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Evidence Report/technology Assessment... Aug 2004
Review
Topics: Community Health Planning; Community Participation; Community-Institutional Relations; Evidence-Based Medicine; Guidelines as Topic; Health Services Research; Humans; Needs Assessment; Outcome Assessment, Health Care; Program Development; Research Design; Research Support as Topic; United States; United States Agency for Healthcare Research and Quality
PubMed: 15460504
DOI: No ID Found -
BMJ (Clinical Research Ed.) Apr 2003
Review
Topics: Health Services Research; Hospital Administration; Humans; Medical Audit; Quality Assurance, Health Care; Research Design; Total Quality Management
PubMed: 12676849
DOI: 10.1136/bmj.326.7392.759 -
Annals of Surgery Jan 2006
Topics: Efficiency, Organizational; Humans; Operating Rooms; Surgical Procedures, Operative; Time Management; Workload
PubMed: 16371731
DOI: 10.1097/01.sla.0000193601.57597.ec -
Implementation Science : IS Sep 2018The emergence of dissemination and implementation (D&I) science has driven a rapid increase in studies of how new scientific discoveries are translated and developed... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The emergence of dissemination and implementation (D&I) science has driven a rapid increase in studies of how new scientific discoveries are translated and developed into evidence-based programs and policies. However, D&I science has paid much less attention to what happens to programs once they have been implemented. Public health programs can only deliver benefits if they reach maturity and sustain activities over time. In order to achieve the full benefits of significant investment in public health research and program development, there must be an understanding of the factors that relate to sustainability to inform development of tools and trainings to support strategic long-term program sustainability. Tobacco control programs, specifically, vary in their abilities to support and sustain themselves over time. As of 2018, most states still do not meet the CDC-recommended level for funding their TC program, allowing tobacco use to remain the leading cause of preventable disease and death in the USA. The purpose of this study is to empirically develop, test, and disseminate training programs to improve the sustainability of evidence-based state tobacco control programs and thus, tobacco-related health outcomes.
METHODS
This paper describes the methods of a group randomized, multi-phase study that evaluates the empirically developed "Program Sustainability Action Planning Training" and technical assistance in US state-level tobacco control programs. Phase 1 includes developing the sustainability action planning training curriculum and technical assistance protocol and developing measures to assess long-term program sustainability. Phase 2 includes a group randomized trial to test the effectiveness of the training and technical assistance in improving sustainability outcomes in 24 state tobacco control programs (12 intervention, 12 comparison). Phase 3 includes the active dissemination of final training curricula materials to a broader public health audience.
DISCUSSION
Empirical evidence has established that program sustainability can improve through training and technical assistance; however, to our knowledge, no evidence-based sustainability training curriculum program exists. Therefore, systematic methods are needed to develop, test, and disseminate a training that improves the sustainability of evidence-based programs.
TRIAL REGISTRATION
NCT03598114 . Registered 25 July 2018-retrospectively registered.
Topics: Capacity Building; Curriculum; Evidence-Based Practice; Humans; Implementation Science; Information Dissemination; Policy; Program Evaluation; Public Health Administration; Research Design; Retrospective Studies; Tobacco Use; United States
PubMed: 30257695
DOI: 10.1186/s13012-018-0819-5 -
Physical Therapy Sep 2021The purpose of this case report is to describe the challenges that COVID-19 presented for therapists in a pediatric hospital and the response to these challenges.
OBJECTIVE
The purpose of this case report is to describe the challenges that COVID-19 presented for therapists in a pediatric hospital and the response to these challenges.
METHODS
The case report setting is a physical therapy and occupational therapy department (department) of an academic pediatric medical center that provides a range of health care services for children and youth. Challenges that COVID-19 presented to the department included (1) managing safety concerns for patients, their families, and staff; (2) continuing to provide high-quality therapy services within state-mandated restrictions; (3) triaging patients; and (4) keeping clinicians employed and working productively.
RESULTS
The department therapists responded to these challenges by (1) increasing communication huddles; (2) developing procedures for staffing and triaging of patients; (3) developing procedures for telehealth therapy services; and (4) designing a remote work program for all department employees. The number of patients and staff on site were reduced by initiating telehealth services, triaging patients, and developing a remote work plan. Communication huddles, department meetings, and supervision meetings were converted to virtual meetings. Staffing rates, patient-care productivity, and department project work were maintained.
CONCLUSION
In response to COVID-19, the department developed new protocols and provided information about the protocols, which might be helpful for other pediatric hospitals or outpatient settings when planning for future pandemics or other issues that challenge the ability to provide usual care. Increasing the frequency of verbal and written communication on operational topics is recommended. Primary sources of information from national organizations (eg, the American Physical Therapy Association and the American Occupational Therapy Association) can assist with determining the scope of practice and code of conduct during a pandemic.
