Congratulations to Janet Squires. Janet has been selected to receive one of two CIHR Institute of Health Services and Policy Research Rising Star Awards!!
This award recognizes the potential impact and contribution of Janet’s recent article To what extent do nurses use research in clinical practice. A systematic review on health services and policy research. Way to go Janet!!!
New Article by KUSP team members FIRE (Facilitating Implementation of Research Evidence): a study protocol
Seers K, Cox K, Crichton NJ, Edwards RT, Eldh AC, Estabrooks CA, et al.
Implementation science : IS 2012 Mar 27;7(1):25
BACKGROUND: Research evidence underpins best practice, but is not always used in healthcare. The Promoting Action on Research Implementation in Health Services (PARIHS) framework suggests that the nature of evidence, the context in which it is used, and whether those trying to use evidence are helped (or facilitated) affect the use of evidence. Urinary incontinence has a major effect on quality of life of older people, has a high prevalence, and is a key priority within European health and social care policy. Improving continence care has the potential to improve the quality of life for older people and reduce the costs associated with providing incontinence aids. Objectives This study aims to advance understanding about the contribution facilitation can make to implementing research findings into practice via: extending current knowledge of facilitation as a process for translating research evidence into practice; evaluating the feasibility, effectiveness, and cost-effectiveness of two different models of facilitation in promoting the uptake of research evidence on continence management; assessing the impact of contextual factors on the processes and outcomes of implementation; and implementing a pro-active knowledge transfer and dissemination strategy to diffuse study findings to a wide policy and practice community. Setting and sample Four European countries, each with six long-term nursing care sites (total 24 sites) for people aged 60 years and over with documented urinary incontinence Methods and design Pragmatic randomised controlled trial with three arms (standard dissemination and two different programmes of facilitation), with embedded process and economic evaluation. The primary outcome is compliance with the continence recommendations. Secondary outcomes include proportion of residents with incontinence, incidence of incontinence-related dermatitis, urinary tract infections, and quality of life. Outcomes are assessed at baseline, then at 6, 12, 18, and 24 months after the start of the facilitation interventions. Detailed contextual and process data are collected throughout, using interviews with staff, residents and next of kin, observations, assessment of context using the Alberta Context Tool, and documentary evidence. A realistic evaluation framework is used to develop explanatory theory about what works for whom in what circumstances. Trial registration Current Controlled Trials ISRCTN11598502.
New Article by Lars Wallin and Anne Marie Böstrom Capability Beliefs Regarding Evidence-Based Practice are Associated with Application of EBP and Research Use: Validation of a New Measure.
Wallin L, Bostrom AM, Gustavsson JP.
Worldviews on evidence-based nursing / Sigma Theta Tau International, Honor Society of Nursing 2012 Mar 27
Beliefs about capabilities, or self-efficacy, is a construct originating in social cognitive psychology. Capability beliefs have been found to be positively associated with intention and healthcare practice behaviour. A measure of an individual’s beliefs about his/her capability to apply the components of evidence-based practice (EBP) has potential to be useful in implementation research. Aims: To evaluate the concurrent validity and internal structure of a new scale measuring nurses’ capability beliefs regarding EBP. Methods: Data were taken from a prospective longitudinal study in Sweden (the Longitudinal Analyses of Nursing Education and Entry in Worklife [LANE]). A cohort of nursing students who graduated in the autumn of 2004 that was followed up 2 years after their graduation was used (n= 1,256). Concurrent validity was tested relating different levels of capability beliefs to extent of research use and application of EBP. An item-response approach was applied in the evaluation of internal structure of the proposed scale (six items). Results: The psychometric analyses indicated that the six items could be summed to reflect a one-dimensional scale. Nurses with the highest level of capability beliefs reported that they used research findings in clinical practice more than twice as often as those with lower levels of capability beliefs. They also participated in the implementation of evidence seven times more often. Implications: There is a need for further studies of the construct and predictive validity of the scale. It should also be validated in other groups of health professionals. Learning including mastery experiences, role modelling, social persuasion, and manageable stress could be used in undergraduate education as well as practice development to increase beliefs about capabilities which might open the way to increased application of EBP in healthcare practice. Conclusions: This new measure is well grounded in social cognitive theory, functions as a one-dimensional scale and possesses promising properties of concurrent validity. ©2012 Sigma Theta Tau International.
Call for abstracts Health Research Transfer Network of Alberta
Banff, AB October 10-12, 2012 Deadline: Tuesday, May 15, 2012
Abstracts on projects or research on any aspect of knowledge translation are welcome. Abstracts will undergo a peer-review process, with members of the Conference Planning Committee serving on the review committee. Authors of abstracts selected for presentation will be contacted via email by Monday, June 5 and invited to present either a poster or oral presentation at the Conference. All selected abstracts will be published in an abstract booklet which will be provided to delegates at the Conference.
Grants & Awards
CIHR: Science Policy Fellowships
Deadline: June 4, 2012
This program provides highly qualified candidates at the doctoral, post-doctoral, new investigator and mid-senior investigator stages of health research with the opportunity to learn more about current health policy activities and the science/policy interface.
