2021 Archives - Page 3 of 7 - Implementation Science at UW

✪ The relationship between first-level leadership and inner-context and implementation outcomes in behavioral health: a scoping review

Abstract:

Background

First-level leadership is uniquely positioned to support evidence-based practice (EBP) implementation for behavioral health due to first-level leaders’ access to and relationship with service providers. First-level leaders are individuals who directly supervise and manage frontline employees who do not manage others. However, first-level leadership is underrepresented in existing reviews of the impact of leadership on EBP implementation. This review describes the relationship between first-level leadership and implementation determinants and outcomes.

Methods

A scoping review was performed to synthesize the literature on the relationship between first-level leadership and inner-context and implementation outcomes. A literature search was conducted in PubMed, Eric, PsycINFO, CINAHL, Scopus, and Web of Science. To be eligible, studies had to examine first-level leadership, be conducted in settings providing behavioral health services, and examine the relationship between first-level leadership and an implementation or inner-context outcome. Data extraction and synthesis were performed to describe study characteristics, leader-outcome relationships, and overlap in leadership frameworks.

Results

Twenty-one records met our inclusion criteria. Studies primarily relied on observational designs and were often cross-sectional. Studies more often examined general leadership rather than leadership strategically focused on EBP implementation (i.e., strategic implementation leadership). Our findings suggest that several forms of first-level leadership are inconsistently related to a broad set of implementation determinants, with infrequent examination of specific implementation outcomes. The broad set of implementation determinants studied, limited number of replications, and inconsistent findings have resulted in sparse evidence for any specific leadership-outcome relationship. The greatest accumulation of evidence exists for general leadership’s positive relationship with providers’ EBP attitudes, most notably in the form of transformational leadership. This was followed by evidence for strategic implementation leadership facilitating general implementation. Our synthesis revealed moderate conceptual overlap of strategic implementation leadership behaviors described in the theory of implementation leadership and theory of middle managers’ role in implementation.

Conclusions

Our findings suggest that first-level leadership may play an important role in shaping implementation determinants and outcomes, but consistent empirical support is sparse and confidence dampened by methodological issues. To advance the field, we need studies that adopt stronger methodological rigor, address the conceptual overlap in leadership frameworks, examine a broader set of implementation outcomes, and examine conditions under which leadership impacts implementation.

^{**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**}

Male Caregiver Barriers to HIV Index Case Testing of Untested Children

✪ Building Implementation Science Capacity in Academic Pharmacy: Report of the 2020-2021 AACP Research and Graduate Affairs Committee

Abstract:

Executive Summary

The 2020-2021 AACP Research and Graduate Affairs Committee (RGAC) continued the work begun by the 2019-2020 RGAC to increase awareness of and capacity for implementation research to advance practice transformation in academic pharmacy. AACP President Anne Lin charged the RGAC with developing resources and programs for training faculty and graduate students in implementation science. The committee was further charged with developing a mechanism to pair pharmacy faculty and implementation experts on practice advancement projects. In its work, the committee focused on generating near-term opportunities for pharmacy practice faculty to pursue projects while developing programs that would support ongoing career development and future implementation practice and research by pharmacy faculty and trainees.

To support training, the RGAC developed a competency framework for graduate education that builds on the six domains of graduate education in pharmaceutical sciences put forward by the 2016-2017 RGAC. The new, specialized framework identifies and organizes those competencies that should be cultivated to successfully pursue implementation research in pharmacy, with utility beyond graduate education. The identified competencies could act as the base for pharmacy-specific implementation science training materials suitable for faculty development. The committee proposes a faculty development program that leverages the framework and existing implementation science training resources offered by federal agencies and universities to provide facilitated learning opportunities and peer support for faculty who wish to pursue implementation research.

The committee considered multiple approaches AACP could take to promote collaboration between pharmacy faculty and implementation experts. While recognizing the importance of individual development support for pharmacy faculty, the committee felt that a focus on supporting interdisciplinary teams that span practice and research and engage faculty, trainees and preceptors would have the greatest impact on enabling practice advancement projects in the near term while increasing capacity in the long-term. The committee envisions a program in which AACP creates opportunities for pharmacy faculty and implementation experts to come together with the purpose of matching researchers and projects. AACP support for these collaborations should begin prior to any such matching event, for example by helping pharmacy faculty articulate the scope and value of their proposed practice advancement projects, and extend beyond the initial match to include assisting nascent collaborations establish connections and secure institutional and external backing.

The RGAC made specific recommendations to AACP about how the framework and proposed programs could be used to further develop pharmacy faculty and graduate students as researchers while advancing the goal of sustainable transformation of pharmacy practice. A key recommendation is that AACP cultivate an inclusive community of interest in implementation science in pharmacy that will promote adoption of the framework, act as facilitators and coaches for training programs and assist in planning and supporting collaborative research projects.

