Applied Health Services Research Research Articles

Systematic Literature Review of the Prevalence, Pattern, and Determinant of Multimorbidity Among Older Adults in Nigeria.

Multimorbidity is a rising health issue globally and it is likely to become challenging in developing countries like Nigeria as they experience economic, demographic, and epidemiological transition. Yet, evidence of prevalence and patterns of multimorbidity, and their determinants, are scarce. This study aims to systematically review studies of the prevalence, patterns, and determinants of multimorbidity in Nigeria. Studies were identified by searching 5 electronic databases (PubMed, Web of Science, CINAHL, PsycINFO, Africa Index Medicus/Global Index Medicus). Multimorbidity as well as other versions of it was used to search. The prevalence and determinants were also searched. According to preestablished inclusion criteria, and using different search strategies, 6 articles were included. The quality and risk of bias were assessed using Joanna Briggs Institute appraisal tool for prevalence studies. Two researchers assessed the eligibility of studies for inclusion. The protocol was registered on PROSPERO Ref no. CRD42021273222. The overall prevalence, pattern, and determinants were analyzed. We identified 6 eligible publications describing studies that included a total of 3332 (men 47.5%, women 52.5%) patients from 4 states plus the federal capital territory Abuja. The multimorbidity prevalence ranges from 27% to 74% among elderly Nigerians. Cardiovascular together with metabolic and/or musculoskeletal conditions were the frequent patterns of multimorbidity. A positive association was observed between age and multimorbidity in most studies. Other factors associated with multimorbidity were female gender, low education status, poor monthly income/unemployment, hospitalization, medical visits, and emergency services. There has been a growing need for more applied health services research to understand better and manage multimorbidity in developed countries. The scarcity of studies in our review reveals that multimorbidity is not a priority area of research in Nigeria, and this will continue to hinder policy development in that area.

Towards collaborative action: A project on interprofessional stroke care in the Covid-19 pandemic

Abstract Background Stroke is one of the leading causes of disability in adulthood. Cooperatively organised stroke care requires a high degree of interprofessional competence of junior professionals. Objectives The project aim was to develop interprofessional competences for stroke care, to identify gaps in care as well as approaches to innovation during the pandemic through joint research. The focus was on person-centred care, communication and collaboration, roles and responsibilities, including stroke-navigators. German Bachelor students of occupational therapy, physiotherapy and speech therapy of the 7th semester (n = 22) were accompanied online in 60 teaching units in 2020/2021. The seminars consisted of (a) theoretical introduction to interprofessional stroke care (b) case-based collaboration with problem-based learning (c) applied health services research. The evaluation was based on a central questionnaire and written reflections from all students. Results The following themes were identified and investigated in 5 interprofessional groups: (1) Impact of the Covid-19 pandemic on the acute care and rehabilitation of stroke patients, (2) International comparison of interprofessional stroke care based on guidelines to improve current practice, (3) Interprofessional diagnostics in stroke care, (4) Interprofessional patient-centered goal setting in outpatient stroke care, (5) Agreements of actors involved in stroke treatment to best serve the needs of the patient. The response rate to the centralised evaluation was low (14%). The project was rated good to very good in terms of planning and presentation, relevance, and interaction with students. Conclusions The students reported central aspects for interprofessional learning: The reflections predominantly described growth in professional competences, in skills for cooperation and problem solving, which can be transferred to professional life. The main point of criticism was the necessity of digital teaching in the pandemic. Key messages • Empowering interprofessional cooperation through a joint project of different Bachelor programmes helps to strengthen the students’ professional identity and shared responsibility for stroke care. • Online teaching can be a valuable facilitator of learning, but should not completely replace face-to-face teaching for stroke care.

LOng COvid Multidisciplinary consortium Optimising Treatments and servIces acrOss the NHS (LOCOMOTION): protocol for a mixed-methods study in the UK.

