1,721,384 research outputs found
The contribution of implementation science to improving the design and evaluation of integrated care programmes for older people with frailty
Full text linkPurposeThe purpose of this paper is to discuss three potential contributions from implementation science that can help clinicians and researchers to design and evaluate more effective integrated care programmes for older people with frailty.Design/methodology/approachThis viewpoint paper focuses on three contributions: stakeholder engagement, using implementation science frameworks, and assessment of implementation strategies and outcomes.FindingsStakeholder engagement enhances the acceptability of interventions to recipients and providers and improves reach and sustainability. Implementation science frameworks assess provider, recipient and wider context factors enabling and hindering implementation, and guide selection and tailoring of appropriate implementation strategies. The assessment of implementation strategies and outcomes enables the evaluation of the effectiveness and implementation of integrated care programmes for this population.Research limitations/implicationsImplementation science provides a systematic way to think about why integrated care programmes for older people with frailty are not implemented successfully. The field has an evidence base, including how to tailor implementation science strategies to the local setting, and assess implementation outcomes to provide clinicians and researchers with an understanding of how their programme is working. The authors draw out implications for policy, practice and future research.Originality/valueDifferent models to deliver integrated care to support older people with frailty exist, but it is not known which is most effective, for which individuals and in which clinical or psychosocial circumstances. Implementation science can play a valuable role in designing and evaluating more effective integrated care programmes for this population
Perioperative medicine for Older People undergoing Surgery (POPS): A guide to designing, developing and embedding POPS services
No full textA prospective risk assessment of informal carers’ medication administration errors within the domiciliary setting
No full textIncreasingly, medication is being administered at home by family and friends of the care-recipient. This study aims to identify and analyse risks associated with potential drug administration errors made by informal carers at home. We mapped medication administration at home with a multidisciplinary team that included carers, healthcare professionals and patients. Evidence-based risk-analysis methodologies were applied: Healthcare Failure Modes and Effect Analysis (HFMEA), Systematic Human Error Reduction and Prediction Analysis (SHERPA) and Systems-Theoretic Accident Model and Processes (STAMP). The process of administration comprises seven sub-processes. Thirty-four possible failure modes were identified and six of these were rated as high risk. These highlighted that medications may be given with a wrong dose, stored incorrectly, not discontinued as instructed, not recorded, or not ordered on time, and often caused by communication and support problems. Combined risk analyses contributed unique information helpful to better understand the medication administration risks and causes within homecare
Linked symptom monitoring and depression treatment programmes for specialist cancer services: Protocol for a mixed-methods implementation study
No full textIntroduction: There is growing awareness that cancer services need to address patients’ well-being as well as treating their cancer. We developed systematic approaches to (1) monitoring patients’ symptoms including depression using a ‘Symptom Monitoring Service’ and (2) providing treatment for those with major depression using a programme called ‘Depression Care for People with Cancer’. Used together, these two programmes were found to be highly effective and cost-effective in clinical trials. The overall aims of this project are to: (1) study the process of introducing these programmes into routine clinical care in a large cancer service, (2) identify the challenges associated with implementation and how these are overcome, (3) determine their effectiveness in a routine non-research setting and (4) describe patients’ and clinicians’ experience of the programmes.Methods and analysis: This is a mixed-methods longitudinal implementation study. We will study the process of implementation in three phases (April 2016–December 2018): ‘Pre-implementation’ (setting up of the new programmes), ‘Early Implementation’ (implementation of the programmes in a small number of clinics) and ‘Implementation and Maintenance’ (implementation in the majority of clinics). We will use the following methods of data collection: (1) contemporaneous logs of the implementation process, (2) interviews with healthcare professionals and managers, (3) interviews with patients and (4) routinely collected clinical data.Ethics and dissemination: The study has been reviewed by a joint committee of Oxford University Hospitals National Health Service Foundation Trust Research and Development Department and the University of Oxford’s Clinical Trials and Research Governance Department and judged to be service evaluation, not requiring ethics committee approval. The findings of this study will guide the scaling up implementation of the programmes across the UK and will enable us to construct an implementation toolkit. We will disseminate our findings in publications and at relevant national and international conferences
Implementing collaborative care for major depression in a cancer center: an observational study using mixed-methods
Full text linkObjectives: To describe the implementation of a collaborative care (CC) screening and treatment program for major depression in people with cancer, found to be effective in clinical trials, into routine outpatient care of a cancer center.
Method: A mixed-methods observational study guided by the RE-AIM implementation framework using quantitative and qualitative data collected over five years.
Results: Program set-up took three years and required more involvement of CC experts than anticipated. Barriers to implementation were uncertainty about whether oncology or psychiatry owned the program and the hospital's organizational complexity. Selecting and training CC team members was a major task. 90% (14,412/16,074) of patients participated in depression screening and 61% (136/224) of those offered treatment attended at least one session. Depression outcomes were similar to trial benchmarks (61%; 78/127 patients had a treatment response). After two years the program obtained long-term funding. Facilitators of implementation were strong trial evidence, effective integration into cancer care and ongoing clinical and managerial support.
