Identifying Core Functions of an Evidence-Based Intervention to Improve Cancer Care Quality in Rural Hospitals

Wahlen, Madison M; Schroeder, Mary C.; Johnson, Erin C.; Lizarraga, Ingrid M.; Engelbart, Jacklyn; Tatman, David; Wagi, Cheyenne R.; Charlton, Mary E.; Birken, Sarah A.

doi:10.3389/frhs.2022.891574

Cited by 9 publications

(3 citation statements)

References 29 publications

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“…OTIS could be used to inform data collection or analysis. For example, OTIS could be used to develop guides for interviews with cancer program leadership to understand the potential influence of participation in quality improvement networks, professional norms, and the ability to recruit providers influence compliance with cancer program accreditation standards ( 30 ). We plan to use OTIS to analyze data that were previously collected regarding factors influencing cancer programs' implementation of exercise interventions.…”

Section: Discussionmentioning

confidence: 99%

Toward a more comprehensive understanding of organizational influences on implementation: the organization theory for implementation science framework

Birken,

Wagi,

Peluso

et al. 2023

Front. Health Serv.

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IntroductionImplementation is influenced by factors beyond individual clinical settings. Nevertheless, implementation research often focuses on factors related to individual providers and practices, potentially due to limitations of available frameworks. Extant frameworks do not adequately capture the myriad organizational influences on implementation. Organization theories capture diverse organizational influences but remain underused in implementation science. To advance their use among implementation scientists, we distilled 70 constructs from nine organization theories identified in our previous work into theoretical domains in the Organization Theory for Implementation Science (OTIS) framework.MethodsThe process of distilling organization theory constructs into domains involved concept mapping and iterative consensus-building. First, we recruited organization and implementation scientists to participate in an online concept mapping exercise in which they sorted organization theory constructs into domains representing similar theoretical concepts. Multidimensional scaling and hierarchical cluster analyses were used to produce visual representations (clusters) of the relationships among constructs in concept maps. Second, to interpret concept maps, we engaged members of the Cancer Prevention and Control Research Network (CPCRN) OTIS workgroup in consensus-building discussions.ResultsTwenty-four experts participated in concept mapping. Based on resulting construct groupings' coherence, OTIS workgroup members selected the 10-cluster solution (from options of 7–13 clusters) and then reorganized clusters in consensus-building discussions to increase coherence. This process yielded six final OTIS domains: organizational characteristics (e.g., size; age); governance and operations (e.g., organizational and social subsystems); tasks and processes (e.g., technology cycles; excess capacity); knowledge and learning (e.g., tacit knowledge; sense making); characteristics of a population of organizations (e.g., isomorphism; selection pressure); and interorganizational relationships (e.g., dominance; interdependence).DiscussionOrganizational influences on implementation are poorly understood, in part due to the limitations of extant frameworks. To improve understanding of organizational influences on implementation, we distilled 70 constructs from nine organization theories into six domains. Applications of the OTIS framework will enhance understanding of organizational influences on implementation, promote theory-driven strategies for organizational change, improve understanding of mechanisms underlying relationships between OTIS constructs and implementation, and allow for framework refinement. Next steps include testing the OTIS framework in implementation research and adapting it for use among policymakers and practitioners.

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Section: Discussionmentioning

confidence: 99%

Toward a more comprehensive understanding of organizational influences on implementation: the organization theory for implementation science framework

Birken,

Wagi,

Peluso

et al. 2023

Front. Health Serv.

Self Cite

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“…The second step is to conduct mechanistic studies 30,41 with qualitative and quantitative methods to identify causal mechanisms of the intervention within the most critical subsystems or across all subsystems, identifying system‐specific and cross‐system mechanisms. For interventions with multiple components, it is useful to distinguish the core component from the ancillary components 82,83 and, accordingly, to distinguish the theories about the core components from the theories about the ancillary components.…”

Section: Combining Ebm Ebm+ and Theory: A Three Step‐approachmentioning

confidence: 99%

“…For interventions with multiple components, it is useful to distinguish the core component from the ancillary components 82,83 and, accordingly, to distinguish the theories about the core components from the theories about the ancillary components.…”

Section: Reducing Intervention Uncertainty With the Three-step Approachmentioning

confidence: 99%

Reducing uncertainty in evidence‐based health policy by integrating empirical and theoretical evidence: An EbM+theory approach

