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International Journal of Nursing Studies Jan 2008The increase in prevalence of long-term conditions in Western societies, with the subsequent need for non-acute quality patient healthcare, has brought the issue of... (Review)
Review
BACKGROUND
The increase in prevalence of long-term conditions in Western societies, with the subsequent need for non-acute quality patient healthcare, has brought the issue of collaboration between health professionals to the fore. Within primary care, it has been suggested that multidisciplinary teamworking is essential to develop an integrated approach to promoting and maintaining the health of the population whilst improving service effectiveness. Although it is becoming widely accepted that no single discipline can provide complete care for patients with a long-term condition, in practice, interprofessional working is not always achieved.
OBJECTIVES
This review aimed to explore the factors that inhibit or facilitate interprofessional teamworking in primary and community care settings, in order to inform development of multidisciplinary working at the turn of the century.
DESIGN
A comprehensive search of the literature was undertaken using a variety of approaches to identify appropriate literature for inclusion in the study. The selected articles used both qualitative and quantitative research methods.
FINDINGS
Following a thematic analysis of the literature, two main themes emerged that had an impact on interprofessional teamworking: team structure and team processes. Within these two themes, six categories were identified: team premises; team size and composition; organisational support; team meetings; clear goals and objectives; and audit. The complex nature of interprofessional teamworking in primary care meant that despite teamwork being an efficient and productive way of achieving goals and results, several barriers exist that hinder its potential from becoming fully exploited; implications and recommendations for practice are discussed.
CONCLUSIONS
These findings can inform development of current best practice, although further research needs to be conducted into multidisciplinary teamworking at both the team and organisation level, to ensure that enhancement and maintenance of teamwork leads to an improved quality of healthcare provision.
Topics: Attitude of Health Personnel; Chronic Disease; Communication; Community Health Services; Conflict, Psychological; Cooperative Behavior; Group Processes; Health Services Needs and Demand; Humans; Information Storage and Retrieval; Interprofessional Relations; Leadership; Nursing Research; Organizational Objectives; Outcome and Process Assessment, Health Care; Patient Care Team; Primary Health Care; Professional Role; Qualitative Research; Research Design; Social Support; Socialization; United Kingdom
PubMed: 17383655
DOI: 10.1016/j.ijnurstu.2007.01.015 -
The Journal of Extra-corporeal... Sep 2008
Topics: Database Management Systems; Databases, Factual; Extracorporeal Circulation; Information Storage and Retrieval; Medical Records Systems, Computerized; Observation
PubMed: 18853826
DOI: No ID Found -
The clinician crowdsourcing challenge: using participatory design to seed implementation strategies.Implementation Science : IS Jun 2019In healthcare settings, system and organization leaders often control the selection and design of implementation strategies even though frontline workers may have the...
BACKGROUND
In healthcare settings, system and organization leaders often control the selection and design of implementation strategies even though frontline workers may have the most intimate understanding of the care delivery process, and factors that optimize and constrain evidence-based practice implementation within the local system. Innovation tournaments, a structured participatory design strategy to crowdsource ideas, are a promising approach to participatory design that may increase the effectiveness of implementation strategies by involving end users (i.e., clinicians). We utilized a system-wide innovation tournament to garner ideas from clinicians about how to enhance the use of evidence-based practices (EBPs) within a large public behavioral health system.
METHODS
Our innovation tournament occurred in three phases. First, we invited over 500 clinicians to share, through a web-based platform, their ideas regarding how their organizations could best support use of EBPs. Clinicians could rate and comment on ideas submitted by others. Second, submissions were judged by an expert panel (including behavioral scientists, system leaders, and payers) based on their rated enthusiasm for the idea. Third, we held a community-facing event during which the six clinicians who submitted winning ideas presented their strategies to 85 attendees representing a cross-section of clinicians and system and organizational leaders.
RESULTS
We had a high rate of participation (12.3%), more than double the average rate of previous tournaments conducted in other settings (5%). A total of 65 ideas were submitted by 55 participants representing 38 organizations. The most common categories of ideas pertained to training (42%), financing and compensation (26%), clinician support and preparation tools (22%), and EBP-focused supervision (17%). The expert panel and clinicians differed on their ratings of the ideas, highlighting value of seeking input from multiple stakeholder groups when developing implementation strategies.
