Browsing by Subject "implementation"
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Item Comparison of Assertive Community Treatment Fidelity Assessment Methods: Reliability and Validity(Springer, 2016-03) Rollins, Angela L.; McGrew, John H.; Kukla, Marina; McGuire, Alan B.; Flanagan, Mindy E.; Hunt, Marcia G.; Leslie, Doug L.; Collins, Linda A.; Wright-Berryman, Jennifer L.; Hicks, Lia J.; Salyers, Michelle P.; Department of Psychology, School of ScienceAssertive community treatment is known for improving consumer outcomes, but is difficult to implement. On-site fidelity measurement can help ensure model adherence, but is costly in large systems. This study compared reliability and validity of three methods of fidelity assessment (on-site, phone-administered, and expert-scored self-report) using a stratified random sample of 32 mental health intensive case management teams from the Department of Veterans Affairs. Overall, phone, and to a lesser extent, expert-scored self-report fidelity assessments compared favorably to on-site methods in inter-rater reliability and concurrent validity. If used appropriately, these alternative protocols hold promise in monitoring large-scale program fidelity with limited resources.Item Developing a Common Framework for Evaluating the Implementation of Genomic Medicine Interventions in Clinical Care: The IGNITE Network’s Common Measures Working Group(Nature Publishing group, 2018-06) Orlando, Lori A.; Sperber, Nina R.; Voils, Corrine; Nichols, Marshall; Myers, Rachel A.; Wu, R. Ryanne; Rakhra-Burris, Tejinder; Levy, Kenneth D.; Levy, Mia; Pollin, Toni I.; Guan, Yue; Horowitz, Carol R.; Ramos, Michelle; Kimmel, Stephen E.; McDonough, Caitrin W.; Madden, Ebony B.; Damschroder, Laura J.; Medicine, School of MedicinePurpose Implementation research provides a structure for evaluating the clinical integration of genomic medicine interventions. This paper describes the Implementing GeNomics In PracTicE (IGNITE) Network’s efforts to promote: 1) a broader understanding of genomic medicine implementation research; and 2) the sharing of knowledge generated in the network. Methods To facilitate this goal the IGNITE Network Common Measures Working Group (CMG) members adopted the Consolidated Framework for Implementation Research (CFIR) to guide their approach to: identifying constructs and measures relevant to evaluating genomic medicine as a whole, standardizing data collection across projects, and combining data in a centralized resource for cross network analyses. Results CMG identified ten high-priority CFIR constructs as important for genomic medicine. Of those, eight didn’t have standardized measurement instruments. Therefore, we developed four survey tools to address this gap. In addition, we identified seven high-priority constructs related to patients, families, and communities that did not map to CFIR constructs. Both sets of constructs were combined to create a draft genomic medicine implementation model. Conclusion We developed processes to identify constructs deemed valuable for genomic medicine implementation and codified them in a model. These resources are freely available to facilitate knowledge generation and sharing across the field.Item Essential Components of Early Intervention Programs for Psychosis: Available Intervention Services in the United States(Elsevier, 2015-10) White, Dominique A.; Luther, Lauren; Bonfils, Kelsey A.; Salyers, Michelle P.; Department of Psychology, School of SciencePrograms providing interventions for early psychosis are becoming commonplace in the United States (U.S.); however, the characteristics of existing services remain undocumented. We examined program characteristics, clinical services, and program eligibility criteria for outpatient early intervention programs across the U.S. using a semi-structured telephone interview. Content analysis was used to identify the presence or absence of program components, based in part on a recent list of essential evidence-based components recommended for early intervention programs (Addington, MacKenzie, Norman, Wang and Bond, 2013) as well as program characteristics, including eligibility criteria. A total of 34 eligible programs were identified; 31 (91.2%) program representatives agreed to be interviewed. Of the examined components, the most prevalent were individual psychoeducation and outcomes tracking; the least prevalent were outreach services and communication with inpatient units. The populations served by US programs were most frequently defined by restrictions on the duration of psychosis and age. This study provides critical feedback on services for the early psychosis population and identifies research to practice gaps and areas for future improvement.Item Leadership Characteristics of Nurse Managers Associated with Implementation of Evidence-Based Practice(2021-12) Noth-Matchett, Amanda Ann; Newhouse, Robin; Von Ah, Diane; Ellis, Rebecca Bartlett; Menachemi, NirThe implementation of evidence into practice is a complex process. Estimates indicate that it takes seventeen years on average for research to be translated into practice. Delay in implementation of evidence-based practice (EBP) results in poor patient outcomes and negative impacts to healthcare systems. While many factors