Asthma dissemination around patient-centered treatments in North Carolina (ADAPT-NC): a cluster randomized control trial evaluating dissemination of an evidence-based shared decision-making intervention for asthma management

Ludden, Thomas M.; Shade, Lindsay; Reeves, Kelly; Welch, Madelyn; Taylor, Yhenneko J.; Mohanan, Sveta; McWilliams, Andrew; Halladay, Jacqueline R.; Donahue, Katrina E; Coyne‐Beasley, Tamera; Dolor, Rowena J; Bray, Paul; Tapp, Hazel

doi:10.1080/02770903.2018.1514630

Cited by 14 publications

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“…Since the recording and consenting of calls began after the third monthly group call, not all information about the different types of dissemination of information could be captured from all calls. While the design of our trial compared different dissemination methods,29 31 dissemination of information could not be correlated by practice to the outcomes data since Medicaid data was only collected for patients at each practice in the study.…”

Section: Discussionmentioning

confidence: 99%

“…The data collection for this study revolved around recording monthly group calls to discuss a 12-week roll-out to implement the asthma SDM intervention into 10 primary care practices across North Carolina as part of the Asthma Dissemination Around Patient-centered Treatments in North Carolina Study using PFs 1 29 31 32. The research team invited providers and clinical staff from 10 primary care practices across the state (figure 1) to participate in a monthly group call with their PFs beginning in August 2014.…”

Section: Methodsmentioning

confidence: 99%

“…Here we describe a qualitative analysis of dissemination of information occurring within monthly group calls discussing implementation of an asthma SDM intervention. Previously published results showed that the patients from the practices that received the facilitator-led dissemination of the intervention had significantly higher perceptions of SDM occurring during asthma visits compared with patients from practices that received a traditional lunch-and-learn approach (75% vs 66%, p=0.001) 29 30. For this study, the research team examined dissemination of information between researchers including the practice facilitators (PFs), practice providers and clinical staff from each practice during the facilitator-led dissemination intervention.…”

Section: Introductionmentioning

confidence: 99%

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What types of dissemination of information occurred between researchers, providers and clinical staff while implementing an asthma shared decision-making intervention: a directed content analysis

et al. 2020

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ObjectiveTo qualitatively analyse different types of dissemination of information during monthly group calls between researchers, providers and clinical staff used to establish best practices for implementing an asthma shared decision-making (SDM) intervention. Evaluating dissemination of information can provide a better understanding of how best practices are shared, informing implementation approaches to improve the uptake of new evidence and overcome barriers.Setting10 primary care practices in North Carolina.ParticipantsProviders and clinical staff participated in monthly group phone calls with researchers to share best practices during implementation of a SDM intervention for asthma patients.DesignThe research team transcribed and coded statements using content analysis into three different knowledge types: Knowledge Position, Knowledge Form and Knowledge Object. Knowledge Objects were further classified using directed content analysis where the research team interpreted the content objects through a classification process of identifying themes or patterns to describe three different types of dissemination of information: (A) Confirmation of Existing Knowledge, (B) Generation of New Knowledge and (C) Spreading of New Knowledge.ResultsAcross the 8 transcripts, 4 Knowledge Positions, 7 Knowledge Forms and 18 types of Knowledge Objects were identified. From the Knowledge Objects, Confirmation of Existing Knowledge occurred during the training of participating practices. The review also identified Generation of New Knowledge by providers and clinical staff raised in these calls. This Generation of New Knowledge was later documented being used by other practices with the identification of Spreading of New Knowledge.ConclusionThe research team described the types of dissemination of information that occurred between researchers, providers and clinical staff during implementation of an asthma SDM intervention. Both Confirmation of Existing Knowledge and Generation of New Knowledge in response to barriers occurred. These exploratory dissemination of information results provide additional mechanisms for evaluating implementation science.Trial registration numberNCT02047929; Post-results

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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What types of dissemination of information occurred between researchers, providers and clinical staff while implementing an asthma shared decision-making intervention: a directed content analysis

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“…From earlier work, we demonstrated that a facilitated approach to implementation of SDM was associated with improved perceptions of SDM and improved ED utilization for pediatric patients [17,18,[27][28][29]. Identified implementation barriers included time constraints of the clinical team in a volume-based reimbursement structure, staff turnover, and lack of availability of staff to train as health coaches.…”

Section: Introductionmentioning

confidence: 94%

Evaluation of a shared decision-making intervention for pediatric patients with asthma in the emergency department

