Implementation Of Care Program Research Articles

How to improve preconception care in a local setting? Views from Dutch multidisciplinary healthcare providers

ObjectiveTo explore healthcare providers’ views on improving preconception care in their region. DesignMixed-methods study. SettingWorking conferences aimed to educate healthcare providers on preconceptional risk factors and conduct a region-specific analysis of barriers and facilitators for implementing preconception care, were organised in ten municipalities in the Netherlands. Participants250 healthcare providers of various disciplines attended a working conference and participated in the study. Measurements and findingsParticipants were asked to both fill out a questionnaire concerning statements and experiences with preconception care and to participate in a workshop, to identify barriers and facilitators for the implementation of a local preconception care program. Almost all healthcare providers suggested that the responsibility for providing preconception care consultations lies within primary care (general practitioners (n = 239; 95.6%) and midwives (n = 236; 94.4%)). Professionals other than midwives found it significantly more difficult to start a conversation about a wish to conceive compared to midwives (26.8% versus 20.2%, p-value = 0.006) and felt less competent to provide preconceptional information (32.3% versus 15.1%, p-value = <0.001). Innovative facilitators were mentioned to improve reaching the target population with preconceptional information, i.e. the use of social media and local ambassadors. Key conclusionWhile the responsibility for providing preconception care consultations is best suited with primary care, many other healthcare providers involved may act as referrers towards preconception care. Still, approximately 1 in 7 midwives (strongly) disagree with the statement that it is part of their job to provide preconceptional information to couples with a wish to conceive. Implications for practiceThere is a need for integrating preconception care in many curricula and postgraduate courses, especially for non-midwives, to improve the delivery of preconception care. Insights in the suggested barriers and facilitators can improve the implementation of (local) preconception care programs.

Utilizing the Consolidated Framework for Implementation Research to Explore Palliative Care Program Implementation for American Indian and Alaska Natives throughout the United States.

Background: A significant shortage of palliative care (PC) services exists for American Indian and Alaska Native people (AI/ANs) across the United States. Using an implementation science framework, we interviewed key individuals associated with AI/AN-focused PC programs to explore what is needed to develop and sustain such programs. Objectives: To identify facilitators of implementation and barriers to sustainability associated with the development of PC programs designed for AI/ANs across the United States. Methods: We interviewed 12 key individuals responsible for the implementation of AI/AN-focused PC services. The Consolidated Framework for Implementation Research (CFIR) guided data coding and interpretation of themes. Results: We identified nine themes that map to CFIR constructs. Facilitators of implementation include high tension for change and respecting cultural values. Barriers to program sustainability include a lack of administrative leadership support. Discussion: AI/AN-focused PC programs should be congruent with community needs. PC program developers should focus on sustainability well before initial implementation.

Residential aged care staff perceptions and responses towards neuropsychiatric symptoms: a mixed methods analysis of electronic healthcare records

Objectives To investigate electronic care notes to better understand reporting and management of neuropsychiatric symptoms (NPS) by residential aged care (RAC) staff. Methods We examined semi-structured care notes from electronic healthcare notes of 77 residents (67% female; aged 67–101; 79% with formal dementia diagnosis) across three RAC facilities. As part of standard clinical practice, staff documented the NPS presentation and subsequent management amongst residents. Using a mixed-method approach, we analyzed the type of NPS reported and explored care staff responses to NPS using inductive thematic analysis. Results 465 electronic care notes were recorded during the 18-month period. Agitation-related behaviors were most frequently reported across residents (48.1%), while psychosis (15.6%), affective symptoms (14.3%), and apathy (1.3%) were less often reported. Only 27.5% of the notes contained information on potential causes underlying NPS. When faced with NPS, care staff responded by either providing emotional support, meeting resident’s needs, removing identified triggers, or distracting. Conclusion Results suggest that RAC staff primarily detected and responded to those NPS they perceived as distressing. Findings highlight a potential under-recognition of specific NPS types, and lack of routine examination of NPS causes or systematic assessment and management of NPS. These observations are needed to inform the development and implementation of non-pharmacological interventions and care programs targeting NPS in RAC. Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2022.2032597 .