contribute to delayed implementation of evidence, organizational characteristics of healthcare institutions have a significant impact on implementation. Leaders play a critical role by influencing these organizational characteristics to support evidence-based practice implementation. A key leadership role within acute care healthcare organizations is that of the front-line nurse manager (NM). Front-line nurse managers have responsibility for nursing unit operations and clinical nurses who deliver patient care under the nurse managers supervision. The relationship between NM leadership competencies and implementation of EBP is not well understood. Therefore, there is a critical need to identify how NM leadership behaviors influence the implementation of EBP. This dissertation examined the relationship between NM leadership behaviors and implementation of EBP. Results link the role of the NM to evidence-based clinical practice, and describe competencies and education needed for NM development. With an understanding of the NM leadership behaviors associated with implementation of EBP, healthcare leaders can develop education, processes, and interventions to increase competencies on NM leadership behaviors. Better implementation support by NMs will result in an improvement in use of EBPs. To examine the NM leadership behaviors that are associated with implementation of EBP, the following activities were completed: (1) an integrative review of the literature related to NM competencies associated with implementation, (2) identification and description of nurse manager competencies associated with EBP implementation using the Delphi method, and (3) examination of NM leadership behaviors associated with implementation of EBP during the COVID-19 pandemic response through a multi-site descriptive correlational survey of NMs and their nursing staff. Results of these studies demonstrate the importance of NM leadership characteristics and behaviors on EBP implementation.Item Multi-site investigation of strategies for the implementation of CYP2C19 genotype-guided antiplatelet therapy(Wiley, 2018) Empey, Philip E.; Stevenson, James M.; Tuteja, Sony; Weitzel, Kristin W.; Angiolillo, Dominick J.; Beitelshees, Amber L.; Coons, James C.; Duarte, Julio D.; Franchi, Francesco; Jeng, Linda J. B.; Johnson, Julie A.; Kreutz, Rolf P.; Limdi, Nita A.; Maloney, Kristin A.; Obeng, Aniwaa Owusu; Peterson, Josh F.; Petry, Natasha; Pratt, Victoria M.; Rollini, Fabiana; Scott, Stuart A.; Skaar, Todd C.; Vesely, Mark R.; Stouffer, George A.; Wilke, Russell A.; Cavallari, Larisa H.; Lee, Craig R.; Medicine, School of MedicineCYP2C19 genotype-guided antiplatelet therapy following percutaneous coronary intervention is increasingly implemented in clinical practice. However, challenges such as selecting a testing platform, communicating test results, building clinical decision support processes, providing patient and provider education, and integrating methods to support the translation of emerging evidence to clinical practice are barriers to broad adoption. In this report, we compare and contrast implementation strategies of 12 early adopters, describing solutions to common problems and initial performance metrics for each program. Key differences between programs included the test result turnaround time and timing of therapy changes which are both related to CYP2C19 testing model and platform used. Sites reported the need for new informatics infrastructure, expert clinicians such as pharmacists to interpret results, physician champions, and ongoing education. Consensus lessons learned are presented to provide a path forward for those seeking to implement similar clinical pharmacogenomics programs within their institutions. This article is protected by copyright.Item The Participant-Reported Implementation Update and Score (PRIUS): A Novel Method for Capturing Implementation-Related Data Over Time(JoVE, 2021-02) Miech, Edward J.; Rattray, Nicholas A.; Bravata, Dawn M.; Myers, Jennifer; Damush, Teresa M.; Medicine, School of Medicine"Implementation" of new initiatives in healthcare settings typically encompasses two distinct components: a "clinical intervention" plus accompanying "implementation strategies" that support putting the clinical intervention into day-to-day practice. A novel clinical intervention, for example, might consist of a new medication, a new protocol, a new device, or a new program. As clinical interventions are not self-implementing, however, they nearly always require effective implementation strategies in order to succeed. Implementation strategies set out to engage healthcare providers, staff and patients in ways that increase the likelihood of the new initiative being successfully adopted, a process that often involves behavior change and new ways of thinking by participants. One of the challenges in studying implementation is that it can be difficult to collect data about the status and progress of implementation, including participants' own perspectives and experiences concerning implementation to date. This protocol describes a novel method for collecting and analyzing data related to ongoing implementation called the Participant-Reported Implementation Update and Score, or PRIUS. The PRIUS method allows for the