Changes in mammography screening in Ontario and Alberta following national guideline dissemination: an interrupted time series analysis

Background: In November 2011, the Canadian Task Force on Preventive Health Care released guidelines for screening women at average breast cancer risk. Weak recommendations (framed using GRADE methodology) were made for screening women aged 50 to 74 years every two to three years, and for not screening women aged 40 to 49 years. Methods: We conducted an interrupted time series analysis using administrative data to examine bilateral mammography use before and after a national guideline dissemination strategy targeting primary care physicians. Women aged 40 to 74 years living in Ontario or Alberta from 30th November 2008 to 30th November 2014 were included. Strata included age, region of residence, neighbourhood income quintile, immigration status, and education level. Results: In both provinces, mammography use rates were lower in the post-intervention period (527 vs. 556 and 428 vs. 465/1000 participant-months - the monthly screening rate/1000 - in Ontario and Alberta, respectively). In Ontario, mammography trends decreased following guideline release to align with recommendations for women aged 40 to 74 (decrease of 2.21/1000 women, SE 0.26/1000, p<0.0001). In Alberta, mammography trends decreased for women aged 40 to 49 years (3/1000 women, SE 0.32, p<0.001) and 50 to 69 (2.9/1000 women, SE 0.79, p<0.001), but did not change for women aged 70 to 74 (0.7/1000 women, SE 1.23, p=0.553). In both provinces, trends in mammography use rates were sustained for up to three years after guideline release. Conclusions: The guideline dissemination strategy appeared to increase uptake of guideline-concordant screening practice in women aged 40 to 49 years in Ontario and Alberta and for women aged 50 to 74 years in Ontario. Further work is required to understand these findings and whether shared decision making about mammography between women and providers increased among women considering mammography.

Evaluating the Implementation of a National COVID-19 Hospital Guideline in Wales

BackgroundThe COVID-19 pandemic created a unique situation where a national clinical guideline would address uncertainty, and provide a trusted source for up-to-date information and advice. We developed a dynamic online infrastructure together with a dedicated implementation team to deliver this at scale and pace. The guideline was implemented through a digital implementation framework (SIMPSI framework) deploying facilitators to maximise guideline adoption, particularly targeting senior clinical decision makers (consultants) involved with the care of COVID-infected patients across six Health Boards (HB) in Wales. Methods We evaluated guideline implementation using the Taxonomy of Implementation Outcomes Model. The primary outcome was consultant engagement, with a target of 193 registrations. We assessed wider impact through analysis of guideline platform activity and a user survey, with additional sensitivity analysis to derive penetration ratios, catchment population, clinical staff, acute beds, and COVID-19 admissions. ResultsThe guideline platform had 4521 total registrants, with over 170,000 page views during the first wave. We exceeded the target nearly six-fold (1159 consultant registrants). This represented 45% of all medical consultants in Wales, and made up the highest proportion of guideline registrants of all professional groups (23%, 1159/4521). We observed significant variation in guideline penetration across the six HBs, ranging from 31% to 74% of consultants registered. The HB with highest penetration had the most active guideline facilitator. The HB with the lowest penetration was the region first impacted and most affected by COVID-19 at the time of guideline publication (37% inpatients of peak, versus 10% or less for the other HBs). ConclusionWe utilised a digital implementation framework to construct a system that could be rapidly applied throughout all hospitals in Wales. Whilst we exceeded the intended target demonstrating full implementation, we identified two key factors to account for differences in the penetration rates across the different HBs. First, an experienced and active facilitator with the capacity to undertake the role was associated with significantly better penetration. Second, timeliness of implementation was crucial as evidenced by lower penetrance is the one HB that was impacted earliest by COVID-19 at the time of guideline dissemination. Nevertheless, the rapid implementation of the guideline has coincided with Wales demonstrating more favourable intensive care survival rates and maintaining one of the lowest mortality rates when compared to the UK as a whole for the first wave of the COVID-19 pandemic.