Supporting Community Partners in Reducing HIV-Related Health Disparities: Technical Assistance Across a Spectrum of Intensity.

The HIV epidemic remains a public health threat in the U.S., and the dissemination and implementation of evidence-based prevention and care programs are critical to addressing significant HIV health disparities. The provision of technical assistance (TA) to program providers and evaluators is key for uptake of these programs. The University of California San Francisco Prevention Research Center (UCSF PRC) model for TA delivery uses topics and strategies adapted to address HIV health disparities for a global audience. This model specifically matches TA requests to a TA provider who has expertise in that area upon receiving a request through various communication channels. Areas of expertise include research methods, community engagement strategies, interventions, and Implementation Sciences. Our evaluation of diverse TA services indicates that on-demand TA is effective for light-touch requests and well-suited for moderate to intensive requests. The model is a promising, broad-reaching, and responsive alternative for providing TA to a multitude of HIV workforce recipients.

TELEMEDICINA: ESTADO NUTRICIONAL Y TOLERANCIA AL TRATAMIENTO QUIMIOTERÁPICO EN PACIENTES DOMICILIARIOS

Introduction: Malnutrition affects 40 to 70% of cancer patients increasing morbidity and mortality, decreasing quality of life and worsening response to treatments. Home chemotherapy is an effective patient centered strategy. Telemedicine is essential in the home care setting. Objectives: To determine the nutritional status of oncological patients in home chemotherapy and the relationship between nutritional status and adverse effects and tolerance to treatment. Methods: Observational, descriptive, and longitudinal study between March and October 2020. We included patients with diagnosis of cancer who received home treatment. The routes of administration were intravenous, intramuscular, subcutaneous and intravesical. Nutritional screening was performed using NutriScore ®. Variables Age, sex, diagnosis, nutritional status, route of administration, tolerance, intake, nutritional intervention, previous nutritional support. Descriptive statistical analysis and correlation between Nutritional Status and tolerance and adverse effects (Fisher's Test) were performed. Results: We included 105 patients (67 men), average age 67.7 years. Thirty presented nutritional risk. At baseline, 3 patients received nutritional support (2 oral and 1 parenteral). 836 chemotherapy sessions were performed. Tolerance: 621 (74.3%) very good; 151 (18%) good; 50 (6%) regular and 14 (1.7%) bad. Intake: Average 1517 calories / day. Of the 105 patients, 40 had adverse event, mainly digestive. One patient stopped treatment due to intolerance. Correlation between nutritional status and adverse events: no statistically significant differences. Correlation between Nutritional Status and tolerance: statistically significant association. Conclusion: Malnutrition is a frequent condition in cancer patients; high nutritional risk is related to lower tolerance to treatments. The implementation of remote nutritional care programs allows early detection of changes in nutritional status. Key words: Home chemotherapy; Telemedicine; nutritional support; cancer; malnutrition.

Effective Factors on Implementation of Pediatric Home Care Program Amid COVID 19 Pandemic: Facilitators and Barriers.

Background:Home care service is considered as comprehensive care for children with chronic disease or COVID-19. This study aimed to investigate the factors affecting the implementation of a home care nursing program for such children in 2019–2020.Materials and Methods:A descriptive-analytical study was conducted with 198 nurses working in pediatric wards of selective hospitals of Isfahan University of Medical Sciences. The data were collected through an author-administered questionnaire with 44 questions. The questionnaire was designed in two parts. Part one involved gathering the demographic data of the participants. Facilitating and barrier factors of the implementation of the care were prioritized and examined in part two by using the Likert scale in both the individual and the organizational domains. The data were analyzed using the mean frequency and paired t test.Results:The mean (SD) score of individual and organizational facilitating factors were 65.65 (16.24) and 65.98 (11.29), respectively, and the mean (SD) score of the organizational barriers was 82.04 (14.36), which was significantly higher than the mean score (SD) of the individual barriers of 57.94 (14.82) (t197 = 21.32, p < 0.05). The most important individual facilitating factor (53.82%) was “respectful communication with the family,” and the most important organizational facilitator (80.40%) was “Physicians’ support of the nurses.”Conclusions:Organizational factors were the most significant barriers. Therefore, the findings of this study will help policymakers in the program implementation.