Reeves

O’Hare

Shade

et al. 2020

Implement Sci Commun

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Background: Asthma is a difficult-to-manage chronic disease marked with associated outcome disparities including an increase rate of emergency department (ED) visits for uncontrolled asthma among patients who are most at-risk. Shared decision making (SDM) is a process by which the patient and provider jointly make a healthcare choice. SDM improves patient outcomes; however, implementation barriers of time constraints and staff availability are limitations. The use of health IT solutions may increase the adoption of SDM, but best practices for implementation are not well understood. The Consolidated Framework for Implementation Research (CFIR) is a flexible comprehensive model used to identify barriers and facilitators influencing implementation. The goal of this study is to implement an innovative web-based pediatric SDM tool in the real-world setting of two large healthcare system EDs through the following aims: (1) convene a patient, research, and ED stakeholder advisory board to oversee review of protocol and study materials prior to implementation, (2) implement the SDM intervention where providers and staff will be trained to incorporate use of this SDM intervention, (3) conduct on-going evaluation of barriers, facilitators, and implementation outcomes to tailor implementation in the EDs, (4) evaluate patientcentered outcomes of primary care utilization and changes in ED visits and hospitalizations before and after the SDM intervention, and (5) understand and document best practices for ED implementation. Methods: The CFIR model will guide the implementation evaluation. Researchers will administer surveys to the clinical team and patients at baseline, 3, 6, and 12 months to inform implementation design, determine barriers and facilitators, and resource-needs to allow for real-time process adjustments within the EDs. Focus group or keyinformant interviews and analysis will provide additional feedback to the stakeholder team to iterate the implementation process. Researchers will track patient-centered outcomes including increased primary care, ED, and inpatient utilization over the duration of the study. Discussion: To advance asthma care and the field of implementation science, further research is needed to assess best practices for incorporating SDM into high-need healthcare settings such as the ED. This knowledge will facilitate improved outcomes and appropriate policy changes towards further use of SDM interventions in local and national acute care settings.

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“…The patient and provider then discuss several evidence-based options and work towards an agreement on a treatment regimen [25,26]. This SDM process has been shown to improve medication adherence and clinically relevant disease outcomes for patients with asthma [26][27][28][29].…”

Section: Introductionmentioning

confidence: 99%

Research nurses as practice facilitators to disseminate an asthma shared decision making intervention

et al. 2020

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Background: Practice facilitation is a method of introducing and sustaining organizational change. It involves the use of skilled healthcare professionals called practice facilitators (PFs) to help address the challenges associated with implementing evidence-based guidelines and complex interventions into practice. PFs provide a framework for translating research into practice by building relationships, improving communication, fostering change, and sharing resources. Nurses are well positioned to serve as PFs for the implementation of complex interventions, however, there is little evidence currently available to describe nurses in this role. Additionally, the best strategies to implement complex interventions into practices are still not fully understood. Combining practice facilitation with the train-the-trainer model has the potential to spread knowledge and skills. Shared decision making (SDM), which involves patients and providers jointly engaging in decisions around treatment options, has been shown to improve outcomes for patients with asthma. The goal of this manuscript is to describe and evaluate the practice facilitation process from the ADAPT-NC Study which successfully utilized research nurses to implement a complex asthma SDM toolkit intervention into primary care practices. Methods: As part of a larger study, 10 primary care practices were recruited for a facilitator-led dissemination intervention involving a 12-week rollout of an asthma SDM toolkit (trial registration: 1.28.2014, #NCT02047929). An experienced lead PF trained research nurses as PFs from each of the 4 participating practice-based research networks (PBRNs) in a train-the-trainer model utilizing a one-day training event and subsequent remote meetings. Evaluation of PF engagement was measured through process improvement surveys. Results: Overall, the asthma SDM intervention was successfully implemented within the 4 PBRNs. All 10 facilitatorled practices remained engaged with their PFs, with 8 out of the 10 practices able to incorporate and sustain SDM visits or clinics. Responses from the surveys for process improvement yielded improved PF communication and team dynamics over time.

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Asthma dissemination around patient-centered treatments in North Carolina (ADAPT-NC): a cluster randomized control trial evaluating dissemination of an evidence-based shared decision-making intervention for asthma management

Abstract: Tapp (2019) Asthma dissemination around patient-centered treatments in North Carolina (ADAPT-NC): a cluster randomized control trial evaluating dissemination of an evidence-based shared decision-making intervention for asthma management,

Cited by 14 publications

References 26 publications

What types of dissemination of information occurred between researchers, providers and clinical staff while implementing an asthma shared decision-making intervention: a directed content analysis

What types of dissemination of information occurred between researchers, providers and clinical staff while implementing an asthma shared decision-making intervention: a directed content analysis

Evaluation of a shared decision-making intervention for pediatric patients with asthma in the emergency department

Research nurses as practice facilitators to disseminate an asthma shared decision making intervention

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