IntroductionLong COVID, a new condition whose origins and natural history are not yet fully established, currently affects 1.5 million people in the UK. Most do not have access to specialist long COVID services. We seek to optimise long COVID care both within and outside specialist clinics, including improving access, reducing inequalities, helping self-management and providing guidance and decision support for primary care. We aim to establish a ‘gold standard’ of care by systematically analysing current practices, iteratively improving pathways and systems of care.Methods and analysisThis mixed-methods, multisite study is informed by the principles of applied health services research, quality improvement, co-design, outcome measurement and learning health systems. It was developed in close partnership with patients (whose stated priorities are prompt clinical assessment; evidence-based advice and treatment and help with returning to work and other roles) and with front-line clinicians. Workstreams and tasks to optimise assessment, treatment and monitoring are based in three contrasting settings: workstream 1 (qualitative research, up to 100 participants), specialist management in 10 long COVID clinics across the UK, via a quality improvement collaborative, experience-based co-design and targeted efforts to reduce inequalities of access, return to work and peer support; workstream 2 (quantitative research, up to 5000 participants), patient self-management at home, technology-supported monitoring and validation of condition-specific outcome measures and workstream 3 (quantitative research, up to 5000 participants), generalist management in primary care, harnessing electronic record data to study population phenotypes and develop evidence-based decision support, referral pathways and analysis of costs. Study governance includes an active patient advisory group.Ethics and disseminationLOng COvid Multidisciplinary consortium Optimising Treatments and servIces acrOss the NHS study is sponsored by the University of Leeds and approved by Yorkshire & The Humber—Bradford Leeds Research Ethics Committee (ref: 21/YH/0276). Participants will provide informed consent. Dissemination plans include academic and lay publications, and partnerships with national and regional policymakers.Trial registration number NCT05057260, ISRCTN15022307.

Partnerships to Connect Aging Research to Policy

The fifth speaker is Dr. Kali Thomas. Dr. Thomas will discuss her experience working in partnership with government and non-profit organizational stakeholders to conduct aging research that informs policy and practice. Dr. Thomas is an Associate Professor at the Brown School of Public Health and research health science specialist at the Providence VA Medical Center, where her research focuses on identifying ways to improve the quality of life of older adults needing long-term services and supports (LTSS) through applied health services research.

MORE Care: an evaluation of an interprofessional oral health quality improvement initiative.

This evaluation assesses the Medical Oral Expanded Care (MORE Care) initiative in four states that focused on oral health integration into primary care practices located in dental shortage areas. This analysis is conducted using self-reported primary data collected from each of the participating MORE Care clinics in South Carolina, Pennsylvania, Colorado and Oregon. Three measures: the percentage of pediatric patients with a) fluoride varnish applied, b) self-management goals reviewed, and c) risk assessed, were evaluated to compare the impact and timing of change tactics on participating teams. An engagement dashboard tool was also hand coded with inductive codes using an adapted grounded theory approach common in applied health services research, to iteratively identify themes that could illuminate or explain quantitative findings. The average proportion of pediatric patients receiving fluoride varnish increased from 25 percent after the first collaborative learning session to 40 percent after the third collaborative learning session. The proportion of pediatric patients with self-management goals reviewed also improved, increasing from 25 percent to 62 percent. There was more variation in the proportion of pediatric patients with oral health risk assessments completed increasing from 47 percent to 77 percent. Qualitative analysis of MORE Care open text data produced three themes related to facilitators and barriers of project implementation and criteria for project success. The results of this analysis demonstrated that MORE Care is effective in creating an operational structure for integrating oral health care into primary care practices and most successful when participating clinics meet success criteria.