Implementing and Sustaining Family Care Programs in Real-World Settings: Barriers and Facilitators

This presentation will summarize the extant published studies on the translation of proven family care programs for dementia in different care settings. This review is the first to our knowledge to examine the specific implementation efforts deployed in care settings for different family caregiver programs. In this review, we sought to answer three basic questions: (1) What theory base(s) or conceptual framework(s) guided the implementation of evidence-based family care programs?; (2) What implementation strategies were used to support translation into practice?; and (3) What were the identified drivers of and barriers to organizational change required for adoption of an evidence-based program? Understanding the frameworks and strategies deployed in translational studies published to date can help guide future translation efforts, inform the design of new family caregiver support programs that optimize their implementation potential, and ultimately help to minimize the “family care gap.”

Barriers and facilitators to virtual care in a geriatric medicine clinic: a semi-structured interview study of patient, caregiver and healthcare provider perspectives.

COVID-19-related physical distancing measures necessitated widespread adoption of virtual care (i.e. telephone or videoconference), but patients, caregivers and healthcare providers raised concerns about its implementation and sustainability given barriers faced by older adults. To describe barriers and facilitators experienced by people accessing and providing virtual care in a geriatric medicine clinic. Qualitative semi-structured interview study. We recruited and interviewed 20 English-speaking patients, caregivers and healthcare providers who participated in virtual care at St. Michael's Hospital's geriatric medicine clinic, Toronto, Canada, between 22 October 2020 and 23 January 2021. We analyzed data in two stages: framework analysis and deductive coding to the Theoretical Domains Framework. We included six healthcare providers, seven patients and seven caregivers. We identified eight themes: impact of the COVID-19 pandemic on virtual care uptake, complexity of virtually caring for older adults, uncertain accuracy of virtual assessments, inequity in access to virtual care, importance of caring for the patient-caregiver dyad, assimilating technology into the lives of older adults, impact of technology-related factors on virtual care uptake and impact of clinic processes on integration of virtual care into outpatient care. Further, we identified knowledge, skills, belief in capabilities, and environmental context and resources as key barriers and facilitators to uptake. Patients, caregivers and healthcare providers believe that there is a role for virtual care after COVID-19-related physical distancing measures relax, but we must tailor implementation of virtual care programs for older adults based on identified barriers and facilitators.

Designing of a Parenting Education Web Program in Overcoming Students' Learning Difficulties at Home during the COVID-19 Pandemic

This is the result of the research entitled Web Design of Parenting Education Programs in Overcoming Students' Learning Difficulties at Home during the Covid-19 Pandemic. This research was conducted in FIP-UMJ Labs. Elementary School in South Tangerang, Indonesia. The research method was model development, with a qualitative descriptive approach, a prototype model. The number of respondents was 397 elementary school students. The purpose of the study was to determine the problems faced by parents, so far in an effort to help their children study at home. The results of this study were proven based on the results of the analysis of respondent data, where only 79% of parents understand the child's parenting education web program at home, while the implementation of child care programs at school where 82% have been implemented properly. The effectiveness to overcome their children's learning difficulties at home is 65%, while for parents who have good communication between teachers and parents, the figure is 64%. The highest percentage gain of 91% is parents who accompany their children to study at home, while as many as 42% of parents prepare special time, to accompany their children to study at home. Difficulties in assisting children to study at home yielded a percentage of 47% and regarding concentration on learning for children, to overcome this, a percentage 72% was obtained. The parents who studied their children's learning materials was as much as 66%. Regarding the parents who prepared study time for their children at home according to the schedule given by the school, the obstacles faced by them in accompanying learning at home, were due to the busyness of parents and was reflected by a percentage rate of 53%.

