What helps implement and sustain communication systems designed to improve addiction: an interim report on a randomized controlled trial (Preprint)

2021 ◽  
Author(s):  
David Gustafson Sr ◽  
Julie Horst ◽  
Deanne Boss ◽  
Kathryn Fleddermann ◽  
Nora Jacobson ◽  
...  
Keyword(s):  
Communication Systems ◽  
Addiction Treatment ◽  
Controlled Trial ◽  
Implementation Strategies ◽  
Training Model ◽  
Lessons Learned ◽  
Practical Implementation ◽  
Healthcare Organizations ◽  
Treatment Technology ◽  
Improvement Process

BACKGROUND Researchers have conducted numerous studies seeking to understand how to improve implementation of changes in healthcare organizations, but less focus has been given to applying lessons already learned from implementation science to current projects. Finding innovative ways to apply these findings efficiently will improve current research on implementation strategies and will allow organizations utilizing these techniques to make changes more easily. OBJECTIVE This research seeks to compare a practical implementation approach that uses principles from prior implementation studies to more traditional ways of implementing change to further understand this issue. METHODS Forty-three addiction treatment sites in Iowa were randomly assigned to two different implementation strategies in a randomized comparative effectiveness trial studying implementation of an e-health substance use disorder (SUD) treatment technology. One strategy used an adaptation of the NIATx improvement approach developed for use in addiction treatment organizations, while the other utilized a traditional product training model. This paper discusses lessons learned from interviews with clinicians at these organizations and other informal feedback gathered throughout the study. RESULTS Use of the NIATx approach led to improved outcomes on several measures, including initial and sustained use of new technology by both counselors and patients. Additionally, feedback from clinicians and organizations indicates that utilizing strategies like ensuring that changes address current challenges and outlining how it does so, integrating organizational changes into workflows, and utilizing coaching to overcome hurdles and assess progress are important to improving implementation projects. CONCLUSIONS At this interim point in the study, it seems clear that use of the NIATx improvement process leads to better outcomes in implementation of changes within healthcare organizations. However, some strategies utilized in this improvement process are more useful and should be drawn on more heavily in future implementation efforts. CLINICALTRIAL ClinicalTrials.gov, NCT03954184. Registered 17 May 2019.

scholarly journals NIATx-TI versus typical product training on e-health technology implementation: a clustered randomized controlled trial study protocol

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Veronica M. White ◽  
Todd Molfenter ◽  
David H. Gustafson ◽  
Julie Horst ◽  
Rachelle Greller ◽  
...  
Keyword(s):  
Technology Implementation ◽  
Addiction Treatment ◽  
Controlled Trial ◽  
Health Technology ◽  
Individual Treatment ◽  
Evidence Based ◽  
Treatment Technology ◽  
Treatment Pathways ◽  
Health Technologies ◽  
Link Type

Abstract Background Substance use disorders (SUDs) lead to tens-of-thousands of overdose deaths and other forms of preventable deaths in the USA each year. This results in over $500 billion per year in societal and economic costs as well as a considerable amount of grief for loved ones of affected individuals. Despite these health and societal consequences, only a small percentage of people seek treatment for SUDs, and the majority of those that seek help fail to achieve long-term sobriety. E-health applications in healthcare have proven to be effective at sustaining treatment and reaching patients traditional treatment pathways would have missed. However, e-health adoption and sustainment rates in healthcare are poor, especially in the SUD treatment sector. Implementation engineering can address this gap in the e-health field by augmenting existing implementation models, which explain organizational and individual e-health behaviors retrospectively, with prospective resources that can guide implementation. Methods This cluster randomized control trial is designed to test two implementation strategies at adopting an evidence-based mobile e-health technology for SUD treatment. The proposed e-health implementation model is the Network for the Improvement of Addiction Treatment–Technology Implementation (NIATx-TI) Framework. This project, based in Iowa, will compare a control condition (using a typical software product training approach that includes in-person staff training followed by access to on-line support) to software implementation utilizing NIATx-TI, which includes change management training, followed by coaching on how to implement and use the mobile application. While e-health spans many modalities and health disciplines, this project will focus on implementing the Addiction Comprehensive Health Enhancement Support System (A-CHESS), an evidence-based SUD treatment recovery app framework. This trial will be conducted in Iowa at 46 organizational sites within 12 SUD treatment agencies. The control arm consists of 23 individual treatment sites based at five organizations, and the intervention arm consists of 23 individual SUD treatment sites based at seven organizations Discussion This study addresses an issue of substantial public health significance: enhancing the uptake of the growing inventory of patient-centered evidence-based addiction treatment e-health technologies. Trial registration ClinicalTrials.gov, NCT03954184. Posted 17 May 2019