Conclusion: A CC program for major depression, designed for the cancer setting, can be successfully implemented into routine care, but requires time, persistence and involvement of CC experts. Once operating it can be an effective and valued component of medical care
Establishing a Perioperative medicine for Older People undergoing Surgery (POPS) service for general surgical patients at a district general hospital
No full textIntroduction There is growing recognition of the need for perioperative medicine services for older surgical patients. Comprehensive geriatric assessment and optimisation methodology has been successfully used to improve perioperative outcomes at tertiary centres. This paper describes translation of an established model of geriatrician-led perioperative care to a district general hospital (DGH) setting.Methods A mixed methods quality improvement programme was used and included stakeholder co-design, identification of core components, definition of mechanisms for change, and measurement of impact through qualitative and quantitative approaches.Results Within 18 months, a substantive perioperative service for older people was established at a DGH, funded by the surgical directorate. Key outcomes included reduction in length of stay and 30-day readmission and positive staff and patient experience.Discussion This study is in keeping with improvement science literature demonstrating the importance of a mixed-methods approach in translating an evidenced-based intervention into another setting, maintaining fidelity and replicating results
SC15 ‘let me take care of you’: utilising simulation to bridge the gap between dining and healthcare, generating a wider discussion on what care should feel like
No full textBackground:
Simulation in healthcare is mainly associated with clinical training and assessment needs. However, its uses can be much broader than is currently practiced. Recent applications have seen it be used for quality improvement projects, public and patient engagement and outreach, evaluation of new interventions, identification of latent safety threats, and the development of new models of care to name but a few. This short communication will present an unorthodox use of simulation that builds on this current trend and reveals its potential as more than just for training and assessment practices.
Summary of project:
This Arts and Humanities Research Council funded project aimed to observe instances of care in both clinical and dining settings through direct observations and field notes. Although these disciplines seem worlds apart at first glance, both require an element of anticipation. Whether it is waiting for premium food or an operation, both require the experience to be as good as the outcome. Collaborations were built between Heston Blumenthal’s three-Michelin star Fat Duck restaurant and a National Health Service (NHS) Trust. The principles of care identified at each site were abstracted and are to be re-presented to members of the public across the country through the medium of simulation. The simulations are designed to be immersive in nature and focus on a restaurant front-of-house and a day surgery unit. Real waiting staff and clinicians will undertake their roles incorporating the identified principles of care. Members of the public will be invited to be a patient and a diner in each simulation before participating in a wider discussion on the experience of care and if there is any transferrable learning between the settings.
Summary of results:
The initial observations revealed similarities in terms of expectation setting, however, differences were noted in terms of the visibility of the patient/diner. The simulation events are set to take place in June 2018 in London, Worcester, and Glasgow. Results from the discussions will be available in time for the conference.
Conclusions:
Simulation as a tool can be used to enable us to think differently about what care is and how we deliver it. This project has presented a unique way of capturing clinical care and working with different yet complimentary domains to present current approaches and generate wider discussions with members of the public
Expanding healthcare failure mode and effect analysis: A composite proactive risk analysis approach
Full text linkHealthcare Failure Mode and Effect Analysis (HFMEA) is a systematic risk assessment method derived from high risk industries to prospectively examine complex healthcare processes. Like most methods, HFMEA has strengths and weaknesses. In this paper we provide a review of HFMEA's limitations and we introduce an expanded version of traditional HFMEA, with the addition of two safety management techniques: Systematic Human Error Reduction and Prediction Analysis (SHERPA) and Systems-Theoretic Accident Model and Processes – Systems-Theoretic Process Analysis (STAMP-STPA). The combination of the three methodologies addresses significant HFMEA limitations. To test the viability of the proposed hybrid technique, we applied it to assess the potential failures in the process of administration of medication in the home setting. Our findings suggest that it is both a viable and effective tool to supplement the analysis of failures and their causes. We also found that the hybrid technique was effective in identifying corrective actions to address human errors and detecting failures of the constraints necessary to maintain safety
An evaluation of Colorectal Cancer multidisciplinary team meetings
Full text linkThe management of Colorectal Cancer has evolved, and in many parts of the world is provided by multidisciplinary teams (MDTs). In the UK all patients with colorectal cancer have their management discussed at MDTs. This thesis presents a series of mixed method studies aimed at developing and utilising methods to evaluate and assess the functioning of Colorectal Cancer MDTs.
The introduction presents an overview Colorectal Cancer and the role of MDTs. Chapter 2 presents a systematic review and meta-analysis of studies on Colorectal Cancer MDTs. Chapter 3 explores the views of core members of Colorectal Cancer MDTs on potential assessment tools. Chapter 4 concludes this section with an analysis of the costs involved with these teams.
In Chapter 5 I describe the development and validation of an observational tool for evaluation of Colorectal Cancer MDTs, followed by an evaluation of the relationships between decision making within the team and the various aspects of the tool described in Chapter 6. Chapter 7 presents the feasibility of reliably using this tool for video based assessments of Colorectal Cancer MDTs.
I conclude this thesis with a general discussion – focussing on relevant findings, clinical implications of my work and directions for future research.Open Acces
Case management for integrated care of frail older people in community settings
Full text linkThis is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness of case management for integrated care of frail older people compared to usual care
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