BioMeT and algorithm challenges: A proposed digital standardized evaluation framework

Technology is advancing at an extraordinary rate. Continuous flows of novel data are being generated with the potential to revolutionize how we better identify, treat, manage, and prevent disease across therapeutic areas. However, lack of security of confidence in digital health technologies is hampering adoption, particularly for biometric monitoring technologies (BioMeTs) where frontline healthcare professionals are struggling to determine which BioMeTs are fit-for-purpose and in which context. Here, we discuss the challenges to adoption and offer pragmatic guidance regarding BioMeTs, cumulating in a proposed framework to advance their development and deployment in healthcare, health research, and health promotion. Furthermore, the framework proposes a process to establish an audit trail of BioMeTs (hardware and algorithms), to instill trust amongst multidisciplinary users

Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

Abstract Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.http://deepblue.lib.umich.edu/bitstream/2027.42/78272/1/1748-5908-4-50.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/2/1748-5908-4-50-S1.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/3/1748-5908-4-50-S3.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/4/1748-5908-4-50-S4.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/5/1748-5908-4-50.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/6/1748-5908-4-50-S2.PDFPeer Reviewe

Firelight Foundation: An interim evaluation report of the Early Learning Innovation Fund

The Hewlett Foundation in 2014 selected Management Systems International (MSI) to implement a midterm evaluation of the Early Learning Innovation Fund. This evaluation explores the concept and design of the Fund; progress in achieving the Hewlett Foundation's four intermediary outcomes; and Firelight's implementation of the innovation fund with a focus on its approach to capacity building and expanding innovative programs. This evaluation also reviews the quality of the sub-grantees' monitoring and evaluation (M&E) systems and explores the potential of conducting an impact evaluation of sub-grantee activities

Toolbox Talks: Insights for Improvement

Tool box talks (TBTs) have the potential to improve communication, empower workers, reduce injuries and improve safety; however, they can also be “missed opportunities” for providing important safety messages in construction. The goal of this paper is to share the results from two research projects designed to improve the frequency, delivery, participation, and outcomes of TBTs. The results of these projects provide suggestions for planning and delivering TBTs in construction. METHODS: In the first project, 86 residential carpentry foremen from 8 different residential contractors in the St. Louis region participated in training for delivering TBTs as part of an 8-hour fall prevention and safety communication intervention. We compared baseline measures of safety behavior and fall prevention knowledge items to follow-up between participating foremen and their crewmembers. Concurrently, surveys of 300 apprentice carpenters were collected to describe the frequency and delivery methods of TBT and to serve as a comparison group for the TBT intervention. In the second project, we evaluated the utility of ergonomics TBTs delivered by a safety representative to 36 carpenters and laborers. Workers rated their perceptions of topic relevance, delivery method, similarities to traditional TBTs, and intent to change behaviors. The safety representative provided feedback regarding the TBTs and reported their observations of improved worker use of ergonomics in work tasks post-training. DISCUSSION / CONCLUSIONS: Both interventions described in this paper improved workplace safety. The interventions demonstrate how to simply shift from non-collaborative TBTs to participatory, context-driven TBTs by using a pre-printed TBT template, modified to address the hazards present at the worksite. Delivery suggestions relate the information to the workers, and include workers in the identification of problems and safety-related solutions. These participatory methods for preparing and delivering TBTs have the potential to improve construction workplace safety practices

Hazardous drinking by first-year college-athletes: The differential roles of drinking motives, alcohol consequences, and season status

College student-athletes and first-year students are two undergraduate populations at risk for heavy-episodic drinking and alcohol-related negative consequences. In this study, 63 (56% female, 62% Caucasian) first-year student-athletes completed a preliminary questionnaire assessing demographic characteristics, athlete-specific drinking motives, alcohol-related negative consequences, and season status. Scores of five or more on the ,4 UDIT-C defined the at-risk subsample. Participants who met the criteria for hazardous drinking (n = 19) reported higher levels of alcohol-related negative consequences and drinking motives. A logistic regression, with these variables, successfully distinguished between the two groups. Sport-related coping2, and positive reinforcement drinking motives, emerged as the most robust predictors of hazardous drinking. Implications for screening, prevention, and brief intervention strategies for first-year student-athletes are discussed

The Use of Tailored Interventions to Prevent Falls: A Quality Improvement Project in the Telemetry Unit

Background: Every year in the United States, hundreds of thousands of patients fall in hospitals with 30 to 50 percent resulting in injury. In Texas, the fall rate in adult patients is 33.9 percent, and in one teaching hospital in South Texas, patient fall rates have been above the national benchmark for two years (2017-2019), despite increased use of sitters for patient safety and multiple fall prevention strategies. The annual direct care cost of all fall events in the United States for individuals more than 65 years old is about $34 billion. Practice problem: The objectives of the fall initiative program were increasing adherence to documentation of data from the Morse Fall Assessment and tailored interventions in the electronic health record. The goal of the project was to promote patient safety by decreasing the fall rate per 1000 patient days to below the national benchmark of 3.44/1000 patient days. Intervention: The project was piloted in two telemetry units over 12 weeks using the Iowa Model of Evidence-based Practice. Telemetry staff received one-on-one education from the educator in the unit using a tailored intervention poster. The Nurse Champion observed 58 rooms and conducted chart documentation to ensure universal fall precautions were carried out during every shift. Incidence of falls was tracked daily, and post fall huddles were conducted after any incidents. Outcome: The average monthly fall rate after implementation was 2.47/1000 patient days, which was below the national benchmark. Conclusion: The fall assessment documentation in two telemetry units at DHR Health can be adapted or implemented hospital-wide. The results showed a statistically significant correlation between the Morse fall score assessment on EHR and monthly fall events (p=0. 0078). Champions were able to identify interventions and areas that needed to be improved such as education, patient engagement and stakeholder buy-in

Implementation-effectiveness trial of an ecological intervention for physical activity in ethnically diverse low income senior centers.