CIHR Team Grant: China-Canada initiative on Alzheimer’s Disease and Related Disorders
Deadline June 21, 2012
The Team Grant: China-Canada initiative on Alzheimer’s Disease and Related Disorders funding opportunity is jointly managed and funded by the CIHR and the National Natural Science Foundation of China (NSFC). Within CIHR, the joint program is part of the International Collaborative Research Strategy for Alzheimer’s Disease (ICRSAD) The scientific agenda for ICRSAD focuses on the early events in ARD including risk factor identification, early diagnosis, early intervention, and prevention. Funding will be provided for applications that are determined to be relevant to the following research areas: 1) Models; 2) Biomarkers and Brain Imaging; 3) Genetics/Epigenetics; 4) Drug Development; 5) Vascular Dementia, and 6) Clinical Studies. For Canadian researchers, the maximum amount per project is CAD $250,000 per year for up to four years. For Chinese researchers, the amount available per project is 3 million RMB for up to four years.
Healthcare Renewal Policy Analysis grants depend on meaningful partnerships between researchers and senior-level policy makers who work directly within the health sector in federal, provincial or territorial government departments, regional health authorities, or LHINs as well as those who work in other sectors (e.g., education, social services, industry) that develop policy with population-level health impacts.
CIHR Catalyst Grant: Health Services and Systems for an Aging Population
Registration deadline June 15, 2012
This funding opportunity provides seed funding, on a short term basis, to:
- support innovative ideas and projects aligned with the goals, objectives and principles of the Institute of Aging (IA)’s Health Services and Systems for an Aging Population (HSSAP) initiative;
- support original, high quality projects which have the potential to generate high impact results and/or innovative research proposals, research tools, techniques, or methodologies;
- encourage researchers from other fields to consider research questions related to Health Services and Systems for an Aging Population.
CIHR Planning Grants
Application deadline June 15, 2012
The Planning Grants – Aging opportunity will provide funding for applications that address research priority areas that are consistent with the mandate of the Institute, that will stimulate planning activities and/or partnership development, and exchange, and that are relevant to the research priority areas described in the funding opportunity. The Planning Grants – Health Services and Systems for an Aging Population opportunity will provide funding for applications that will stimulate research planning activities and/or research partnership development and that are relevant to Health Services and Systems for an Aging Population. The maximum amount awarded for a single Planning Grant is $25,000 for eligible non-recurring meetings and events, for up to one year.
Depression and anxiety screening after stroke: adherence to guidelines and future directions.
Morris R, Jones J, Wilcox J, Cole S.
Disability and rehabilitation 2012;34(9):733-739
Purpose: This article examines practical approaches to increasing rates of screening for depression and anxiety in hospital-based stroke services. Method: The literature on depression and anxiety following stroke is briefly reviewed together with evidence relating to screening. A small-scale trial of an educational and support package to improve screening rates compared 30 consecutive admissions before and after the intervention. An extended commentary on the outcome considered alternative approaches to improving screening. Results: The literature review confirmed that depression after stroke has multiple adverse effects and that screening is not universally applied. There has been less research into anxiety after stroke, but it is likely that anxiety screening is also incomplete. The trial of the intervention to promote screening demonstrated strong trends towards improvement for depression (23.3%; odds ratio 2.67; χ(2) p = 0.067) and a trend for anxiety (16.7%; odds ratio 1.96; χ(2) p = 0.20). Conclusions: Education and training about depression and anxiety screening and access to screening materials improved rates of screening to a limited degree. An extended commentary explored how screening rates might be further improved by considering the intervention strategy, the staffing model, the training approach and the screening methods themselves. Finally, consideration is given to treatment approaches for mood disorders.
Clinical nurse specialists shaping policies and procedures via an evidence-based clinical practice council.
Becker E, Dee V, Gawlinski A, Kirkpatrick T, Lawanson-Nichols M, Lee B, et al.
Clinical nurse specialist CNS 2012 Mar-Apr;26(2):74-86
In the practice of nursing, organizations with progressive evidence-based practice programs implement structures and processes whereby nurses are engaged in the review of existing research and in the development of clinical practice documents to better align nursing practices with the best available scientific knowledge. At our academic hospital system, clinical nurse specialists (CNSs) took the lead to help transform a traditional nursing policy and procedure committee into a hospital-wide, staff-represented Clinical Practice Council (CPC) that ensures evidence-based nursing practices are reflected in the organization’s nursing practice documents for the provision of patient care. Clinical nurse specialists function as mentors and cochairs who are dedicated to ensuring that nursing practice is supported by the latest evidence and committed to guiding staff nurses to continually move their practice forward. The success of the CPC is due to the leadership and commitment of the CNSs. This article describes the structure, process, and outcomes of an effective CPC where CNSs successfully engage frontline clinicians in promoting nursing care that is evidence based. Clinical nurse specialist leadership is increasingly made visible as CNSs effectively involve staff nurses in practice reforms to improve patient outcomes.
Evidence-based practice for staff nurses.
Grant M, Hanson J, Johnson S, Idell C, Rutledge DN.
Journal of continuing education in nursing 2012 Mar;43(3):117-124
BACKGROUND: Barriers to the involvement of staff nurses in evidence-based practice include time commitments, staffing challenges, and limited experience in identifying evidence. METHODS: A 1-day, hands-on course focused on small, achievable, evidence-based practice projects; follow-up after the course by a project director; and commitment to implementation of participants’ projects by management. Faculty included a librarian who helped with computer searches and a quality assurance representative to facilitate availability of institutional data for project evaluation. RESULTS: Nine courses held over a 3-year period involved 79 home institution nurses and 76 community nurses. Course evaluations were overwhelmingly positive. Completed projects were displayed on participants’ units and circulated throughout the institution. The courses are continuing as part of the regular annual nursing education calendar. CONCLUSION: Streamlined approaches to teaching evidence-based practice can be used to involve staff nurses and raise awareness of evidence-based practice across nursing. Key positive findings include achievable projects, provisions for follow-up, and management support. Copyright 2012, SLACK Incorporated.