efficient and systematic capture of qualitative and quantitative data that can provide a detailed and nuanced account of implementation over time and from multiple viewpoints. This longitudinal method can enable researchers, as well as implementation leaders and organizational stakeholders, to monitor implementation progress more closely, conduct formative evaluation, identify improvement opportunities, and gauge the effect of any implementation changes on a rolling basis.Item A Physiologic approach to the pharmacogenomics of hypertension(Elsevier, 2016-03) Eadon, Michael T.; Chapman, Arlene B.; Department of Medicine, IU School of MedicineHypertension is a multifactorial condition with diverse physiological systems contributing to its pathogenesis. Individuals exhibit significant variation in their response to antihypertensive agents. Traditional markers, such as age, gender, diet, plasma renin level, and ethnicity, aid in drug selection. However, this review explores the contribution of genetics to facilitate antihypertensive agent selection and predict treatment efficacy. The findings, reproducibility, and limitations of published studies are examined, with emphasis placed on candidate genetic variants affecting drug metabolism, the renin-angiotensin system, adrenergic signalling, and renal sodium reabsorption. Single-nucleotide polymorphisms identified and replicated in unbiased genome-wide association studies of hypertension treatment are reviewed to illustrate the evolving understanding of the disease's complex and polygenic pathophysiology. Implementation efforts at academic centers seek to overcome barriers to the broad adoption of pharmacogenomics in the treatment of hypertension. The level of evidence required to support the implementation of pharmacogenomics in clinical practice is considered.Item Pregnancy Options Counseling for Pediatric Residents and Fellows: Effectiveness, Acceptability, and Appropriateness(2023-04-28) Bell, Lauren A; Kirkpatrick, Laura; Robbins, CynthiaBACKGROUND: Pediatricians are likely to encounter a pregnant adolescent in their lifetime of practice, yet many do not obtain clinical experience in pregnancy options counseling during residency. OBJECTIVE: To assess the effectiveness and perceived acceptability and appropriateness of a 2-hour interactive training in pregnancy options counseling including role-play simulation. METHODS: Pediatric residents on their adolescent medicine rotation participated in a required training in options counseling for adolescents each month between July-December 2022. Pediatric fellows were invited to participate if desired. Participants completed anonymous surveys on Redcap before and after training. We utilized 4-option Likert-scale measures ranging from “1= not at all important” or “1= strongly disagree” to “4 = very important” or “4 = strongly agree” looking at knowledge and attitudes related to pregnancy options counseling. The post-training survey also included the Acceptability of Intervention Measure (AIM) and Intervention Appropriateness Measure (IAM) which each utilize a mean of 4 different questions with 5-option Likert scale responses ranging from “1=completely disagree” to “5=completely agree.” This study was deemed exempt by the Indiana University Institutional Review Board. We used IBM SPSS (28.0) to perform descriptive statistics and Wilcoxon sign tests to analyze baseline and post-training data. RESULTS: 145 individuals completed the baseline survey. Of 33 participants who completed the training, 75% (n=25) filled out the post-participation survey. These were 3 pediatric fellows, 13 categorical pediatric residents, 8 combined pediatric residents, and 1 who did not disclose. Baseline demographics did not differ significantly between those who did or did not complete the post-test. Only 60% (n=15) of post-test completers correctly selected “parenting, adoption, abortion” as the three options to discuss during options counseling pre-training, but 92% (n=23) selected the correct answer after the training. Only 52% of participants (n=13) knew about judicial bypass requirements compared to 76% (n=19) post- training. Median AIM-Acceptability and IAM-Appropriateness scores post-intervention were high at 5.00 (IQR 1.00) and 4.75 (IQR 1.00). 85% (n=22) of participants endorsed the 2-hour training period as having “just the right amount of time. 81% (n=21) strongly agreed with the training’s value to their medical education. There were statistically significant improvements in attitudinal measures: participants’ perceived ability to discuss parenting (p<.001), adoption (p=.002), and abortion (p<.001); feeling knowledgeable about pregnancy-related resources (p<.001); and confidence making prenatal referrals for prenatal services (p<.001), abortion services (p=.002), and adoption services (p<.001). Participants rated some measures highly at baseline, with no significant change between pre-test and post-test: the importance of pregnancy options counseling training for pediatric residents, discussing all options as consistent with professional medical practice, and endorsement of referring to another colleague if they could not discuss all options. These measures all had a median of 4.00 and a mean of 3.88 on the pre-test. CONCLUSIONS: Pediatric residents showed gains in knowledge in and confidence around pregnancy options counseling for adolescents after completing a 2-hour interactive training. This format of training was rated highly in value to medical education, acceptability, and appropriateness by participating pediatric residents.Item Rapid, Full-Scale Change to Virtual PCIT During the COVID-19 Pandemic: Implementation and Clinical Implications(Springer, 2021-04) Garcia, Dainelys; Blizzard, Angela M.; Peskin, Abigail; Rothenberg, W. Andrew; Schmidt, Ellyn; Piscitello, Jennifer; Espinosa, Natalie; Salem, Hanan; Rodriguez, Gabriela M.; Sherman, Jamie A.; Parlade, Meaghan V.; Landa, Alexis L.; Davis, Eileen M.; Weinstein, Allison; Garcia, Angela; Perez, Camille; Rivera, Jessica M.; Martinez, Chary; Jent, Jason F.; Psychiatry, School of MedicineHealth agencies call for the immediate mobilization of existing interventions in response to numerous child and family mental health concerns that have arisen as result of the COVID-19 pandemic. Answering this call, this pilot study describes the rapid, full-scale change from a primarily clinic-based Parent–Child Interaction Therapy (PCIT) model to a virtual service model (i.e., I-PCIT) in an academic and community-based program in Miami, Florida. First, we describe the virtual service training model our program developed and its implementation with 17 therapists (MAge = 32.35, 88.2% female, 47.1% Hispanic) to enable our clinic to shift from providing virtual services to a small portion of the families served (29.1%) to all of the families served. Second, we examine the effect of I-PCIT on child and caregiver outcomes during the 2-month stay-at-home period between March 16, 2020, and May 16, 2020, in 86 families (MChildAge = 4.75, 71% Hispanic). Due to the rapid nature of the current study, all active participants were transferred to virtual services, and therefore there was no comparison or control group, and outcomes represent the most recently available scores and not treatment completion. Results reveal that I-PCIT reduced child externalizing and internalizing problems and caregiver stress, and increased parenting skills and child compliance with medium to large effects even in the midst of the COVID-19 pandemic. Finally, the study examined components of our virtual service training model associated with the greatest improvements in child and caregiver outcomes. Preliminary findings revealed that locally and collaboratively developed strategies (e.g., online communities of practice, training videos and guides) had the strongest association with child and caregiver outcomes. Implications for virtual service delivery, implementation, and practice in the midst of the COVID-19 pandemic are discussed.Item Re-Implementing Assertive Community Treatment: One Agency's Challenge of Meeting State Standards(2012-03-20) Godfrey, Jenna Lynn; Bond, Gary R.; Salyers, Michelle P.; McGrew, John H., 1953-; Horton-Deutsch, Sara L.Assertive Community Treatment (ACT) is a widely implemented evidence-based practice for consumers with severe mental illness. However, fidelity to the model is variable and program drift, in which programs decrease in fidelity over time, can occur. Given substantial variability in fidelity and program drift in evidence-based practices, a study to examine how to re-implement ACT to high fidelity on established teams was warranted. The present study examined three teams providing moderate fidelity services prior to a state-wide policy change to the definition of ACT. Two of the teams attempted to implement ACT in accordance with state standards, while the third team served as a quasi-control for factors related to other state policy changes, such as a change to the funding mechanism. The implementation effort was examined using qualitative and quantitative measures over a 14-month period at a large, psychosocial rehabilitation center. Themes that were common across all three teams included the perceived negative impact of fee-for-service, ambiguity of stipulations and lack of guidance from the Department of Mental Health (DMH), difficulties with the managed care organization, importance of leadership within the agency, and familiarity with the services. Perceived barriers specific to the implementation of ACT standards included DMH stipulations, staff turnover, lack of resources, and implementation overload, i.e., too many changes at once. One team also had the significant barrier of a misalignment of requirements between two funding sources. Staff attitudes represented both a facilitator and a barrier to ACT implementation, while management being supportive of ACT was viewed as a major facilitator. One of the two teams seeking ACT status was rated at high fidelity within 6 months and maintained high fidelity throughout the study. The other team seeking ACT status never achieved high fidelity and decertified from ACT status after 6 months. The agency’s focus on productivity standards during the implementation effort hampered fidelity on the two teams seeking ACT status and greatly contributed to burnout on all three teams. The team achieving ACT status overcame the barriers in the short-term; however, DMH requirements may have threatened the long-term sustainability of ACT at the agency.