http://hdl.handle.net/2144/1152 2013-06-20T03:07:31Z 2013-06-20T03:07:31Z Stetler, Cheryl B Ritchie, Judith A Rycroft-Malone, Jo Schultz, Alyce A Charns, Martin P http://hdl.handle.net/2144/3314 2012-01-12T07:01:45Z 2009-11-30T00:00:00Z

Institutionalizing Evidence-Based Practice: An Organizational Case Study Using a Model of Strategic Change Stetler, Cheryl B; Ritchie, Judith A; Rycroft-Malone, Jo; Schultz, Alyce A; Charns, Martin P BACKGROUND. There is a general expectation within healthcare that organizations should use evidence-based practice (EBP) as an approach to improving the quality of care. However, challenges exist regarding how to make EBP a reality, particularly at an organizational level and as a routine, sustained aspect of professional practice. METHODS. A mixed method explanatory case study was conducted to study context; i.e., in terms of the presence or absence of multiple, inter-related contextual elements and associated strategic approaches required for integrated, routine use of EBP ('institutionalization'). The Pettigrew et al. Content, Context, and Process model was used as the theoretical framework. Two sites in the US were purposively sampled to provide contrasting cases: i.e., a 'role model' site, widely recognized as demonstrating capacity to successfully implement and sustain EBP to a greater degree than others; and a 'beginner' site, self-perceived as early in the journey towards institutionalization. RESULTS. The two sites were clearly different in terms of their organizational context, level of EBP activity, and degree of institutionalization. For example, the role model site had a pervasive, integrated presence of EBP versus a sporadic, isolated presence in the beginner site. Within the inner context of the role model site, there was also a combination of the Pettigrew and colleagues' receptive elements that, together, appeared to enhance its ability to effectively implement EBP-related change at multiple levels. In contrast, the beginner site, which had been involved for a few years in EBP-related efforts, had primarily non-receptive conditions in several contextual elements and a fairly low overall level of EBP receptivity. The beginner site thus appeared, at the time of data collection, to lack an integrated context to either support or facilitate the institutionalization of EBP. CONCLUSION. Our findings provide evidence of some of the key contextual elements that may require attention if institutionalization of EBP is to be realized. They also suggest the need for an integrated set of receptive contextual elements to achieve EBP institutionalization; and they further support the importance of specific interactions among these elements, including ways in which leadership affects other contextual elements positively or negatively.

2009-11-30T00:00:00Z Helfrich, Christian D Damschroder, Laura J Hagedorn, Hildi J Daggett, Ginger S Sahay, Anju Ritchie, Mona Damush, Teresa Guihan, Marylou Ullrich, Philip M Stetler, Cheryl B http://hdl.handle.net/2144/3315 2012-01-12T07:01:55Z 2010-10-25T00:00:00Z

A Critical Synthesis of Literature on the Promoting Action on Research Implementation in Health Services (PARIHS) Framework Helfrich, Christian D; Damschroder, Laura J; Hagedorn, Hildi J; Daggett, Ginger S; Sahay, Anju; Ritchie, Mona; Damush, Teresa; Guihan, Marylou; Ullrich, Philip M; Stetler, Cheryl B BACKGROUND. The Promoting Action on Research Implementation in Health Services framework, or PARIHS, is a conceptual framework that posits key, interacting elements that influence successful implementation of evidence-based practices. It has been widely cited and used as the basis for empirical work; however, there has not yet been a literature review to examine how the framework has been used in implementation projects and research. The purpose of the present article was to critically review and synthesize the literature on PARIHS to understand how it has been used and operationalized, and to highlight its strengths and limitations. METHODS. We conducted a qualitative, critical synthesis of peer-reviewed PARIHS literature published through March 2009. We synthesized findings through a three-step process using semi-structured data abstraction tools and group consensus. RESULTS. Twenty-four articles met our inclusion criteria: six core concept articles from original PARIHS authors, and eighteen empirical articles ranging from case reports to quantitative studies. Empirical articles generally used PARIHS as an organizing framework for analyses. No studies used PARIHS prospectively to design implementation strategies, and there was generally a lack of detail about how variables were measured or mapped, or how conclusions were derived. Several studies used findings to comment on the framework in ways that could help refine or validate it. The primary issue identified with the framework was a need for greater conceptual clarity regarding the definition of sub-elements and the nature of dynamic relationships. Strengths identified included its flexibility, intuitive appeal, explicit acknowledgement of the outcome of 'successful implementation,' and a more expansive view of what can and should constitute 'evidence.' CONCLUSIONS. While we found studies reporting empirical support for PARIHS, the single greatest need for this and other implementation models is rigorous, prospective use of the framework to guide implementation projects. There is also need to better explain derived findings and how interventions or measures are mapped to specific PARIHS elements; greater conceptual discrimination among sub-elements may be necessary first. In general, it may be time for the implementation science community to develop consensus guidelines for reporting the use and usefulness of theoretical frameworks within implementation studies.

2010-10-25T00:00:00Z Ramani, Sudha http://hdl.handle.net/2144/3316 2012-01-12T07:01:55Z 2009-04-01T00:00:00Z

Can We Transplant Conceptual Frameworks of Healthcare Quality Evaluation from Developed Countries into Developing Countries? Ramani, Sudha

2009-04-01T00:00:00Z Noël, Polly Hitchcock Parchman, Michael L. Williams, John W. Cornell, John E. Shuko, Lee Zeber, John E. Kazis, Lewis E. Lee, Austin F. S. Pugh, Jacqueline A. http://hdl.handle.net/2144/3317 2012-01-12T07:01:55Z 2007-11-16T00:00:00Z

The Challenges of Multimorbidity from the Patient Perspective Noël, Polly Hitchcock; Parchman, Michael L.; Williams, John W.; Cornell, John E.; Shuko, Lee; Zeber, John E.; Kazis, Lewis E.; Lee, Austin F. S.; Pugh, Jacqueline A. BACKGROUND Although multiple co-occurring chronic illnesses within the same individual are increasingly common, few studies have examined the challenges of multimorbidity from the patient perspective. OBJECTIVE The aim of this study is to examine the self-management learning needs and willingness to see non-physician providers of patients with multimorbidity compared to patients with single chronic illnesses. DESIGN. This research is designed as a cross-sectional survey. PARTICIPANTS Based upon ICD-9 codes, patients from a single VHA healthcare system were stratified into multimorbidity clusters or groups with a single chronic illness from the corresponding cluster. Nonproportional sampling was used to randomly select 720 patients. MEASUREMENTS Demographic characteristics, functional status, number of contacts with healthcare providers, components of primary care, self-management learning needs, and willingness to see nonphysician providers. RESULTS Four hundred twenty-two patients returned surveys. A higher percentage of multimorbidity patients compared to single morbidity patients were "definitely" willing to learn all 22 self-management skills, of these only 2 were not significant. Compared to patients with single morbidity, a significantly higher percentage of patients with multimorbidity also reported that they were "definitely" willing to see 6 of 11 non-physician healthcare providers. CONCLUSIONS Self-management learning needs of multimorbidity patients are extensive, and their preferences are consistent with team-based primary care. Alternative methods of providing support and chronic illness care may be needed to meet the needs of these complex patients.

2007-11-16T00:00:00Z