Translating Research Into Practice: The Role of Provider-based Research Networks in the Diffusion of an Evidence-based Colon Cancer Treatment Innovation.
Carpenter WR, Meyer AM, Wu Y, Qaqish B, Sanoff HK, Goldberg RM, et al.
Medical care 2012 Mar 20
Provider-based research networks (PBRNs)-collaborative research partnerships between academic centers and community-based practitioners-are a promising model for accelerating the translation of research into practice; however, empirical evidence of accelerated translation is limited. Oxaliplatin in adjuvant combination chemotherapy is an innovation with clinical trial-proven survival benefit compared with prior therapies. The goal of this study is to examine the diffusion of oxaliplatin into community practice, and whether affiliation with the National Cancer Institute’s (NCI’s) Community Clinical Oncology Program (CCOP)-a nationwide cancer-focused PBRN-is associated with accelerated innovation adoption. DESIGN, SETTING, AND PARTICIPANTS: This retrospective observational study used linked Surveillance, Epidemiology, and End Results-Medicare and NCI CCOP data to examine Medicare participants with stage III colon cancer initiating treatment in 2003 through 2006, the years surrounding oxaliplatin’s Food and Drug Administration approval. A fixed-effects analysis examined chemotherapy use among patients treated outside academic centers at CCOP-affiliated practices compared with non-CCOP practices. Two-group modeling controlled for multiple levels of clustering, year of chemotherapy initiation, tumor characteristics, patient age, race, comorbidity, Medicaid dual-eligibility status, and education. RESULTS: Of 4055 community patients, 35% received 5-fluoruracil, 20% received oxaliplatin, 7% received another chemotherapy, and 38% received no chemotherapy. Twenty-five percent of CCOP patients received oxaliplatin, compared with 19% of non-CCOP patients. In multivariable analysis, CCOP exposure was associated with higher odds of receiving guideline-concordant treatment in general, and oxaliplatin specifically. CONCLUSIONS: These findings contribute to a growing set of evidence linking PBRNs with a greater probability of receiving treatment innovations and high-quality cancer care, with implications for clinical and research policy.
Research, evidence and policymaking: the perspectives of policy actors on improving uptake of evidence in health policy development and implementation in Uganda.
Orem JN, Mafigiri DK, Marchal B, Ssengooba F, Macq J, Criel B.
BMC public health 2012 Feb 9;12:109
Use of evidence in health policymaking plays an important role, especially in resource-constrained settings where informed decisions on resource allocation are paramount. Several knowledge translation (KT) models have been developed, but few have been applied to health policymaking in low income countries. If KT models are expected to explain evidence uptake and implementation, or lack of it, they must be contextualized and take into account the specificity of low income countries for example, the strong influence of donors. The main objective of this research is to elaborate a Middle Range Theory (MRT) of KT in Uganda that can also serve as a reference for other low- and middle income countries. METHODS: This two-step study employed qualitative approaches to examine the principal barriers and facilitating factors to KT. Step 1 involved a literature review and identification of common themes. The results informed the development of the initial MRT, which details the facilitating factors and barriers to KT at the different stages of research and policy development. In Step 2, these were further refined through key informant interviews with policymakers and researchers in Uganda. Deductive content and thematic analysis was carried out to assess the degree of convergence with the elements of the initial MRT and to identify other emerging issues. RESULTS: Review of the literature revealed that the most common emerging facilitating factors could be grouped under institutional strengthening for KT, research characteristics, dissemination, partnerships and political context. The analysis of interviews, however, showed that policymakers and researchers ranked institutional strengthening for KT, research characteristics and partnerships as the most important. New factors emphasized by respondents were the use of mainstreamed structures within MoH to coordinate and disseminate research, the separation of roles between researchers and policymakers, and the role of the community and civil society in KT. CONCLUSIONS: This study refined an initial MRT on KT in policymaking in the health sector in Uganda that was based on a literature review. It provides a framework that can be used in empirical research of the process of KT on specific policy issues.
The Guideline Implementability Research and Application Network (GIRAnet): an international collaborative to support knowledge exchange: study protocol
Gagliardi AR, Brouwers MC, Bhattacharyya OK.
Implementation science : IS 2012 Apr 2;7(1):26
Modifying the format and content of guidelines may facilitate their use and lead to improved quality of care. We reviewed the medical literature to identify features desired by different users and associated with guideline use to develop a framework of implementability and found that most guidelines do not contain these elements. Further research is needed to develop and evaluate implementability tools. METHODS: We are launching the Guideline Implementability Research and Application Network (GIRAnet) to enable the development and testing of implementability tools in three domains: Resource Implications, Implementation, and Evaluation. Partners include the Guidelines International Network (G-I-N) and its member guideline developers, implementers, and researchers. In phase one, international guidelines will be examined to identify and describe exemplar tools. Indication-specific and generic tools will populate a searchable repository. In phase two, qualitative analysis of cognitive interviews will be used to understand how developers can best integrate implementability tools in guidelines and how health professionals use them for interpreting and applying guidelines. In phase three, a small-scale pilot test will assess the impact of implementability tools based on quantitative analysis of chart-based behavioural outcomes and qualitative analysis of interviews with participants. The findings will be used to plan a more comprehensive future evaluation of implementability tools. DISCUSSION: Infrastructure funding to establish GIRAnet will be leveraged with the in-kind contributions of collaborating national and international guideline developers to advance our knowledge of implementation practice and science. Needs assessment and evaluation of GIRAnet will provide a greater understanding of how to develop and sustain such knowledge-exchange networks. Ultimately, by facilitating use of guidelines, this research may lead to improved delivery and outcomes of patient care.
