Implementation Science is Imperative to the Optimization of Obstetric Care

Hamm, Rebecca F.; Iriye, Brian; Srinivas, Sindhu K.

doi:10.1055/s-0040-1721728

Cited by 10 publications

(4 citation statements)

References 56 publications

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“…Although the potential benefits are clear, maternal health is lagging far behind other fields in the application of implementation science methods [27]. There is an urgent need for more investment in implementation research to address the maternal health crisis in the USA [28,29].…”

Section: Introductionmentioning

confidence: 99%

Implementation research priorities for addressing the maternal health crisis in the USA: results from a modified Delphi study among researchers

Hamm

Moniz

Wahid

et al. 2023

Implement Sci Commun

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Background Maternal health outcomes in the USA are far worse than in peer nations. Increasing implementation research in maternity care is critical to addressing quality gaps and unwarranted variations in care. Implementation research priorities have not yet been defined or well represented in the plans for maternal health research investments in the USA. Methods This descriptive study used a modified Delphi method to solicit and rank research priorities at the intersection of implementation science and maternal health through two sequential web-based surveys. A purposeful, yet broad sample of researchers with relevant subject matter knowledge was identified through searches of published articles and grant databases. The surveys addressed five implementation research areas in maternal health: (1) practices to prioritize for broader implementation, (2) practices to prioritize for de-implementation, (3) research questions about implementation determinants, (4) research questions about implementation strategies, and (5) research questions about methods/measures. Results Of 160 eligible researchers, 82 (51.2%) agreed to participate. Participants were predominantly female (90%) and White (75%). Sixty completed at least one of two surveys. The practices that participants prioritized for broader implementation were improved postpartum care, perinatal and postpartum mood disorder screening and management, and standardized management of hypertensive disorders of pregnancy. For de-implementation, practices believed to be most impactful if removed from or reduced in maternity care were cesarean delivery for low-risk patients and routine discontinuation of all psychiatric medications during pregnancy. The top methodological priorities of participants were improving the extent to which implementation science frameworks and measures address equity and developing approaches for involving patients in implementation research. Conclusions Through a web-based Delphi exercise, we identified implementation research priorities that researchers consider to have the greatest potential to improve the quality of maternity care in the USA. This study also demonstrates the feasibility of using modified Delphi approaches to engage researchers in setting implementation research priorities within a clinical area.

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Section: Introductionmentioning

confidence: 99%

Implementation research priorities for addressing the maternal health crisis in the USA: results from a modified Delphi study among researchers

Hamm

Moniz

Wahid

et al. 2023

Implement Sci Commun

Self Cite

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“…One study has reported that health professionals are supportive of an interdisciplinary midwifery group practice model of care for vulnerable women where disciplines provide specialty support with the benefits of a continuity of care model [ 29 ]. Furthermore, to ensure sustained success, implementation of a midwifery group practice for vulnerable women requires careful planning using the principles of implementation science [ 30 ]. Risk management assessment indicates the need to identify likely barriers and enablers.…”

Section: Introductionmentioning

confidence: 99%

“…Risk management assessment indicates the need to identify likely barriers and enablers. Effective processes and strategies used to implement a midwifery group practice for vulnerable women depend on full engagement of stakeholders and a clear picture of the health service context [ 30 , 31 ]. Not all stakeholders may be supportive and there may be less-visible aspects of the health service that may make sustained implementation of a midwifery group practice for vulnerable women difficult.…”

Section: Introductionmentioning

confidence: 99%

Implementation barriers and enablers of midwifery group practice for vulnerable women: a qualitative study in a tertiary urban Australian health service

