BackgroundMiddle managers have received little attention in extant health services research, yet they may have a key role in healthcare innovation implementation. The gap between evidence of effective care and practice may be attributed in part to poor healthcare innovation implementation. Investigating middle managers' role in healthcare innovation implementation may reveal an opportunity for improvement. In this paper, we present a theory of middle managers' role in healthcare innovation implementation to fill the gap in the literature and to stimulate research that empirically examines middle managers' influence on innovation implementation in healthcare organizations.DiscussionExtant healthcare innovation implementation research has primarily focused on the roles of physicians and top managers. Largely overlooked is the role of middle managers. We suggest that middle managers influence healthcare innovation implementation by diffusing information, synthesizing information, mediating between strategy and day-to-day activities, and selling innovation implementation.SummaryTeamwork designs have become popular in healthcare organizations. Because middle managers oversee these team initiatives, their potential to influence innovation implementation has grown. Future research should investigate middle managers' role in healthcare innovation implementation. Findings may aid top managers in leveraging middle managers' influence to improve the effectiveness of healthcare innovation implementation.

OBJECTIVE:To develop and validate a short health literacy assessment tool for Portuguese-speaking adults. METHODS:The Short Assessment of Health Literacy for Portuguesespeaking Adults is an assessment tool which consists of 50 items that assess an individual's ability to correctly pronounce and understand common medical terms. We evaluated the instrument's psychometric properties in a convenience sample of 226 Brazilian older adults. Construct validity was assessed by correlating the tool scores with years of schooling, self-reported literacy, and global cognitive functioning. Discrimination validity was assessed by testing the tool's accuracy in detecting inadequate health literacy, defi ned as failure to fully understand standard medical prescriptions. RESULTS:Moderate to high correlations were found in the assessment of construct validity (Spearman's coeffi cients ranging from 0.63 to 0.76). The instrument showed adequate internal consistency (Cronbach's alpha=0.93) and adequate test-retest reliability (intraclass correlation coeffi cient=0.95). The area under the receiver operating characteristic curve for detection of inadequate health literacy was 0.82. A version consisting of 18 items was tested and showed similar psychometric properties. CONCLUSIONS:The instrument developed showed good validity and reliability in a sample of Brazilian older adults. It can be used in research and clinical settings for screening inadequate health literacy. Health literacy is defi ned as the ability to perform basic reading and numerical tasks required to function in the health care environment.1 There is increasing evidence that health literacy skills are related to important health outcomes, even after adjustments for confounding factors such as education, age, and gender. Inadequate health literacy has been independently associated with lower utilization of preventive services, poor self-management of chronic conditions, low medication adherence, increased hospitalization, and higher death rates. 4 Some population groups are at greater risk for inadequate health literacy including the socioeconomically disadvantaged, immigrants, and older adults. Inadequate health literacy may disproportionately affect the health of older people, not only as a result of generation gap in education, but also because the elderly have more medical conditions, use more health care services, and are more likely to require complex therapeutic regimens. 12Because years of formal schooling alone are not a reliable indicator of health literacy and individuals with lower health literacy skills may try to hide it, it is diffi cult to recognize those patients with inadequate health literacy during routine clinical care.15 Developing RESUMO OBJETIVO: Desenvolver e validar um instrumento breve para avaliação de alfabetismo em saúde na língua portuguesa. MÉTODOS:O instrumento desenvolvido consiste de 50 itens que avaliam a capacidade do indivíduo de pronunciar e compreender termos médicos comuns. As propriedades psicométricas foram avaliadas e...

r Dissemination of Choosing Wisely guidelines alone is unlikely to reduce the use of low-value health services. r Interventions by health systems to implement Choosing Wisely guidelines can reduce the use of low-value services. r Multicomponent interventions targeting clinicians are currently the most effective types of interventions. Context: Choosing Wisely aims to reduce the use of unnecessary, low-value medical services through development of recommendations related to service utilization. Despite the creation and dissemination of these recommendations, evidence shows low-value services are still prevalent. This paper synthesizes literature on interventions designed to reduce medical care identified as low value by Choosing Wisely and evaluates which intervention characteristics are most effective. Methods: We searched peer-reviewed and gray literature from the inception of Choosing Wisely in 2012 through June 2019 to identify interventions in the United States motivated by or using Choosing Wisely recommendations.We also included studies measuring the impact of Choosing Wisely on its own, without interventions. We developed a coding guide and established coding agreement. We coded all included articles for types of services targeted, components of each intervention, results of the intervention, study type, and, where

Over the past 10 years, the field of health services and management research has seen renewed interest in the use of qualitative research methods. This article examines the volume and characteristics of qualitative research articles published in nine major health services and management journals between 1998 and 2008. Qualitative research articles comprise 9% of research articles published in these journals. Although the publication rate of qualitative research articles has not kept pace with that of quantitative research articles, citation analysis suggests that qualitative research articles contribute comparably to the field’s knowledge base. A wide range of policy and management topics has been examined using qualitative methods. Case study designs, interviews, and documentary sources were the most frequently used methods. Half of qualitative research articles provided little or no detail about key aspects the study’s methods. Implications are discussed and recommendations are offered for promoting the publication of qualitative research.

This work proposes a revision of the 30 item Rapid Estimate of Adult Literacy in Dentistry (REALD-30), into a more efficient and easier-to-use two-stage scale. Using a sample of 1,405 individuals (primarily women) enrolled in a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), the present work utilizes principles of item response theory and multi-stage testing to revise the REALD-30 into a two-stage test of oral health literacy, named Two-Stage REALD or TS-REALD, which maximizes score precision at various levels of participant ability. Based on the participant’s score on the 5-item first-stage (i.e., routing test), one of three potential stage-two tests is administered: a 4-item Low Literacy test, a 6-item Average Literacy test, or a 3-item High Literacy test. The reliability of scores for the TS-REALD is greater than .85 for a wide range of ability. The TS-REALD was found to be predictive of perceived impact of oral conditions on well-being, after controlling for educational level, overall health, dental health, and a general health literacy measure. While containing approximately one-third of the items on the original scale, the TS-REALD was found to maintain similar psychometric qualities.