The challenge of dementia care knowledge exchange: Key factors in a national approach
Parke B, Woo TKW, Cruttenden KE, Sapergia S, D’Hondt A.
We report a dementia knowledge-to-practice exchange activity to describe the process undertaken to improve care and support for older adults living with dementia. We describe the team’s early development and decision-making process (including its early focus on family physicians), and eventual creation of a Dementia Pocket Card tool. The tool can support health professionals and families with dementia case-finding, assessment, diagnosis and appropriate service provision. © The Author(s) 2012.
Planning for implementation of evidence-based practice.
Cullen L, Adams SL.
The Journal of nursing administration 2012 Apr;42(4):222-230
Expectations for evidence-based healthcare are growing, yet the most difficult step in the process, implementation, is often left to busy nursing leaders who may be unprepared for the challenge. Selecting from the long list of implementation strategies and knowing when to apply them are a bit of an “art,” matching clinician needs and organizational context. This article describes an application-oriented resource that nursing leaders can use to plan evidence-based practice implementation in complex healthcare systems.
Towards a sociology of knowledge translation: the importance of being dis-interested in knowledge translation.
Kitto SC, Sargeant J, Reeves S, Silver I.
Advances in health sciences education : theory and practice 2012 May;17(2):289-299
Over the last 15 years there has been an increasingly energetic search for theories and definitions in the burgeoning area of knowledge translation (KT) in the health care context. The focus has been on the design and evaluation of KT activities with little attention to developing a considered KT theoretical/methodological approach that takes a more distanced critical inquiry to the studying of KT interventions. As such, what has been overlooked in the health professions KT literature to date is a suitably complex conceptualisation of translation that encompasses the multiplicity of KT interventions, the dynamic environments in which they are occurring, and the production of new knowledge which arises from their interactions. Attending to these epistemological issues; i.e. issues of the type of knowledge and how it is produced, is crucial to developing a relational understanding of the production and emergence of context-specific clinical knowledge and practice in KT processes. Such an approach is compared to the traditional KT evaluations by KT practitioners themselves of the compliance or non-compliance of individual and organisational behaviour change. A Sociology of KT (SKT) is proposed to complement the applied and evaluative research practice of implementing planned action KT activities. The purpose of a SKT basic research agenda is to understand both the context-specific nature of KT interventions and the epistemological premises of the activities of KT implementers themselves, in order to advance the science of KT and inform, complement and add to the success of applied and evaluative KT research in the future.
Health Care Administration & Organization
NHSRU: Leading Practices and Programs for Developing Leadership Among Health Professionals at the Point of Care
Doran D, Koh M, Dick A, Hayes L, VanWiechen C, Yim O
The Nursing Health Services Research Unit at the University of Toronto reviewed both nurse‐specific evidence and evidence from other professions as well as models of leadership development initiatives at the point of care. This research is intended to support policy development and planning to improve Ontario’s health system. The objectives of this study were to:
- Conduct a comprehensive literature review of currently or recently implemented health professional leadership development initiatives around the world
- Identify relevant leading practices and programs, or innovations of new nursing and allied health roles or models, with demonstrated evidence of quality work environment or quality patient care outcomes at the point of care
- Engage with key informants knowledgeable about front‐line health professional leadership development initiatives for further research evidence
- Analyze literature and consultations with key informants, to derive major themes throughout leadership initiatives with evidence of successful outcomes. Barriers and facilitators to building leadership capacity were also examined.
- Formulate conclusions and recommendations that will provide evidence to support policy development and leadership opportunities for frontline nurses
- Develop a chart of the leading frameworks, programs and practices for developing health professionals as leaders, with further details and key contacts for follow‐up
Health Care Innovation & Quality Assurance
Methods to assess the validity of the interRAI Acute Care: a framework to guide clinimetric testing.
Wellens NI, Milisen K, Flamaing J, Moons P.
Journal of evaluation in clinical practice 2012 Apr;18(2):296-306
The objective was to present an overview of methods to examine the validity of the minimum data set of the interRAI Acute Care (interRAI AC). Because of the multidimensional character of this comprehensive geriatric assessment tool, clinimetric testing of the interRAI AC can be more complex than that of one-dimensional instruments. Thus to facilitate testing of the interRAI AC, we translated this complexity into a structured methodological framework that outlines procedures to assess various lines of evidence. Our framework combined traditional clinimetric techniques and the standards of psychological testing. For each line of evidence, examples of hypotheses and research questions were summarized. Future clinimetric testing can use these guidelines as a basis to obtain and provide a wide and diverse body of evidence. © 2010 Blackwell Publishing Ltd.
Linking nurse characteristics, team member effectiveness, practice environment, and medication error incidence.
Fasolino T, Snyder R.
Journal of nursing care quality 2012 Apr-Jun;27(2):E9-16
Clinical unit nurse characteristics, practice environment, and team member effectiveness are assumed to play a critical role in medication safety. This study used a multimethod approach to examine the association of these factors with medication errors. Findings suggested that older, more experienced registered nurses made less medication errors. Environment and team member effectiveness were not strongly associated with medication error incidence. Numerous system factors limited implementation and outcomes of this safety study and are discussed.