CONCLUSIONS
Innovation tournaments are a useful and feasible methodology for engaging end users, system leaders, and behavioral scientists through a structured approach to developing implementation strategies. The process and resultant strategies engendered significant enthusiasm and engagement from participants at all levels of a healthcare system. Research is needed to compare the effectiveness of strategies developed through innovation tournaments to strategies developed through design approaches.
Topics: Behavioral Medicine; Crowdsourcing; Evidence-Based Practice; Humans; Organizational Innovation; Research Design
PubMed: 31200730
DOI: 10.1186/s13012-019-0914-2 -
Medical Science Monitor : International... Aug 2021BACKGROUND Length of stay (LOS) in the emergency department (ED) should be measured and evaluated comprehensively as an important indicator of hospital emergency...
BACKGROUND Length of stay (LOS) in the emergency department (ED) should be measured and evaluated comprehensively as an important indicator of hospital emergency service. In this study, we aimed to analyze clinical characteristics of critically ill patients admitted to the ED and identify the factors associated with LOS. MATERIAL AND METHODS All patients with level 1 and level 2 of the Emergency Severity Index who were admitted to the ED from January 2018 to December 2019 were included in this retrospective study. The patients were divided into 2 groups: LOS ≥4 h and LOS <4 h. Variables were comprehensively analyzed and compared between the 2 groups. RESULTS A total of 19 616 patients, including 7269 patients in the LOS ≥4 h group and 12 347 patients in the LOS <4 group, were included. Advanced age, admission in winter and during the night shift, and diseases excluding nervous system diseases, cardiovascular diseases, and trauma were associated with higher risk of LOS. Nervous system diseases, cardiovascular diseases, trauma, and procedures including tracheal intubation, surgery, percutaneous coronary intervention, and thrombolysis were associated with lower risk of LOS. CONCLUSIONS Prolonged LOS in the ED was associated with increased age and admission in winter and during the night shift, while shortened LOS was associated with nervous system diseases, cardiovascular diseases, and trauma, as well as with procedures including tracheal intubation, surgery, percutaneous coronary intervention, and thrombolysis. Our findings can serve as a guide for ED physicians to individually evaluate patient condition and allocate medical resources more effectively.
Topics: Adult; Age Factors; Aged; China; Critical Illness; Emergencies; Emergency Medical Services; Emergency Service, Hospital; Health Care Rationing; Humans; Length of Stay; Middle Aged; Needs Assessment; Patient Selection; Retrospective Studies; Seasons; Shift Work Schedule
PubMed: 34333509
DOI: 10.12659/MSM.931286 -
Implementation Science : IS Mar 2012Many delivery-system interventions are fundamentally about change in social systems (both planned and unplanned). This systems perspective raises a number of...
BACKGROUND
Many delivery-system interventions are fundamentally about change in social systems (both planned and unplanned). This systems perspective raises a number of methodological challenges for studying the effects of delivery-system change--particularly for answering questions related to whether the change will work under different conditions and how the change is integrated (or not) into the operating context of the delivery system.
METHODS
The purpose of this paper is to describe the methodological and measurement challenges posed by five key issues in delivery-system research: (1) modeling intervention context; (2) measuring readiness for change; (3) assessing intervention fidelity and sustainability; (4) assessing complex, multicomponent interventions; and (5) incorporating time in delivery-system models to discuss recommendations for addressing these issues. For each issue, we provide recommendations for how research may be designed and implemented to overcome these challenges.
RESULTS AND CONCLUSIONS
We suggest that a more refined understanding of the mechanisms underlying delivery-system interventions (treatment theory) and the ways in which outcomes for different classes of individuals change over time are fundamental starting points for capturing the heterogeneity in samples of individuals exposed to delivery-system interventions. To support the research recommendations outlined in this paper and to advance understanding of the "why" and "how" questions of delivery-system change and their effects, funding agencies should consider supporting studies with larger organizational sample sizes; longer duration; and nontraditional, mixed-methods designs.A version of this paper was prepared under contract with the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services for presentation and discussion at a meeting on "The Challenge and Promise of Delivery System Research," held in Sterling, VA, on February 16-17, 2011. The opinions in the paper are those of the author and do not represent the views or recommendations of AHRQ or the US Department of Health and Human Services.1.
