A conceptual model to guide research on the activities and effects of innovation champions

Background: The importance of having a champion to promote implementation efforts has been discussed in the literature for more than five decades. However, the empirical literature on champions remains underdeveloped. As a result, health organizations commonly use champions in their implementation efforts without the benefit of evidence to guide decisions about how to identify, prepare, and evaluate their champions. The goal of this article is to present a model of champion impact that draws upon previous literature and is intended to inform future research on champions and serve as a guide for practitioners serving in a champion role. Methods: The proposed model is informed by existing literature, both conceptual and empirical. Prior studies and reviews of the literature have faced challenges in terms of operationalizing and reporting on champion characteristics, activities, and impacts. The proposed model addresses this challenge by delineating these constructs, which allows for consolidation of factors previously discussed about champions as well as new hypothesized relationships between constructs. Results: The model proposes that a combination of champion commitment and champion experience and self-efficacy influence champion performance, which influences peer engagement with the champion, which ultimately influences the champion's impact. Two additional constructs have indirect effects on champion impact. Champion beliefs about the innovation and organizational support for the champion affect champion commitment. Conclusion: The proposed model is intended to support prospective studies of champions by hypothesizing relationships between constructs identified in the champion literature, specifically relationships between modifiable factors that influence a champion?s potential impact. Over time, the model should be modified, as appropriate, based on new findings from champion-related research. Plain language summary: An innovation champion is an individual who works within an organization and who dedicates themselves to promoting a change within the organization, such as implementing a new intervention or a new quality improvement effort. Health organizations commonly rely on innovation champions, and existing literature on champions suggests they are important for successful organizational change. However, many questions remain about what effective champions do and what types of support they need to perform their champion role well. The goal of this article is to present a model of champion impact that draws upon previous literature and is intended to serve as a guide for future research on champions. In doing so, the model could support coordinated research efforts that answer questions about the characteristics, activities, and impacts of champions. Ultimately, this research could lead to development of useful guidance and tools for health system leaders to support champions within their organizations

What is the extent of research on the characteristics, behaviors, and impacts of health information technology champions? A scoping review

Abstract Background Although champions are commonly employed in health information technology (HIT) implementations, the state of empirical literature on HIT champions’ is unclear. The purpose of our review was to synthesize quantitative and qualitative studies to identify the extent of research on the characteristics, behaviors, and impacts of HIT champions. Ultimately, our goal was to identify gaps in the literature and inform implementation science. Methods Our review employed a broad search strategy using multiple databases—Embase, Pubmed, Cinahl, PsychInfo, Web of Science, and the Cochrane library. We identified 1728 candidate articles, of which 42 were retained for full-text review. Results Of the 42 studies included, fourteen studies employed a multiple-case study design (33 %), 12 additional articles employed a single-case study design (29 %), five used quantitative methods (12 %), two used mixed-methods (5 %), and one used a Delphi methodology (2 %). Our review revealed multiple categories and characteristics of champions as well as influence tactics they used to promote an HIT project. Furthermore, studies have assessed three general types of HIT champion impacts: (1) impacts on the implementation process of a specific HIT; (2) impacts on usage behavior or overall success of a specific HIT; and (3) impacts on general organizational-level innovativeness. However the extent to which HIT projects fail even with a champion and why such failures occur is not clear. Also unclear is whether all organizations require a champion for successful HIT project implementation. In other words, we currently do not know enough about the conditions under which (1) a health IT champion is needed, (2) multiple champions are needed, and (3) an appointed champion—as opposed to an emergent champion—can be successful. Conclusions Although champions appear to have contributed to successful implementation of HIT projects, simply measuring the presence or absence of a champion is not sufficient for assessing impacts. Future research should aim for answers to questions about who champions should be, when they should be engaged, what they should do, how management can support their efforts, and what their impact is given the organizational context

Quality improvement teams, super-users, and nurse champions: a recipe for meaningful use?