Decentering health research networks: Framing collaboration in the context of narrative incompatibility and regional geo-politics

Research innovations and breakthroughs are increasingly realised through collaborative networks amongst state and non-state actors. This article investigates the utilisation of such networks in the field of applied health services research, where policy narratives repeatedly emphasise the importance of collaboration between university researchers, clinical and health service leaders, patient representatives and industry. The translation of policy into practice suggests that these networks are not always designed and managed in line with policy aspirations. Taking a decentred approach, the study reported in this article examines how local policy actors translate national policies for collaborative health research networks in the context of their own histories of applied research, including local narratives and priorities for health research. The study shows that local actors face key dilemmas and opportunities for situated agency, as they experience three competing policy narratives, first, for carrying out world-class research; second, for ensuring research meets local needs and third, for developing new understanding about the implementation of research into practice. Although these expectations might appear coherent to policy-makers, at the regional level, they provide the basis for disagreement and negotiation amongst local policy actors through which the local narrative of collaborative research is framed to regional stakeholders. The study shows how the tensions between elite and local narratives can be reconciled through re-framing activities, especially the articulation of ‘parallel frames’ within a ‘cascade framing’ process.

Learning from a Feasibility Trial of a Simple Intervention: Is Research a Barrier to Service Delivery, or is Service Delivery a Barrier to Research?

(1) Background: Applied health services research (AHSR) relies upon coordination across multiple organizational boundaries. Our aim was to understand how competing organizational and professional goals enhance or impede the conduct of high quality AHSR. (2) Methods: A qualitative study was conducted in two local health care systems in the UK, linked to a feasibility trial of a clinic-based intervention in secondary care. Data collection involved 24 semi-structured interviews with research managers, clinical research staff, health professionals, and patients. (3) Results: This study required a dynamic network of interactions between heterogeneous health and social care stakeholders, each characterized by differing ways of organizing activities which constitute their core functions; cultures of collaboration and interaction and understanding of what research involves and how it contributes to patient care. These interrelated factors compounded the occupational and organizational boundaries that hindered communication and coordination. (4) Conclusions: Despite the strategic development of multiple organizations to foster inter-professional collaboration, the competing goals of research and clinical practice can impede the conduct of high quality AHSR. To remedy this requires the alignment and streamlining of organizational goals, so that all agencies involved in AHSR develop a shared understanding and mutual respect for the progress of evidence-based medicine and the complex and often nuanced environments in which it is created and practiced.

Building Research Capacity for Impact in Applied Health Services Research Partnerships Comment on "Experience of Health Leadership in Partnering With University-Based Researchers in Canada - A Call to "Re-imagine" Research".

Bowen and colleagues ask us to re-imagine how to conduct research in academic-practice partnerships, and to develop capacity in the applied research and health workforce to do this. This commentary reinforces their messages, and describes a framework of research capacity development for impact (RCDi) which emphasizes active and continuous experiential learning within research partnerships. The RCDi framework includes the need to focus on multiple levels in the collaboration architecture, and describes principles of working that aims to increase impact on services, and learning opportunities for all partners.

Nursing Home Length of Stay in 3 Canadian Health Regions: Temporal Trends, Jurisdictional Differences, and Associated Factors