Activity-based costing for HIV, primary care and nutrition services in low- and middle-income countries: A systematic literature review and synthesis

BackgroundThis study is a systematic literature review of HIV, nutrition, and primary care activity-based costing (ABC) studies conducted in low- and middle-income countries. ABC studies are critical for understanding the quantities and unit costs of the activities and resources for specific cost functions. The results of ABC studies enable governments, funders, and policymakers to utilize costing results to make efficient, cost-effective decisions on how to allocate scarce resources.MethodsWe followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology for systematic literature reviews. Key search terms included: (1) activity-based costing and time-driven activity-based costing, (2) cost of services, (3) HIV interventions OR (4) primary health care. Terms were searched within article titles and abstracts in PubMed, EconLit, and Scopus.Results1,884 abstracts were screened and reduced to 57 articles using exclusion criteria. After a full text review, 16 articles were included in the final data synthesis. Findings were used to classify costs into relevant and common inputs for activity-based costing. All costs were converted to unit cost (cost per patient) and inflated to January 2020 USD. The largest unit cost across nutrition services was training (US$194.16 per patient, 34.6% of total unit cost). The largest unit cost for HIV was antiretroviral therapy (ART) (US$125.41, 71.0%). The largest unit cost for primary care services was human resources (US$84.78, 62.5%). Overall costs per patient for HIV services were US$176.71, US$135.67 for primary care services, and US$561.68 for nutrition services. The costing results presented suggest that spending on HIV exceeds the actual cost of HIV services.ConclusionsThis is the first systematic literature review to summarize the costs of HIV, primary care, and nutrition services across activity-based costing studies. While there was a wide variation in the study designs and economic methods, many of the input cost categories were similar. With the increasing number of costing studies in countries around the world, understanding trends in costs by function and service can lead to greater efficiency in the implementation of HIV, primary care, and nutrition programs.

Factors associated with unmet supportive care needs of oncology patients at Dessie Referral Hospital, 2020.

BackgroundAssessment of supportive care needs for cancer patients and identifying factors affecting these needs is important for the implementation of supportive care programmes, as the burden of cancer is increasing in Ethiopia.ObjectiveTo determine the prevalence and associated factors of unmet supportive care needs of cancer patients at Dessie Referral Hospital, Dessie, South Wollo, North East Ethiopia, 2020.MethodsA cross-sectional study design was implemented among 405 cancer patients from February to 30 July 2020, at Dessie Referral Hospital. The data were collected using a validated supportive care needs survey questionnaire through face to face interview and data extraction tools. Both descriptive and inferential statistics were used and bi-variable and multivariable logistic regressions were used to describe the association between dependent and independent variables. Thus, a p-value of less than 0.05 was considered statistically significant.ResultFrom the total 405 participants, 275 (67.5%) were females with a mean age of (mean ± standard deviation) 48.6 ± 15.4 years. Unmet supportive care needs were higher among psychological needs (81.0%, 95% (confidence interval) CI = 77.0–84.9) and physical needs (74.6%, 95% CI = 70.1–79.0). Old age was associated with unmet physical and psychological needs domain than young age (adjusted odds ratio (AOR) = 1.03; 95% CI: 1.01–1.06), (AOR = 1.06; 95% CI: 1.03–1.09), respectively. High household income was significantly associated with health information needs (AOR = 2.22; 95% CI: 1.33–13.93), remission status (AOR = 0.37; 95% CI: 0.22–0.62) was associated with patient/supportive care needs, late stage cancer was also significantly associated with physical, psychological and health information needs of patients (AOR = 2.19; 95% CI: 1.18–4.06), (AOR = 2.3; 95% CI: 1.18–4.57) and (AOR = 2:95%; CI: 1.03–3.86), respectively. Besides, source of information had a statistically significant association with psychological, health information and patient care needs domain (AOR = 2.61; 95% CI: 1.15–5.93), (AOR = 3.1; 95% CI: 1.65–5.82) and (AOR = 2.2; 95% CI: 1.25–3.87), respectively.Conclusion and recommendationThis study shows that the prevalence of unmet supportive care needs in cancer patients is high in each domain. Age, income, cancer stage, cancer site, treatment option, time since diagnosis and sources of information were associated across one or more unmet supportive care needs domains. Therefore, the government and health professionals should work together to improve the unmet needs of cancer patients.