Objective This study assessed whether having an electronic health record (EHR) super-user, nurse champion for meaningful use (MU), and quality improvement (QI) team leading MU implementation is positively associated with MU Stage 1 demonstration

Using Latent Class Analysis to Identify Sophistication Categories of Electronic Medical Record Systems in U.S. Acute Care Hospitals

Many believe that electronic medical record systems hold promise for improving the quality of health care services. The body of research on this topic is still in the early stages, however, in part because of the challenge of measuring the capabilities of electronic medical record systems. The purpose of this study was to identify classes of Electronic Medical Record (EMR) system sophistication in hospitals as well as hospital characteristics associated with the sophistication categories. The data used were from the American Hospital Association (AHA) and the Health Information Management and Systems Society (HIMSS). The sample included acute care hospitals in the United States with 50 beds or more. We used latent class analysis to identify the sophistication classes and logistic regression to identify relationships between these classes and hospital characteristics. Our study identifies cumulative categories of EMR sophistication: ancillary-based, ancillary/data aggregation, and ancillary-to-bedside. Rural hospital EMRs are likely to be ancillary-based, while hospitals in a network are likely to have either ancillary-based or ancillary-to-bedside EMRs. Future research should explore the effect of network membership on EMR system development

Unmanned Aerial System-Based Data Ferrying over a Sensor Node Station Network in Maize

© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/)

Contrasting Development of Canopy Structure and Primary Production in Planted and Naturally Regenerated Red Pine Forests

Globally, planted forests are rapidly replacing naturally regenerated stands but the implications for canopy structure, carbon (C) storage, and the linkages between the two are unclear. We investigated the successional dynamics, interlinkages and mechanistic relationships between wood net primary production (NPPw) and canopy structure in planted and naturally regenerated red pine (Pinus resinosa Sol. ex Aiton) stands spanning ≥ 45 years of development. We focused our canopy structural analysis on leaf area index (LAI) and a spatially integrative, terrestrial LiDAR-based complexity measure, canopy rugosity, which is positively correlated with NPPw in several naturally regenerated forests, but which has not been investigated in planted stands. We estimated stand NPPw using a dendrochronological approach and examined whether canopy rugosity relates to light absorption and light–use efficiency. We found that canopy rugosity increased similarly with age in planted and naturally regenerated stands, despite differences in other structural features including LAI and stem density. However, the relationship between canopy rugosity and NPPw was negative in planted and not significant in naturally regenerated stands, indicating structural complexity is not a globally positive driver of NPPw. Underlying the negative NPPw-canopy rugosity relationship in planted stands was a corresponding decline in light-use efficiency, which peaked in the youngest, densely stocked stand with high LAI and low structural complexity. Even with significant differences in the developmental trajectories of canopy structure, NPPw, and light use, planted and naturally regenerated stands stored similar amounts of C in wood over a 45-year period. We conclude that widespread increases in planted forests are likely to affect age-related patterns in canopy structure and NPPw, but planted and naturally regenerated forests may function as comparable long-term C sinks via different structural and mechanistic pathways

A Toolkit for Pediatric CT Dose Reduction in Community Hospitals

"Eighty percent of success is just showing up."—Woody Allen Pediatric CT radiation dose optimization is a challenging process for pediatric-focused facilities and community hospitals alike. Ongoing experience and trial-and-error approaches to dose reduction in the large academic hospital setting may position these centers to help community hospitals that strive for CT quality improvement. We describe our hands-on approach in a pilot project to create a partnership between an academic medical center and a community hospital to develop a toolkit for implementing CT dose reduction. Our aims were to (1) assess the acceptability of an interactive educational program and electronic toolkit booklet, (2) conduct a limited test of the efficacy of the toolkit in promoting knowledge and readiness to change, and (3) assess the acceptability and practicality of a collaborative approach to implementing dose reduction protocols in community hospitals. In partnering with the community hospital, we found that they had size-specific radiation doses two to three times higher than those at our center. Survey results after a site visit with interactive educational presentations revealed an increase in knowledge, stronger opinions about the health risks of radiation from CT scans, and willingness and perceived ability to reduce pediatric CT doses

