Implementing change in primary care practice: lessons from a mixed-methods evaluation of a frailty initiative

© 2018, BJGP Open. Background: The NHS is facing increasing needs from an aging population, which is acutely visible in the emerging problem of frailty. There is growing evidence describing new models of care for people living with frailty, but a lack of evidence on successful implementation of these complex interventions at the practice level. Aim: This study aimed to determine what factors enable or prevent implementation of a wholesystem, complex intervention for managing frailty (the PACT initiative) in the UK primary care setting. Design & setting: A mixed-methods evaluation study undertaken within a large clinical commissioning group (CCG). Design and analysis was informed by normalisation process theory (NPT). Method: Data collection from six sites included: observation of delivery, interviews with staff, and an online survey. NPT-informed analysis sought to identify enablers and barriers to implementation of change. Results: Seven themes were identified. PACT was valued by professionals and patients but a lack of clarity on its aims was identified as a barrier to implementation. Successful implementation relied on champions pushing the work forward, and dealing with unanticipated resistance. Contracts focused on delivery of service outcomes, but these were sometimes at odds with professional priorities. Implementation followed evidence-informed rather than evidence-based practice, requiring redesign of the intervention and potentially created a new body of knowledge on managing frailty. Conclusion: Successful implementation of complex interventions in primary care need inbuilt capacity for flexibility and adaptability, requiring expertise as well as evidence. Professionals need to be supported to translate innovative practice into practice-based evidence

Evaluations of the sum-score-based and item response theory-based tests of group mean differences under various simulation conditions

The use of patient-reported outcomes measures is gaining popularity in clinical trials for comparing patient groups. Such comparisons typically focus on the differences in group means and are carried out using either a traditional sum-score-based approach or item response theory (IRT)-based approaches. Several simulation studies have evaluated different group mean comparison approaches in the past, but the performance of these approaches remained unknown under certain uninvestigated conditions (e.g. under the impact of differential item functioning (DIF)). By incorporating some of the uninvestigated simulation features, the current study examines Type I error, statistical power, and effect size estimation accuracy associated with group mean comparisons using simple sum scores, IRT model likelihood ratio tests, and IRT expected-a-posteriori scores. Manipulated features include sample size per group, number of items, number of response categories, strength of discrimination parameters, location of thresholds, impact of DIF, and presence of missing data. Results are summarized and visualized using decision trees

Valuation of Child Behavioral Problems from the Perspective of US Adults

To assess preferences between child behavioral problems and estimate their value on a quality-adjusted life year (QALYs) scale

Pre-diagnosis health-related quality of life, surgery, and survival in women with advanced epithelial ovarian cancer: A SEER-MHOS study

Health-related quality of life (HRQOL) has been found to be associated with overall survival in women with ovarian cancer. However, previous studies assessed HRQOL after surgery within clinical trial populations only. The study goal was to determine the association of pre-cancer diagnosis HRQOL with the likelihood of receiving surgery and with overall survival in a national, population-based cohort of older women with advanced ovarian cancer

Psychometric Properties of the Four-Item Morisky Green Levine Medication Adherence Scale among Atherosclerosis Risk in Communities (ARIC) Study Participants

To evaluate the reliability and factorial validity of the four-item Morisky Green Levine Medication Adherence Scale (MGLS) among Atherosclerosis Risk in Communities (ARIC) Study participants

A Systematic Review of Psychometric Properties of Health-Related Quality-of-Life and Symptom Instruments in Adult Acute Leukemia Survivors

Acute leukemia represents 4% of cancer cases in the United States (US) annually. There are over 302,000 people living with acute and chronic leukemia in the US. Treatment has been shown to have both positive and negative effects on health-related quality of life (HRQOL)

Known-groups validity of the Patient-Reported Outcomes Measurement Information System (PROMIS®) in adolescents and young adults with special healthcare needs

To examine known-groups validity of the Patient-Reported Outcomes Measurement Information System (PROMIS®) Short Forms (SFs) for adolescents and young adults with special health care needs (SHCN) using data collected from the PROMIS Linking Study

The Value Adults Place On Child Health And Functional Status

By summarizing the value adults place on child health and functional status, this study provides a new quantitative tool that enhances our understanding of the benefits of new health technologies and illustrates the potential contributions of existing datasets for comparative effectiveness research in pediatrics

Responsiveness to Change in PROMIS

AbstractObjectiveTo compare the responsiveness to change of the Patient-Reported Outcomes Measurement Information System (PROMIS®) asthma impact, pain interference, fatigue, depressive symptoms, mobility, and peer relationship scales to a legacy scale, the Paediatric Asthma Quality of Life Questionnaire (PAQLQ).MethodsTwo hundred and twenty-nine child-parent dyads from public insurance programs were enrolled. PROMIS pediatric short forms (SFs) and the PAQLQ were used to measure health-related quality of life across four time points (T1–T4) over 2 years. The Asthma Control and Communication Instrument was used to measure the change in asthma control, and the Global Rating of Change (GRC) Index for breathing problems and overall health was used to measure the change in health status. Responsiveness was tested by comparing the changes in health-related quality of life with the changes in asthma control and health status over time using t tests, generalized estimating equations, and relative validity approaches. Magnitudes of the responsiveness between the Pediatric PROMIS and PAQLQ were assessed through statistical significance, Cohen's d effect size (ES), and standardized response mean (SRM).ResultsThe PROMIS asthma impact scale and all PAQLQ scales exhibited significant responsiveness (p'sConclusionsThe PROMIS asthma impact SF indicated similar responsiveness to the PAQLQ scales. Due to its brevity and responsiveness, the PROMIS asthma impact SF is useful for clinical practice or research

An item-level response shift study on the change of health state with the rating of asthma-specific quality of life: a report from the PROMIS® Pediatric Asthma Study

To examine item-level response shift associated with the change in asthma-related health state (i.e., change in asthma control status and global rating of change (GRC) in breathing problems)