IMPACT
COVID-19 posed challenges to operations and delivery of patient care. Although this case report is specific to COVID-19, principles applied and lessons learned from this experience can be applied to other emergency situations.
Topics: COVID-19; Clinical Protocols; Hospitals, Pediatric; Humans; Infection Control; Massachusetts; Occupational Therapy Department, Hospital; Organizational Case Studies; Patient Selection; Physical Therapy Department, Hospital; Rehabilitation; Telemedicine; Triage
PubMed: 34174072
DOI: 10.1093/ptj/pzab164 -
BMC Health Services Research Nov 2020Hypertension and diabetes are among the most common and deadly chronic conditions globally. In India, most adults with these conditions remain undiagnosed, untreated, or...
The Integrated Tracking, Referral, and Electronic Decision Support, and Care Coordination (I-TREC) program: scalable strategies for the management of hypertension and diabetes within the government healthcare system of India.
BACKGROUND
Hypertension and diabetes are among the most common and deadly chronic conditions globally. In India, most adults with these conditions remain undiagnosed, untreated, or poorly treated and uncontrolled. Innovative and scalable approaches to deliver proven-effective strategies for medical and lifestyle management of these conditions are needed.
METHODS
The overall goal of this implementation science study is to evaluate the Integrated Tracking, Referral, Electronic decision support, and Care coordination (I-TREC) program. I-TREC leverages information technology (IT) to manage hypertension and diabetes in adults aged ≥30 years across the hierarchy of Indian public healthcare facilities. The I-TREC program combines multiple evidence-based interventions: an electronic case record form (eCRF) to consolidate and track patient information and referrals across the publicly-funded healthcare system; an electronic clinical decision support system (CDSS) to assist clinicians to provide tailored guideline-based care to patients; a revised workflow to ensure coordinated care within and across facilities; and enhanced training for physicians and nurses regarding non-communicable disease (NCD) medical content and lifestyle management. The program will be implemented and evaluated in a predominantly rural district of Punjab, India. The evaluation will employ a quasi-experimental design with mixed methods data collection. Evaluation indicators assess changes in the continuum of care for hypertension and diabetes and are grounded in the Reach, Effectiveness, Adoption Implementation, and Maintenance (RE-AIM) framework. Data will be triangulated from multiple sources, including community surveys, health facility assessments, stakeholder interviews, and patient-level data from the I-TREC program's electronic database.
DISCUSSION
I-TREC consolidates previously proven strategies for improved management of hypertension and diabetes at single-levels of the healthcare system into a scalable model for coordinated care delivery across all levels of the healthcare system hierarchy. Findings have the potential to inform best practices to ultimately deliver quality public-sector hypertension and diabetes care across India.
TRIAL REGISTRATION
The study is registered with Clinical Trials Registry of India (registration number CTRI/2020/01/022723 ). The study was registered prior to the launch of the intervention on 13 January 2020. The current version of protocol is version 2 dated 6 June 2018.
Topics: Adult; Databases as Topic; Decision Support Systems, Clinical; Delivery of Health Care; Diabetes Mellitus; Electronic Health Records; Humans; Hypertension; India; Referral and Consultation; Research Design; Rural Population
PubMed: 33168004
DOI: 10.1186/s12913-020-05851-w -
BMC Health Services Research Dec 2018Organizational Participatory Research (OPR) seeks organizational learning and/or practice improvement. Previous systematic literature reviews described some OPR...
BACKGROUND
Organizational Participatory Research (OPR) seeks organizational learning and/or practice improvement. Previous systematic literature reviews described some OPR processes and outcomes, but the link between these processes and outcomes is unknown. We sought to identify and sequence the key processes of OPR taking place with and within healthcare organizations and the main outcomes to which they contribute, and to define ideal-types of OPR.
METHODS
This article reports a participatory systematic mixed studies review with qualitative synthesis A specialized health librarian searched MEDLINE, CINAHL, Embase Classic + Embase, PsycINFO, the Cochrane Library, Social Work Abstracts and Business Source Complete, together with grey literature data bases were searched from inception to November 29, 2012. This search was updated using forward citation tracking up to June 2014. Reporting quality was appraised and unclear articles were excluded. Included studies clearly reported OPR where the main research related decisions were co-constructed among the academic and healthcare organization partners. Included studies were distilled into summaries of their OPR processes and outcomes, which were subsequently analysed using deductive and inductive thematic analysis. All summaries were analysed; that is, data analysis continued beyond saturation.
RESULTS
Eighty-three studies were included from the 8873 records retrieved. Eight key OPR processes were identified. Four follow the phases of research: 1) form a work group and hold meetings, 2) collectively determine research objectives, 3) collectively analyse data, and 4) collectively interpret results and decide how to use them. Four are present throughout OPR: 1) communication, 2) relationships; 3) commitment; 4) collective reflection. These processes contribute to extra benefits at the individual and organizational levels. Four ideal-types of OPR were defined. Basic OPR consists of OPR processes leading to achieving the study objectives. This ideal-type and may be combined with any of the following three ideal-types: OPR resulting in random additional benefits for the individuals or organization involved, OPR spreading to other sectors of the organization and beyond, or OPR leading to subsequent initiatives. These results are illustrated with a novel conceptual model.