Users’ views of hospital environmental quality: Validation of the Perceived Hospital Environment Quality Indicators (PHEQIs)
Andrade C, Lima ML, Fornara F, Bonaiuto M.
Journal of Environmental Psychology 2012;32(2):97-111
Environmental Quality Perception (EQP) is an important construct used to help to understand the relationship between people and the hospital environment. From a patient-centered care perspective, it is important that hospital design take into account the patients’ (and other users’) point of view. This paper presents the adaptation and validation of a measure of hospital EQP, the Perceived Hospital Environment Quality Indicators (PHEQIs; . Fornara, Bonaiuto, & Bonnes, 2006), and seeks to confirm the factor structure of this construct in a different cultural context. Three scales, two focusing on physical environments and one evaluating the social environment, were completed by 562 users of four orthopedic units in Portuguese hospitals, two older and two recently built or renovated. To assess criterion validity, hospital physical environments were also objectively evaluated by two architects. Using a confirmatory factor analysis the three validation procedures produced acceptable fit indices in the final measurement models. Overall reliability values were satisfactory, as was the evidence for criterion validity. PHEQIs scales and factors correlated with global evaluation of the environment, supporting concurrent criterion validity; and predictive criterion validity was demonstrated given that users of older and newer hospitals differed significantly on the perception of quality of hospital EQP, and that high congruence between users’ and experts’ evaluations was found. Discriminant construct validity was supported, and some difficulties in showing convergent validity are discussed in terms of item formulation adequacy. Implications for research and practice are described. © 2011 Elsevier Ltd.
Uncovering middle managers’ role in healthcare innovation implementation.
Birken SA, Lee SY, Weiner BJ.
Implementation science : IS 2012 Apr 3;7(1):28
Middle managers have received little attention in extant health services research, yet they may have a key role in healthcare innovation implementation. The gap between evidence of effective care and practice may be attributed in part to poor healthcare innovation implementation. Investigating middle managers’ role in healthcare innovation implementation may reveal an opportunity for improvement. In this paper, we present a theory of middle managers’ role in healthcare innovation implementation to fill the gap in the literature and to stimulate research that empirically examines middle managers’ influence on innovation implementation in healthcare organizations. DISCUSSION: Extant healthcare innovation implementation research has primarily focused on the roles of physicians and top managers. Largely overlooked is the role of middle managers. We suggest that middle managers influence healthcare innovation implementation by diffusing information, synthesizing information, mediating between strategy and day-to-day activities, and selling innovation implementation. SUMMARY: Teamwork designs have become popular in healthcare organizations. Because middle managers oversee these team initiatives, their potential to influence innovation implementation has grown. Future research should investigate middle managers’ role in healthcare innovation implementation. Findings may aid top managers in leveraging middle managers’ influence to improve the effectiveness of healthcare innovation implementation.
Producing Synergy in Collaborations: A Successful Hospital Innovation
Research Centre for Health Promotion, University of Bergen
Innovation J;2012 17(1)
Patient malnutrition in hospitals is common and impedes recovery. Part of the problem is that hospitals are organised around diagnosis and treatment, not for good nutrition. This paper describes a Norwegian hospital’s nutrition innovation that enhanced collaboration across and within the hospital hierarchy. The Bergen Model of Collaborative Functioning was the analysis framework for the study reported here. Success factors included having a clear mission, a sound implementation plan, leader commitment, trust and coordination, committed partners, clear structure, rules and roles, face-to-face communication, celebrating accomplishments underway, and utilising the surrounding context to give the innovation visibility and publicity.
National Evaluation of the Department of Health’s Integrated Care Pilots
RAND Europe, March 2012
This report evaluates 16 autonomous Integrated Care Pilot projects (ICPs) that aimed to generate local improvements in care and wellbeing. The projects included projects looking at: structured care for dementia, falls reduction, CVD, diabetes, end of life care, and COPD.
The temporal trajectories of innovative search: Insights from public hospital services
Research Policy 2012;41(4):720-733
I wasn’t sure what this article was about. Innovative search means dedication to innovation.
This article explores the temporal trajectories of innovative search. Drawing on conceptual ideas from the behavioural theory of the firm, it proposes that the level of temporal persistence in organisations’ innovative search activities is affected by four key factors. These include (i) the mode of innovative search as well as organisations’ (ii) strategic aspirations, (iii) slack resources and (iv) performance feedback. This conceptual model is tested in the context of public hospital services in England. Results from dynamic panel data analyses reveal stronger temporal persistence in science- than in practice-based innovative search activities. Findings also suggest that specialist hospitals relying on a continuous stream of new products, services and processes to meet their strategic aspirations are better positioned to sustain science-based innovative search activities than their generalist counterparts. Similarly, results uncover a positive association between the availability of financial slack and hospitals’ ability to continuously engage in superior levels of science-based innovative search. Contrary to theoretical expectations, however, positive performance feedback does not appear to have any persistence-enhancing effect.
The associations between organizational culture and knowledge, attitudes, and practices in a multicenter Veterans Affairs quality improvement initiative to prevent methicillin-resistant Staphylococcus aureus.
Sinkowitz-Cochran RL, Burkitt KH, Cuerdon T, Harrison C, Gao S, Obrosky DS, et al.