Expected Organizational Costs for Inserting Prevalence Information Into Lumbar Spine Imaging Reports

Authors:

Brian W. Bresnahan, Jeffrey G. Jarvik, Eric N. Meier, Kathryn T. James, Laura S. Gold, Sean D. Rundell, Judith A. Turner, Pradeep Suri, Patrick H. Luetmer, Janna L. Friedly, Karen J. Sherman,
Patrick J. Heagerty, David F. Kallmes, Andrew L. Avins, Brent D. Griffith, & Larry G. Kessler

^{University of Washington affiliated authors are displayed in bold.}

Subscription Required for Full Text Access

Published: June 2021

Read the full text in the subscription access Journal of the American College of Radiology

Financial Incentives for Pediatric HIV Testing (FIT): Caregiver Insights on Incentive Mechanisms, Focus Populations, and Acceptability for Programmatic Scale Up

✪ Development of an Asthma Home-Visit Training Program for Community Health Workers and Their Supervisors in Washington State

Abstract:

The community health worker (CHW) asthma home-visiting model developed by Public Health-Seattle & King County (PHSKC) is an evidence-based approach proven to improve health outcomes and quality of life. In addition, it has been shown to be an effective and culturally appropriate approach to helping people with asthma understand the environmental and behavioral causes of uncontrolled asthma, while acquiring the skills they need to control their asthma.

This paper describes the development and implementation of training curricula for CHWs and supervisors in the asthma home visiting program. To facilitate dissemination, this program took advantage of the current healthcare landscape in Washington State resulting from Centers for Medicare & Medicaid Services (CMS) approval of the 1115 Medicaid Waiver project. Key aspects of the training program development included: (1) Engagement: forming a Community Advisory Board with multiple stakeholders to help prioritize training content; (2) Curriculum Development: building the training on evidence-based home-visit protocols previously developed at PHSKC; (3) Implementation of the training program; (4) Evaluation of the training; and (5) Adaptation of the training based on lessons learned.

We describe key factors in the training program's improvement including the use of a community-based participatory approach to engage stakeholders at multiple phases of the project and ensure regional adaption; combining in-person and online modules for delivery; and holding learning collaboratives for post-training and technical support. We also outline our training program evaluation plan and the planned evaluation of the home visit program which the trainees will deliver, both of which follow the RE-AIM framework. However, because the COVID-19 pandemic has curtailed training activities and prohibited the trainees from implementation of these CHW home visit practices, our evaluation is currently incomplete. Therefore, this case study provides insight into the adaptation of the training program, but not the delivery of the home visit program, the outcomes of which remain to be seen.

✪ Perceived consequences of healthcare service decentralization on access, affordability and quality of care in Khartoum locality, Sudan

Abstract:

Background

Decentralization of healthcare services has been widely utilized, especially in developing countries, to improve the performance of healthcare systems by increasing the access and efficiency of service delivery. Experiences have been variable secondary to disparities in financial and human resources, system capacity and community engagement. Sudan is no exception and understanding the perceived effect of decentralization on access, affordability, and quality of care among stakeholders is crucial.

Methods

This was a mixed method, cross-sectional, explorative study that involved 418 household members among catchment areas and 40 healthcare providers of Ibrahim Malik Hospital (IBMH) and Khartoum Teaching Hospital (KTH). Data was collected through a structured survey and in-depth interviews from July-December 2015.

Results

Access, affordability and quality of healthcare services were all perceived as worse, compared to before decentralization was implemented. Reported affordability was found to be 53 and 55% before decentralization compared to 24 to 16% after decentralization, within KTH and IBMH catchment areas respectively, (p = 0.01). The quality of healthcare services was reported to have declined from 47 and 38% before decentralization to 38 and 28% after, in KTH and IBMH respectively (p = 0.02). Accessibility was found to be more limited, with services being accessible before decentralization approximately 59 and 52% of the time, compared to 41 and 30% after, in KTH and IBMH catchment areas respectively, (p = 0.01). Accessibility to healthcare was reported to have decreased secondary to facility closures, reverse transference of services, and low capacity of devolved facilities. Lastly, privatized services were reported as strengthened in response to this decentralization of healthcare.

Conclusions

The deterioration of access, affordability and quality of health services was experienced as the predominant perception among stakeholders after decentralization implementation. Our study results suggest there is an urgent need for a review of the current healthcare policies, structure and management within Sudan in order to provide evidence and insights regarding the impact of decentralization.

^{**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**}

Authors:

✪ Open Access

Read the full text in the open access journal Implementation Science

Abstract:

Background

Methods

Results

Conclusions

Authors:

Subscription Required for Full Text Access

Read the full text in the subscription access Journal of Acquired Immune Deficiency Syndrome

Authors:

✪ Open Access

Read the full text in the American Journal of Pharmaceutical Education

Abstract:

Executive Summary

Authors:

Subscription Required for Full Text Access

Read the full text in the subscription access Journal of the American College of Radiology

Authors:

Subscription Required for Full Text Access

Read the full text in the subscription access journal AIDS and Behavior

Authors:

✪ Open Access

Read the full text in the open access journal Frontiers in Public Health

Abstract:

Authors:

✪ Open Access

Read the full text in the open access journal BMC Health Services Research

Abstract:

Background

Methods

Results

Conclusions

Authors:

Subscription Required for Full Text Access

Read the full text in the subscription access journal Austism

Authors:

Subscription Required for Full Text Access

Read the full text in the subscription access Maternal and Child Health Journal

Authors:

Subscription Required for Full Text Access

Read the full text in the subscription access journal Research in Social and Administrative Pharmacy