Launching and supporting the SGA Project in Kentucky and Minnesota: Experiences and perspectives of the Senior Technical Assistance Team

2020 ◽  
Vol 53 (3) ◽  
pp. 287-296 ◽  
Author(s):  
Joe Marrone ◽  
Russ Thelin ◽  
Linda Mock
Keyword(s):  
Vocational Rehabilitation ◽  
Staff Training ◽  
Technical Assistance ◽  
Controlled Trial ◽  
Team Approach ◽  
Implementation Phase ◽  
Randomized Controlled ◽  
Rehabilitation Agency ◽  
Multiple Levels ◽  
Competing Priorities

BACKGROUND: The SGA Project tested a rapid coordinated team approach in Kentucky and Minnesota. OBJECTIVE: The authors are members of a five-person Senior Technical Assistance (TA) Team that supported Kentucky and Minnesota as host sites in a l randomized controlled trial. METHODS: The TA team participated in a planning and implementation phase over the course of three years. At closeout, the TA team interviewed SVRA personnel on participation, recommendations, and challenges. RESULTS: TA was adapted to the needs of each state vocational rehabilitation agency to identify solutions to capacity challenges, staff training, concerns about randomization, and team approaches. In both Kentucky and Minnesota, the dedicated TA team balanced the fidelity of the model with the need to align solutions with agency priorities, goals, and culture. CONCLUSIONS: Provision of intensive TA to support state vocational rehabilitation agencies to participate in a research intervention requires a focus on counselor skills and expectations, attention to competing priorities and interests of State VR Agencies, and an ability to build relationships at multiple levels of the agency.

scholarly journals Team approach to polypharmacy evaluation and reduction: study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Dee Mangin ◽  
Larkin Lamarche ◽  
Gina Agarwal ◽  
Hoan Linh Banh ◽  
Naomi Dore Brown ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Randomized Controlled Trial ◽  
Clinical Pathway ◽  
Controlled Trial ◽  
Primary Objective ◽  
Control Group ◽  
Team Approach ◽  
Potentially Inappropriate Medications ◽  
Randomized Controlled

Abstract Background Polypharmacy in older adults can be associated with negative outcomes including falls, impaired cognition, reduced quality of life, and general and functional decline. It is not clear to what extent these are reversible if the number of medications is reduced. Primary care does not have a systematic approach for reducing inappropriate polypharmacy, and there are few, if any, approaches that account for the patient’s priorities and preferences. The primary objective of this study is to test the effect of TAPER (Team Approach to Polypharmacy Evaluation and Reduction), a structured operationalized clinical pathway focused on reducing inappropriate polypharmacy. TAPER integrates evidence tools for identifying potentially inappropriate medications, tapering, and monitoring guidance and explicit elicitation of patient priorities and preferences. We aim to determine the effect of TAPER on the number of medications (primary outcome) and health-related outcomes associated with polypharmacy in older adults. Methods We designed a multi-center randomized controlled trial, with the lead implementation site in Hamilton, Ontario. Older adults aged 70 years or older who are on five or more medications will be eligible to participate. A total of 360 participants will be recruited. Participants will be assigned to either the control or intervention arm. The intervention involves a comprehensive multidisciplinary medication review by pharmacists and physicians in partnership with patients. This review will be focused on reducing medication burden, with the assumption that this will reduce the risks and harms of polypharmacy. The control group is a wait list, and control patients will be given appointments for the TAPER intervention at a date after the final outcome assessment. All patients will be followed up and outcomes measured in both groups at baseline and 6 months. Discussion Our trial is unique in its design in that it aims to introduce an operationalized structured clinical pathway aimed to reduce polypharmacy in a primary care setting while at the same time recording patient’s goals and priorities for treatment. Trial registration Clinical Trials.gov NCT02942927. First registered on October 24, 2016.

scholarly journals A cluster randomized controlled trial comparing Virtual Learning Collaborative and Technical Assistance strategies to implement an early palliative care program for patients with advanced cancer and their caregivers: a study protocol

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Lisa Zubkoff ◽  
Kathleen Doyle Lyons ◽  
J. Nicholas Dionne-Odom ◽  
Gregory Hagley ◽  
Maria Pisu ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Technical Assistance ◽  
Controlled Trial ◽  
Implementation Strategies ◽  
Care Program ◽  
Early Palliative Care ◽  
Randomized Controlled ◽  
Community Oncology ◽  
Cluster Randomized

Abstract Background Virtual Learning Collaboratives (VLC), learning communities focused on a common purpose, are used frequently in healthcare settings to implement best practices. Yet, there is limited research testing the effectiveness of this approach compared to other implementation strategies. This study evaluates the effectiveness of a VLC compared to Technical Assistance (TA) among community oncology practices implementing ENABLE (Educate, Nurture, Advise, Before Life Ends), an evidence-based, early palliative care telehealth, psycho-educational intervention for patients with newly diagnosed advanced cancer and their caregivers. Methods Using Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) and Proctor’s Implementation Outcomes Frameworks, this two-arm hybrid type-III cluster-randomized controlled trial (RCT) will compare two implementation strategies, VLC versus TA, among the 48 National Cancer Institute Community Oncology Research Program (NCORP) practice clusters that have not historically provided palliative care to all patients with advanced cancer. Three cohorts of practice clusters will be randomized to the study arms. Each practice cluster will recruit 15–27 patients and a family caregiver to participate in ENABLE. The primary study outcome is ENABLE uptake (patient level), i.e., the proportion of eligible patients who complete the ENABLE program (receive a palliative care assessment and complete the six ENABLE sessions over 12 weeks). The secondary outcome is overall program implementation (practice cluster level), as measured by the General Organizational Index at baseline, 6, and 12 months. Exploratory aims assess patient and caregiver mood and quality of life outcomes at baseline, 12, and 24 weeks. Practice cluster randomization will seek to keep the proportion of rural practices, practice sizes, and minority patients seen within each practice balanced across the two study arms. Discussion This study will advance the field of implementation science by evaluating VLC effectiveness, a commonly used but understudied, implementation strategy. The study will advance the field of palliative care by building the capacity and infrastructure to implement an early palliative care program in community oncology practices. Trial registration Clinicaltrials.gov. NCT04062552; Pre-results. Registered: August 20, 2019. https://clinicaltrials.gov/ct2/show/NCT04062552?term=NCT04062552&draw=2&rank=1