Feasibility and Implementation of a Multimodal Supportive Care Program to Improve Outcomes in Older Patients Undergoing Allogeneic Stem Cell Transplantation

Increasingly, patients age ≥65 years are undergoing allogeneic hematopoietic stem cell transplantation (allo-SCT). Although age alone is a well-documented predictor of overall survival (OS) and nonrelapse mortality (NRM), growing evidence suggests that poor functional status and frailty associated with aging may have roles as well. Our goal in the present study was to identify and improve these and other aging-related maladies by developing a multimodal supportive care program for older allo-SCT recipients. We designed and implemented a multimodal supportive care program, Enhanced Recovery in Stem Cell Transplant (ER-SCT), for patients age ≥65 years undergoing allo-SCT. The ER-SCT program consists of evaluation and critical interventions by key health care providers from multiple disciplines starting before hospital admission for transplantation and extending through 100 days post-allo-SCT. We determined the feasibility of implementing this program in a large stem cell transplantation center. After 1 year of ongoing process improvements, multiple evaluations, and enrollment, we found that a dedicated weekly clinic was necessary to coordinate care and evaluate patients early. We successfully enrolled 57 of 64 eligible patients (89%) in the first year. Our data show that a multimodal supportive care program to enhance recovery for older patients undergoing allo-SCT is feasible. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.

Implementation of the Serious Illness Care Program on Hospital Medical Wards

BackgroundPoor communication with hospitalized patients facing serious, life-limiting illnesses can result in care that is not consistent with patients’ values and goals. The Serious Illness Care Program (SICP) is a communication intervention originally designed for the outpatient oncology setting that could address this practice gap. MethodsA multihospital quality improvement initiative adapted and implemented the SICP on the medical wards of four teaching hospitals in Calgary, Hamilton, Ottawa, and Montreal. The SICP consists of three main components: tools (including the Serious Illness Conversation Guide for clinicians), training for frontline clinicians to practice using the Guide, and system change to trigger and support serious illness conversations in practice. Implementation of the SICP at each site followed a phased approach: (1) Building a Foundation; (2) Planning; (3) Implementation; and (4) Sustainability. To assess the success of implementation and its impact, we developed an evaluation framework that includes process measures (e.g., number and proportion of eligible clinicians trained, number and proportion of eligible patients who received a serious illness conversation), patient-reported outcomes (including a validated, single-item “Feeling Heard and Understood” question), and clinician-reported outcomes. ConclusionBased on our adaptation and implementation efforts to date, we have found that the SICP is readily adaptable to an inpatient medical ward setting. Future manuscripts will report on the fidelity of implementation, impact on patient- and clinician-reported outcomes, and lessons learned about how to implement and sustain the program. RésuméContexteUne mauvaise communication avec les patients hospitalisés atteints d’une maladie grave qui limite leur espérance de vie peut se traduire par des soins qui ne correspondent pas à leurs valeurs et à leurs objectifs. Le Programme de soins dans le cas de maladies graves (PSMG) est une intervention de communication conçue à l’origine pour l’oncologie externe qui pourrait remédier à cette lacune dans la pratique. MéthodologieUne initiative multihospitalière visant l’amélioration de la qualité a adapté et mis en œuvre le PSMG dans les unités de soins de quatre hôpitaux universitaires situés à Calgary, à Hamilton, à Ottawa et à Montréal. Le PSMG comprend trois principaux éléments : des outils (dont le guide de conversation sur les maladies graves à l’intention des cliniciens), de la formation pour que les cliniciens de première ligne puissent s’exercer à l’aide du guide et un changement de système pour entamer et faciliter les conversations sur les maladies graves dans la pratique. À chaque endroit, la mise en œuvre du PSMG a suivi une approche progressive : 1) l’établissement d’une base; 2) la planification; 3) la mise en œuvre; 4) la durabilité. Pour évaluer le succès de la mise en œuvre et ses répercussions, nous avons créé un cadre d’évaluation qui comprend des mesures de processus (p. ex., le nombre et la proportion de cliniciens admissibles formés, le nombre et la proportion de patients admissibles qui ont eu une conversation sur les maladies graves), des résultats rapportés par les patients (dont une question validée à un seul élément « se sentir écouté et compris ») et des résultats rapportés par les cliniciens.ConclusionÀ la lumière de nos activités d’adaptation et de mise en œuvre réalisées jusqu’à maintenant, nous constatons que le PSMG est facilement adaptable à un contexte d’unité de soins pour les patients hospitalisés. Les prochains manuscrits porteront sur la fidélité de la mise en œuvre, les répercussions sur les résultats rapportés par les patients et les cliniciens et les leçons apprises sur la façon de mettre en œuvre et de maintenir le programme.

