Abstract:Objective: To identify strategies associated with sustained guideline adherence and high-quality pediatric asthma care in community hospitals. Data sources: Primary qualitative data from clinicians in hospitals across the United States (collected December 2019-February 2021).Study design: Pathways for Improving Pediatric Asthma Care (PIPA) was a national quality improvement (QI) intervention. In a prior quantitative study, data from 23 community hospitals in PIPA were analyzed to identify sites with the highes… Show more
“…In total, 25 studies (reported in 27 papers due to 2 companion reports) met the final inclusion criteria for the review (Fig. 1 ) [ 51 – 77 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…The 25 included studies reported on 16 health disciplines. Most studies focused on the adult population ( n = 16) [ 51 , 55 – 57 , 59 , 61 , 62 , 64 , 66 – 71 , 73 , 74 ], while fewer had a pediatric focus ( n = 8) [ 53 , 58 , 60 , 63 , 65 , 72 , 75 , 77 ], and one reported on the neonatal intensive care unit [ 76 ]. Thirteen of the included studies took place in acute care [ 55 , 57 , 60 – 62 , 66 , 68 , 69 , 71 , 73 , 75 – 77 ], 11 in tertiary care [ 51 , 53 , 56 , 58 , 59 , 63 – 65 , 70 , 72 , 74 ], and 1 in ambulatory care [ 67 ].…”
Section: Resultsmentioning
confidence: 99%
“…Most studies focused on the adult population ( n = 16) [ 51 , 55 – 57 , 59 , 61 , 62 , 64 , 66 – 71 , 73 , 74 ], while fewer had a pediatric focus ( n = 8) [ 53 , 58 , 60 , 63 , 65 , 72 , 75 , 77 ], and one reported on the neonatal intensive care unit [ 76 ]. Thirteen of the included studies took place in acute care [ 55 , 57 , 60 – 62 , 66 , 68 , 69 , 71 , 73 , 75 – 77 ], 11 in tertiary care [ 51 , 53 , 56 , 58 , 59 , 63 – 65 , 70 , 72 , 74 ], and 1 in ambulatory care [ 67 ]. Fifty-two percent ( n = 13) [ 53 , 56 – 58 , 61 – 63 , 65 , 67 , 71 , 75 – 77 ] of the included studies were published in the USA, with the remaining ( n = 12) published in Australia ( n = 2) [ 68 , 74 ], Canada ( n = 2) [ 60 , 69 ], Italy ( n = 2) [ 66 , 72 ], Sweden ( n = 2) [ 59 , 73 ], Spain ( n = 1) [ 70 ]...…”
Section: Resultsmentioning
confidence: 99%
“…Thirteen of the included studies took place in acute care [ 55 , 57 , 60 – 62 , 66 , 68 , 69 , 71 , 73 , 75 – 77 ], 11 in tertiary care [ 51 , 53 , 56 , 58 , 59 , 63 – 65 , 70 , 72 , 74 ], and 1 in ambulatory care [ 67 ]. Fifty-two percent ( n = 13) [ 53 , 56 – 58 , 61 – 63 , 65 , 67 , 71 , 75 – 77 ] of the included studies were published in the USA, with the remaining ( n = 12) published in Australia ( n = 2) [ 68 , 74 ], Canada ( n = 2) [ 60 , 69 ], Italy ( n = 2) [ 66 , 72 ], Sweden ( n = 2) [ 59 , 73 ], Spain ( n = 1) [ 70 ], United Kingdom ( n = 1) [ 64 ], Netherland ( n = 1) [ 51 ], and Northern Ireland ( n = 1) [ 55 ]. Mixed method research was the most common study design ( n = 8) [ 51 , 57 – 59 , 67 , 71 , 74 , 75 ].…”
Background
Knowledge translation (KT) strategies are widely used to facilitate the implementation of EBIs into healthcare practices. However, it is unknown what and how KT strategies are used to facilitate the sustainability of EBIs in institutional healthcare settings.
Objectives
This scoping review aimed to consolidate the current evidence on (i) what and how KT strategies are being used for the sustainability of EBIs in institutional healthcare settings; (ii) the reported KT strategy outcomes (e.g., acceptability) for EBI sustainability, and (iii) the reported EBI sustainability outcomes (e.g., EBI activities or component of the intervention continue).
Methods
We conducted a scoping review of five electronic databases. We included studies describing the use of specific KT strategies to facilitate the sustainability of EBIs (more than 1-year post-implementation). We coded KT strategies using the clustered ERIC taxonomy and AIMD framework, we coded KT strategy outcomes using Tierney et al.’s measures, and EBI sustainability outcomes using Scheirer and Dearing’s and Lennox’s taxonomy. We conducted descriptive numerical summaries and a narrative synthesis to analyze the results.
