illness career and the type of condition (i.e. before depression gets too bad or time to reflect on existing knowledge about a condition and how it is to be managed) and in terms of the pre-existing relationship with services (i.e. options explored and tried). More considered use of information (how it is provided, by whom and at w... Implementation Science journals http://www.medworm.com/rss/comments.php?id=1872809 Mon, 13 Oct 2008 04:00:00 +0100 1872809 http://www.medworm.com/index.php?rid=1840539&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F40 Conclusions: CCM-based interventions, which include care managers, mental health integration, and patient education, are most likely to be implemented successfully because they effectively address several important barriers to care and are endorsed by physicians. Practices considering the adoption of interventions that received less support should educate physicians about the benefit of the interventions and attend to physician concerns prior to implementation. A focus on interventions that address systems-related barriers is needed to overcome all barriers to care. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1840539 Tue, 30 Sep 2008 04:00:00 +0100 1840539 http://www.medworm.com/index.php?rid=1708166&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F38 DiscussionThis work will provide initial evidence about whether a patient decision aid can improve the informed consent process. The larger goal of this work is to examine whether study recruitment can be improved from (barely) informed consent based on disclosure-oriented documents, towards a process of high-quality participant decision-making. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1708166 Wed, 23 Jul 2008 04:00:00 +0100 1708166 http://www.medworm.com/index.php?rid=1674351&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F37 Background: In an effort to ensure that all physicians have access to valid and reliable evidence on drug effectiveness, the Italian Drug Agency sponsored a free-access e-learning system, based on Clinical Evidence, called ECCE. Doctors have access to an electronic version and related clinical vignettes. Correct answers to the interactive vignettes provide Continuing Medical Education credits. The aims of this trial are to establish whether the e-learning program (ECCE) increases physicians' basic knowledge about common clinical scenarios, and whether ECCE is superior to the passive diffusion of information through the printed version of Clinical Evidence.DesignAll Italian doctors naïve to ECCE will be randomised to three groups. Group one will have access to ECCE for Clinical Evidence ch... Implementation Science journals http://www.medworm.com/rss/comments.php?id=1674351 Thu, 17 Jul 2008 04:00:00 +0100 1674351 http://www.medworm.com/index.php?rid=1634639&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F37 Background: In an effort to ensure that all physicians have access to valid and reliable evidence on drug effectiveness, the Italian Drug Agency sponsored a free-access e-learning system, based on Clinical Evidence, called ECCE. Doctors have access to an electronic version and related clinical vignettes. Correct answers to the interactive vignettes provide Continuing Medical Education credits. The aims of this trial are to establish whether the e-learning program (ECCE) increases physicians' basic knowledge about common clinical scenarios, and whether ECCE is superior to the passive diffusion of information through the printed version of Clinical Evidence.DesignAll Italian doctors naive to ECCE will be randomised to three groups. Group one will have access to ECCE for Clinical Evidence cha... Implementation Science journals http://www.medworm.com/rss/comments.php?id=1634639 Thu, 17 Jul 2008 04:00:00 +0100 1634639 http://www.medworm.com/index.php?rid=1560109&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F35 The development and implementation of an evidence-based approach to health workforce planning is a necessary step to achieve access to best practice chronic disease management. In its absence, the widely reported failure in implementation of clinical best practice guidelines is almost certain to continue. This paper describes a demand model to estimate the community-based primary care health workforce consistent with the delivery of best practice chronic disease management and prevention. The model takes a geographic region as the planning frame and combines data about the health status of the regional population by disease category and stage, with best practice guidelines to estimate the clinical skill requirement or competencies for the region. The translation of the skill requirement in... Implementation Science journals http://www.medworm.com/rss/comments.php?id=1560109 Wed, 18 Jun 2008 04:00:00 +0100 1560109 http://www.medworm.com/index.php?rid=1554331&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F33 Conclusion: This report further reinforces what others have noted, namely that educational interventions intended to change clinical practice should employ a multilevel approach if patients are to truly benefit from new skills gained by clinicians. We utilize an implementation research model to illustrate how the aims of the second intervention were realized and sustained over the 12-month follow-up period, and to suggest directions for future implementation research. The present report attests to the validity of, and contributes to, the emerging literature on implementation research. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1554331 Tue, 03 Jun 2008 04:00:00 +0100 1554331 http://www.medworm.com/index.php?rid=1487666&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F31 Conclusions: Modifiable characteristics of organizational context at the patient care unit level influence research utilization by nurses. These findings have implications for patient care unit structures and offer beginning direction for the development of interventions to enhance research use by nurses. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1487666 Mon, 02 Jun 2008 04:00:00 +0100 1487666 http://www.medworm.com/index.php?rid=1487665&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F32 Conclusions: A multi-modal intervention, which included mailing a patient reminder with a colon cancer decision aid to patients and system changes allowing patients direct access to schedule screening tests, increased colon cancer screening test completion in a subset of patients within a single academic practice. Although the uptake of the decision aid was low, the cost was also modest, suggesting that this method could be a viable approach to colon cancer screening. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1487665 Mon, 02 Jun 2008 04:00:00 +0100 1487665 http://www.medworm.com/index.php?rid=1477616&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F28 Conclusions: There may be some benefit to focused effort to implement electronic clinical reminders, although reminders designed to improve relatively simple tasks, such as ordering tests, may be more beneficial than reminders designed to improve more complex tasks, such as initiating or titrating medications, because of the less complex nature of the task. There is value in monitoring the process, as well as outcome, of an implementation effort. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1477616 Thu, 29 May 2008 04:00:00 +0100 1477616 http://www.medworm.com/index.php?rid=1477615&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F29 Conclusions: Understanding the organizational context of delivering evidence-based practice is a critical adjunct to efforts to systematically improve quality. Given the size and diversity of VA practices, coupled with unique organizational data sources, QUERI is well-positioned to make valuable contributions to the field of implementation science. More explicit accommodation of organizational inquiry into implementation research agendas has helped QUERI researchers to better frame and extend their work as they move toward regional and national spread activities. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1477615 Thu, 29 May 2008 04:00:00 +0100 1477615 http://www.medworm.com/index.php?rid=1477614&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F30 Conclusion: QUERI's experience and success provide a case study in organizational change. It demonstrates that progress requires a strategic, systems-based effort. QUERI's evidence-based initiative involved a deliberate cultural shift, requiring ongoing commitment in multiple forms and at multiple levels. VA's commitment to QUERI came in the form of visionary leadership, targeted allocation of resources, infrastructure refinements, innovative peer review and study methods, and direct involvement of key stakeholders. Stakeholders included both those providing and managing clinical care, as well as those producing relevant evidence within the health care system. The organizational framework and related implementation interventions used to achieve contextual change resulted in engaged investi... Implementation Science journals http://www.medworm.com/rss/comments.php?id=1477614 Thu, 29 May 2008 04:00:00 +0100 1477614 http://www.medworm.com/index.php?rid=1448809&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F25 Background: The relationship between health care practices' capacity for change and the results and sustainability of interventions to improve health care delivery is unclear. Methods: In the setting of an intervention to increase preventive service delivery (PSD), we assessed practice capacity for change by rating motivation to change and instrumental ability to change on a one to four scale. After combining these ratings into a single score, random effects models tested its association with change in PSD rates from baseline to immediately after intervention completion and 12 months later. Results: Our measure of practices' capacity for change varied widely at baseline (range 2-8; mean 4.8 +/- 1.6). Practices with greater capacity for change delivered preventive services to eligible pat... Implementation Science journals http://www.medworm.com/rss/comments.php?id=1448809 Fri, 16 May 2008 04:00:00 +0100 1448809 http://www.medworm.com/index.php?rid=1448808&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F26 