Implementation strategy of primary health care in Ovia communities

Primary health care is the essential health service provided at the grassroot level. Over the years the implementation of Primary Health Care (PHC) programmes in Edo state are bedeviled with associated challenges such as limited community participation, great communication gap that limit evaluation processes of PHC programme and slow pace collaboration among stakeholders. These challenges need to be averted through effective and people oriented strategies to ensure the implementation of primary health care. A descriptive research design with a population of the study comprised 1,024 primary health care stakeholders in Edo state. Multi-stage sampling technique was used to select 180 respondents for the study. The study found that intersectoral collaboration involving partnerships with community health agencies such as village health committees and ward health committees significantly influenced the implementation of PHC. Intersectoral collaboration, community mobilization strategy and community feedback mechanism are effective and efficient strategies for improved implementation of PHC programmes. The study recommended among others that National Primary Health Care Development Agency (NPHCDA) and State Primary Health Care Development Agency (SPHCDA) should strengthen partnership with international health organizations such as WHO, UNICEF, GAVI, UNDP and boost confidence and trust of these international organizations.

Clinicians’ Perspectives After Implementation of the Serious Illness Care Program

Discussions about goals of care with patients who are seriously ill typically occur infrequently and late in the illness trajectory, are of low quality, and focus narrowly on the patient's resuscitation preferences (ie, code status), risking provision of care that is inconsistent with patients' values. The Serious Illness Care Program (SICP) is a multifaceted communication intervention that builds capacity for clinicians to have earlier, more frequent, and more person-centered conversations. To explore clinicians' experiences with the SICP 1 year after implementation. This qualitative study was conducted at 2 tertiary care hospitals in Canada. The SICP was implemented at Hamilton General Hospital (Hamilton, Ontario) from March 1, 2017, to January 19, 2018, and at Foothills Medical Centre (Calgary, Alberta) from March 1, 2018, to December 31, 2020. A total of 45 clinicians were invited to participate in the study, and 23 clinicians (51.1%) were enrolled and interviewed. Semistructured interviews of clinicians were conducted between August 2018 and May 2019. Content analysis was used to evaluate information obtained from these interviews between May 2019 and May 2020. The SICP includes clinician training, communication tools, and processes for system change. Clinicians' experiences with and perceptions of the SICP. Among 23 clinicians interviewed, 15 (65.2%) were women. The mean (SD) number of years in practice was 14.6 (9.1) at the Hamilton site and 12.0 (6.9) at the Calgary site. Participants included 19 general internists, 3 nurse practitioners, and 1 social worker. The 3 main themes were the ways in which the SICP (1) supported changes in clinician behavior, (2) shifted the focus of goals-of-care conversations beyond discussion of code status, and (3) influenced clinicians personally and professionally. Changes in clinician behavior were supported by having a unit champion, interprofessional engagement, access to copies of the Serious Illness Conversation Guide, and documentation in the electronic medical record. Elements of the program, especially the Serious Illness Conversation Guide, shifted the focus of goals-of-care conversations beyond discussion of code status and influenced clinicians on personal and professional levels. Concerns with the program included finding time to have conversations, building transient relationships, and limiting conversation fluidity. In this qualitative study, hospital clinicians described components of the SICP as supporting changes in their behavior and facilitating meaningful patient interactions that shifted the focus of goals-of-care conversations beyond discussion of code status. The perceived benefits of SICP implementation stimulated uptake within the medical units. These findings suggest that the SICP may prompt hospital culture changes in goals-of-care dialogue with patients and the care of hospitalized patients with serious illness.

