Building D&I Capacity Around the Globe: A Review of D&I Centers and Programs

Posted on May 7, 2021May 7, 2021 by coprhcon

BACKGROUND

Research programs focused on dissemination and implementation science (D&I) training, mentorship, and capacity building have proliferated in recent years. There has yet to be a comprehensive inventory of D&I initiatives cataloguing information about activities, infrastructure, and priorities. Further, there is a need to explore areas of overlap and redundancy across programs as well as opportunities for shared resources, collaboration, and growth. This study seeks to identify and describe existing D&I programs and build a compendium of strategies to boost discrete D&I capacity building efforts.

METHODS

Our systematic, multimethod search process to identify D&I programs includes two phases. Phase 1 involved: 1) a targeted review of CTSA programs and NIH Reporter awarded programs (e.g., NIMH P50 Centers) as well as expert recommendations of D&I programs; 2) systematic screening of program websites for D&I relevance; and 3) distribution of a D&I Capacity Building Survey (n=33) to PIs or administrators of identified programs to characterize infrastructure and activities using domains from the Brownson et al. D&I Capacity Building model. Phase 2 will include further program identification and qualitative data collection: 1) an advanced algorithmic Google search with D&I terms, 2) screening for relevance and saturation by independent reviewers, and 3) interviews to examine outcomes and impact domains from the D&I Capacity Building model.

RESULTS

The phase 1 search yielded 140 programs. We excluded 106 because they either did not have a D&I component or were duplicates. The final total from phase 1 included 33 D&I programs. 28 (85%) of the 33 identified are affiliated with a US institution and of these, 18 (55%) are embedded within a CTSA. Five programs (15%) are internationally based. 12 (36%) completed the D&I Capacity Building Survey. The majority surveyed reported having an academic affiliation (n=10, 83%) and offered several D&I capacity building activities including D&I Training and Education (n=9, 75%), Mentorship (n=9, 75%), Consultation (n=9, 75%), and Grant Development services (n=9, 75%). About half (n=7, 58%) reported provision of D&I Technical Assistance, Resources and Tools, and Professional Networking opportunities.

CONCLUSIONS

Programs identified offer a similar set of D&I training services, highlighting prioritized and feasible capacity-building activities. After phase 2, we will summarize program characteristics, highlight overlap, and propose priority areas to boost D&I capacity building endeavors. We will also recommend shared measures to evaluate success (e.g., number of outputs, revenue generated). To our knowledge, this is the first mixed-methods study to catalogue existing D&I programs and synthesize learnings across programs into a set of priorities and sustainment strategies to support D&I capacity building efforts domestically and globally.

A Pragmatic Stepped-Wedge Hybrid Effectiveness-Implementation Trial Evaluating Engagement and Collaborative Management to Proactively Advance Sepsis Survivorship (ENCOMPASS)

Posted on May 7, 2021May 18, 2021 by coprhcon

BACKGROUND

Sepsis survivors experience high morbidity and mortality, and healthcare systems lack effective strategies to address patient needs after hospital discharge. The Sepsis Transition and Recovery (STAR) program is a navigator-led, telehealth-based multicomponent strategy to provide proactive care coordination and monitoring of high-risk patients using evidence-driven, post-sepsis care tasks. The purpose of this study is to evaluate the effectiveness of STAR to improve outcomes for sepsis patients and to examine contextual factors that influence STAR implementation.

METHODS

This study uses a hybrid type I effectiveness-implementation design to concurrently test clinical effectiveness and gather implementation data. The effectiveness evaluation is a two-arm, pragmatic, stepped-wedge cluster randomized controlled trial at eight hospitals in North Carolina comparing clinical outcomes between sepsis survivors who receive Usual Care versus care delivered through STAR. Each hospital begins in a Usual Care control phase and transitions to STAR in a randomly assigned sequence (one every four months). During months that a hospital is allocated to Usual Care, all eligible patients will receive usual care. Once a hospital transitions to STAR, all eligible patients will receive STAR during their hospitalization and extending through 90 days from discharge. STAR includes centrally located nurse navigators using telephonic counseling and electronic health record-based support to facilitate best-practice post-sepsis care strategies including post-discharge review of medications, evaluation for new impairments or symptoms, monitoring existing comorbidities, and palliative care referral when appropriate. Adults admitted with suspected sepsis, defined by clinical criteria for infection and organ failure, are included. Planned enrollment is 4032 patients during a 36-month period; as of March 26, 999 (25%) patients have been enrolled, which is on target. The primary effectiveness outcome is the composite of all-cause hospital readmission or mortality within 90 days of discharge. We are conducting an implementation determinants evaluation conceptually guided by the Consolidated Framework for Implementation Research (CFIR) before, during, and after STAR implementation. To increase policy impact, we are also conducting a prospective economic evaluation to provide an understanding of the resource implications of the STAR program intervention on post-sepsis health benefits and costs.

Perspectives about Pharmacy Champions for Medication Safety for Veterans

Posted on May 7, 2021May 21, 2021 by coprhcon

BACKGROUND

The focus of the Department of Veteran Affairs’ (VA) Medication Safety QUERI Program is to reduce potentially unsafe or unnecessary medications for the Veterans. VA facilities (sites) use strategies to implement VA Pharmacy Benefits Management (PBM) Services initiatives and VISN (region) measures. The Medication Safety QUERI Program aimed to understand the role and use of champions in promoting select strategies to optimize medication safety for Veterans which included provider education, academic detailing, electronic reminders, patient specific care plan, draft orders, patient mailings and calling patients.

METHODS

In Summer 2018 we conducted semi-structured phone interviews with these pharmacists. Participants were asked “…is there is a “Champion” such as a VA provider, pharmacist, administrator, or someone else who is leading or promoting the efforts to implement these strategies at your facility?” and if yes, participants were asked to respond regarding the champion’s location at the facility, VISN or both levels. All interviews were recorded and then transcribed for coding and analysis. An open iterative process was used to create the codebook which was then applied by a trained qualitative coder who adjudicated content as needed.

RESULTS

Sixteen participants (44.4%) said they have champion(s) leading or promoting effective implementation strategies, while the remaining majority of participants (55.6%) said they do not have such a champion. Among those participants who reported having champion(s), the number of champions ranged from having one champion (n=8), two champions (n=3) to multiple champions (n=5). These champions were located at their own local level (n=11), at their own region(n=2) and both at their own local and own regional levels (n=3).

Participants identified qualities in a ‘champion’ as one who encourages strategy utilization, is willing to listen and have regular communications such as hosting monthly phone calls and VISN meetings, addresses potential barriers encountered by the providers, encourages provider education about best practices and assists with the development, implementation and on-going oversight of initiatives and measures at their facility.

These champions were described as “…he really is overseeing and helping us throughout the entire process” and “…has been more than willing to listen to our recommendations, provide feedback, kind of go out on a limb…to discuss these issues with a provider that may not be seeing eye-to-eye with us and recommend what can we do to resolve this issue and keep the patient safe and provide good care…”.