ObjectivesTo assess (1) temporal changes (2008–2015) in nursing home (NH) length of stay (LoS) in 3 Canadian health jurisdictions (Edmonton, Calgary, Winnipeg), (2) resident admission characteristics associated with LoS, and (3) temporal changes of admission characteristics in each of the 3 jurisdictions. DesignRetrospective cohort study using data previously collected in Translating Research in Elder Care (TREC), a longitudinal program of applied health services research in Canadian NHs. Setting and participants7817 residents admitted between January 2008 and December 2015 to a stable cohort of 18 NHs that have consistently participated in TREC since 2007. MethodsLoS was defined as time between a resident's first NH admission and final discharge from the NH sector. Analyses included descriptive statistics, Kaplan Meier estimates (unadjusted LoS), and Cox proportional hazard regressions (adjusted LoS), adjusted for resident characteristics (eg, age, cognitive performance, and health instability). We also controlled for NH size and ownership. ResultsIn jurisdictions with increasing care needs, unadjusted median LoS [95% confidence interval (CI)] decreased over time (2008 and 2009 vs 2014 and 2015 admissions); in Calgary from 1.837 (95% CI 1.618, 2.275) to 1.328 (95% CI 1.185, 1.489) years and in Edmonton from 1.927 (95% CI 1.725, 2.188) to 1.073 (95% CI 0.936, 1.248) years. In Winnipeg, care needs and LoS remained constant (2.163, 95% CI 1.867, 2.494, vs 2.459, 95% CI 2.155, 2.883, years). Resident characteristics including higher physical dependency [hazard ratio (HR) 1.205, 95% CI 1.133, 1.282], higher cognitive impairment (HR 1.112, 95% CI 1.042, 1.187), or higher health instability (HR 1.333, 95% CI 1.224, 1.452) were associated with lower LoS. Adjustment for resident characteristics reduced jurisdictional LoS differences and rendered temporal LoS differences within jurisdictions statistically nonsignificant. Conclusions/ImplicationsIn jurisdictions where care needs at admission have increased since 2008, resident LoS has decreased. Jurisdictional differences in care needs and LoS indicate that health policies may affect these outcomes. Variations of resident outcomes by policy environment require additional scrutiny.

Exploring the synergies between focused ethnography and integrated knowledge translation

BackgroundIssues with the uptake of research findings in applied health services research remain problematic. Part of this disconnect is attributed to the exclusion of knowledge users at the outset of a study, which often results in the generation of knowledge that is not usable at the point of care. Integrated knowledge translation blended with qualitative methodologies has the potential to address this issue by working alongside knowledge users throughout the research process. Nevertheless, there is currently a paucity of literature about how integrated knowledge translation can be integrated into qualitative methodology; herein, we begin to address this gap in methodology discourse. The purpose of this paper is to describe our experience of conducting a focused ethnography with a collaborative integrated knowledge translation approach, including the synergies and potential sources of discord between integrated knowledge translation and focused ethnography.MethodsWe describe the specific characteristics and synergies that exist when using an integrated knowledge translation approach with focused ethnography, using a research exemplar about the experiences of frail, older adults undergoing a transcatheter aortic valve implantation.ResultsEmbedding integrated knowledge translation within focused ethnography resulted in (1) an increased focus on the culture and values of the context under study, (2) a higher level of engagement among researchers, study participants and knowledge users, and (3) a commitment to partnership between researchers and knowledge users as part of a larger programme of research, resulting in a (4) greater emphasis on the importance of reciprocity and trustworthiness in the research process.ConclusionsEngaging in integrated knowledge translation from the outset of a study ensures that research findings are relevant for application at the point of care. The integration of integrated knowledge translation within focused ethnography allows for real-time uptake of meaningful and emerging findings, the strengthening of collaborative research teams, and opportunities for sustained programmes of research and relationships in the field of health services research. Further exploration of the integration of knowledge translation approaches with qualitative methodologies is recommended.

Developing the Librarians' Role in Supporting Grant Applications and Reducing Waste in Research: Outcomes From a Literature Review and Survey in the NIHR Research Design Service

ABSTRACTLibrarians and information specialists' involvement during the development of grant applications for external funding can save researchers' time, provide specialist support, and contribute to reducing avoidable waste in research. This article presents a survey of information specialists working for the National Institute for Health Research's Research Design Service within English applied health services research and a scoping review to identify other examples of librarians supporting grant applications. The survey found that support included: verifying proposed research has not already been performed; searching literature to provide background for the project; and advising on or writing systematic review methods. The scoping review found three examples where librarians were involved: in writing sections of the application; conducting reviews, and becoming a co-applicant. We recommend librarians engage with researchers by checking whether search requests are to support an application and by becoming familiar with resources and techniques to support grant proposal development.