Development, Implementation, and Outcomes of a Serious Illness Care Community of Practice

ContextCommunities of Practice (CoP) can help geographically separated individuals who share a joint enterprise, mutual engagement, and a repertoire of tools to gain, maintain, and implement new skills, including serious illness communication. ObjectivesTo investigate the health system uptake, implementation and outcomes of the Serious Illness Community of Practice (SICoP). MethodsParticipants included members of the online SICoP, including participants from all 50 states in the United States and 44 countries, interested in implementation of the Serious Illness Care Program. Yearly surveys asked members about their program's composition, completed trainings, number of serious illness conversations, and utilization of the online SICoP tools and resources. ResultsOver four years, membership in the SICoP increased from 429 to 1,912, with an estimated 17,785 clinicians trained and 38,945 serious illness conversations conducted. Members have continued to utilize and modify the SICoP resources. ConclusionsUtilizing a CoP has contributed to improving the health care system implementation and process outcomes of serious illness communication training. Key MessageThis article describes the implementation and health system outcomes of a Community of Practice developed to support serious illness communication. The results indicate that the membership of the community grew and that the community supported growth in the number of trained clinicians and the number of serious illness conversations conducted.

Incidence of Stillbirth in Relation to Period of Delivery, Socioeconomic Status and Period of Gestation in a Rural Tertiary Care Hospital-MGIMS, Sewagram Within Study Period of Three Years (2013-2016).

Stillbirth remains one of the most common adverse outcomes of pregnancy, yet is among the least studied. Occurrence of stillbirth is a tragic event faced by mother as well as obstetrician. It has implications on couple, their family and the health care providers. It reflects a failure or lapse in implementation of maternal and child health care programs. Worldwide 3.2 million stillbirth occur in world, 20-66 per 1000 total births in India in different states. Stillbirth in India is largely underreported. Stillbirths contribute to more than half of perinatal death. More than 2/3rd Stillbirth take place during pregnancy and remaining during course of labour. Registration of all live births and stillbirths, together with evaluation of cause of stillbirths are important initial steps for developing countries. A standard classification system would be important to document aetiology of stillbirth in developing countries. All cases who delivered a stillborn baby in the hospital were studied in details. The records were maintained date-wise. Initially, the basic demographic information was taken giving special attention to age, education, occupation, socioeconomic status, rural or urban residence etc. The two controls of live births were also asked the same details and the data were entered in Microsoft word excel sheet and analyzed by Chi-square test. Incidence of stillbirth in MGIMS Sewagram which is Tertiary care centre placed in rural area was 30.57%. Incidence in relation to place (rural) 62.42%, more in antepartum 94.9% (149/157), in low socioeconomic status 48%. It was found more in 30-32 weeks of period of gestation as in this period most of medical disorders of pregnancy precipitate. The online version of this article (10.1007/s13224-021-01453-6) contains supplementary material, which is available to authorized users.

Effectiveness and acceptability of a multidisciplinary approach in improving the care of patients with advanced chronic kidney disease: a pilot study.