Results
The search identified 3776 studies for review. Following the screening, 25 studies (reported in 27 papers due to two companion reports) met the final inclusion criteria. Most studies used multi-component KT strategies for EBI sustainability (n = 24). The most common ERIC KT strategy clusters were to train and educate stakeholders (n = 38) and develop stakeholder interrelationships (n = 34). Education was the most widely used KT strategy (n = 17). Many studies (n = 11) did not clearly report whether they used different or the same KT strategies between EBI implementation and sustainability. Seven studies adapted KT strategies from implementation to sustainability efforts. Only two studies reported using a new KT strategy for EBI sustainability. The most reported KT strategy outcomes were acceptability (n = 10), sustainability (n = 5); and adoption (n = 4). The most commonly measured EBI sustainability outcome was the continuation of EBI activities or components (n = 23), followed by continued benefits for patients, staff, and stakeholders (n = 22).
Conclusions
Our review provides insight into a conceptual problem where initial EBI implementation and sustainability are considered as two discrete time periods. Our findings show we need to consider EBI implementation and sustainability as a continuum and design and select KT strategies with this in mind. Our review has emphasized areas that require further research (e.g., KT strategy adaptation for EBI sustainability). To advance understanding of how to employ KT strategies for EBI sustainability, we recommend clearly reporting the dose, frequency, adaptations, fidelity, and cost of KT strategies. Advancing our understanding in this area would facilitate better design, selection, tailored, and adapted use of KT strategies for EBI sustainability, thereby contributing to improved patient, provider, and health system outcomes.
“…In total, 25 studies (reported in 27 papers due to 2 companion reports) met the final inclusion criteria for the review (Fig. 1 ) [ 51 – 77 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…The 25 included studies reported on 16 health disciplines. Most studies focused on the adult population ( n = 16) [ 51 , 55 – 57 , 59 , 61 , 62 , 64 , 66 – 71 , 73 , 74 ], while fewer had a pediatric focus ( n = 8) [ 53 , 58 , 60 , 63 , 65 , 72 , 75 , 77 ], and one reported on the neonatal intensive care unit [ 76 ]. Thirteen of the included studies took place in acute care [ 55 , 57 , 60 – 62 , 66 , 68 , 69 , 71 , 73 , 75 – 77 ], 11 in tertiary care [ 51 , 53 , 56 , 58 , 59 , 63 – 65 , 70 , 72 , 74 ], and 1 in ambulatory care [ 67 ].…”
Section: Resultsmentioning
confidence: 99%
“…Most studies focused on the adult population ( n = 16) [ 51 , 55 – 57 , 59 , 61 , 62 , 64 , 66 – 71 , 73 , 74 ], while fewer had a pediatric focus ( n = 8) [ 53 , 58 , 60 , 63 , 65 , 72 , 75 , 77 ], and one reported on the neonatal intensive care unit [ 76 ]. Thirteen of the included studies took place in acute care [ 55 , 57 , 60 – 62 , 66 , 68 , 69 , 71 , 73 , 75 – 77 ], 11 in tertiary care [ 51 , 53 , 56 , 58 , 59 , 63 – 65 , 70 , 72 , 74 ], and 1 in ambulatory care [ 67 ]. Fifty-two percent ( n = 13) [ 53 , 56 – 58 , 61 – 63 , 65 , 67 , 71 , 75 – 77 ] of the included studies were published in the USA, with the remaining ( n = 12) published in Australia ( n = 2) [ 68 , 74 ], Canada ( n = 2) [ 60 , 69 ], Italy ( n = 2) [ 66 , 72 ], Sweden ( n = 2) [ 59 , 73 ], Spain ( n = 1) [ 70 ]...…”
Section: Resultsmentioning
confidence: 99%
“…Thirteen of the included studies took place in acute care [ 55 , 57 , 60 – 62 , 66 , 68 , 69 , 71 , 73 , 75 – 77 ], 11 in tertiary care [ 51 , 53 , 56 , 58 , 59 , 63 – 65 , 70 , 72 , 74 ], and 1 in ambulatory care [ 67 ]. Fifty-two percent ( n = 13) [ 53 , 56 – 58 , 61 – 63 , 65 , 67 , 71 , 75 – 77 ] of the included studies were published in the USA, with the remaining ( n = 12) published in Australia ( n = 2) [ 68 , 74 ], Canada ( n = 2) [ 60 , 69 ], Italy ( n = 2) [ 66 , 72 ], Sweden ( n = 2) [ 59 , 73 ], Spain ( n = 1) [ 70 ], United Kingdom ( n = 1) [ 64 ], Netherland ( n = 1) [ 51 ], and Northern Ireland ( n = 1) [ 55 ]. Mixed method research was the most common study design ( n = 8) [ 51 , 57 – 59 , 67 , 71 , 74 , 75 ].…”
Background
Knowledge translation (KT) strategies are widely used to facilitate the implementation of EBIs into healthcare practices. However, it is unknown what and how KT strategies are used to facilitate the sustainability of EBIs in institutional healthcare settings.