Evidence in the learning organization

BackgroundOrganizational leaders in business and medicine have been experiencing a similar dilemma: how to ensure that their organizational members are adopting work innovations in a timely fashion. Organizational leaders in healthcare have attempted to resolve this dilemma by offering specific solutions, such as evidence-based medicine (EBM), but organizations are still not systematically adopting evidence-based practice innovations as rapidly as expected by policy-makers (the knowing-doing gap problem). Some business leaders have adopted a systems-based perspective, called the learning organization (LO), to address a similar dilemma. Three years ago, the Society of General Internal Medicine's Evidence-based Medicine Task Force began an inquiry to integrate the EBM and LO concepts into one model to address the knowing-doing gap problem.MethodsDuring the model development process, the authors searched several databases for relevant LO frameworks and their related concepts by using a broad search strategy. To identify the key LO frameworks and consolidate them into one model, the authors used consensus-based decision-making and a narrative thematic synthesis guided by several qualitative criteria. The authors subjected the model to external, independent review and improved upon its design with this feedback.ResultsThe authors found seven LO frameworks particularly relevant to evidence-based practice innovations in organizations. The authors describe their interpretations of these frameworks for healthcare organizations, the process they used to integrate the LO frameworks with EBM principles, and the resulting Evidence in the Learning Organization (ELO) model. They also provide a health organization scenario to illustrate ELO concepts in application.ConclusionThe authors intend, by sharing the LO frameworks and the ELO model, to help organizations identify their capacities to learn and share knowledge about evidence-based practice innovations. The ELO model will need further validation and improvement through its use in organizational settings and applied health services research.

University Collaboration in Delivering Applied Health and Nursing Services Research Training

In 2001-2002, the Canadian Health Services Research Foundation (CHSRF) and the Canadian Institutes of Health Research (CIHR) committed 10 years of funding for the creation and implementation of three Regional Training Centres to build capacity in health services and policy research in the Atlantic, Ontario and Western regions of Canada and one training centre in Quebec to focus on the development of nursing services researchers. Each RTC comprises several universities that collaborate to deliver the graduate training. The authors of this paper describe the consortium-related features of the RTCs, including approval processes, formal agreements, governance, communication, students, curriculum, administration and use of educational technology. The discussion outlines the benefits and challenges of university collaboration for participating students, faculty and universities and summarizes lessons learned.

A Foot in Both Camps: Graduate Voices at the Interface of Applied Health Services Research, Policy and Decision-making

The Regional Training Centres (RTCs) have established a new, non-traditional model of applied health services research training. Graduates report that the programs provide an academic "home" where they can pursue their health and nursing services research interests while engaging with decision-makers. This discussion paper shares perspectives from eight RTC graduates about their lives and careers at the interface of applied health and nursing services research, policy and decision-making, in particular, training in a novel graduate program, building lasting connections among researchers, policy makers and managers and acting as liaisons among these communities. Graduates cite their exclusive access to a health services and policy network as an enticing feature of their training experience. They have forged careers that require work in both the research and decision-making realms, and clearly prefer having "a foot in both camps."

CHSRF Column: Building Capacity in Applied Health Services Research

CHSRF Column: Building Capacity in Applied Health Services Research

An agenda for clinical research in geriatrics

The health of the older segment of the population is affected by two types of problems: those that cause death and those that cause disability. Both types need to be studied. All levels of investigation, from basic clinical research to applied health services research, are needed. Areas of investigation must include the killer diseases (cardiovascular disease, cerebrovascular disease, and cancer) and disability-causing conditions, such as Alzheimer's disease and metabolic, genitourinary, musculoskeletal, and special sense disorders. Pharmacotherapeutics and disease management are also subjects that deserve attention. Problems related to race and gender differences, health services research, and technology development and assessment need to be addressed. Clinical investigators in geriatrics must be recruited and trained, and funding for their activities must be increased.

Applied health services research

Applied health services research

Applied Health Services Research

Applied Health Services Research

Applied Health Services Research

Applied Health Services Research