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Implementation Research (implementation + research)

Distribution by Scientific Domains

Medical Sciences	71%

Selected Abstracts

Guideline Implementation Research: Exploring the Gap between Evidence and Practice in the CRUSADE Quality Improvement Initiative

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Andra L. Blomkalns MD
Translating research results into routine clinical practice remains difficult. Guidelines, such as the 2002 American College of Cardiology/American Heart Association Guidelines for the Management of Patients with Unstable Angina and non-ST-segment elevation myocardial infarction, have been developed to provide a streamlined, evidence-based approach to patient care that is of high quality and is reproducible. The Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation (CRUSADE) Quality Improvement Initiative was developed as a registry for non,ST-segment elevation acute coronary syndromes to track the use of guideline-based acute and discharge treatments for hospitalized patients, as well as outcomes associated with the use of these treatments. Care for more than 200,000 patients at more than 400 high-volume acute care hospitals in the United States was tracked in CRUSADE, with feedback provided to participating physicians and hospitals regarding their performance over time and compared with similar institutions. Such access to data has proved important in stimulating improvements in non,ST-segment elevation acute coronary syndromes care at participating hospitals for delivery of acute and discharge guideline-based therapy, as well as improving outcomes for patients. Providing quality improvement methods such as protocol order sets, continuing education programs, and a CRUSADE Quality Improvement Initiative toolbox serve to actively stimulate physician providers and institutions to improve care. The CRUSADE Initiative has also proven to be a fertile source of research in translation of treatment guidelines into routine care, resulting in more than 52 published articles and 86 abstracts presented at major emergency medicine and cardiology meetings. The cycle for research of guideline implementation demonstrated by CRUSADE includes four major steps,observation, intervention, investigation, and publication,that serve as the basis for evaluating the impact of any evidence-based guideline on patient care. Due to the success of CRUSADE, the American College of Cardiology combined the CRUSADE Initiative with the National Registry for Myocardial Infarction ST-segment elevation myocardial infarction program to form the National Cardiovascular Data Registry,Acute Coronary Treatment & Intervention Outcomes Network Registry beginning in January 2007. [source]

Developing a theory-based taxonomy of methods for implementing change in practice

JOURNAL OF ADVANCED NURSING, Issue 2 2007
Jennifer Leeman
Abstract Title. Developing a theory-based taxonomy of methods for implementing change in practice Aim., In this paper we present a theory-based taxonomy of the methods used to implement change in practice. Background., Implementation research is characterized by inconsistent terminology for the methods employed and inattention to differences in the relevance of methods across different disciplines. Studies of the effectiveness of implementation have yielded mixed results. Positive effects shown have been small. The limited success of many efforts to implement change in practice may be due, in part, to the absence of a framework to guide the use of implementation methods. Method., A provisional taxonomy of implementation methods, derived from theory and existing taxonomies, was used to content analyse a convenience sample of 43 reports of empirical studies of the implementation of one or more research-based practice changes involving nurses that had been published between 1995 and 2005. This taxonomy was revised throughout the course of analysis to capture more completely the information in each report. Findings., Following the analysis, nine of the 11 methods in the provisional taxonomy were retained, two were removed and five new methods were identified. The final taxonomy includes 14 implementation methods organized into five categories: (a) increasing coordination; (b) raising awareness; (c) persuasion via interpersonal channels; (d) persuasion via reinforcing belief that behaviour will lead to desirable results and (e) increasing behavioural control. Conclusions., The taxonomy presented here differs from prior taxonomies by focusing on nursing and by providing a clear and mutually exclusive guide to implementation methods. By deriving the initial coding strategy from theory, the taxonomy links the methods to theoretical constructs that may inform the selection of methods across different practice changes and settings. [source]

Implementation research for ,evidence-based' guideline development by dietitians: a pilot study to test an instrument

JOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 4 2002
B. M. Wammes
Abstract Aim, To improve the quality of dietetic care, dietitians in the University Medical Center Utrecht (UMCU) are encouraged to develop and implement ,evidence-based' guidelines. The aim of this pilot study was to develop and test a questionnaire for implementation research to monitor the process of developing and implementing these guidelines. Methods, A questionnaire was developed and distributed to 15 dietitians, who have started developing an ,evidence-based' guideline. The questionnaire measures determinants of dietitians' behaviour and the presence of conditions facilitating the development of a guideline. Cronbach's , with a cut-off point of 0.7 was used to analyse the internal consistence between the items related to behavioural determinants. A panel of professionals such as a member of staff from the UMCU, a communication expert and project-managers ensured the completeness of the questionnaire. Results, The internal consistency was high (, > 0.7) between the items related to the determinants of behaviour. The questionnaire gives a structured overview of factors affecting positively or negatively the process of guideline development. Although dietitians have a positive behaviour towards guideline development, they perceived barriers related to the presence of conditions to develop a guideline. Conclusion, We concluded that the applied questionnaire is appropriate for implementation research and has given a structured overview of factors that influence the development of dietetic guidelines by dietitans in the UMCU. [source]

Pharmacists' role in smoking cessation: an examination of current practice and barriers to service provision

INTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 4 2006
David Edwards PhD student
Objective This study addressed the potential role of pharmacists in helping their patients to quit smoking by providing a summary of their self-reported levels of current activities, confidence, and readiness to change around the provision of brief advice and support for patients who smoke. In addition to investigating which barriers are perceived to be most important, this study also examined the relative importance of confidence, barriers and practice factors in relation to pharmacists' smoking cessation practices. Method A 58-item questionnaire was mailed to 720 pharmacists. The questionnaire measured demographic and background variables, level of smoking cessation activity (asking, advising, assessing, assisting and arranging including follow-up), confidence in undertaking smoking-cessation activities, readiness to change, perceived importance of barriers to providing smoking-cessation services, and further education or training in relation to smoking cessation. Setting Community pharmacists in South Australia. Key findings Respondents indicated high rates of activity in relation to assessing and assisting patients to quit smoking, with lower rates of advising and arranging including following up. Recording of smoking status was very low. Confidence emerged as the most important predictor of smoking-cessation activities, with pharmacist barriers including fear of alienating patients approaching significance. Reported levels of smoking-specific education and training were low. Conclusions South Australian pharmacists are contributing to the prevention of tobacco-related harms. With additional support there is a greater scope for involvement. Results indicate a need for a team-based, systematic and multifaceted approach to address barriers and enhance pharmacists' confidence. Further implementation research is required to assess the effectiveness of multifaceted pharmacy support programmes on the uptake and sustainability of smoking-cessation services. [source]

Implementation research for ,evidence-based' guideline development by dietitians: a pilot study to test an instrument

Adherence and Flexibility: They Can (and Do) Coexist!

CLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 3 2010
Rex Forehand
[Clin Psychol Sci Prac 17: 258,264, 2010] Using their experiences disseminating the Triple P parenting program, Mazzucchelli and Sanders (2010) make a strong case for how flexibility enhances provider satisfaction, critical thinking about intervention delivery, and most importantly, adherence and fidelity. Their article makes an outstanding and innovative contribution to the literature on implementation research, advancing the field to a view of flexibility as a feature that may facilitate adherence. In this commentary, we place Mazzucchelli and Sanders's work within the context of ongoing implementation research. We also call for embedding questions about implementation science into effectiveness trials to better inform dissemination efforts aimed at facilitating provider adoption and adherence to empirically supported treatments. [source]