Innovative Practice Models Research Articles

Developing an initial explanatory theory for Partnering for Change using realist evaluation.

Partnering for Change (P4C) is an innovative practice model for school-based occupational therapy developed in Canada and informed by a program of research spanning nearly two decades. National and international interest in P4C necessitated development of an explanatory theory to guide implementation in varied contexts. The purpose of this study is to document the process of theory development and to provide an overview of the initial P4C explanatory theory. Realist evaluation was used to construct an initial explanatory theory of P4C drawing on P4C developers' conceptualisations of the model, document analysis, and analysis of transcripts from interviews and focus groups. No consumers were involved in the study design or analysis. Four sets of premises expressed as context-mechanism-outcome configurations (CMOCs) comprise the initial explanatory theory of P4C. An abstracted summary of these four sets along with contexts, mechanisms, and outcomes central to the P4C initial explanatory theory is presented. An exemplar CMOC is shared to illustrate how theoretical premises are developed and expressed using realist evaluation. This study advances knowledge regarding the hypothesised core elements of P4C and provides an example of using realist evaluation to advance knowledge in occupational therapy. Preliminary implications for clinical practice are discussed. Partnering for Change (P4C) is a way of providing occupational therapy services in schools that helps all children to learn and participate successfully. P4C was created in Ontario, Canada, and has been researched for almost 20 years. People in different parts of Canada and other countries are interested in trying P4C. As the researchers who created P4C, we think there is a need to explain how it works so it can be used in different places. This study explains how we created a theory to describe P4C. To develop this theory, we used a method called realist evaluation that would help us explain how, why, and in what situations P4C works best. To do this, we analysed documents and transcripts of interviews and focus groups. Our findings are organised into four main ideas, each explained in terms of contexts (the situations), mechanisms (how and why P4C works), and outcomes (the impacts of P4C). One detailed example is given to show how these ideas were formed and work together. In conclusion, our study helps us understand the key parts of P4C and shows how realist evaluation can be used to improve knowledge in occupational therapy. The study also suggests some early ideas on how P4C can be used in practice.

Analysis of the Role and Guidance of Art Management in Music Education in Chinese Primary and Secondary Schools

In recent years, China has demonstrated a growing commitment to the aesthetic education of young people, with primary and secondary schools implementing a range of art activities. This paper, through the methods of literature review and case study, seeks to examine the theories of art management and art education. It analyses the role of aesthetic education in fostering the holistic development of young people and enhancing the vitality of social aesthetics through case studies. The paper discusses the commonality, intersection and complementary between the two disciplines, and considers the specific practical methods and significance of the combination of them. In combination with three case studies, and in the context of music education in Chinese public primary and secondary schools, this study will discuss the role of arts organizations in establishing new paths and methods of education, exploring innovative models of classroom practice, and effectively increasing the popularity of high-level music education. Art organizations and schools fulfil their respective roles and strengths, ranging from teaching and research to practice, and collaborating to enhance the aesthetic literacy and creativity of Chinese youth.

Freedom dreaming in carceral spaces: Youth care workers' imagined alternatives to anti-Black racism in residential facilities.

Although youth-adult partnerships (Y-APs) have been linked to a wide range of positive youth and community outcomes, the possibility of Y-AP occurrence in spaces of racialized social control such as youth residential facilities remains unknown. Rooted in a social justice and rights-based ethos, Y-APs represent an innovative conceptual and practice model of youth engagement that challenges longstanding patterns of control that characterize adult-youth relationships in these settings. This study uses narrative thematic inquiry and counter storytelling to examine frontline youth care workers' narratives (N = 21) of Y-AP enactment against the backdrop of anti-Black racism in youth residential facilities. Workers' narratives include instances of both enhanced and diminished forms of partnership, and explanations for Y-AP diminishment depict an interplay of racist (anti-Black) ideologies and organizational processes, including selective racial cognizance in hiring practices, color-evasive and elitist training, and racialized blame-shifting. Importantly, workers' narratives suggest that although flourishing Y-APs remain elusive, it is not a foregone conclusion that Y-APs cannot occur to realize youth development and social change in these extreme contexts.