Prenatal and Postnatal Management of Gastroschisis in German-Speaking Countries: Is There a Standardized Management?

2017 ◽  
Vol 28 (02) ◽  
pp. 183-193 ◽  
Author(s):  
Katharina Schib ◽  
Marc Schumacher ◽  
Martin Meuli ◽  
Sasha Tharakan ◽  
Ulrike Subotic
Keyword(s):  
Controlled Trial ◽  
Treatment Modalities ◽  
Abdominal Pressure ◽  
Team Approach ◽  
Fetal Therapy ◽  
Randomized Controlled ◽  
Ultrasound Monitoring ◽  
Starting Point ◽  
Multicenter Randomized Controlled Trial ◽  
German Speaking

Introduction Evidence-based guidelines or protocols regarding the perinatal management of babies born with gastroschisis are lacking. The aim of this work is to evaluate the different current treatment modalities for newborns with gastroschisis during the perinatal period in the German-speaking countries Germany, Austria, and Switzerland. These data could serve as a starting point for the development of a multicenter randomized controlled trial. Materials and Methods A questionnaire was developed with 30 questions divided into five sections: (1) prenatal diagnosis, (2) fetal therapy, (3) mode and timing of delivery, (4) operative management, and (5) postoperative management. All pediatric surgery institutions that treat newborns with gastroschisis were identified and asked to participate. Data were categorized by country and analyzed using descriptive statistics (frequency and percentage). Results The return rate of the questionnaire was 95% (89 hospitals). A standard procedure was identified regarding prenatal ultrasound monitoring, interdisciplinary team approach, planned delivery through cesarean section, postnatal coverage of the intestine with a silastic bag, first intervention within the first 6 hours after birth, attempt of primary abdominal wall closure, and perioperative antibiotic treatment. For many crucial parameters, management was not standardized. Conclusions There is no gold standard in German-speaking countries on how to manage fetuses and babies with gastroschisis. Moreover, this report unveils some questionable elements of daily practice for which there is no evidence at all and which can jeopardize outcome and even prove fatal (fetal therapy, preterm delivery, lack of abdominal pressure monitoring). Prospective randomized-controlled multicenter studies are needed to set a standard.

scholarly journals Integration of a task strengthening strategy for hypertension management into HIV care in Nigeria: a cluster randomized controlled trial study protocol

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Angela A. Aifah ◽  
Oluwatosin Odubela ◽  
Ashlin Rakhra ◽  
Deborah Onakomaiya ◽  
Jiyuan Hu ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Implementation Strategy ◽  
Controlled Trial ◽  
Hiv Care ◽  
Hypertension Management ◽  
Hypertension Control ◽  
Implementation Phase ◽  
Randomized Controlled ◽  
Cluster Randomized ◽  
The Impact

Abstract Background In regions with weak healthcare systems, critical shortages of the healthcare workforce, and increasing prevalence of dual disease burdens, there is an urgent need for the implementation of proven effective interventions and strategies to address these challenges. Our mixed-methods hybrid type II effectiveness-implementation study is designed to fill this evidence-to-practice gap. This study protocol describes a cluster randomized controlled trial which evaluates the effectiveness of an implementation strategy, practice facilitation (PF), on the integration, adoption, and sustainability of a task-strengthening strategy for hypertension control (TASSH) intervention within primary healthcare centers (PHCs) in Lagos State, Nigeria. Design Guided by the Consolidated Framework for Implementation Research (CFIR) and the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM), this study tests the impact of a proven effective implementation strategy to integrate hypertension management into the HIV care cascade, across 30 PHCs. The study will be conducted in three phases: (1) a pre-implementation phase that will use CFIR to develop a tailored PF intervention for integrating TASSH into HIV clinics; (2) an implementation phase that will use RE-AIM to compare the clinical effectiveness of PF vs. a self-directed condition (receipt of information on TASSH without PF) on BP reduction; and (3) a post-implementation phase that will use RE-AIM to evaluate the effect of PF vs. self-directed condition on adoption and sustainability of TASSH. The PF intervention components comprise (a) an advisory board to provide leadership support for implementing TASSH in PHCs; (b) training of the HIV nurses on TASSH protocol; and (c) training of practice facilitators, who will serve as coaches, provide support, and performance feedback to the HIV nurses. Discussion This study is one of few, if any trials, to evaluate the impact of an implementation strategy for integrating hypertension management into HIV care, on clinical and implementation outcomes. Findings from this study will advance implementation science research on the effectiveness of tailoring an implementation strategy for the integration of an evidence-based, system-level hypertension control intervention into HIV care and treatment. Trial registration ClinicalTrials.gov (NCT04704336). Registered on 11 January 2021.

Sign in / Sign up

Export Citation Format

Share Document