Topics: Delivery of Health Care; Evidence-Based Practice; Humans; Organizational Innovation; Research Design; Therapeutics; Time Factors; Treatment Outcome
PubMed: 22409885
DOI: 10.1186/1748-5908-7-15 -
Value in Health : the Journal of the... 2005The objective of this article is to discuss issues surrounding the conduct of "piggyback evaluations," in which health-economic data are collected within an otherwise... (Review)
Review
OBJECTIVE
The objective of this article is to discuss issues surrounding the conduct of "piggyback evaluations," in which health-economic data are collected within an otherwise typical clinical trial.
METHODS
We review the methodologic literature on piggyback economic evaluations, as well as selected empiric studies. We summarize the challenges encountered in the conduct of these studies, alternative ways of addressing these challenges, and their future role in pharmacoeconomic research.
RESULTS
Piggyback evaluations have certain advantages over other types of pharmacoeconomic studies. An economic evaluation can benefit from the experimental design that maximizes the trial's internal validity, and it is often more practical to collect economic data alongside a trial rather than to fund a stand-alone economic study. However, piggyback evaluations are subject to problems deriving from the competing nature of clinical versus economic study objectives, which can give rise to tension in such fundamental aspects of study design as the selection of study subjects and sites; the extent of protocol-mandated health-care services; and the determination of sample size, length of follow-up, and the study comparator(s). Many solutions have been put forth in the literature to address these challenges.
CONCLUSIONS
Piggyback evaluations can be an appropriate means to measure the economic impact of medical interventions, provided that the methodologic challenges are acknowledged and addressed within the context of each individual study. As long as a desire for patient-level data from clinical trials exists, there will be a need for piggyback economic evaluations in the future.
Topics: Clinical Protocols; Data Collection; Data Interpretation, Statistical; Double-Blind Method; Drug Monitoring; Economics, Pharmaceutical; Forecasting; Health Resources; Health Services Needs and Demand; Health Services Research; Humans; Multicenter Studies as Topic; Organizational Objectives; Patient Compliance; Patient Selection; Randomized Controlled Trials as Topic; Reproducibility of Results; Research Design; Sample Size; Time Factors
PubMed: 15841896
DOI: 10.1111/j.1524-4733.2005.03065.x -
PloS One 2013Scientific knowledge can help develop interventions that improve public health. The objectives of this review are (1) to describe the status of research on knowledge... (Review)
Review
OBJECTIVES
Scientific knowledge can help develop interventions that improve public health. The objectives of this review are (1) to describe the status of research on knowledge transfer strategies in the field of complex social interventions in public health and (2) to identify priorities for future research in this field.
METHOD
A scoping study is an exploratory study. After searching databases of bibliographic references and specialized periodicals, we summarized the relevant studies using a predetermined assessment framework. In-depth analysis focused on the following items: types of knowledge transfer strategies, fields of public health, types of publics, types of utilization, and types of research specifications.
RESULTS
From the 1,374 references identified, we selected 26 studies. The strategies targeted mostly administrators of organizations and practitioners. The articles generally dealt with instrumental utilization and most often used qualitative methods. In general, the bias risk for the studies is high.
CONCLUSION
Researchers need to consider the methodological challenges in this field of research in order to improve assessment of more complex knowledge transfer strategies (when they exist), not just diffusion/dissemination strategies and conceptual and persuasive utilization.
Topics: Biomedical Research; Databases, Bibliographic; Health Knowledge, Attitudes, Practice; Humans; Information Dissemination; Interpersonal Relations; Public Health; Public Health Administration; Publication Bias; Research Design
PubMed: 24324593
DOI: 10.1371/journal.pone.0080233 -
BMJ Open Dec 2018To understand what contextual influences, mechanisms and outcomes affect the implementation and use of localised, online care pathways (HealthPathways) in primary and...
AIM
To understand what contextual influences, mechanisms and outcomes affect the implementation and use of localised, online care pathways (HealthPathways) in primary and secondary care.
DESIGN AND PROCEDURE
Mixed-measures design. uantitative data included number of page views and conditions viewed. Qualitative data from semistructured interviews and focus groups were gathered over a 6-month period, and analysed using NVivo software.
SETTING
The first HealthPathways UK site, South Tyneside, England.
PARTICIPANTS
General practitioners, nurses, practice managers, hospital consultants and system leaders (managers, commissioners) (n=76).
RESULTS
Use of the pathways significantly increased over time. Themes were developed showing how online care pathways were used-leadership, pre-existing networks and relationships; development of systems and processes for care pathways, the use of online care pathways to support decision-making and referral, and perceived availability of resources. Inter-related themes were arranged into configurations consisting of contextual influences, mechanisms and outcomes. Recommendations were made for future implementations, such as improved data collection processes to understand how and why there was variance in the use of pathways.