BackgroundAs the US population ages, there is an increasing need for evidence based, peer-led physical activity programs, particularly in ethnically diverse, low income senior centers where access is limited.Methods/designThe Peer Empowerment Program 4 Physical Activity' (PEP4PA) is a hybrid Type II implementation-effectiveness trial that is a peer-led physical activity (PA) intervention based on the ecological model of behavior change. The initial phase is a cluster randomized control trial randomized to either a peer-led PA intervention or usual center programming. After 18 months, the intervention sites are further randomized to continued support or no support for another 6 months. This study will be conducted at twelve senior centers in San Diego County in low income, diverse communities. In the intervention sites, 24 peer health coaches and 408 adults, aged 50 years and older, are invited to participate. Peer health coaches receive training and support and utilize a tablet computer for delivery and tracking. There are several levels of intervention. Individual components include pedometers, step goals, counseling, and feedback charts. Interpersonal components include group walks, group sharing and health tips, and monthly celebrations. Community components include review of PA resources, walkability audit, sustainability plan, and streetscape improvements. The primary outcome of interest is intensity and location of PA minutes per day, measured every 6 months by wrist and hip accelerometers and GPS devices. Secondary outcomes include blood pressure, physical, cognitive, and emotional functioning. Implementation measures include appropriateness & acceptability (perceived and actual fit), adoption & penetration (reach), fidelity (quantity & quality of intervention delivered), acceptability (satisfaction), costs, and sustainability.DiscussionUsing a peer led implementation strategy to deliver a multi-level community based PA program can enhance program adoption, implementation, and sustainment.Trial registrationClinicalTrials.gov, USA ( NCT02405325 ). Date of registration, March 20, 2015. This website also contains all items from the World Health Organization Trial Registration Data Set

The SBIRT Method for Alcohol Misuse Screening and Treatment

Heavy episodic drinking, or “binge drinking”, is a significant behavioral health problem on American college campuses. It is associated with numerous physical, social, and legal consequences in this population, including but not limited to intoxicated driving, physical and sexual assault, accidents, alcohol poisoning, compromised academic performance, criminal justice system involvement, exclusion from athletic competition, and expulsion from student housing. The Screening, Brief Intervention, and Referral to Treatment method, or “SBIRT”, has gained increasing recognition in recent years as an effective, validated tool for screening for and intervening in behavioral health problems generally and problematic alcohol use in particular. The purpose of this project was to deliver an educational presentation on the use of SBIRT to staff members, primarily clinicians, of a local college that does not currently use SBIRT as a routine part of patient care. A PowerPoint presentation was created and presented during a staff meeting for healthcare providers at the Bergeron Wellness Center at Saint Michael’s College, and an editable screening tool was created and disseminated to the staff for use in their clinic in the event that they decide to adopt SBIRT. A post-presentation quiz and survey was administered, which demonstrated that respondents had gained knowledge from the presentation and had found it useful for their practice

Using theory to improve low back pain care in Australian Aboriginal primary care: a mixed method single cohort pilot study

Background: Low back pain (LBP) care is frequently discordant with research evidence. This pilot study evaluated changes in LBP care following a systematic, theory informed intervention in a rural Australian Aboriginal Health Service. We aimed to improve three aspects of care; reduce inappropriate LBP radiological imaging referrals, increase psychosocial oriented patient assessment and, increase the provision of LBP self-management information to patients. Methods: Three interventions to improve care were developed using a four-step systematic implementation approach. A mixed methods pre/post cohort design evaluated changes in the three behaviours using a clinical audit of LBP care in a six month period prior to the intervention and then following implementation. In-depth interviews elicited the perspectives of involved General Practitioners (GPs). Qualitative analysis was guided by the theoretical domains framework. Results: The proportion of patients who received guideline inconsistent imaging referrals (GICI) improved from 4.1 GICI per 10 patients to 0.4 (95 % CI for decrease in rate: 1.6 to 5.6) amongst GPs involved in the intervention. Amongst non-participating GPs (locum/part-time GPs who commenced post-interventions) the rate of GICI increased from 1.5 to 4.4 GICI per 10 patients (95 % CI for increase in rate: .5 to 5.3). There was a modest increase in the number of patients who received LBP self-management information from participating GPs and no substantial changes to psychosocial oriented patient assessments by any participants; however GPs qualitatively reported that their behaviours had changed. Knowledge and beliefs about consequences were important behavioural domains related to changes. Environmental and resource factors including protocols for locum staff and clinical tools embedded in patient management software were future strategies identified. Conclusions: A systematic intervention model resulted in partial improvements in LBP care. Determinants of practice change amongst GPs were increased knowledge of clinical guidelines, education delivered by someone considered a trusted source of information, and awareness of the negative consequences of inappropriate practices, especially radiological imaging on patient outcomes. Inconsistent and non-evidence based practices amongst locum GPs was an issue that emerged and will be a significant future challenge. The systematic approach utilised is applicable to other services interested in improving LBP care