Balancing reality in embedded research and evaluation: Low vs high embeddedness

Jackson, George L.; Damschroder, Laura J.; White, Brandolyn; Henderson, Blake; Vega, Ryan; Kilbourne, Amy M.; Cutrona, Sarah L.

doi:10.1002/lrh2.10294

Cited by 13 publications

(14 citation statements)

References 32 publications

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“…The utility of an embedded researcher to assist with implementation has been increasingly discussed in the literature [33][34][35][36]. The present study aimed to embed a researcher within the general practice prior to conducting interviews to better understand the context of how the practice operated, however co-location was limited due to COVID-19 lockdowns and restrictions.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

The journey to a learning health system in primary care: a qualitative case study utilising an embedded research approach

et al. 2023

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Background Healthcare systems may be resilient and adaptive, but they are not fit for purpose in their current state. Increasing threats to health system sustainability have underscored the need to move towards a learning health system in which research and data are used routinely in clinical practice to facilitate system improvement. This study aimed to establish which elements of the learning health system were being realised within a university-based general practice and determine acceptability from staff to embrace further the transition towards a learning health system. Methods Semi-structured interviews were conducted with practice staff, including clinical and administrative staff, to determine the current state of the learning health system in the practice. An embedded researcher was placed within the general practice on a part-time basis to investigate the learning health system model. Interviews were transcribed and thematically analysed based on the National Academy of Medicine’s framework of learning health systems. Results In total, 32 (91%) practice staff were interviewed, comprising general practitioners (n = 15), nurses (n = 3), administrative staff (n = 13), and a psychologist (n = 1). Participants indicated that the practice was operating with several characteristics of a learning health system (e.g., emphasising science and informatics; focusing on patient-clinician partnerships; applying incentives; supporting a continuous learning culture; and establishing structures and governance for learning). These measures were supported by the university-based setting, and resultant culture of learning. Nevertheless, there were areas of the practice where the learning health system could be strengthened, specifically relating to the use of patient data and informatics. Staff generally expressed willingness to engage with the process of strengthening the learning health system within their practice. Conclusion Although the idea of a learning health system has been gaining traction in recent years, there are comparatively few empirical studies presented in the literature. This research presents a case study of a general practice that is operating as a learning health system and highlights the utility of using the learning health system framework.

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Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

The journey to a learning health system in primary care: a qualitative case study utilising an embedded research approach

et al. 2023

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“…Our team was selected in 2016 to conduct an external evaluation of the DoE, to guide program improvements and assess the impact of the program on VHA (see previous publications and Additional file 1 for more information about the evaluation [9,[27][28][29]). In earlier phases of our evaluation, we focused on implementation and initial sustainment of DoE practices [28].…”

Section: Organizational Context and Role Of The Authorsmentioning

confidence: 99%

Sustainment of diverse evidence-informed practices disseminated in the Veterans Health Administration (VHA): initial development and piloting of a pragmatic survey tool