CONCLUSION
The model provides operational guidance to help OPR stakeholders collaboratively address organizational issues and achieve desired outcomes and more.
REVIEW REGISTRATION
As per PROSPERO inclusion criteria, this review is not registered.
Topics: Communication; Delivery of Health Care; Health Services Research; Humans; Learning; Models, Organizational; Organizational Culture; Organizations; Research Design
PubMed: 30577859
DOI: 10.1186/s12913-018-3775-5 -
Value in Health : the Journal of the... Jul 2020
Topics: Decision Making; Health Services Research; Humans; Patient Preference; Reproducibility of Results; Research Design
PubMed: 32762983
DOI: 10.1016/j.jval.2020.05.009 -
Trials Aug 2019Clinical trials management can be studied using project management theory. The CYCLE pilot randomized controlled trial (RCT) was conducted to determine the feasibility...
BACKGROUND
Clinical trials management can be studied using project management theory. The CYCLE pilot randomized controlled trial (RCT) was conducted to determine the feasibility of a future rehabilitation trial of early in-bed cycling in the intensive care unit (ICU). In-bed cycling is a novel intervention, not typically available in ICUs. Implementation of this intervention requires personnel with specialized clinical expertise caring for critically ill patients and use of the in-bed cycle. Our objective was to describe the implementation and conduct of our pilot RCT using a project management approach.
METHODS
We retrospectively reviewed activities, timelines, and personnel involved in the trial. We organized activities into four project management phases: initiation, planning, execution, and monitoring and controlling. Data sources included Methods Centre documents used for trial coordination and conduct, and the trial data set. We report descriptive statistics as counts and proportions and also medians and quartiles, and we summarize the lessons learned.
RESULTS
Seven ICUs in Canada participated in the trial. Time from research ethics board and contracts submission to first enrolment was a median (first quartile, third quartile) of 185 (146, 209) and 162 (114, 181) days, respectively. We trained 128 personnel on the CYCLE pilot RCT protocol, and 80 (63%) completed trial-related activities. Four sites required additional training after start-up due to staff turnover and leaves of absence. Over 15 months, we screened 864 patients: 256 were eligible and 66 were enrolled. Despite an 85% consent rate, 74% (190/256) of eligible patients were not randomized, largely (80% [152/190]) due to physiotherapist availability. Thirteen percent of recruitment weeks were lost due to physiotherapist staffing shortages. We highlight five key lessons learned: (1) prepare and anticipate site needs; (2) communicate regularly; (3) proactively analyse and act on process measure data; (4) develop contingency plans; (5) express appreciation to participating sites.
CONCLUSIONS
Our analysis highlights the scope of relevant activities, rigorous training and monitoring, number and types of required personnel, and time required to conduct a multicentre ICU rehabilitation intervention trial. Our lessons learned can help others interested in implementing complex intervention trials, such as rehabilitation.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT02377830 . Registered prospectively on 4 March 2015.
Topics: Data Collection; Endpoint Determination; Humans; Multicenter Studies as Topic; Patient Selection; Personnel Staffing and Scheduling; Pilot Projects; Randomized Controlled Trials as Topic; Research Design; Research Personnel; Retrospective Studies; Time Factors; Workflow
PubMed: 31455384
DOI: 10.1186/s13063-019-3634-7 -
Canadian Journal of Surgery. Journal... Aug 2011The University of British Columbia Hospital program was designed to augment existing provincial capacity for hip and knee replacement. The patient-surgeon relationship... (Review)
Review
The University of British Columbia Hospital program was designed to augment existing provincial capacity for hip and knee replacement. The patient-surgeon relationship was maintained throughout the entire care pathway and "ring-fenced" capacity (i.e., designated hospital ward bed and operating room capacity that is geographically remote from the emergency intake of patients) minimized the risk of cancellations. Analysis of the results revealed a mean patient satisfaction score of 4.7 out of 5, a complication rate of 4.4%, a mean operating room time of 1 hour and 45 minutes and a mean postoperative length of stay in hospital of 3.4 days. More than 1600 joint replacements -- an additional 16% provincial capacity -- were performed within budget during each of the first 2 years of operation. A high standard of care was maintained, with high rates of patient satisfaction and a low complication rate.
Topics: Arthroplasty, Replacement; British Columbia; Cohort Studies; Critical Pathways; Delivery of Health Care; Humans; Patient Satisfaction; Patient Selection; Physician-Patient Relations; Standard of Care; Waiting Lists
PubMed: 21774879
DOI: 10.1503/cjs.020110