Implementation Science

Implementation Science research guides the implementation of evidence-based interventions across a range of healthcare settings.

Early Noninvasive Cardiac Testing After Emergency Department Evaluation For Suspected Acute Coronary Syndrome

Benjamin Sun, MD
Oct. 5, 2020

Aniket A. Kawatkar, Adam L. Sharp, Aileen S. Baecker, Shaw Natsui, Rita F. Redberg, Ming-Sum Lee, Maros Ferencik, Yi-Lin Wu, Ernest Shen, Chengyi Zheng, Visanee V. Musigdilok, Michael K. Gould, Steve Goodacre, Praveen Thokala , Benjamin C. Sun

Abstract [from journal]

Importance: Professional guidelines recommend noninvasive cardiac testing (NIT) within 72 hours of an emergency department (ED) evaluation for suspected acute coronary syndrome. However, there is inexact evidence that this strategy reduces the risk of future death or acute myocardial infarction (MI).

Objective: To evaluate the effectiveness of early NIT in reducing the risk of death or acute MI within 30 days.

Design, setting, and participants: This retrospective,

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Heart Transplant Waiting List Implications of Increased Ventricular Assist Device Use as a Bridge Strategy: A National Analysis

Oct. 1, 2020

Jason J. Han, Hadi Elzayn, Matthew M. Duda, Amit Iyengar, Andrew M. Acker, William L. Patrick, Mark Helmers, Edo Y. Birati, Pavan Atluri

Abstract [from journal]

Background: The use of ventricular assist devices (VAD) as a bridge to heart transplant (HT) is increasing, while HT volume remains stagnant. This may portend longer waiting times and an otherwise more competitive environment for all patients on the HT waiting list.

Methods: A retrospective analysis of patients who were listed for HT in the United Network for Organ Sharing (UNOS) database from 2000 to 2015 was conducted. Mean waiting time, proportion of HT reception (%HT), proportion of death

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Inside The Black Box Of Improving On Nursing Home Quality Measures

Sep. 28, 2020

Heather Davila, Tetyana P. Shippee, Young Shin Park, Daniel Brauner, Rachel M. Werner, R. Tamara Konetzka

Abstract [from journal]

Nursing Home Compare (NHC) reports quality measures (QMs) for nursing homes (NHs) as part of its 5-star rating system. Most of the QMs are based on facility self-reported data, prompting questions about their validity. To better understand how NHs interact with the QMs, we used qualitative methods, including semistructured interviews with NH personnel (n = 110), NH provider association representatives (n = 23), and observations of organizational processes in 12 NHs in three states. We found that most NHs are working to improve the

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Predicting Implementation: Comparing Validated Measures Of Intention And Assessing The Role Of Motivation When Designing Behavioral Interventions

Sep. 28, 2020

Jessica Fishman, Viktor Lushin, David S. Mandell

Abstract [from journal]

Background: Behavioral intention (which captures one's level of motivation to perform a behavior) is considered a causal and proximal mechanism influencing the use of evidence-based practice (EBP). Implementation studies have measured intention differently, and it is unclear which is most predictive. Some use items referring to "evidence-based practice" in general, whereas others refer to a specific EBP. There are also unresolved debates about whether item stems should be worded "I intend to," "I will," or "How

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The Promise Of Direct-To-Consumer COVID-19 Testing: Ethical And Regulatory Issues

Louiza Kalokairinou
Sep. 23, 2020

Louiza Kalokairinou, Patricia J Zettler, Ashwini Nagappan, Moira A KywelukAnna Wexler

Abstract [from journal]

Widespread diagnostic and serological (antibody) testing is one key to mitigating the COVID-19 pandemic. While at first, the majority of COVID-19 diagnostic testing in the USA took place in healthcare settings, quickly a direct-to-consumer (DTC) testing market also emerged. In these DTC provision models, the test is initiated by a consumer and the sample collection occurs at home or in a commercial laboratory. Although the provision of DTC tests has potential benefits—such as...

Differences In Transitional Care Processes Among High-Performing And Low-Performing Hospital-SNF Pairs: A Rapid Ethnographic Approach

Sep. 21, 2020

Kirstin A. Manges, Roman Ayele, Chelsea Leonard, Marcie Lee, Emily Galenbeck, Robert E. Burke

Abstract [from journal]

Background: Despite the increased focus on improving patient's postacute care outcomes, best practices for reducing readmissions from skilled nursing facilities (SNFs) are unclear. The objective of this study was to observe processes used to prepare patients for postacute care in SNFs, and to explore differences between hospital-SNF pairs with high or low 30-day readmission rates.