Malignant hyperthermia susceptibility: utilization of genetic results in an electronic medical record to increase safety

2020 ◽  
Vol 21 (17) ◽  
pp. 1207-1215
Author(s):  
Jordan F Baye ◽  
Natasha J Petry ◽  
Shauna L Jacobson ◽  
Michelle M Moore ◽  
Bethany Tucker ◽  
...  
Keyword(s):  
Decision Support ◽  
Malignant Hyperthermia ◽  
Clinical Decision Support ◽  
Perioperative Complications ◽  
Implementation Strategies ◽  
Clinical Decision ◽  
Lessons Learned ◽  
Malignant Hyperthermia Susceptibility ◽  
Alert System ◽  
Genotyping Platform

Aim: This manuscript describes implementation of clinical decision support for providers concerned with perioperative complications of malignant hyperthermia susceptibility. Materials & methods: Clinical decision support for malignant hyperthermia susceptibility was implemented in 2018 based around our pre-emptive genotyping platform. We completed a brief descriptive review of patients who underwent pre-emptive testing, focused particularly on RYR1 and CACNA1S genes. Results: To date, we have completed pre-emptive genetic testing on more than 10,000 patients; 13 patients having been identified as a carrier of a pathogenic or likely pathogenic variant of RYR1 or CACNA1S. Conclusion: An alert system for malignant hyperthermia susceptibility – as an extension of our pre-emptive genomics platform – was implemented successfully. Implementation strategies and lessons learned are discussed herein.

scholarly journals Technical Note: Practical implementation strategies of cycloidal computed tomography

2021 ◽  
Author(s):  
Oriol Roche i Morgó ◽  
Fabio Vittoria ◽  
Marco Endrizzi ◽  
Alessandro Olivo ◽  
Charlotte K. Hagen
Keyword(s):  
Computed Tomography ◽  
Implementation Strategies ◽  
Technical Note ◽  
Practical Implementation

scholarly journals Preparedness and response to an emerging health threat—Lessons learned from Candida auris outbreaks in the United States

2021 ◽  
pp. 1-6
Author(s):  
Diane Meyer ◽  
Elena K. Martin ◽  
Syra Madad ◽  
Priya Dhagat ◽  
Jennifer B. Nuzzo
Keyword(s):  
United States ◽  
New York ◽  
Qualitative Interviews ◽  
The United States ◽  
Lessons Learned ◽  
Infection Prevention And Control ◽  
Healthcare Organizations ◽  
Candida Auris ◽  
Term Care ◽  
Healthcare Facilities

Abstract Objective: Candida auris infections continue to occur across the United States and abroad, and healthcare facilities that care for vulnerable populations must improve their readiness to respond to this emerging organism. We aimed to identify and better understand challenges faced and lessons learned by those healthcare facilities who have experienced C. auris cases and outbreaks to better prepare those who have yet to experience or respond to this pathogen. Design: Semi-structured qualitative interviews. Setting: Health departments, long-term care facilities, acute-care hospitals, and healthcare organizations in New York, Illinois, and California. Participants: Infectious disease physicians and nurses, clinical and environmental services, hospital leadership, hospital epidemiology, infection preventionists, emergency management, and laboratory scientists who had experiences either preparing for or responding to C. auris cases or outbreaks. Methods: In total, 25 interviews were conducted with 84 participants. Interviews were coded using NVivo qualitative coding software by 2 separate researchers. Emergent themes were then iteratively discussed among the research team. Results: Key themes included surveillance and laboratory capacity, inter- and intrafacility communication, infection prevention and control, environmental cleaning and disinfection, clinical management of cases, and media concerns and stigma. Conclusions: Many of the operational challenges noted in this research are not unique to C. auris, and the ways in which we address future outbreaks should be informed by previous experiences and lessons learned, including the recent outbreaks of C. auris in the United States.

scholarly journals The ACHIEVE Trial: Lessons Learned From Nesting a Randomized Controlled Trial Within an Observational Cohort Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 811-811
Author(s):  
Jennifer Deal ◽  
Nicholas Reed ◽  
David Couper ◽  
Kathleen Hayden ◽  
Thomas Mosley ◽  
...  
Keyword(s):  
Older Adults ◽  
Randomized Controlled Trial ◽  
Observational Study ◽  
Cognitive Decline ◽  
Controlled Trial ◽  
Lessons Learned ◽  
Community Dwelling ◽  
Randomized Controlled ◽  
Study Staff ◽  
Increased Risk

