Middle managers’ role in implementing evidence-based practices in healthcare: a systematic review

Abstract Background Middle managers are in a unique position to promote the implementation of evidence-based practices (EBPs) in healthcare organizations, yet knowledge of middle managers’ role in implementation and determinants (e.g., individual-, organizational-, and system-level factors) which influence their role remains fractured, spanning decades and disciplines. To synthesize understanding, we undertook a systematic review of studies of middle managers’ role in healthcare EBP implementation and determinants of that role. Methods We searched MEDLINE/PubMed and Business Source Complete (Ebsco) for literature on middle managers’ role in healthcare EBP implementation and its determinants. We abstracted data from records that met inclusion criteria (i.e., written in English, peer-reviewed, and reporting either a protocol or results of an empirical study) into a matrix for analysis. We summarized categorical variables using descriptive statistics. To analyze qualitative data, we used a priori codes and then allowed additional themes to emerge. Results One hundred five records, spanning across several countries and healthcare settings and relating to a range of EBPs, met our inclusion criteria. Studies of middle managers’ role in healthcare EBP implementation and its determinants substantially increased from 1996 to 2015. Results from included studies suggest that middle managers shape implementation climate in addition to fulfilling the four roles hypothesized in extant theory of middle managers’ role in implementation. However, extant studies offered little understanding of determinants of middle managers’ role. Conclusions Our findings suggest that middle managers may play an important role in facilitating EBP implementation. Included studies offered little understanding regarding the relative importance of various roles, potential moderators of the relationship between middle managers’ roles and EBP implementation, or determinants of middle managers’ role in EBP implementation. Future studies should seek to understand determinants and moderators of middle managers’ role. Clearer understanding may facilitate the translation of evidence into practice

A Retrospective Analysis of Dental Provider Distribution and Emergency Department Use for Dental Care in North Carolina

INTRODUCTION Emergency department (ED) use for dental care in North Carolina is higher than in neighboring states. The majority of conditions seen in the ED are infectious and preventable, signifying a lack of access to regular preventive care. Recent analysis shows uneven distribution of dentists around North Carolina; most are concentrated in highly populated urban areas, leaving rural areas heavily underserved. OBJECTIVES The purpose of this study is to establish the burden of ED use for dental care in North Carolina and to determine if the distribution of dentists is associated with ED use for dental conditions. METHODS This analysis uses linear regression. The outcome of interest is the rate of ED visits for dental care per 10,000 people in each county. The primary explanatory variable is the rate of dentists per 10,000 people in each county. Control variables are also at the county level: rural or urban county designation; percent aged 0-19, 20-39, 40-64, 65 and up; percent female; percent black, white, other race, Hispanic; percent estimated eligible for Medicaid. The analysis was also further stratified by urban or rural designation. Regression analysis could not be conducted for Medicaid population relative to significant Medicaid providers, but characteristics of patient population and ED use rates are included. RESULTS 108,625 cases across 100 counties were included, which accounted for approximately 2.5% of all ED visits in 2014. Rates of ED use ranged from 32 visits per 10,000 people to 436 visits per 10,000 people. Patients were disproportionately black, aged 20-39, and the great majority were self-pay or receiving Medicaid. Rural counties had higher rates than urban counties. There was no linear association found between rate of dentists and rate of ED use for dental care. In the overall model and in the rural model, Hispanic ethnicity was associated with a decrease in expected dental ED visits (C:-4.29, p=0.004 and C:-7.56, p=0.005, respectively). In addition, in the rural model, population aged 0-19 was associated with an expected increase in dental ED visits (C:13.18, p=0.015). Patients aged 20-39 made up the greatest portion of visits among those who receive Medicaid, followed by those aged 0-19. There were many more women than men (68% vs. 32). Regression analysis was not conducted for this population. DISCUSSION Analysis confirms results of patient characteristics are consistent with national estimates. Young adults and the uninsured are making up the greatest proportion of visits to the ED for dental care. No significant linear association was found between dental workforce and ED use, which means there are likely other access barriers at play. Rural areas are heavily underserved and will benefit from having more providers, but other barriers, such as cost and fear, must also be addressed.Master of Science in Public Healt

Middle managers’ role in implementing evidence-based practices in healthcare: a systematic review

Abstract Background Middle managers are in a unique position to promote the implementation of evidence-based practices (EBPs) in healthcare organizations, yet knowledge of middle managers’ role in implementation and determinants (e.g., individual-, organizational-, and system-level factors) which influence their role remains fractured, spanning decades and disciplines. To synthesize understanding, we undertook a systematic review of studies of middle managers’ role in healthcare EBP implementation and determinants of that role. Methods We searched MEDLINE/PubMed and Business Source Complete (Ebsco) for literature on middle managers’ role in healthcare EBP implementation and its determinants. We abstracted data from records that met inclusion criteria (i.e., written in English, peer-reviewed, and reporting either a protocol or results of an empirical study) into a matrix for analysis. We summarized categorical variables using descriptive statistics. To analyze qualitative data, we used a priori codes and then allowed additional themes to emerge. Results One hundred five records, spanning across several countries and healthcare settings and relating to a range of EBPs, met our inclusion criteria. Studies of middle managers’ role in healthcare EBP implementation and its determinants substantially increased from 1996 to 2015. Results from included studies suggest that middle managers shape implementation climate in addition to fulfilling the four roles hypothesized in extant theory of middle managers’ role in implementation. However, extant studies offered little understanding of determinants of middle managers’ role. Conclusions Our findings suggest that middle managers may play an important role in facilitating EBP implementation. Included studies offered little understanding regarding the relative importance of various roles, potential moderators of the relationship between middle managers’ roles and EBP implementation, or determinants of middle managers’ role in EBP implementation. Future studies should seek to understand determinants and moderators of middle managers’ role. Clearer understanding may facilitate the translation of evidence into practice