A method to determine the impact of patient-centered care interventions in primary care

The implementation of patient-centered care (PCC) innovations continues to be poorly understood. We used the implementation effectiveness framework to pilot a method for measuring the impact of a PCC innovation in primary care practices

Elements of Palliative Care in the Last 6 Months of Life: Frequency, Predictors, and Timing

IMPORTANCE: Persons living with serious illness often need skilled symptom management, communication, and spiritual support. Palliative care addresses these needs and may be delivered by either specialists or clinicians trained in other fields. It is important to understand core elements of palliative care to best provide patient-centered care. OBJECTIVE: To describe frequency, predictors, and timing of core elements of palliative care during the last 6 months of life. DESIGN: Retrospective chart review. SETTING: Inpatient academic medical center. PARTICIPANTS: Decedents with cancer, dementia, or chronic kidney disease (CKD) admitted during the 6 months preceding death. EXPOSURES: We identified receipt and timing of core elements of palliative care: pain and symptom management, goals of care, spiritual care; and specialty palliative care utilization; hospital encounters; demographics; and comorbid diagnoses.We ran Poisson regression models to assess whether diagnosis or hospital encounters were associated with core elements of palliative care. RESULTS: Among 402 decedents, themean (SD) number of appropriately screened and treated symptoms was 2.9 (1.7)/10. Among 76.1% with documented goals of care, 58.0% had a primary goal of comfort; 55.0% had documented spiritual care. In multivariable models, compared with decedents with cancer, those with dementia or CKD were less likely to have pain and symptom management (respectively, 31% (incidence rate ratio [IRR], 0.69; 95% CI, 0.56–0.85) and 17% (IRR, 0.83; CI, 0.71–0.97)). There was amedian of 3 days (IQR, 0–173) between transition to a goal of comfort and death, and amedian of 12 days (IQR, 5–47) between hospice referral and death. CONCLUSIONS AND RELEVANCE: Although a high proportion of patients received elements of palliative care, transitions to a goal of comfort or hospice happened very near death. Palliative care delivery can be improved by systematizing existing mechanisms, including prompts for earlier goals-of-care discussion, symptom screening, and spiritual care, and by building collaboration between primary and specialty palliative care services

Does Receipt of Recommended Elements of Palliative Care Precede In-Hospital Death or Hospice Referral?

Context. Palliative care aligns treatments with patients’ values and improves quality of life, yet whether receipt of recommended elements of palliative care is associated with end-of-life outcomes is understudied. Objectives. To assess whether recommended elements of palliative care (pain and symptom management, goals of care, and spiritual care) precede in-hospital death and hospice referral and whether delivery by specialty palliative care affects that relationship. Methods. We conducted structured chart reviews for decedents with late-stage cancer, dementia, and chronic kidney disease with a hospital admission during the six months preceding death. Measures included receipt of recommended elements of palliative care delivered by any clinician and specialty palliative care consult. We assessed associations between recommended elements of palliative care and in-hospital death and hospice referral using multivariable Poisson regression models. Results. Of 402 decedents, 67 (16.7%) died in hospital, and 168 (41.8%) had hospice referral. Among elements of palliative care, only goals-of-care discussion was associated with in-hospital death (incidence rate ratio [IRR] 1.37; 95% CI 1.01e1.84) and hospice referral (IRR 1.85; 95% CI 1.31e2.61). Specialty palliative care consult was associated with a lower likelihood of in-hospital death (IRR 0.57; 95% CI 0.44e0.73) and a higher likelihood of hospice referral (IRR 1.45; 95% CI 1.12e1.89) compared with no consult. Conclusion. Goals-of-care discussions by different types of clinicians commonly precede end-of-life care in hospital or hospice. However, engagement with specialty palliative care reduced in-hospital death and increased hospice referral. Understanding the causal pathways of goals-of-care discussions may help build primary palliative care interventions to support patients near the end of life