Abstract Hearing impairment in older adults is linked to accelerated cognitive decline and a 94% increased risk of incident dementia in population-based observational studies. Whether hearing treatment can delay cognitive decline is unknown but could have substantial clinical and public health impact. The NIH-funded ACHIEVE randomized controlled trial of 977 older adults aged 70-84 years with untreated mild-to-moderate hearing loss, is testing the efficacy of hearing treatment versus health education on cognitive decline over 3 years in community-dwelling older adults (Clinicaltrials.gov Identifier: NCT03243422.) This presentation will describe lessons learned from ACHIEVE’s unique study design. ACHIEVE is nested within a large, well-characterized multicenter observational study, the Atherosclerosis Risk in Communities Study. Such nesting within an observational study maximizes both operational and scientific efficiency. With trial results expected in 2022, this presentation will focus on the benefits gained in design and recruitment/retention, including dedicated study staff, well-established protocols, and established study staff-participant relationships. Part of a symposium sponsored by Sensory Health Interest Group.

scholarly journals Meeting the Challenges of Longitudinal Cluster-Based Trials in Schools: Lessons From the Chicago Trial of Positive Action

2016 ◽  
Vol 40 (4) ◽  
pp. 450-482 ◽  
Author(s):  
Kendra M. Lewis ◽  
David L. DuBois ◽  
Peter Ji ◽  
Joseph Day ◽  
Naida Silverthorn ◽  
...  
Keyword(s):  
Public Schools ◽  
Low Income ◽  
Urban Areas ◽  
Statistical Power ◽  
Student Mobility ◽  
Controlled Trial ◽  
Lessons Learned ◽  
Study Planning ◽  
Positive Action ◽  
Cluster Randomized

We describe challenges in the 6-year longitudinal cluster randomized controlled trial (CRCT) of Positive Action (PA), a social–emotional and character development (SECD) program, conducted in 14 low-income, urban Chicago Public Schools. Challenges pertained to logistics of study planning (school recruitment, retention of schools during the trial, consent rates, assessment of student outcomes, and confidentiality), study design (randomization of a small number of schools), fidelity (implementation of PA and control condition activities), and evaluation (restricted range of outcomes, measurement invariance, statistical power, student mobility, and moderators of program effects). Strategies used to address the challenges within each of these areas are discussed. Incorporation of lessons learned from this study may help to improve future evaluations of longitudinal CRCTs, especially those that involve evaluation of school-based interventions for minority populations and urban areas.

scholarly journals How to approach a many splendoured thing: Proxy Technology Assessment as a methodological praxis to study virtual experience

2010 ◽  
Vol 3 (1) ◽  
Author(s):  
Lizzy Bleumers ◽  
Kris Naessens ◽  
An Jacobs
Keyword(s):  
Virtual Worlds ◽  
Technology Assessment ◽  
New Technologies ◽  
New Technology ◽  
Methodological Approach ◽  
Lessons Learned ◽  
Practical Implementation ◽  
Natural Setting ◽  
Functional Requirements ◽  
Virtual Experiences

This article introduces Proxy Technology Assessment (PTA) as a methodological approach that can widen the scope of virtual world and game research. Studies of how people experience virtual worlds and games often focus on individual in-world or in-game experiences. However, people do not perceive these worlds and games in isolation. They are embedded within a social context that has strongly intertwined online and offline components. Studying virtual experiences while accounting for these interconnections calls for new methodological approaches. PTA answers this call.Combining several methods, PTA can be used to investigate how new technology may impact and settle within people's everyday life (Pierson et al., 2006). It involves introducing related devices or applications, available today, to users in their natural setting and studying the context-embedded practices they alter or evoke. This allows researchers to detect social and functional requirements to improve the design of new technologies. These requirements, like the practices under investigation, do not stop at the outlines of a magic circle (cf. Huizinga, 1955).We will start this article by contextualizing and defining PTA. Next, we will describe the practical implementation of PTA. Each step of the procedure will be illustrated with examples and supplemented with lessons learned from two interdisciplinary scientific projects, Hi-Masquerade and Teleon, concerned with how people perceive and use virtual worlds and games respectively.

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