American Journal of Infection Control 2012 Mar;40(2):138-143
BACKGROUND: Previous research demonstrates that organizational culture (OC) and knowledge, attitudes, and practices of health care personnel are associated with the overall success of infection control programs; however, little attention has been given to the relationships among these factors in contributing to the success of quality improvement programs. METHODS: Cross-sectional surveys assessing OC and knowledge, attitudes, and practices related to methicillin-resistant Staphylococcus aureus (MRSA) were distributed to 16 medical centers participating in a Veterans Affairs MRSA prevention initiative in 2 time periods. Factor analysis was performed on the OC survey responses, and factor scores were generated. To assess associations between OC and knowledge, attitudes, and practices of health care personnel, regression analyses were performed overall and then stratified by job type. RESULTS: The final analyzable sample included 2,314 surveys (43% completed by nurses, 9% by physicians, and 48% by other health care personnel). Three OC factors emerged accounting for 53% of the total variance: “Staff Engagement,” “Overwhelmed/Stress-Chaos,” and “Hospital Leadership.” Overall, higher Staff Engagement was associated with greater knowledge scores, better hand hygiene practices, fewer reported barriers, and more positive attitudes. Higher Hospital Leadership scores were associated with better hand hygiene practices, fewer reported barriers, and more positive attitudes. Conversely, higher Overwhelmed/Stress-Chaos scores were associated with poorer reported prevention practices, more barriers, and less positive attitudes. When these associations were stratified by job type, there were significant associations between OC factors and knowledge for nurses only, between OC factors and practice items for nurses and other health care personnel, and between OC factors and the barriers and attitudes items for all job types. OC factors were not associated with knowledge and practices among physicians. CONCLUSIONS: Three OC factors-Staff Engagement, Overwhelmed/Stress-Chaos, and Hospital Leadership-were found to be significantly associated with individual health care personnel knowledge, attitudes, and self-reported practices regarding MRSA prevention. When developing a prevention intervention program, health care organizations should not only focus on the link between OC and the knowledge, attitudes, and practices of health care personnel, but also target programs based on health care personnel type to maximize their effectiveness. Published by Mosby, Inc.
Using a theory-driven conceptual framework in qualitative health research.
Macfarlane A, O’Reilly-de Brun M.
Qualitative health research 2012 May;22(5):607-618
The role and merits of highly inductive research designs in qualitative health research are well established, and there has been a powerful proliferation of grounded theory method in the field. However, tight qualitative research designs informed by social theory can be useful to sensitize researchers to concepts and processes that they might not necessarily identify through inductive processes. In this article, we provide a reflexive account of our experience of using a theory-driven conceptual framework, the Normalization Process Model, in a qualitative evaluation of general practitioners’ uptake of a free, pilot, language interpreting service in the Republic of Ireland. We reflect on our decisions about whether or not to use the Model, and describe our actual use of it to inform research questions, sampling, coding, and data analysis. We conclude with reflections on the added value that the Model and tight design brought to our research.
Finding pure and simple truths with administrative data.
Sarrazin MS, Rosenthal GE.
JAMA : the journal of the American Medical Association 2012 Apr 4;307(13):1433-1435.
Administrative data have been used to assess quality of care and variations in health care delivery for nearly 3 decades. Indeed, administrative data have provided important insights on racial disparities in care, geographic differences in utilization, and variations in outcomes across hospitals. In the absence of national clinical registries, administrative data will continue to be an important source of information about health care delivery in the United States because of their ready availability, low cost, and ability to span multiple years and health care settings. Moreover, in contrast to data from randomized controlled trials, administrative data reflect real-world treatment settings and unselected populations. However, users must be aware of the inherent limitations of administrative data to avoid erroneous conclusions.
Identifying trustworthy experts: how do policymakers find and assess public health researchers worth consulting or collaborating with?
Haynes AS, Derrick GE, Redman S, Hall WD, Gillespie JA, Chapman S, et al.
PloS one 2012;7(3):e32665
This paper reports data from semi-structured interviews on how 26 Australian civil servants, ministers and ministerial advisors find and evaluate researchers with whom they wish to consult or collaborate. Policymakers valued researchers who had credibility across the three attributes seen as contributing to trustworthiness: competence (an exemplary academic reputation complemented by pragmatism, understanding of government processes, and effective collaboration and communication skills); integrity (independence, “authenticity”, and faithful reporting of research); and benevolence (commitment to the policy reform agenda). The emphases given to these assessment criteria appeared to be shaped in part by policymakers’ roles and the type and phase of policy development in which they were engaged. Policymakers are encouraged to reassess their methods for engaging researchers and to maximise information flow and support in these relationships. Researchers who wish to influence policy are advised to develop relationships across the policy community, but also to engage in other complementary strategies for promoting research-informed policy, including the strategic use of mass media.
Twenty-five years of Australian nursing and allied health professional journals: bibliometric analysis from 1985 through 2010
Wiles L, Olds T, Williams M.
The generation of research involves producers (study authors and funders), products (studies and arising publications) and consumption (measured through readership and citation). Bibliometric analyses of research producers, products and consumption over time can be used to describe the evolution of health professions as captured in professional journal publications. Numerous bibliometric studies have been conducted however few have sampled nursing and allied health professional journals. This is despite a growing health workforce and socioeconomic pressures. The aim of this study was to use bibliometric analyses to track change in the producers, products and consumption of seven Australian nursing and allied health professional journals from 1985 through 2010. An analysis of all original research articles published in these journals was performed using a reliable bibliometric audit tool. Articles were sampled every 3 months and at 5 year intervals over a 25 year period. Information relating to authorship, the research methods used and citation patterns was collected. Data were analysed descriptively. Over the study period, all journals shifted towards publishing research that used higher study designs, reported more quantitative data, and were authored by larger research teams. The rate at which this transition occurred (greater evidence base, quantitation and collaboration) differed among the journals sampled. The changes seen in the research published in these journals are likely to be a function of the strategic purpose of each publication (to its professional readership) as well as reflect wider socioeconomic phenomena. Therefore these trends are likely to continue in the future. © 2012 Akadémiai Kiadó, Budapest, Hungary.