This study aimed at determining the feasibility of conducting a large-scale pragmatic effectiveness study on the implementation of multidisciplinary care (MDC) program for patients with advanced chronic kidney disease (CKD). This is a single-arm pre-post intervention design pilot study over 12months. Participants with an estimated glomerular filtration rate (eGFR) between 11 and 20ml/min/1.73m2 were screened and recruited at the initial MDC clinic visit and followed for 12months. Clinical parameters, KDQOL™-36, questionnaires, and interviews were collected, administered, and analysed for enrolment and completion rates, baseline characteristics, implementation fidelity, adherence to CKD interventions, eGFR decline, CKD complications, health-related quality of life, and participants' acceptability of the program. The study enrolment and completion rates were 43.1% (50/116 screened) and 66.0% (33/50 recruited) respectively. The participants had a mean age of 68.5years (SD9.0) and a mean eGFR of 15.4ml/min/1.73m2(3.2). After 12months of MDC program, there was increased adherence to CKD interventions (difference -0.6(1.0), 95%CI -1.1, -0.1, p = 0.02). There was good participants' acceptability of the program with participants being more satisfied with the waiting time and having a better understanding of kidney failure after attending the program. No difference in the eGFR decline noted (difference 0.0ml/min/1.73m2(5.3), 95%CI -1.9, 1.9, p = 1.00). Our pilot data suggest increased adherence to CKD interventions and good acceptability to MDC program, albeit no difference in eGFR decline probably because of the small sample size. However, reasons for overall low enrolment and completion rates need to be explored and addressed while designing a future large-scale randomised controlled trial.

Effect of COVID-19 on High-risk Neonate Home Care Program: An Audit Study

One of the most important goals of the health system in this pandemic was to provide a home care for the high-risk neonates. The aim of this study was to audit a high-risk neonate home care program during the COVID-19 pandemic. This descriptive-analytical study was conducted with the participation of 158 high-risk neonates discharged from neonatal intensive care units of hospitals. Data collection was performed through questionnaire and a researcher-made checklist. The researcher observed and evaluated 7 areas of healthcare. The study was first performed in person, but after the COVID-19 pandemic, the researcher evaluated these cares in absentia. The results of the study showed that the mean score of in-person “conduction” was 56.7 and in-absentia conduction was 52.5 and the mean score of in-person “education” was 63.6 and in-absentia conduction was 65.6. The results showed that there was no significant difference between the in-person and in-absentia methods. Moreover, while 53.2% of caregivers performed well, 33.5% of them performed poorly. According to the results, the implementation of home care program for high-risk neonates is relatively desirable. However, some regular evaluation and review need to be conducted on instructions and implementations. Regular education of caregivers and, finally, regular in-person and in-absentia monitoring is essential. In-absentia home care during the COVID-19 pandemic was not an obstacle to the implementation of the program and it was implemented through telephone and follow-up.

Evaluating the implementation of a chronic obstructive pulmonary disease management program using the Consolidated Framework for Implementation Research: a case study

BackgroundChronic obstructive pulmonary disease (COPD) is a prevalent chronic disease that requires comprehensive approaches to manage; it accounts for a significant portion of Canada’s annual healthcare spending. Interprofessional teams are effective at providing chronic disease management that meets the needs of patients. As part of an ongoing initiative, a COPD management program, the Best Care COPD program was implemented in a primary care setting. The objectives of this research were to determine site-specific factors facilitating or impeding the implementation of a COPD program in a new setting, while evaluating the implementation strategy used.MethodsA qualitative case study was conducted using interviews, focus groups, document analysis, and site visits. Data were deductively analyzed using the Consolidated Framework for Implementation Research (CFIR) to assess the impact of each of its constructs on Best Care COPD program implementation at this site.ResultsEleven CFIR constructs were determined to meaningfully affect implementation. Five were identified as the most influential in the implementation process. Cosmopolitanism (partnerships with other organizations), networks and communication (amongst program providers), engaging (key individuals to participate in program implementation), design quality and packaging (of the program), and reflecting and evaluating (throughout the implementation process). A peer-to-peer implementation strategy included training of registered respiratory therapists (RRT) as certified respiratory educators and the establishment of a communication network among RRTs to discuss experiences, collectively solve problems, and connect with the program lead.ConclusionsThis study provides a practical example of the various factors that facilitated the implementation of the Best Care COPD program. It also demonstrates the potential of using a peer-to-peer implementation strategy. Focusing on these factors will be useful for informing the continued spread and success of the Best Care COPD program and future implementation of other chronic care programs.