Smith¹,

Kilgour

Rice

et al. 2022

BMC Health Serv Res

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Background Maternity services have limited formalised guidance on planning new services such as midwifery group practice for vulnerable women, for example women with a history of substance abuse (alcohol, tobacco and other drugs), mental health challenges, complex social issues or other vulnerability. Continuity of care through midwifery group practice is mostly restricted to women with low-risk pregnancies and is not universally available to vulnerable women, despite evidence supporting benefits of this model of care for all women. The perception that midwifery group practice for vulnerable women is a high-risk model of care lacking in evidence may have in the past, thwarted implementation planning studies that seek to improve care for these women. We therefore aimed to identify the barriers and enablers that might impact the implementation of a midwifery group practice for vulnerable women. Methods A qualitative context analysis using the Consolidated Framework for Implementation Research was conducted at a single-site tertiary health facility in Queensland, Australia. An interdisciplinary group of stakeholders from a purposeful sample of 31 people participated in semi-structured interviews. Data were analysed using manual and then Leximancer computer assisted methods. Themes were compared and mapped to the Framework. Results Themes identified were the woman’s experience, midwifery workforce capabilities, identifying “gold standard care”, the interdisciplinary team and costs. Potential enablers of implementation included perceptions that the model facilitates a relationship of trust with vulnerable women, that clinical benefit outweighs cost and universal stakeholder acceptance. Potential barriers were: potential isolation of the interdisciplinary team, costs and the potential for vicarious trauma for midwives. Conclusion There was recognition that the proposed model of care is supported by research and a view that clinical benefits will outweigh costs, however supervision and support is required for midwives to manage and limit vicarious trauma. An interdisciplinary team structure is also an essential component of the service design. Attention to these key themes, barriers and enablers will assist with identification of strategies to aid successful implementation. Australian maternity services can use our results to compare how the perceptions of local stakeholders might be similar or different to the results presented in this paper.

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“…Implementation science is increasingly gaining credence as a revolution in healthcare, partly because it is being recognised as the thing that-makes-the-thing happen, but also offers answers to why it (very often) does not happen. The result is a proliferation of applied studies, particularly in healthcare (124)(125)(126)(127), but also in education (128)(129)(130)(131).…”

Section: Implementation Practicementioning

confidence: 99%

A Framework for Implementing National Respiratory Guidelines in Wales

Jefferies

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Introduction: Implementation outcomes are necessary to experience clinical impact of interventions in the real world. Clear synergy exists between evidence-based clinical recommendations in clinical guidelines and the evidence-based process of implementing them, however less than a quarter of clinical guidelines are implemented using a framework. Methods: Critical review and analysis of the published literature provided the basis for developing framework constructs to facilitate the process of implementing national clinical guidelines in Wales. This is an observational assessment using mixed methods to assess the acceptability and adoption of novel national clinical guidelines in Wales. The framework is adapted in preparation for formal validation. Results: A conceptual framework for implementing clinical guidelines at scale was developed from the literature and findings from thematic analysis of potential guideline adopters in Wales. This was deemed relevant to wider strategies and was therefore applied to the implementation of novel asthma/COPD and COVID-19 guidelines. Applying the framework demonstrated widespread acceptance and adoption of the guidelines across all Health Boards in NHS Wales, however evidence of widespread adherence of the guidelines with fidelity remains unproven as this requires longitudinal observation of process and clinical outcome benefits relating to each guideline recommendations. Conclusions: The differentiation of contexts between the two case studies presented here highlights the difference in pace and urgency of implementation to optimise penetration of a guideline 23 implementation strategy across a target population in Wales. It addresses much of the ambiguity of definitions and joins common principles to create a framework that can be recommended for further testing with other clinical specialities and contexts outside of Wales. Whilst the COVID-19 pandemic introduced a major barrier to guideline adoption for asthma and COPD, it also presented a unique scenario that stimulated large-scale use of a novel COVID guideline. Whilst it was too soon to explore the correlation between implementation strategies, guideline adherence, and clinical outcomes – achieving acceptance and adoption of the guidelines lays the foundations for further exploration of social benefits on a national scale.

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Implementation Science is Imperative to the Optimization of Obstetric Care

Cited by 10 publications

References 56 publications

Implementation research priorities for addressing the maternal health crisis in the USA: results from a modified Delphi study among researchers

Implementation research priorities for addressing the maternal health crisis in the USA: results from a modified Delphi study among researchers

Implementation barriers and enablers of midwifery group practice for vulnerable women: a qualitative study in a tertiary urban Australian health service

A Framework for Implementing National Respiratory Guidelines in Wales

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