Design: We used a rapid ethnographic approach with intensive multiday observations and key informant interviews at

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Implementing Couple's Human Immunodeficiency Virus Testing And Counseling In The Antenatal Care Setting

Florence Marie Momplaisir, MD, MSHP, FACP
Aug. 6, 2020

Florence Momplaisir, Emily Finley, Sandra Wolf, Erika Aaron, Itoro Inoyo, David Bennett, Sara Seyedroudbari, Allison Groves

Abstract [from journal]

Objective: To describe a pilot implementation of couple's human immunodeficiency virus (HIV) testing and counseling in an antenatal care clinic in the United States.

Methods: We used a cross-sectional study design. Couples were recruited from an antenatal care clinic of a large, urban, tertiary medical center, and were eligible if both partners agreed to receive HIV test results together and reported no coercion to participate in testing and counseling and no intimate partner violence. We

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Public Insurance Expansions And Mental Health Care Availability

Aug. 1, 2020

Elson Oshman Blunt, Johanna Catherine Maclean, Ioana Popovici, Steven C. Marcus

Abstract [from journal]

Objective: To provide new evidence on the effects of large-scale public health insurance expansions, associated with the Affordable Care Act (ACA), on the availability of specialty mental health care treatment in the United States. We measure availability with the probability that a provider accepts Medicaid.

Data source/study setting: The National Mental Health Services Survey (N-MHSS) 2010-2018.

Study design: A quasi-experimental differences-in-differences design

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Institutional Review Board Quality, Private Equity, And Promoting Ethical Human Subjects Research

Holly Fernandez Lynch 160
Jul. 21, 2020

Holly Fernandez Lynch, Stephen Rosenfeld

Abstract [from journal]

Evaluating the quality and effectiveness of the institutional review boards (IRBs) responsible for overseeing research involving human participants is critically important but perpetually challenging. Seemingly common-sense measures, such as the number of proposals approved with and without major modifications and the number of unexpected adverse events occurring in approved protocols, can be misleading indicators of participant protection, and regulatory compliance may not correspond to achieving ethical goals. These measurement

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Cold Debriefings After In-hospital Cardiac Arrest In An International Pediatric Resuscitation Quality Improvement Collaborative

Heather Wolfe, MD
Jul. 8, 2020

Heather A. Wolfe, Jesse Wenger, Robert Sutton, Roopa Seshadri, Dana E. Niles, Vinay Nadkarni, Jordan Duval-Arnould, Anita I. Sen, Adam Cheng

Abstract [from journal]

Introduction: Clinical event debriefing functions to identify optimal and suboptimal performance to improve future performance. "Cold" debriefing (CD), or debriefing performed more than 1 day after an event, was reported to improve patient survival in a single institution. We sought to describe the frequency and content of CD across multiple pediatric centers.

Methods: Mixed-methods, a retrospective review of prospectively collected in-hospital cardiac arrest (IHCA) data, and a supplemental

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Variation In Tonsillectomy Cost And Revisit Rates: Analysis Of Administrative And Billing Data From US Children's Hospitals

Ron Keren, MD, MPH
Jun. 30, 2020

Sanjay Mahant, Troy Richardson, Ron Keren, Rajendu Srivastava, Jeremy Meier, Pediatric Research in Inpatient Setting (PRIS) Network

Abstract [from journal]

Background: Tonsillectomy is one of the most common and cumulatively expensive surgical procedures in children. We determined if substantial variation in resource use, as measured by standardised costs, exists across hospitals for performing tonsillectomy and if higher resource use is associated with better quality of care, as measured by revisits to hospital.

Methods: We conducted a retrospective analysis of children undergoing routine outpatient tonsillectomy between 2011 to 2017 across US

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Ethical And Regulatory Issues For Embedded Pragmatic Trials Involving People Living With Dementia

Jun. 26, 2020

Emily A. Largent, Spencer Phillips Hey, Kristin Harkins, Allison K. HoffmanSteven Joffe, Julie C. Lima, Alex John London, Jason Karlawish

Abstract [from journal]

Embedded pragmatic clinical trials (ePCTs) present an opportunity to improve care for people living with dementia (PLWD) and their care partners, but they also generate a complex constellation of ethical and regulatory challenges. These challenges begin with participant identification. Interventions may be delivered in ways that make it difficult to identify who is a human subject and therefore who needs ethical and regulatory protections. The need for informed consent, a core human subjects protection, must be considered but can be

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