Implementation of a practice model for inpatient psychiatric clinical pharmacist practitioners with prescriptive authority at a veterans health care facility.

Clinical pharmacists play a valuable role on collaborative health care teams, especially in the field of mental health. However, there is a need to explore innovative practice models that optimize their potential in providing comprehensive medication management in inpatient psychiatric settings. This report aims to describe the implementation of a practice model using an inpatient psychiatric clinical pharmacist practitioner performing comprehensive medication management. The implementation of a practice model using a psychiatric clinical pharmacist practitioner was a feasible way to deliver comprehensive medication management and other clinical services in an inpatient psychiatric setting amid staffing challenges. Whereas limitations such as resource constraints must be considered, the success of this model highlights the value of a versatile psychiatric clinical pharmacist practitioner. These findings might offer insight to other health care facilities considering a similar approach to provide mental health care through the use of a psychiatric clinical pharmacist practitioner.

Microsurgical Training: A Review of Existing Methods and an Innovative Practice Model

Abstract Surgery under magnification with the use of the operating microscope has seen great advances, and numerous surgical procedures today depend on optical magnification. Training (to impart basic skills) in microsurgery is particularly essential to enable surgeons to take their place in the surgical team and learn further as they progressively observe, assist, and in time, perform microsurgical procedures. Various materials and models are used and have been objectively assessed and validated for simulation in microsurgical training. One such model, the live animal model (with all its disadvantages), has been the “gold standard” for simulation in microsurgical training. We have identified and put into use a new tissue model for training in microvascular surgery – the chicken mesentery, which will offer a good practical solution where the live animal model is unavailable. Further studies using this model for training at various centers will be required for validation and comparison of this tool against existing methods.

EAST MEETS WEST: INTERVENTIONS, PRACTICE MODELS, AND POLICIES TO SUPPORT FAMILY CAREGIVERS IN DIVERSE CULTURES

Abstract This East Meets West symposium consists of six studies that examined innovative interventions, practice models and policies designed to support family caregivers of older adults in the U.S., Taiwan, and mainland China. The first two papers both used case management interventions to assist family caregivers with a focus on caregiver depression. The paper from the U.S. found that more difficulties of performing caregiving tasks and less caregiver preparation contributed to higher levels of depression, and the paper from Taiwan found that caregivers who received the case management service reduced depression at four-month and six-month follow-up assessments. The third paper discussed a “time travel” paradigm developed to guide service design and delivery for persons with dementia at different stages. The fourth paper used the state of Michigan as a case to examine service gaps in the current aging service network, and identifies an urgent need for statewide policy renovations to support family caregivers. The fifth and sixth papers both used large secondary data analyses to examine the effects of piloted policy and practice efforts on family caregiver outcomes. One study found that the long-term care insurance programs have resulted in positive caregiver outcomes including reduced caregiving financial cost, time, and physical and psychological burden. The other study found the use of home-based care services reduced adult children caregiver burden and did not affect the relationship between older adults and adult children caregivers. After individual presentations are done, two discussants will summarize shared themes in these papers and provide critical feedback.

Effect of an Innovative Immunization Practice Model to Improve Population Health: Results of the Project IMPACT Immunizations Scaled Demonstration.