Objectives
This scoping review aimed to consolidate the current evidence on (i) what and how KT strategies are being used for the sustainability of EBIs in institutional healthcare settings; (ii) the reported KT strategy outcomes (e.g., acceptability) for EBI sustainability, and (iii) the reported EBI sustainability outcomes (e.g., EBI activities or component of the intervention continue).
Methods
We conducted a scoping review of five electronic databases. We included studies describing the use of specific KT strategies to facilitate the sustainability of EBIs (more than 1-year post-implementation). We coded KT strategies using the clustered ERIC taxonomy and AIMD framework, we coded KT strategy outcomes using Tierney et al.’s measures, and EBI sustainability outcomes using Scheirer and Dearing’s and Lennox’s taxonomy. We conducted descriptive numerical summaries and a narrative synthesis to analyze the results.
Results
The search identified 3776 studies for review. Following the screening, 25 studies (reported in 27 papers due to two companion reports) met the final inclusion criteria. Most studies used multi-component KT strategies for EBI sustainability (n = 24). The most common ERIC KT strategy clusters were to train and educate stakeholders (n = 38) and develop stakeholder interrelationships (n = 34). Education was the most widely used KT strategy (n = 17). Many studies (n = 11) did not clearly report whether they used different or the same KT strategies between EBI implementation and sustainability. Seven studies adapted KT strategies from implementation to sustainability efforts. Only two studies reported using a new KT strategy for EBI sustainability. The most reported KT strategy outcomes were acceptability (n = 10), sustainability (n = 5); and adoption (n = 4). The most commonly measured EBI sustainability outcome was the continuation of EBI activities or components (n = 23), followed by continued benefits for patients, staff, and stakeholders (n = 22).
Conclusions
Our review provides insight into a conceptual problem where initial EBI implementation and sustainability are considered as two discrete time periods. Our findings show we need to consider EBI implementation and sustainability as a continuum and design and select KT strategies with this in mind. Our review has emphasized areas that require further research (e.g., KT strategy adaptation for EBI sustainability). To advance understanding of how to employ KT strategies for EBI sustainability, we recommend clearly reporting the dose, frequency, adaptations, fidelity, and cost of KT strategies. Advancing our understanding in this area would facilitate better design, selection, tailored, and adapted use of KT strategies for EBI sustainability, thereby contributing to improved patient, provider, and health system outcomes.
“…EMR) can help your organization meet its goals, and developing a plan to collect and reassess data going forward [43,44]. Sustainability of these interventions can pose a challenge, but may rely on creating accountability for roles/responsibilities, the availability of champions advocating use of the intervention and having adequate support/resources at the organizational level [45 ▪▪ ].…”
Section: Challenges With Practical Implementationmentioning
Purpose of reviewThis is a summative review of recent trends and novel programming integrated into various clinical settings (i.e. emergency departments, urgent care centres and paediatric clinics) to enhance the quality of care received by paediatric asthma patients Asthma is the most common chronic disease in paediatric patients and despite recognized national management guidelines, implementation and aftercare, especially in the emergency room, remain challenging.Recent findingsOutcome-based systematic quality improvement initiatives are described as well as evidence-based recommendations to enhance the education of providers, patients and caregivers.SummaryMany of the care initiatives described in the literature have been integrated into the emergency room. The authors feel some of these process improvements, such as pathway-based care, reducing time to delivery of medications, and personalized asthma education, may also be applicable and add value to clinical practice in additional community-based acute care settings such as urgent care centers and paediatric clinics.
BackgroundResearch into low‐value routine testing at children's hospitals has not consistently evaluated changing patterns of testing over time.ObjectivesTo identify changes in routine laboratory testing rates at children's hospitals over ten years and the association with patient outcomes.Design, Settings, and ParticipantsWe performed a multi‐center, retrospective cohort study of children aged 0–18 hospitalized with common, lower‐severity diagnoses at 28 children's hospitals in the Pediatric Health Information Systems database.Main Outcomes and MeasuresWe calculated average annual testing rates for complete blood counts, electrolytes, and inflammatory markers between 2010 and 2019 for each hospital. A > 2% average testing rate change per year was defined as clinically meaningful and used to separate hospitals into groups: increasing, decreasing, and unchanged testing rates. Groups were compared for differences in length of stay, cost, and 30‐day readmission or ED revisit, adjusted for demographics and case mix index.ResultsOur study included 576,572 encounters for common, low‐severity diagnoses. Individual hospital testing rates in each year of the study varied from 0.3 to 1.4 tests per patient day. The average yearly change in hospital‐specific testing rates ranged from ‐6% to +7%. Four hospitals remained in the lowest quartile of testing and two in the highest quartile throughout all ten years of the study. We grouped hospitals with increasing (8), decreasing (n = 5), and unchanged (n = 15) testing rates. No difference was found across subgroups in costs, length of stay, 30‐day ED revisit, or readmission rates. Comparing resource utilization trends over time provides important insights into achievable rates of testing reduction.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