DiscussionPolicymaking that is informed by the implementation literature requires that policymakers deploy strategies across multiple levels of the ecology of implementation. At the organizational level, policies are needed to resource the added marginal costs of EBPs, and to assist organizational learning by re-engineering continuing education units. At the payor and regulatory levels, policies are needed to creatively utilize contractual mechanisms, develop disease management programs and similar comprehensive care management approaches, carefully utilize provider and organizational profiling, and develop outcomes assessment. At the political level, legislation is required to promote mental health parity, reduce discrimination, and support loan forgiveness programs. Regulations are also ... Implementation Science journals http://www.medworm.com/rss/comments.php?id=1448808 Fri, 16 May 2008 04:00:00 +0100 1448808 http://www.medworm.com/index.php?rid=1413330&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F24 Background: One strategy to enhance research use and change current practice is to identify barriers and then implement tailored interventions to reduce these barriers. In nursing, the BARRIERS scale has been frequently used to identify nurses' perceptions of barriers to research utilization. However, this scale has not been applied to care of older people, and only one study has investigated how identified barriers link to research utilization. Therefore, the purpose of this study was twofold: to describe RNs' perceptions of barriers to and facilitators of research utilization and to examine the validity of the BARRIERS scale in relation to research use. Methods: A cross-sectional survey design was used and registered nurses (RNs) working in the care of older people participated (response... Implementation Science journals http://www.medworm.com/rss/comments.php?id=1413330 Thu, 01 May 2008 04:00:00 +0100 1413330 http://www.medworm.com/index.php?rid=1399004&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F23 Conclusions: Findings support that while guidelines might be necessary to communicate evidence, other strategies may be necessary to target discordant behaviours. Further research designed to examine the relationships found in the current study is required. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1399004 Fri, 25 Apr 2008 04:00:00 +0100 1399004 http://www.medworm.com/index.php?rid=1390815&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F20 Conclusion: Economics appears to play an important role in QUERI implementation studies, only after implementation has reached the stage of multi-site trials. Economic analysis could better inform the choice of which clinical best practices to implement and the choice of implementation interventions to employ. QUERI economics also would benefit from research on costing methods and development of widely accepted international standards for implementation economics. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1390815 Tue, 22 Apr 2008 04:00:00 +0100 1390815 http://www.medworm.com/index.php?rid=1390814&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F21 This article explores the variety of conceptualizations of implementation sustainability, as well as behavioral and organizational factors that influence the maintenance of gains. It highlights the finer points of design considerations and draws on our own experiences with measuring sustainability, framed within the rich theoretical and empirical contributions of others. In addition, recommendations are made for designing sustainability analyses. This article is one in a Series of articles documenting implementation science frameworks and approaches developed by the U.S. Department of Veterans Affairs Quality Enhancement Research Initiative (QUERI). (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1390814 Tue, 22 Apr 2008 04:00:00 +0100 1390814 http://www.medworm.com/index.php?rid=1390813&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F22 Conclusions: Formative evaluations provided the project team with a broad view of the processes of implementing multi-targeted interventions as well as the evolving status of the related best practice. Using FE was useful, although the challenges of conducting FE for non-field researchers should be addressed. Work is needed to develop methods for conducting FE across multiple sites, as well as acknowledging variations in local contexts that affect implementation of interventions. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1390813 Tue, 22 Apr 2008 04:00:00 +0100 1390813 http://www.medworm.com/index.php?rid=1313918&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F16 We describe how we used the framework of the U.S. Department of Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) to develop a program to improve rates of diagnostic testing for the Human Immunodeficiency Virus (HIV). This venture was prompted by the observation by the CDC that 25% of HIV-infected patients do not know their diagnosis - a point of substantial importance to the VA, which is the largest provider of HIV care in the United States. Methods: Following the QUERI steps (or process), we evaluated: 1) whether undiagnosed HIV infection is a high-risk, high-volume clinical issue within the VA, 2) whether there are evidence-based recommendations for HIV testing, 3) whether there are gaps in the performance of VA HIV testing, and 4) the barriers and facilitators to i... Implementation Science journals http://www.medworm.com/rss/comments.php?id=1313918 Wed, 19 Mar 2008 04:00:00 +0100 1313918 http://www.medworm.com/index.php?rid=1313917&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F17 Conclusions: The implementation development process described here is presented as an optional method (or series of steps) to consider when designing a small scale, multisite implementation study. The process grew from an evidence based quality improvement strategy developed for and proven efficacious in primary care settings. The authors are currently studying the efficacy of the process across a spectrum of specialty care treatment settings. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1313917 Wed, 19 Mar 2008 04:00:00 +0100 1313917 http://www.medworm.com/index.php?rid=1313916&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F18 Conclusions: Work by DM-QUERI to promote changes in the delivery of eye care services for veterans with diabetes demonstrates the value of the QUERI process in facilitating the more rapid implementation of evidence into practice. However, our experience with using the QUERI process also highlights certain challenges, including those related to the hybrid nature of the research-operations partnership as a mechanism for promoting rapid, system-wide implementation of important research findings. In addition, this paper suggests a number of important considerations for future implementation work, both in the area of pro-active scheduling interventions, as well as for implementation science in general. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1313916 Wed, 19 Mar 2008 04:00:00 +0100 1313916 http://www.medworm.com/index.php?rid=1281953&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F15 Background: Most patients with type 2 diabetes have suboptimal control of their glucose, blood pressure (BP), and lipids - three risk factors for diabetes complications. Although the chronic care model (CCM) provides a roadmap for improving these outcomes, developing theoretically sound implementation strategies that will work across diverse primary care settings has been challenging. One explanation for this difficulty may be that most strategies do not account for the complex adaptive system (CAS) characteristics of the primary care setting. A CAS is comprised of individuals who can learn, interconnect, self-organize, and interact with their environment in a way that demonstrates non-linear dynamic behavior. One implementation strategy that may be used to leverage these properties is pra... Implementation Science journals http://www.medworm.com/rss/comments.php?id=1281953 Wed, 05 Mar 2008 05:00:00 +0100 1281953 http://www.medworm.com/index.php?rid=1269523&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F13 Background: It is generally acknowledged that a disparity between knowledge and its implementation is adversely affecting quality of care. An example commonly cited is the failure of clinicians to follow clinical guidelines. A guiding assumption of this view is that adherence should be gauged by a standard of conformance. At least some guideline developers dispute this assumption and claim that their efforts are intended to inform and assist clinical practice, not to function as standards of performance. However, their ability to assist and inform will remain limited until an alternative to the conformance criterion is proposed that gauges how evidence-based guidelines are incorporated into clinical decisions. Methods: The proposed investigation has two specific aims to identify the proces... Implementation Science journals http://www.medworm.com/rss/comments.php?id=1269523 Fri, 29 Feb 2008 05:00:00 +0100 1269523 http://www.medworm.com/index.php?rid=1269522&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F14 Conclusions: Strategies to implement evidence-based interventions into routine clinical settings should include multi-method, pre-implementation assessments of the clinical environment and address multiple barriers to initial uptake as well as long-term sustainability. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1269522 Fri, 29 Feb 2008 05:00:00 +0100 1269522 http://www.medworm.com/index.php?rid=1250021&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F11 This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation. Methods: This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters), which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-sp... Implementation Science journals http://www.medworm.com/rss/comments.php?id=1250021 Fri, 22 Feb 2008 05:00:00 +0100 1250021 http://www.medworm.com/index.php?rid=1250020&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F12 DiscussionThe protocol provided here registers our intent to conduct an economic evaluation alongside the IMPLEMENT study, facilitates peer-review of proposed methods and provides a transparent statement of planned analyses. Trial registration. Australian New Zealand Clinical Trials Registry ACTRN012606000098538 (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1250020 Fri, 22 Feb 2008 05:00:00 +0100 1250020 http://www.medworm.com/index.php?rid=1215143&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F7 Conclusions: Promoting adherence to the LBP guideline requires more than enhancing knowledge about evidence-based management of LBP. Public education and an interdisciplinary consensus are important requirements for successful guideline implementation into daily practice. Guideline recommendations need to be adapted to the infrastructure of the health care system. Trial registration BMBF Grant Nr. 01EM0113. FORIS [database for research projects in social science (www.gesis.org/Information/FORIS/Recherche/index.htm)] Reg #: 20040116. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1215143 Thu, 07 Feb 2008 05:00:00 +0100 1215143 http://www.medworm.com/index.php?rid=1191177&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F6 Conclusion: CP training workshops have been associated with subsequent CP implementations at resource centers but not clinics. We hypothesize that CP workshops combined with an internal champion and adequate program resources may be sufficient for selected some patient support organizations to implement CP. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1191177 Thu, 31 Jan 2008 05:00:00 +0100 1191177 http://www.medworm.com/index.php?rid=1160886&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F4 Conclusion: Despite the clear need for mapping software and maps, there remain several challenges to their effective implementation. Some can be modified, while other challenges might require attention at the systemic level. Future research is needed to identify barriers and facilitators related to using mapping software and maps for decision-making by other users, and to subsequently develop mapping best practices guidelines to assist community-based agencies circumvent some challenges and support information equity across a region. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1160886 Fri, 18 Jan 2008 05:00:00 +0100 1160886 http://www.medworm.com/index.php?rid=1160885&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F5 Conclusions: Although difficult, high implementation fidelity by community-based organizations can be achieved. This study suggests some important factors that organizations should consider to ensure fidelity, such as selecting programs with features that minimize complexity while maximizing flexibility. Time constraints in the classroom should be considered when choosing a program. Student behavior also influences program delivery, so schools should train teachers in the use of classroom management skills. This project involved comprehensive program monitoring and technical assistance that likely facilitated the identification and resolution of problems and contributed to the overall high quality of implementation. Schools should recognize the importance of training and technical assistan... Implementation Science journals http://www.medworm.com/rss/comments.php?id=1160885 Fri, 18 Jan 2008 05:00:00 +0100 1160885 http://www.medworm.com/index.php?rid=1155597&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F3 Conclusions: This conceptual framework provides a mental model which can serve as a guide for practice leaders implementing clinical guidelines in primary care practice using electronic medical records. Using the concepts as implementation and evaluation criteria, program developers and teams can stimulate improvements in their practice settings. Investing in collaborative team development of clinicians and staff may enable the practice environment to be more adaptive to change and improvement. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1155597 Wed, 16 Jan 2008 05:00:00 +0100 1155597 http://www.medworm.com/index.php?rid=1149516&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F3%2F1%2F2 This study protocol aims to inform researchers, educators, and clinicians interested in improving their understanding of effective strategies to implement shared decision-making in clinical practice using a theory-based dyadic perspective. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1149516 Mon, 14 Jan 2008 05:00:00 +0100 1149516 http://www.medworm.com/index.php?rid=1106931&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F2%2F1%2F44 We describe Szulanski's model, the empirical work he conducted, and illustrate its potential applicability with a hypothetical healthcare example based on improving palliative care services. We follow a doctor through two different posts and analyse aspects of knowledge transfer in different primary care settings. The factors included in the sticky knowledge model include: causal ambiguity, unproven knowledge, motivation of source, credibility of source, recipient motivation, recipient absorptive capacity, recipient retentive capacity, barren organisational context, and arduous relationship between source and recipient. We found that we could apply all these factors to the difficulty of implementing new knowledge into practice in primary care settings.DiscussionSzulanski argues that knowle... Implementation Science journals http://www.medworm.com/rss/comments.php?id=1106931 Thu, 20 Dec 2007 05:00:00 +0100 1106931 http://www.medworm.com/index.php?rid=1099953&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F2%2F1%2F43 Conclusions: We found some evidence of improvement in breast cancer screening practices due to enhanced academic detailing among primary care physicians practicing in urban underserved communities. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1099953 Mon, 17 Dec 2007 05:00:00 +0100 1099953 http://www.medworm.com/index.php?rid=1082020&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F2%2F1%2F42 Conclusions: REP is a well-suited framework for implementing health care interventions, as it specifies steps needed to maximize fidelity while allowing opportunities for flexibility (i.e., local customizing) to maximize transferability. Strategies that foster the sustainability of REP as a tool to implement effective health care interventions need to be developed and tested. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1082020 Sun, 09 Dec 2007 05:00:00 +0100 1082020 http://www.medworm.com/index.php?rid=1064053&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F2%2F1%2F41 Background: Reviews of guideline implementation recommend matching strategies to the specific setting, but provide little specific guidance about how to do so. We hypothesized that the highest level of guideline-concordant care would be achieved where implementation strategies fit well with physicians' cognitive styles. Methods: We conducted an observational study of the implementation of guidelines for hypertension management among patients with diabetes at 43 Veterans' Health Administration medical center primary care clinics. Clinic leaders provided information about all implementation strategies employed at their sites. Guidelines implementation strategies were classified as education, motivation/incentive, or barrier reduction using a pre-specified system. Physician's cognitive styles... Implementation Science journals http://www.medworm.com/rss/comments.php?id=1064053 Sat, 01 Dec 2007 05:00:00 +0100 1064053 http://www.medworm.com/index.php?rid=1049807&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F2%2F1%2F37 Background: There are gaps between what family practitioners do in clinical practice and the evidence-based ideal. The most commonly used strategy to narrow these gaps is the printed educational message (PEM); however, the attributes of successful printed educational messages and their overall effectiveness in changing physician practice are not clear. The current endeavor aims to determine whether such messages change prescribing quality in primary care practice, and whether these effects differ with the format of the message. Methods/design The design is a large, simple, factorial, unblinded cluster-randomized controlled trial. PEMs will be distributed with informed, a quarterly evidence-based synopsis of current clinical information produced by the Institute for Clinical Evaluative Sci... Implementation Science journals http://www.medworm.com/rss/comments.php?id=1049807 Mon, 26 Nov 2007 05:00:00 +0100 1049807 http://www.medworm.com/index.php?rid=1049806&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F2%2F1%2F38 This study protocol describes a theory-based process evaluation alongside the Ontario Printed Educational Message (OPEM) trial. We hypothesize that the OPEM intervention is most likely to operate through changes in physicians' behavioural intentions due to improved attitudes or subjective norms with little or no change in perceived behavioural control. We will test this hypothesis using a well-validated social cognition model, the theory of planned behaviour (TPB) that incorporates these constructs. Methods/design We will develop theory-based surveys using standard methods based upon the TPB for the second and third replications, and survey a subsample of Ontario family physicians from each arm of the trial two months before and six months after the dissemination of the index edition of i... Implementation Science journals http://www.medworm.com/rss/comments.php?id=1049806 Mon, 26 Nov 2007 05:00:00 +0100 1049806 http://www.medworm.com/index.php?rid=1049805&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F2%2F1%2F39 Background: A challenge for implementation researchers is to develop principles that could generate testable hypotheses that apply across a range of clinical contexts, thus leading to generalisability of findings. Such principles may be provided by systematically developed theories. The opportunity has arisen to test some of these theoretical principles in the Ontario Printed Educational Materials (OPEM) trial by conducting a sub-trial within the existing trial structure. OPEM is a large factorial cluster-randomised trial evaluating the effects of short directive and long discursive educational messages embedded into informed, an evidence-based newsletter produced in Canada by the Institute for Clinical Evaluative Sciences (ICES) and mailed to all primary care physicians in Ontario. The co... Implementation Science journals http://www.medworm.com/rss/comments.php?id=1049805 Mon, 26 Nov 2007 05:00:00 +0100 1049805 http://www.medworm.com/index.php?rid=1048297&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F2%2F1%2F36 Conclusions: The community of practice approach was a successful method to develop guidelines on low-back pain, with participants providing information to improve guideline recommendations. The information technology infrastructure that was developed remains for continuous interdisciplinary exchanges and updating of the guidelines. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1048297 Sat, 24 Nov 2007 05:00:00 +0100 1048297 http://www.medworm.com/index.php?rid=1019960&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F2%2F1%2F35 Conclusions: The training course is the first to address sex differences in guideline development. Results from the pilot test suggest that the course achieved its objectives. Because its modules and teaching methods of the course are widely transferable, the course could be useful for many organizations that are involved in developing guidelines. Follow-up studies are needed to assess the long-term effect of the course on the actions of guideline developers and its utility in other settings. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=1019960 Mon, 12 Nov 2007 05:00:00 +0100 1019960 http://www.medworm.com/index.php?rid=991663&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F2%2F1%2F34 Conclusions: This work suggests that the efficacy of interaction approaches to research translation may be more limited than current theory proposes and underscores the need for more completely specified models of research utilization that can help address the slow pace of change in this area. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=991663 Tue, 30 Oct 2007 04:00:00 +0100 991663 http://www.medworm.com/index.php?rid=927632&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F2%2F1%2F32 DiscussionThe current knowledge translation agenda in Canadian healthcare involves the influence of values, priorities, and people; stakes which greatly shape the discovery of research knowledge and how it is or is not instituted in healthcare delivery. As this agenda continues to take shape and direction, ensuring that it is accountable for its influences is essential and should be at the forefront of concern to the Canadian public and healthcare community. This transparency will allow for scrutiny, debate, and improvements in health knowledge discovery and health services delivery. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=927632 Thu, 04 Oct 2007 04:00:00 +0100 927632 http://www.medworm.com/index.php?rid=902632&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F2%2F1%2F31 Conclusions: These psychological models can explain up to half of the variation in intention to perform key disclosure behaviours. This provides an empirically-supported, theoretical basis for the design of interventions to improve disclosure practice by targeting relevant predictive factors. Trial Registration: ISRCTN15871014. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=902632 Tue, 25 Sep 2007 04:00:00 +0100 902632 http://www.medworm.com/index.php?rid=895445&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F2%2F1%2F30 Conclusions: Educational outreach was accepted by general practitioners and was effective. It could be applied to other health care quality problems in this setting. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=895445 Mon, 24 Sep 2007 04:00:00 +0100 895445 http://www.medworm.com/index.php?rid=827548&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F2%2F1%2F28 Conclusion: The significant association between CAS characteristics and effectiveness of reported outcomes for patients with Type II diabetes suggests that complexity science may provide an effective framework for designing and implementing interventions that lead to improved patient outcomes. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=827548 Tue, 28 Aug 2007 04:00:00 +0100 827548 http://www.medworm.com/index.php?rid=777218&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F2%2F1%2F26 Conclusions: The study provides evidence that psychological models can be useful in understanding and predicting clinical behaviour. Taking a theory-based approach enables the creation of a replicable methodology for identifying factors that predict clinical behaviour. However, a number of conceptual and methodological challenges remain. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=777218 Fri, 03 Aug 2007 04:00:00 +0100 777218 http://www.medworm.com/index.php?rid=762879&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F2%2F1%2F24 We examined whether peer chart audits performed by internal medicine residents were associated with improved documentation of foot care in patients with diabetes mellitus. Methods: A retrospective electronic chart review was performed on 347 patients with diabetes mellitus cared for by internal medicine residents in a university-based continuity clinic from May 2003 to September 2004. Residents abstracted information pertaining to documentation of foot examinations (neurological, vascular, and skin) from the charts of patients followed by their physician peers. No formal feedback or education was provided. Results: Significant improvement in the documentation of foot exams was observed over the course of the study. The percentage of patients receiving neurological, vascular, and skin exa... Implementation Science journals http://www.medworm.com/rss/comments.php?id=762879 Fri, 27 Jul 2007 04:00:00 +0100 762879 http://www.medworm.com/index.php?rid=762878&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F2%2F1%2F25 Conclusions: Our findings support research arguing that technologies are not fixed entities moving from invention through diffusion and into routine use. Rather, it is the interplay between technical and social factors that produces a particular outcome. The success of a technology depends on how this interplay is managed during the process of implementation. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=762878 Fri, 27 Jul 2007 04:00:00 +0100 762878 http://www.medworm.com/index.php?rid=755515&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F2%2F1%2F22 Background: Laboratory services have a central role in supporting screening, diagnosis, and management of patients. The increase in chronic disease management in primary care for conditions such as diabetes mellitus requires regular monitoring of patients' biochemical parameters. This process offers a route for improving the quality of care that patients receive by using test results as a vehicle for delivering educational messages as well as the test result itself. Aim To develop and evaluate the effectiveness of a quality improvement initiative to improve the care of patients with diabetes using test report reminders. DesignA programme of four cluster randomised controlled trials within one population of general practices. Participants General practices in Newcastle-upon-Tyne, United Kin... Implementation Science journals http://www.medworm.com/rss/comments.php?id=755515 Tue, 24 Jul 2007 04:00:00 +0100 755515 http://www.medworm.com/index.php?rid=712935&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F2%2F1%2F20 Conclusions: There were a number of similarities across organization type with respect to perceived barriers to research transfer, as well as the types of activities the organizations engaged in to promote research use in decision-making. These findings support the importance of developing interactive, collaborative knowledge transfer strategies, as well as the need to foster relationships with health care decision-makers, practitioners and policymakers. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=712935 Tue, 03 Jul 2007 04:00:00 +0100 712935 http://www.medworm.com/index.php?rid=696478&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F2%2F1%2F19 Conclusions: NorthStar is an integrated, accessible, practical, and acceptable tool to assist developers and evaluators of QI interventions. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=696478 Tue, 26 Jun 2007 04:00:00 +0100 696478 http://www.medworm.com/index.php?rid=672075&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F2%2F1%2F18 DiscussionThis work will provide insight into the extent to which clinicians' judgments about the likelihood of important treatment outcomes explain inappropriate treatment decisions. This work will also provide information necessary for the development of an individualized feedback tool designed to improve treatment decisions. The techniques developed here have the potential to be applicable to a wide range of clinical areas where inappropriate utilization stems from biased judgments. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=672075 Thu, 07 Jun 2007 04:00:00 +0100 672075 http://www.medworm.com/index.php?rid=596358&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F2%2F1%2F14 Conclusions: Telehealth includes a rapidly evolving and potentially promising range of technologies for meeting the growing number of patients and clinicians who face the challenges of diabetes care, and future research should explore the most effective means of ensuring successful program implementation. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=596358 Wed, 02 May 2007 04:00:00 +0100 596358 http://www.medworm.com/index.php?rid=573262&cid=s_34068_51_f&fid=34068&url=http%3A%2F%2Fwww.implementationscience.com%2Fcontent%2F2%2F1%2F13 Conclusions: This study suggests there may be problems applying conventional CVF subscales to non-supervisors, and underscores the importance of assessing psychometric properties of instruments in each new context and population they are used. It also further highlights the challenges management scholars face in assessing organizational culture in a reliable and comparable way. More research is needed to determine if the emergent two-subscale solution is a valid or meaningful alternative and whether these findings generalize beyond VHA. (Source: Implementation Science) Implementation Science journals http://www.medworm.com/rss/comments.php?id=573262 Wed, 25 Apr 2007 04:00:00 +0100 573262