Abstract:
BACKGROUND:Patients with opioid use disorder (OUD) frequently present to the emergency department (ED) after overdose, or seeking treatment for general medical conditions, their addiction, withdrawal symptoms, or complications of injection drug use, such as soft tissue infections. ED-initiated buprenorphine has been shown to be effective in increasing patient engagement in treatment compared with brief intervention with a facilitated referral or referral alone. However, adoption into practice has lagged behind need. To address this implementation challenge, we are evaluating the impact of implementation facilitation (IF) on the adoption of ED-initiated buprenorphine for OUD into practice. METHODS:This protocol describes a study that is being conducted through the National Institute on Drug Abuse's Center for the Clinical Trials Network. A hybrid type III effectiveness-implementation study design is used to evaluate the effectiveness of a standard educational dissemination strategy versus IF on implementation (primary) and effectiveness (secondary) outcomes in four urban, academic EDs. Sites start with a standard 60-min "Grand Rounds" educational intervention describing the prevalence of ED patients with OUD, the evidence for opioid agonist treatment and for innovative interventions with ED-initiated buprenorphine; followed by a 1-year baseline evaluation period. Using a modified stepped wedge design, sites are randomly assigned to the IF intervention which is guided by the Promoting Action on Research Implementation in Health Services (PARiHS) framework to assess evidence, context, and facilitation-related factors impacting the adoption of ED-initiated buprenorphine. During the 6 months of IF through the 1-year IF evaluation period, external facilitators work with local stakeholders to tailor and refine a bundle of activities to meet the site's needs. The primary analyses compare the baseline evaluation period to the IF evaluation period (n = 120 patients with untreated OUD enrolled during each period) on (1) rates of provision of ED-initiated buprenorphine by ED providers with referral for ongoing medication (implementation outcome) and (2) rates of patient engagement in addiction treatment on the 30th day after the ED visit (effectiveness outcome). Finally, we will perform a cost-effectiveness analysis (CEA) to determine if the effectiveness benefits are worth the additional costs. DISCUSSION:Results will generate novel information regarding the impact of IF as a strategy to promote ED-initiated buprenorphine. TRIAL REGISTRATION:ClinicalTrials.gov NCT03023930 first posted 1/10/2017, https://clinicaltrials.gov/ct2/show/NCT03023930?term=0069&rank=1.
journal_name
Implement Scijournal_title
Implementation science : ISauthors
D'Onofrio G,Edelman EJ,Hawk KF,Pantalon MV,Chawarski MC,Owens PH,Martel SH,VanVeldhuisen P,Oden N,Murphy SM,Huntley K,O'Connor PG,Fiellin DAdoi
10.1186/s13012-019-0891-5subject
Has Abstractpub_date
2019-05-07 00:00:00pages
48issue
1issn
1748-5908pii
10.1186/s13012-019-0891-5journal_volume
14pub_type
杂志文章abstract:BACKGROUND:The continuing gap between available evidence and current practice in health care reinforces the need for more effective solutions, in particular related to organizational context. Considerable advances have been made within the U.S. Veterans Health Administration (VA) in systematically implementing evidence...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-3-30
更新日期:2008-05-29 00:00:00
abstract:BACKGROUND:Clinical practice guidelines have the potential to facilitate the implementation of evidence into practice, support clinical decision making, specify beneficial therapeutic approaches, and influence public policy. However, these potential benefits have not been consistently achieved. The limited impact of gu...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-6-69
更新日期:2011-07-06 00:00:00
abstract:BACKGROUND:Cerebral palsy is a permanent disorder of posture and movement caused by disturbances in the developing brain. It affects approximately 1 in every 500 children in developed countries and is the most common form of childhood physical disability. People with cerebral palsy may also have problems with speech, v...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-014-0202-0
更新日期:2015-02-06 00:00:00
abstract:BACKGROUND:Teaching the content of clinical practice guidelines (CPGs) is important to both clinical care and graduate medical education. The objective of this study was to determine the characteristics of curricula for teaching the content of CPGs in family medicine and internal medicine residency programs in the Unit...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-4-59
更新日期:2009-09-21 00:00:00
abstract:BACKGROUND:Evidence of variations in red blood cell transfusion practices have been reported in a wide range of clinical settings. Parallel studies in Canada and the United Kingdom were designed to explore transfusion behaviour in intensive care physicians. The aim of this paper is three-fold: first, to explore beliefs...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-7-93
更新日期:2012-09-21 00:00:00
abstract:PURPOSE:The purpose of this study was to undertake a systematic assessment of the need for research-based information by decision-makers working in community-based organizations. It is part of a more comprehensive knowledge transfer and exchange strategy that seeks to understand both the content required and the format...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-2-20
更新日期:2007-07-03 00:00:00
abstract::Trainees (e.g., graduate students, residents, fellows) are increasingly identifying knowledge translation as their research discipline. In Canada, a group of trainees have created a trainee-initiated and trainee-led national collaborative to provide a vehicle for trainees to examine the diversity of knowledge translat...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-6-98
更新日期:2011-08-25 00:00:00
abstract:BACKGROUND:Evidence-based clinical practice guidelines may improve treatment quality, but the uptake of guideline recommendations is often incomplete and slow. Recently new low back pain guidelines are being launched in Denmark. The guidelines are considered to reduce personal and public costs. The aim of this study is...
journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
doi:10.1186/1748-5908-8-124
更新日期:2013-10-20 00:00:00
abstract:BACKGROUND:Evaluating the impact of recommendations based upon health technology assessment (HTA) represents a challenge for both HTA agencies and healthcare policy-makers. Using a psychosocial theoretical framework, this study aimed at exploring the factors affecting physician intention to adopt HTA recommendations. T...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-1-8
更新日期:2006-03-31 00:00:00
abstract:BACKGROUND:The translation of research into policy and practice is enhanced by policymakers who can recognise and articulate their information needs and researchers that understand the policymakers' environment. As researchers, we sought to understand the policymaking process and how research evidence may contribute in...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-015-0315-0
更新日期:2015-09-03 00:00:00
abstract:BACKGROUND:Although there is growing recognition that the implementation of evidence-based practices is a social process, the conceptualization of social capital in implementation frameworks often conflates bonding and bridging social capital. This conflation makes it difficult to concretely operationalize social capit...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-019-0860-z
更新日期:2019-02-14 00:00:00
abstract:BACKGROUND:Translation of evidence-based interventions into hospital systems can provide immediate and substantial benefits to patient care and outcomes, but successful implementation is often not achieved. Existing literature describes a range of barriers and facilitators to the implementation process. This systematic...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-018-0726-9
更新日期:2018-02-23 00:00:00
abstract:BACKGROUND:Significant gaps related to measurement issues are among the most critical barriers to advancing implementation science. Three issues motivated the study aims: (a) the lack of stakeholder involvement in defining pragmatic measure qualities; (b) the dearth of measures, particularly for implementation outcomes...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-015-0287-0
更新日期:2015-07-22 00:00:00
abstract:BACKGROUND:There is a need to unpack the empirical, practical, and personal challenges within participatory approaches advocated to optimize implementation. The unpredictable, chaotic nature of participatory approaches complicates application of implementation theories, methods, and strategies which do not address rese...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-020-01002-1
更新日期:2020-09-03 00:00:00
abstract:BACKGROUND:Implementation of the 'Sepsis Six' clinical care bundle within an hour of recognition of sepsis is recommended as an approach to reduce mortality in patients with sepsis, but achieving reliable delivery of the bundle has proved challenging. There remains little understanding of the barriers to reliable imple...
journal_title:Implementation science : IS
pub_type: 杂志文章,多中心研究
doi:10.1186/s13012-016-0518-z
更新日期:2016-11-16 00:00:00
abstract:BACKGROUND:Variation in effectiveness of continuous quality improvement (CQI) interventions between services is commonly reported, but with little explanation of how contextual and other factors may interact to produce this variation. Therefore, there is scant information available on which policy makers can draw to in...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-8-119
更新日期:2013-10-08 00:00:00
abstract:BACKGROUND:For early stage breast cancer, randomized controlled trials (RCTs) have shown that patient decision aids (PtDAs), when used by surgeons, result in increased patient knowledge about options and different patient treatment choices as compared to standard care. Yet, recent data suggests that PtDAs are used by l...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-014-0174-0
更新日期:2014-11-29 00:00:00
abstract:BACKGROUND:Patients with hypertension continue to have less than optimal blood pressure control, with nearly one in five Canadian adults having hypertension. Pharmacist prescribing is gaining favor as a potential clinically efficacious and cost-effective means to improve both access and quality of care. With Alberta be...