Early evaluations of the medical home: building on a promising start.
Peikes D, Zutshi A, Genevro JL, Parchman ML, Meyers DS.
The American Journal of Managed Care 2012 Feb;18(2):105-116
Objectives: To systematically review the current evidence on the patient-centered medical home (PCMH, or medical home), which aims to reinvigorate primary care and achieve the triple aim of better quality, improved experience, and lower costs. Study Design: Systematic review of quantitative evidence on the PCMH. Methods: Out of 498 studies published or disseminated from January 2000 to September 2010 on US-based interventions, 14 evaluations of 12 interventions met our inclusion criteria: (1) tested a practice-level intervention with 3 or more of 5 key PCMH components and (2) conducted a quantitative study of one of the triple aim outcomes or of healthcare professional experience. We synthesized findings on interventions that were evaluated using rigorous methods. We also provide guidance to structure future evaluations to maximize learning. Results: The interventions most often cited to support the medical home can be viewed as precursors to the medical home. Evaluations of 6 of these interventions provided rigorous evidence on 1 or more outcomes. This evidence indicates some favorable effects on all 3 triple aim outcomes, a few unfavorable effects on costs, and many inconclusive results. Conclusions: Although the PCMH is a promising innovation, rigorous quantitative evaluations and comprehensive implementation analyses are needed to assess effectiveness and refi ne the model to meet stakeholders’ needs. Findings from future evaluations will help guide the substantial efforts practices and payers invest to adopt the PCMH with the goal of achieving the triple aim outcomes.
Managing pain to prevent aggression in people with dementia: a nonpharmacologic intervention.
Bradford A, Shrestha S, Snow AL, Stanley MA, Wilson N, Hersch G, et al.
American Journal of Alzheimer’s Disease and Other Dementias 2012 Feb;27(1):41-47
Aggression is a common form of behavioral disturbance in dementia. Strategies to prevent and treat aggressive behavior are underdeveloped. However, recent work points to several modifiable risk factors that may be targets for intervention. Pain management is an evidence-based, feasible, but potentially underused, strategy that may be incorporated with other behavioral interventions to prevent aggression. In this article, we review areas of overlap in interventions for pain and for behavioral disturbances and describe an intervention concept that may hold promise for older adults with dementia who are at risk of developing aggressive behavior.
EQUATOR Scientific Symposium 2012
11-12 October 2012, Freiburg, Germany
The symposium is aimed at health research scientists and clinicians, journal editors and peer reviewers, reporting guideline developers, publishers, research funders and other professionals involved in research education, research governance and the publication of medical research.
The ScHARR systematic reviews course: Practical skills for undertaking reviews
16-18 July 2012, Sheffield, UK
The aim of this three day course is to provide participants with an introduction to methods
for conducting systematic reviews in health care. Sessions will be delivered by ScHARR staff experienced in systematic review methods.
Evidence Synthesis of Qualitative Research in Europe (ESQUIRE)
4-6 September 2012, Sheffield, UK
The course will follow the systematic review process as it applies, and is adapted to, qualitative evidence syntheses. The Programme Faculty will take participants through the stages of defining and exploring scope, conducting the literature searches, quality assessing studies for inclusion, synthesising data and writing up and presenting the product of the synthesis. Participants will be provided with practical experience of key stages in the review process. The course will conclude on the 8th September with Issues and Challenges for Qualitative Research in Evidence Synthesis (InCQuiRES) a one-day methodological update providing an excellent overview of current developments in qualitative evidence synthesis.
Issues & Challenges for Qualitative Research in Evidence Synthesis (InCQuiRES)
6 September 2012, Sheffield, UK
This methodological update will rehearse the major issues and challenges for the main steps of the systematic review process as it applies, and is adapted to, qualitative evidence syntheses. It will be delivered by the co-convenors of the Cochrane Collaboration’s Qualitative Methods Group
Health Research Methods 2012
University of Calgary, Calgary, AB, Wed May 2-Fri May 4, 2012
Target Audience: Healthcare professionals who want to know more about research
- To learn about new innovations of research and development
- To develop collaborations leading to meaningful research and evaluation
These are a series of workshops on qualitative and quantitative research.
Joanna Briggs Institute Comprehensive Systematic Review Training Workshop
July 9-13, 2012, Queen’s University, Kingston, ON. Cost: $1500/person, includes workshop materials, breaks, lunches and refreshments
This comprehensive, 5-day program is designed to prepare health sciences researchers, clinicians, librarians, graduate students and other individuals involved in quality and practice portfolios, to develop, conduct and report systematic review of evidence. The theme illustrating the methodology is patient safety.
Successful participants will be certified to author JBI systematic reviews. Attendance of the entire workshop is required.
KT Canada: KT Basics Course
July 5-6, 2012 Toronto, ON Course fee: $600/person
This two day course will focus on specific objectives and will include a mixture of didactic and interactive learning and lead to the completion of a project proposal. The course will use the Knowledge to Action Cycle as a framework.
How will I benefit from this course?
This course will provide you with the understanding and tools to increase the impact of your knowledge translation (KT) activities.