Evaluating The Implementation of A National COVID-19 Hospital Guideline In Wales

BackgroundThe COVID-19 pandemic created a unique situation where a national clinical guideline would address uncertainty, and provide a trusted source for up-to-date information and advice. We developed a dynamic online infrastructure together with a dedicated implementation team to deliver this at scale and pace. The guideline was implemented through a digital implementation framework (SIMPSI framework) deploying facilitators to maximise guideline adoption, particularly targeting senior clinical decision makers (consultants) involved with the care of COVID-infected patients across six Health Boards (HB) in Wales. Methods We evaluated guideline implementation using the Taxonomy of Implementation Outcomes Model. The primary outcome was consultant engagement, with a target of 193 registrations. We assessed wider impact through analysis of guideline platform activity and a user survey, with additional sensitivity analysis to derive penetration ratios, catchment population, clinical staff, acute beds, and COVID-19 admissions. ResultsThe guideline platform had 4521 total registrants, with over 170,000 page views during the first wave. We exceeded the target nearly six-fold (1159 consultant registrants). This represented 45% of all medical consultants in Wales, and made up the highest proportion of guideline registrants of all professional groups (23%, 1159/4521). We observed significant variation in guideline penetration across the six HBs, ranging from 31% to 74% of consultants registered. The HB with highest penetration had the most active guideline facilitator. The HB with the lowest penetration was the region first impacted and most affected by COVID-19 at the time of guideline publication (37% inpatients of peak, versus 10% or less for the other HBs). ConclusionWe utilised a digital implementation framework to construct a system that could be rapidly applied throughout all hospitals in Wales. Whilst we exceeded the intended target demonstrating full implementation, we identified two key factors to account for differences in the penetration rates across the different HBs. First, an experienced and active facilitator with the capacity to undertake the role was associated with significantly better penetration. Second, timeliness of implementation was crucial as evidenced by lower penetrance is the one HB that was impacted earliest by COVID-19 at the time of guideline dissemination. Nevertheless, the rapid implementation of the guideline has coincided with Wales demonstrating more favourable intensive care survival rates and maintaining one of the lowest mortality rates when compared to the UK as a whole for the first wave of the COVID-19 pandemic.

Evaluation of the Dissemination of the South African 24-Hour Movement Guidelines for Birth to 5 Years

South Africa (SA) launched their 24-h movement guidelines for birth to five years in December 2018. The guideline dissemination plan adopted a “train-the-trainer” strategy through dissemination workshops with community-based organisations (CBOs) working in early childhood development. The aim of this paper is to: (1) document this dissemination process; and (2) report on the feasibility of implementing the dissemination workshops, the acceptability of the workshops (and guidelines) for different end-user groups, and the extent to which CBO representatives disseminated the guidelines to end-users. Fifteen workshops were held in seven of SA’s nine provinces with a total of 323 attendees. Quantitative and qualitative findings (n = 281) indicate that these workshops were feasible for community-based dissemination of the guidelines and that this method of dissemination was acceptable to CBOs and end-users. Findings from follow-up focus groups (6 groups, n = 28 participants) indicate that the guidelines were shared with end-users of CBOs who participated in the focus groups. An additional musical storytelling resource, the “Woza, Mntwana” song, was well-received by participants; sharing via WhatsApp was believed to be the most effective way to disseminate this song. These findings confirm the feasibility and acceptability of culturally appropriate and context-specific community-based dissemination of behavioural guidelines in low-income settings.

Knowledge translation of the Canadian 24-Hour Movement Guidelines for Adults aged 18–64 years and Adults aged 65 years or older: a collaborative movement guideline knowledge translation process

Establishing a step-by-step process that provides practitioners with a blueprint for translating movement guidelines into action stands to optimize the investment in guideline development, improve guideline promotion and uptake, and ultimately enhance population health. The purpose of this paper is to describe how the Knowledge-to-Action framework and integrated knowledge translation were operationalized to systematically inform our knowledge translation (KT) efforts for the Canadian 24-Hour Movement Guidelines for Adults aged 18–64 years and Adults aged 65 years or older. In October 2018, the need for a KT Process, operating in tandem with the Guideline Development Process, led to the establishment of a KT team with a specific structure and terms of reference. The KT team collaboratively agreed on decision-making principles prior to selecting target audiences to focus their efforts. We undertook formative research to assess the local context and determinants of guideline dissemination and implementation efforts among target audiences. Plans for the subsequent steps and research are outlined. We highlight recommendations and lessons learned for applying the process in other settings. Novelty We outline a collaborative and systematic process and research program for the knowledge translation of movement guidelines. This paper provides an innovative and replicable blueprint to optimize future movement guideline knowledge translation efforts.