journal_title:Implementation science : IS
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1186/1748-5908-6-94
更新日期:2011-08-11 00:00:00
abstract:BACKGROUND:Counselling on health-related lifestyles is key to the prevention and management of chronic diseases. After comprehensive study of determinants of its delivery in general practice and strategies to improve, we composed a tailored improvement program, which included communication skills training, online patie...
journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
doi:10.1186/s13012-016-0460-0
更新日期:2016-08-11 00:00:00
abstract:BACKGROUND:The recent growth in organized efforts to advance dissemination and implementation (D & I) science suggests a rapidly expanding community focused on the adoption and sustainment of evidence-based practices (EBPs). Although promising for the D & I of EBPs, the proliferation of initiatives is difficult for any...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-017-0673-x
更新日期:2017-11-21 00:00:00
abstract:BACKGROUND:Service development innovation in health technology and practice is viewed as a pressing need within the field of mental health yet is relatively poorly understood. Macro-level theories have been criticised for their limited explanatory power and they may not be appropriate for understanding local and fine-g...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-6-120
更新日期:2011-10-26 00:00:00
abstract:BACKGROUND:Adverse drug events could often be prevented. One of their main causes is that patients rarely know how to detect them. Another cause is inadequate communication between patients and physicians. If patients were to be effectively trained in detecting and reporting adverse drug events, this should help to pre...
journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
doi:10.1186/1748-5908-8-69
更新日期:2013-06-19 00:00:00
abstract:BACKGROUND:Over the past years, implementation science has gained more and more importance in German-speaking countries. Reliable and valid questionnaires are needed for evaluating the implementation of evidence-based practices. On an international level, several initiatives focused on the identification of questionnai...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-018-0837-3
更新日期:2018-12-12 00:00:00
abstract:BACKGROUND:This study describes a collaborative planning approach that blends principles of community-based participatory research (CBPR) and intervention mapping to modify a healthcare manager intervention to a new patient population and provider group and to assess the feasibility and acceptability of this modified i...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-6-80
更新日期:2011-07-26 00:00:00
abstract:BACKGROUND:People in close contact with tuberculosis should have screening and appropriate management, as an opportunity for active case detection and prevention. However, implementation of tuberculosis contact screening and management is limited in high-burden settings. Behaviour change is needed across three levels o...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-019-0870-x
更新日期:2019-03-19 00:00:00
abstract:BACKGROUND:Shared decision-making (SDM) is rarely implemented in pediatric practice. Pediatric health decision-making differs from that of adult practice. Yet, little is known about the factors that influence the implementation of pediatric shared decision-making (SDM). We synthesized pediatric SDM barriers and facilit...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-018-0851-5
更新日期:2019-01-18 00:00:00
abstract:BACKGROUND:The effective and timely integration of the best available research evidence into healthcare practice has considerable potential to improve the quality of provided care. Knowledge translation (KT) approaches aim to develop, implement, and evaluate strategies to address the research-practice gap. However, mos...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-7-112
更新日期:2012-11-21 00:00:00
abstract:BACKGROUND:Electronic guideline-based decision support systems have been suggested to successfully deliver the knowledge embedded in clinical practice guidelines. A number of studies have already shown positive findings for decision support systems such as drug-dosing systems and computer-generated reminder systems for...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-4-82
更新日期:2009-12-30 00:00:00
abstract:BACKGROUND:To improve hypertension care for ethnic minority patients of African descent in the Netherlands, we developed a provider intervention to facilitate the delivery of culturally appropriate hypertension education. This pilot study evaluates how the intervention affected the attitudes and perceived competence of...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-5-35
更新日期:2010-05-14 00:00:00
abstract:OBJECTIVE:Formative evaluation of the implementation process for a digitally supported intervention in polypharmacy in Germany. Qualitative research was conducted within a cluster randomized controlled trial (C-RCT). It focused on understanding how the intervention influences behavior-related outcomes in the prescripti...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-020-01043-6
更新日期:2020-09-21 00:00:00