An unresolved issue in the field of implementation research is how to conceptualize and evaluate successful implementation. This paper advances the concept of “implementation outcomes” distinct from service system and clinical treatment outcomes. This paper proposes a heuristic, working “taxonomy” of eight conceptually distinct implementation outcomes—acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability—along with their nominal definitions. We propose a two-pronged agenda for research on implementation outcomes. Conceptualizing and measuring implementation outcomes will advance understanding of implementation processes, enhance efficiency in implementation research, and pave the way for studies of the comparative effectiveness of implementation strategies.
Objectives: To produce nationally representative population estimates of rates of service use among young adults with an autism spectrum disorder during their first few years after leaving high school and to examine correlates of use.
Children walking to school, people cycling to the shops or work and neighbours chatting in the street, these are some of the gauges of an active and healthy community that can be achieved through utilising good design principles. But are these principles being applied in urban developments or are policy-makers following a 'path dependent' trajectory that severely limits the best practice outcomes sought? This review examines current research on path dependence to determine how this concept advances our understanding of barriers to change in the built environment, active transport and healthy communities. An online database search of scholarly bibliographic records identified 22 relevant articles for a critical review of studies that evaluated path dependence in the urban and built environment literature with a focus on transport, urban planning and health. A thematic analysis of the articles showed that different types of path dependence have contributed to the dominance of policies and designs supporting car-based transport to the detriment of public transport and active transport modes, leading to sub-optimal development patterns becoming 'locked-in'. However, the outcomes for active transport and physical activity are not all dire, and path dependence theory does provide some guidance on changing policy to achieve better outcomes. This review suggests that path dependence is one of the best theoretical frameworks to help health promoters understand barriers to change and can provide insights into developing future successful public health interventions. Future studies could focus further on active transport, local neighbourhood development and physical activity.
Combining task-specific training with glove-based SES in chronic stroke resulted in changes in arm sensation and function that were maintained at 3-month follow-up.
The Medicare prescription drug benefit, introduced in January 2006, has had a substantial impact on the lives of adults disabled by mental illness. However, few studies have undertaken an exploration of the difference that this benefit has made to beneficiaries' access to medication. This study uses a qualitative approach to examine beneficiaries' experiences with the Medicare Part D benefit, and whether having Medicare prescription drug coverage is perceived as helpful. Twenty-six Medicare beneficiaries with mental illness were interviewed regarding their opinions of the Part D benefit, and the investigator found that most beneficiaries were highly satisfied with their prescription drug coverage. However, they would appreciate more information from the Medicare program about their benefits. In addition, beneficiaries were concerned about the possibility of increased future costs. Overall, however, these participants in the Medicare Part D program who had mental illness felt that their needs for psychotropic and other medications were met.
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