The purpose of this course is to:
- Learn the basics of putting knowledge into action
- Apply the basics of knowledge translation to a project relevant to your own setting
- Build capacity in the practice of knowledge translation
Skills support (methodology, evaluation, needs assessments etc) will be available to participants as they complete their project plans. Facilitators include Sharon Straus, Director of the KT Program, and Onil Bhattacharyya, Clinical Scientist, of the Li Ka Shing Knowledge Institute, St Michael’s Hospital.
KT Canada: Introduction to Systematic Review and Meta-Analysis
Starts September 10, 2012. Deadline for registration August 31, 2012 Cost $600 per person
This is an introductory course on systematic reviews and meta-analyses and will be delivered online. It is co-taught by Sharon Straus (MD, MSc) and Andrea Tricco (MSc, PhD). The overall course objective is to teach about systematic reviews in general, as well as how to go about doing a systematic review.
CHNET-Works!: Critical Appraisal Skills Programme’s (CASP) Suite of Critical Appraisal Tools
Thursday May 24, 2012 9:30-11:00 (MT) 11:30-13:00 (ET)
Not all published literature is scientifically sound. Only some is valid, sound and useful. The correlate of this is that some research is unreliable and untrustworthy. Do you know how to tell the difference? How can you decide if the evidence you find is good enough and what the results actually mean? The answer is: by critically appraising the research evidence.
What is critical appraisal?
“The process of carefully and systematically examining research to judge its trustworthiness, value and relevance in a particular context” (from Amanda Burls, today’s advisor on tap).
Are there tools or checklists that can help?
The Critical Appraisal Skills Programme’s (CASP) developed tools with checklists specifically designed to appraise:
• Systematic reviews
• Randomized controlled trials (RCTs)
• Qualitative research
• Economic evaluation studies
• Cohort studies
• Case control studies
• Diagnostic test studies
All critical appraisal tools consist of three sections to assess internal validity, results and relevance to practice.
CIHR Funding Opportunity Announcement: Programmatic Grants in Food and Health – Webinar
Wednesday, April 18, 2012 11:00 – 12:30
The CIHR Institute of Nutrition, Metabolism and Diabetes (INMD) is announcing the launch of the CIHR Programmatic Grants in Food and Health funding opportunity. This initiative is launched in partnership with CIHR Institute of Population and Public Health, and the CIHR/Rx&D Collaborative Research Program as well as Health Canada (Bureau of Nutritional Sciences, Office of Nutrition Policy and Promotion, and First Nations and Inuit Health Branch); Public Health Agency of Canada; Agriculture and Agri-Food Canada; the Centrum Foundation the Centrum Foundation of Pfizer Consumer Healthcare; AllerGen NCE Inc. and The Micronutrient Initiative.
According to a report from the Standing Senate Committee on Social Affairs, Science and Technology. The report presents the committee’s findings regarding progress towards the implementation of the 10-Year Plan and the Communiqué on Improving Aboriginal Health and identifies further actions that could be taken in support of the objectives outlined in these documents. It reflects the testimony presented by witnesses over the course of 13 hearings and one roundtable discussion, as well as many written submissions received from interested organizations and individuals.
UofA RSO: New Over Expenditure Procedures
In response to the growing volume of over expended research projects, two new procedures – Research – Over Expenditure (Authorized) and Research – Over Expenditure (Unauthorized) – have been developed, which will become effective June 1, 2012.
The health accord of 2004 prompted hospitals to whittle down backlogs in five areas, including cataract surgery and diagnostic MRI scans. But these may not have been the right priorities. Greater access to primary care might have been a better choice.
In a move likely to alter treatment standards in hospitals and doctors’ offices nationwide, a group of nine medical specialty boards plans to recommend on Wednesday that doctors perform 45 common tests and procedures less often, and to urge patients to question these services if they are offered. Eight other specialty boards are preparing to follow suit with additional lists of procedures their members should perform far less often.
As part of our commitment to reproducible research and transparency, BioMed Central has partnered with LabArchives to work together for the shared goal of making datasets supporting peer-reviewed publications available and permanently linked to online publications – and available under terms which permit reuse freely, as Open Data.
The budget announces a $15 million ongoing increase to CIHR’s base budget, in support of the Strategy for Patient-Oriented Research (SPOR). It also announces $12 million per year in ongoing funding to make the Business-Led NCEs program permanent, which represents an exciting opportunity for striking new partnerships with the private sector. The budget announced total reductions for CIHR of $15M in the 2012/13 fiscal year and $30M thereafter, which correspond to 1.5% of our total budget in year one and to 3% of our total budget in year two. However, these measures explicitly spare critical programs such as the open operating grants program. In fact, the budget firmly stated that CIHR’s programming in support of basic research, student scholarships and industry-related research initiatives and collaborations has been maintained. In protecting CIHR’s grants and awards budget, the Government of Canada has signaled that these are core functions of CIHR and will remain so. As set out in the budget, CIHR will also be working to deliver savings of 5% and 10% in our operating budget over the next two years. At the same time, we are fully committed to pursuing reforms to the peer review system and open operating grants program.
Collaborative for Excellence in Healthcare Quality is pleased to announce the completion and release of the Guide to Developing and Assessing a Quality Plan that resulted from this project. The Guide was developed through a consultative process that incorporated valuable insights from all member organizations over many months. It is targeted primarily at Boards, Senior Management Teams and Quality and Patient Safety Departments of regional health authorities, health regions and hospitals, however, the guidance it provides can be applied to other types of health provider organizations that are developing Quality Plans. The Guide also strives to be adaptable and relevant to organizations of different size, complexity and which may be at different stages of evolution in their quality planning.