ovretveit implementation science research course 1day sept 11
DESCRIPTION
Ovretveit implementation science research course 1day sept 11TRANSCRIPT
Implementation research and science
This PPT and other resources from:
http://public.me.com/johnovr
1
John Øvretveit,Director of Research, Professor of Health Innovation
and Evaluation, Karolinska Institutet, Stockholm, Sweden
04/13/2023
Objectives – after the workshop I will be better able to:
Explain what implementation science and research is
Describe the elements of an implementation programme
Explain the strengths and limitations of an implementation research study
Plan an implementation study which is useful to the users of the study
Know where to go for more details
204/13/2023
How - Learning process
Use tool to analyse implementation programme(CESSiM)
Using tool to assess implementation (REAIM) Assess quality of research using DAGU tool Plan implementation and or research using these tools
Process – John explain, You try, We assess. Do you have Resources – outline, questions and cases?
Johnstone, Ammentor, Helm (1,3,2) 3,
Timetable Introductions what is implementation science and research?
you say “hallo”
Example implementation programme Group case analysis on elements CASSiM
Implementation assessment Group case analysis REAIM
Assess quality of research DAGU
Planning an implementation study – phases, your examples? Group exercise
Guide to resources & Q&A 404/13/2023
Is implementation about evidence based practice?
What is evidence based medicine, evidence based healthcare?
Professionals using research to make better informed decisions in their practice
Usually evaluations showing the most effective treatment for a patient
But - can be evaluations of service delivery model (eg team based care) or health promotion intervention
Implement = enable more practitioners to use a more effective method in their practice
504/13/2023
Implementation also about using improvement methods
An example of an “improvement method”?
PDSA testing: A quality team tests a change to reduce waiting times using a Plan
Do Study Act cycle (eg follow ups optional)
Flow process mapping A quality team maps patient pathway and reduces delays and errors
Implementation not just about getting more people to use effective treatments
6
Definitions: Implementation science and research
“Implementation research is the scientific study of
methods to promote the systematic uptake of
research findings and other evidence-based practices
into routine practice, and, hence, to improve the
quality and effectiveness of health” Eccles and Mittman, Implementation Science 2006.
704/13/2023
Implementation research
Mostly describes, evaluates and explains an
implementation in different real-life settings.
804/13/2023
Confusion warning: IS overlaps with:
‘‘translation research’’: ‘‘an effective translation of the new knowledge, mechanisms, and techniques generated by advances in basic science research into new approaches for prevention, diagnosis, and treatment of diseases essential for improving health’’ Many other related types of research
Knowledge translation research Quality improvement research
etc 9
04/13/2023
Say hallo to the person sitting next to you
Name, title and where you work Are you doing implementation research or
involved in an implementation project? What do you want to learn about
implementation research and practice? Specific question
1004/13/2023
Group rules
Choose chairperson, scribe to report, cuckoo clock
Chairperson says how much time left, when the
group will summarise and agrees the task and
questions
Make room for everyone to contribute.
Cell phones off!
1104/13/2023
Part 1: The elements of an implementation programmeExample: implementing and maintaining a care pathway for the last days of life
CESSiM Content?
Define What was the “thing” implemented?
Efficacious? Was it evidence-based: was the guideline for the care pathway
based on evidence of effective care?
Structure and systems What was the implementation structure: the people and groups
at different levels who took actions to enable others to follow the guideline
1204/13/2023
CESSiM - continued
Strategy: phases/steps, actions, Were there phases or steps in the implementation (different
things done at different times?) What were the implementation actions: what were the 5 main
things done by these people and groups to enable others to follow the guideline? (by whom and when?
implementation Methods: Did they use implementation methods – systematic ways to do
enable change?
1304/13/2023
Case
.
1404/13/2023
Points
1 Implementation is different from the change being
implemented
Before/after change – anti-biotic prophylaxis 1 hr before surgery
Implementation actions – training, reminders, performance data
collection and feedback
2 Efficacy X Implementation = Effectiveness
1504/13/2023
What does “fidelity” mean? Exact “digital” copy of proven practice
Key questions:
For which interventions is fidelity essential
For which is adaption needed
Are some parts of the intervention adaptable and some not (“core”) Eg must copy the change difference
But can implement it in different ways
Or do you have to copy implementation strategy as well?