Reardon

Damschroder

Widerquist

et al. 2023

Implement Sci Commun

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Background There are challenges associated with measuring sustainment of evidence-informed practices (EIPs). First, the terms sustainability and sustainment are often falsely conflated: sustainability assesses the likelihood of an EIP being in use in the future while sustainment assesses the extent to which an EIP is (or is not) in use. Second, grant funding often ends before sustainment can be assessed. The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) program is one of few large-scale models of diffusion; it seeks to identify and disseminate practices across the VHA system. The DoE sponsors “Shark Tank” competitions, in which leaders bid on the opportunity to implement a practice with approximately 6 months of implementation support. As part of an ongoing evaluation of the DoE, we sought to develop and pilot a pragmatic survey tool to assess sustainment of DoE practices. Methods In June 2020, surveys were sent to 64 facilities that were part of the DoE evaluation. We began analysis by comparing alignment of quantitative and qualitative responses; some facility representatives reported in the open-text box of the survey that their practice was on a temporary hold due to COVID-19 but answered the primary outcome question differently. As a result, the team reclassified the primary outcome of these facilities to Sustained: Temporary COVID-Hold. Following this reclassification, the number and percent of facilities in each category was calculated. We used directed content analysis, guided by the Consolidated Framework for Implementation Research (CFIR), to analyze open-text box responses. Results A representative from forty-one facilities (64%) completed the survey. Among responding facilities, 29/41 sustained their practice, 1/41 partially sustained their practice, 8/41 had not sustained their practice, and 3/41 had never implemented their practice. Sustainment rates increased between Cohorts 1–4. Conclusions The initial development and piloting of our pragmatic survey allowed us to assess sustainment of DoE practices. Planned updates to the survey will enable flexibility in assessing sustainment and its determinants at any phase after adoption. This assessment approach can flex with the longitudinal and dynamic nature of sustainment, including capturing nuances in outcomes when practices are on a temporary hold. If additional piloting illustrates the survey is useful, we plan to assess the reliability and validity of this measure for broader use in the field.

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“…However, of significant benefit, the ICDP-ESU collaboration pro- Recognized benefits reported here, predominantly the coproduction of knowledge that is responsive to the host organization's needs, align with experiences of other embedded research partnerships. 17 The collaboration functioned to a high degree of embeddedness within the health system, 48 where researchers were directly involved in the evolution of QI projects; evaluation learnings were shared on a weekly basis with clinical partners to inform iterative improvement. This is perhaps best exemplified in the collaboration's work to inform a nimble telemedicine response early in the COVID-19 pandemic when the health system was most vulnerable, with the ESU serving as a central hub in an evolving clinician-researcher network.…”

Section: Need For Timely Access To Quantitative Datamentioning

confidence: 99%

Evaluating clinician‐led quality improvement initiatives: A system‐wide embedded research partnership at Stanford Medicine

Vilendrer

Saliba‐Gustafsson

Asch

et al. 2022

Learning Health Systems

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Introduction: Many healthcare delivery systems have developed clinician-led quality improvement (QI) initiatives but fewer have also developed in-house evaluation units. Engagement between the two entities creates unique opportunities. Stanford Medicine funded a collaboration between their Improvement Capability Development Program (ICDP), which coordinates and incentivizes clinician-led QI efforts, and the Evaluation Sciences Unit (ESU), a multidisciplinary group of embedded researchers with expertise in implementation and evaluation sciences. Aim: To describe the ICDP-ESU partnership and report key learnings from the first 2 y of operation September 2019 to August 2021.Methods: Department-level physician and operational QI leaders were offered an ESU consultation to workshop design, methods, and overall scope of their annual QI projects. A steering committee of high-level stakeholders from operational, clinical, and research perspectives subsequently selected three projects for indepth partnered evaluation with the ESU based on evaluability, importance to the health system, and broader relevance. Selected project teams met regularly with the ESU to develop mixed methods evaluations informed by relevant implementation science frameworks, while aligning the evaluation approach with the clinical teams' QI goals.Results: Sixty and 62 ICDP projects were initiated during the 2 cycles, respectively, across 18 departments, of which ESU consulted with 15 (83%). Within each annual cycle, evaluators made actionable, summative findings rapidly available to partners to inform ongoing improvement. Other reported benefits of the partnership included rapid adaptation to COVID-19 needs, expanded clinician evaluation skills, external knowledge dissemination through scholarship, and

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Balancing reality in embedded research and evaluation: Low vs high embeddedness

Cited by 13 publications

References 32 publications

The journey to a learning health system in primary care: a qualitative case study utilising an embedded research approach

The journey to a learning health system in primary care: a qualitative case study utilising an embedded research approach

Sustainment of diverse evidence-informed practices disseminated in the Veterans Health Administration (VHA): initial development and piloting of a pragmatic survey tool

Evaluating clinician‐led quality improvement initiatives: A system‐wide embedded research partnership at Stanford Medicine

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