CONCLUSIONS
This study was early in the implementation process; however, emerging themes will facilitate the future implementation and use of online care pathways. Recommendations are made for further research to include other health and social care users and patients to inform future developments.
Topics: Attitude of Health Personnel; Critical Pathways; Evidence-Based Medicine; General Practice; Health Plan Implementation; Humans; Leadership; Online Systems; Outcome and Process Assessment, Health Care; Patient Care Planning; Patient Care Team; Primary Health Care; Referral and Consultation; Research Design; Secondary Care; United Kingdom
PubMed: 30598485
DOI: 10.1136/bmjopen-2018-022991 -
BMJ Open Jun 2019Supervision training aims to develop workplace supervisory competencies. Despite extensive supervision literature, including literature reviews, the processes through...
INTRODUCTION
Supervision training aims to develop workplace supervisory competencies. Despite extensive supervision literature, including literature reviews, the processes through which supervision training interventions produce their effects, for whom and under what circumstances is not clearly delineated. The purpose of this study is to explain the effect of contextual factors on the underpinning mechanisms of supervision training outcomes.
METHODS AND ANALYSIS
We propose to examine supervision training interventions across the health and human services workforce using realist methods. Pawson's five stages for undertaking a realist synthesis will be followed: (1) clarifying the scope of the review; (2) determining the search strategy; (3) study selection; (4) extracting data and (5) synthesising the evidence and drawing conclusions. Extracted data will include study characteristics, characteristics of participant cohort, intervention type, contextual factors, underlying mechanisms and supervision training outcomes. Patterns in context-mechanism-outcome configurations will be identified. Initial programme theories will be developed based on a comprehensive search of the literature, which will include key terms relating to supervision and training. The search strategy will involve: (1) electronic database searching using Medline, Cumulative Index to Nursing and Allied Health Literature, Social Services Abstracts, Educational Resources Information Center, PsycINFO and Australian Public Affairs Information Service and (2) hand and citation searching. We will also contact authors where necessary and discuss identified literature among the project team with extensive expertise in supervision training.
ETHICS AND DISSEMINATION
The realist synthesis will propose an evidence-informed theory of supervision training interventions (ie, what interventions work for whom and why). The findings will be disseminated in peer-reviewed journals and presentations and through discussions with relevant organisations and stakeholders. The research will be used by educators to develop evidenced-based supervision training interventions. It will also help workplace supervisors to better understand what types of supervision training might work most optimally for them and their colleagues. Other researchers could use the synthesis findings to guide future supervision research.
PROSPERO REGISTRATION NUMBER
CRD42018094186.
Topics: Clinical Competence; Evidence-Based Practice; Humans; Inservice Training; Personnel Management; Research Design; Review Literature as Topic; Workplace
PubMed: 31154303
DOI: 10.1136/bmjopen-2018-025777 -
Journal of Epidemiology and Community... Aug 2008Integrating research and action represents a goal and key principles of community-based participatory research (CBPR), but there has been little effort to synthesise the... (Review)
Review
Integrating research and action: a systematic review of community-based participatory research to address health disparities in environmental and occupational health in the USA.
INTRODUCTION
Integrating research and action represents a goal and key principles of community-based participatory research (CBPR), but there has been little effort to synthesise the literature to evaluate whether such integration is occurring.
OBJECTIVES
(1) To examine the extent to which CBPR integrates action to effect community-level change and (2) to ascertain factors that facilitate such integration.
METHODS
Original articles reporting on CBPR in environmental and occupational health in the USA were identified primarily through a MEDLINE search. Inceptions, processes, methods and outcomes of the projects were reviewed.
RESULTS
In 14 of the 20 studies reviewed, CBPR led to community-level action to improve the health and well-being of the community members. Observational studies that investigated problems posed by the affected community and that incorporated qualitative methods were more likely to lead to action. The collaboration among government scientists, university researchers and community partners emerged as a new model of CBPR partnerships that effectively integrates research and action.
CONCLUSIONS
To help CBPR better integrate research and action, a shift towards community-initiated and action-oriented observational studies might be needed.
Topics: Biomedical Research; Community Health Planning; Community Participation; Community-Institutional Relations; Environmental Health; Humans; Occupational Health; Research Design; Socioeconomic Factors; United States
PubMed: 18621950
DOI: 10.1136/jech.2007.067645