1604/13/2023
Making a difference depends more on effective implementation than on an efficacious intervention
Drugs don’t work if the patient does not take them
Implementation is methods to enable patients to get, and take medicines in the way proven to be effective
An efficacious communication training for physicians will not improve patient-physician communication if it is not implemented effectively.
1704/13/2023
One Implementation assessment method Reach
(% target population participated)
Efficacy (outcome success rate if implemented as in original research)
Adoption (proportion of settings, practices that adopt the intervention)
Implementation (extent to which the intervention is implemented as intended in the real
world)
Maintenance (extent to which a program is sustained over time)
18
Case: Ammentorp & Kofoed 2011
Communication skills training in Danish hospitals
Only consider Phase IV and V studies Effectiveness studies: Intervention studies tested in a pre/post
design in two different departments (phase IV) Implementation study evaluated in large scale (phase V) Phase III was an RCT efficacy study
Group – Note for two departments (phase IV), what was Reach, Efficacy, Adoption, Implementation, Maintenance Is this a good method to use to assess implementation? Are all parts needed for implementation study?
1904/13/2023
Case: Ammentorp & Kofoed 2011
2004/13/2023
1 Effectiveness of treatment implementation is more important than efficacy of the improvement
2 Context factors affect each step 21
Use CASSiM and REAIM to explain Falls Guideline Failure (Helm et al 2006)
Groups – read out loud the abstract. From abstract in 15
mins summarise Content, Efficacious, Structure and systems, Strategy,
Implementation methods 15 mins summarise: Reach, Efficacy, Adoption,
Implementation, Maintenance
15 mins: what is your explanation for figure 2 and 3?
22
Case
Results: In the internal medicine ward, the target incidence of 6% was met for four of the 18 months in the intervention period. In the neurology ward, the inci- dence target of 11% was met in five months.
Discussion: Barriers to change and enabling factors may only become apparent during the implementation process itself. A strongly perceived need to change daily practice, a simple guideline, the hospital board’s support, an understanding of local barriers, monitoring of outcomes, a locally tailored multifaceted implemen- tation strategy, and voluntarily cooperating nurses are no guarantees for success. 2
304/13/2023
.Points .
2404/13/2023
Assessing the quality of a research study - DAGU Description
Could we copy this implementation?
Were the measures and data gathered the right ones (were resources used and saved measured?)
Attribution
What else could have explained the findings (how good was the design for the users questions)?
Generalisation Does the study explain in which settings similar findings could be
expected, and in which settings findings may be different?
Use Is it presented in a way users can easily understand and will it help with
users practical decisions? 25
Give 0-5 score for Helms et al 2006 study Description
Could we copy this implementation?
Were the measures and data gathered the right ones (were resources used and saved measured?)
Attribution
What else could have explained the findings (how good was the design for the users questions)?
Generalisation Does the study explain in which settings similar findings could be
expected, and in which settings findings may be different?
Use Is it presented in a way users can easily understand and will it help with
users practical decisions? 26
Plan research or an implementation
Group for designing an implementation project or programme
Group for planning a research study of an implementation
List implementations you want to plan
2704/13/2023
Groups Present timeline picture of main phases and data for monitoring
Group work:
Decide the customer for your plan – who is to use the design or the research when its done?
Use CASSiM to define elements
Use REAIM to define data needed to monitor or for research
Or look at frameworks at end of Johns Outline paper and choose which is most suited to the users questions
Use DAGU to decide how to improve your research design
2804/13/2023
Points .
2904/13/2023
. .
3004/13/2023
04/13/2023 31
Conclusions
Each person write down and then share in the group:
1. These were the main points…
2. This was new or surprising, for me…
3. The most useful idea for my work was…
4. What I would like to find out more about…
DETAILS
3204/13/2023
Resources
Handouts
Tools
Web sites
.
. .
3304/13/2023
Readings
Overview and guide to the literature: Fixsen et al 2005 .
. .
3404/13/2023
Research assessment – DAGU or AGUDMP Attribution
(extent to which intervention influenced the change in outcome data documented, & relative influence of components or synergistic influence)
Generalise Used
(Useful - matched to users questions – then gives information and presented to suit audience)
Description (theory informed data collection) Measures valid Presentation 3
504/13/2023
04/13/2023 36
Conclusions
Each person write down and then share in the group:
1. These were the main points…
2. This was new or surprising, for me…
3. The most useful idea for my work was…
4. What I would like to find out more about…