Pfaff

Schmitt

2023

Evaluation Clinical Practice

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BackgroundTo reduce their decisional uncertainty, health policy decision‐makers rely more often on experts or their intuition than on evidence‐based knowledge, especially in times of urgency. However, this practice is unacceptable from an evidence‐based medicine (EbM) perspective. Therefore, in fast‐changing and complex situations, we need an approach that delivers recommendations that serve decision‐makers' needs for urgent, sound and uncertainty‐reducing decisions based on the principles of EbM.AimsThe aim of this paper is to propose an approach that serves this need by enriching EbM with theory.Materials and MethodsWe call this the EbM+theory approach, which integrates empirical and theoretical evidence in a context‐sensitive way to reduce intervention and implementation uncertainty.ResultsWithin this framework, we propose two distinct roadmaps to decrease intervention and implementation uncertainty: one for simple and the other for complex interventions. As part of the roadmap, we present a three‐step approach: applying theory (step 1), conducting mechanistic studies (EbM+; step 2) and conducting experiments (EbM; step 3).DiscussionThis paper is a plea for integrating empirical and theoretical knowledge by combining EbM, EbM+ and theoretical knowledge in a common procedural framework that allows flexibility even in dynamic times. A further aim is to stimulate a discussion on using theories in health sciences, health policy, and implementation.ConclusionThe main implications are that scientists and health politicians – the two main target groups of this paper—should receive more training in theoretical thinking; moreover, regulatory agencies like NICE may think about the usefulness of integrating elements of the EbM+theory approach into their considerations.

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Hospital Accreditation Status and Treatment Differences Among Black Patients With Colon Cancer

Chan,

Palis,

Cotler

et al. 2024

JAMA Netw Open

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ImportanceHospital-level factors, such as hospital type or volume, have been demonstrated to play a role in treatment disparities for Black patients with cancer. However, data evaluating the association of hospital accreditation status with differences in treatment among Black patients with cancer are lacking.ObjectiveTo evaluate the association of Commission on Cancer (CoC) hospital accreditation status with receipt of guideline-concordant care and mortality among non-Hispanic Black patients with colon cancer.Design, Setting, and ParticipantsThis population-based cohort study used the National Program of Cancer Registries, which is a multicenter database with data from all 50 states and the District of Columbia, and covers 97% of the cancer population in the US. The participants included non-Hispanic Black patients aged 18 years or older diagnosed with colon cancer between January 1, 2018, and December 31, 2020. Race and ethnicity were abstracted from medical records as recorded by health care facilities and practitioners. The data were analyzed from December 7, 2023, to January 17, 2024.ExposureCoC hospital accreditation.Main Outcome and MeasuresGuideline-concordant care was defined as adequate lymphadenectomy during surgery for patients with stages I to III disease or chemotherapy administration for patients with stage III disease. Multivariable logistic regression models investigated associations with receipt of guideline-concordant care and Cox proportional hazards regression models assessed associations with 3-year cancer-specific mortality.ResultsOf 17 249 non-Hispanic Black patients with colon cancer (mean [SD] age, 64.8 [12.8] years; 8724 females [50.6%]), 12 756 (74.0%; mean [SD] age, 64.7 [12.8] years) were treated at a CoC-accredited hospital and 4493 (26.0%; mean [SD] age, 65.1 [12.5] years) at a non–CoC-accredited hospital. Patients treated at CoC-accredited hospitals compared with those treated at non–CoC-accredited hospitals had higher odds of receiving guideline-concordant lymphadenectomy (adjusted odds ratio [AOR], 1.89; 95% CI, 1.69-2.11) and chemotherapy (AOR, 2.31; 95% CI, 1.97-2.72). Treatment at CoC-accredited hospitals was associated with lower cancer-specific mortality for patients with stages I to III disease who received surgery (adjusted hazard ratio [AHR], 0.87; 95% CI, 0.76-0.98) and for patients with stage III disease eligible for chemotherapy (AHR, 0.75; 95% CI, 0.59-0.96).Conclusions and RelevanceIn this cohort study of non-Hispanic Black patients with colon cancer, patients treated at CoC-accredited hospitals compared with those treated at non–CoC-accredited hospitals were more likely to receive guideline-concordant care and have lower mortality risk. These findings suggest that increasing access to high-quality guideline-concordant care at CoC-accredited hospitals may reduce variations in cancer treatment and outcomes for underserved populations.

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Identifying Core Functions of an Evidence-Based Intervention to Improve Cancer Care Quality in Rural Hospitals

Cited by 9 publications

References 29 publications

Toward a more comprehensive understanding of organizational influences on implementation: the organization theory for implementation science framework

Toward a more comprehensive understanding of organizational influences on implementation: the organization theory for implementation science framework

Reducing uncertainty in evidence‐based health policy by integrating empirical and theoretical evidence: An EbM+theory approach

Hospital Accreditation Status and Treatment Differences Among Black Patients With Colon Cancer

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