Background: U.S. adult vaccination rates remain low. Community pharmacists have skills and opportunity to improve this shortcoming. This study sought to evaluate an innovative practice model on identification of unmet vaccination needs and their resolution. Methods: This prospective, multi-site, multi-state, observational study was conducted in 22 community pharmacy practices in Iowa and Washington. Adults receiving influenza vaccination, medication therapy review, prescriptions for diabetes or cardiovascular disease, or another clinical encounter with a participating pharmacist from December 2017 through November 2019 were included. Pharmacists reviewed vaccination forecasts generated by clinical decision support technology based on their state immunization information system (IIS) to identify unmet vaccination needs, educate patients, and improve vaccination rates. The primary outcomes were numbers of vaccination forecast reviews, patients educated, unmet vaccination needs identified and resolved, and vaccinations administered. Secondary outcomes included numbers of vaccination declinations; times a forecasted vaccine was not recommended because a contraindication was identified by the pharmacist; and times the patients declined a forecasted vaccine due to self-reported vaccination despite lack of documentation in the state IIS. Descriptive statistics were calculated. Results: Pharmacists reviewed vaccination forecasts for 6,234 patients. The vaccination forecasts predicted there were 11,789 vaccinations needed (1.9 per person). 6,405 of the 11,789 unmet vaccination needs (54.3%) were fulfilled during the study period, including 60% on the same day. Of the forecasted needs, 1,085 (9.2%) were found to be previously administered and 59 (0.5%) contraindicated. The remaining patients received information about their personal vaccination needs and recommendations to be vaccinated. Conclusion: Availability of vaccination histories during patient encounters allowed pharmacists to identify and resolve adult vaccination needs in independent and chain community practice settings.

A new model of cancer survivorship: Feasibility and findings of a survivorship-based primary care clinic led by a medical oncologist.

e24043 Background: Since the Institute of Medicine published “From Cancer Patient to Cancer Survivor: Lost in Transition,” there has been widespread recognition of the role of primary care in providing long-term care for cancer survivors. However, many gaps remain as patients transition from oncology to primary care. We report on the findings of an innovative practice model in which a medical oncologist opened a primary care clinic to address survivorship-specific needs and ongoing primary care in one place. Methods: The clinic was housed in the primary care division of a large academic medical center. The physician is board certified in internal medicine, oncology, and hematology. Data were collected from when the clinic opened November 1, 2021 through January 31, 2023 via electronic chart review. Results: A total of 209 patients established care. Seventy-four percent were women, with a mean age 54, age range 19 to 89, and 24% adolescents and young adults aged 39 or younger. The most common cancer was breast (44%), followed by leukemia (12%) and lymphoma (10%). Thirty-two patients (15%) had undergone an allogeneic or autologous bone marrow transplant (BMT). Thirty-three patients (16%) had a hereditary cancer syndrome, including 11 with a BRCA mutation and 10 with a TP53 mutation. A majority (74%) were post treatment; 22% had active disease; and 3% were “previvors” with a genetic syndrome without a cancer diagnosis. Twenty-seven (13%) had more than one cancer. Most referrals came from medical oncology (36%), followed by self-referrals (29%) and hematology or BMT (11%). Most (74%) returned for at least one follow-up visit. Long-term and late effects were addressed in 87% and at least one other primary care problem was managed in 96%. These included cardiovascular risk (92%, with a new cardiovascular medication started in 31 patients), mental health (76%), bone health (47%), sexual health (22%), and fertility (19%). Secondary cancer screening was addressed in 93%, and four secondary cancers were diagnosed. Surveillance for the primary cancer was addressed in 86%, and seven recurrences were diagnosed. Conclusions: Given a growing need to care for cancer survivors and known challenges in the oncology to primary care pipeline, new models of comprehensive survivorship care are greatly needed. This study demonstrates the feasibility and high demand for a novel survivorship-based primary care clinic in which both ongoing survivorship needs and routine primary care are managed concurrently.[Table: see text]

The impact of the mainstreaming addiction treatment act and associated legislative action on pharmacy practice

The recent passage of the Mainstreaming Addiction Treatment (MAT) Act will expand access to treatment for opioid use disorder (OUD) by eliminating prescriber registration requirements introduced as part of the Drug Abuse Treatment Act (DATA) of 2000. Without the X-Waiver, and Drug Enforcement Administration (DEA) registered prescriber can now prescribe buprenorphine. Eliminating DATA-2000 registration is the first step in improving access to buprenorphine, but additional barriers, including unclear restrictions on wholesale buprenorphine supply and insurance coverage, remain. Recently, the DEA formally clarified that suspicious order monitoring programs were managed entirely by wholesalers and manufacturers and that DEA does not set suspicious order monitoring limits. In this commentary, we address the somewhat conflicting implications of the MAT Act and recent DEA guidance on buprenorphine dispensing in community pharmacies. We also discuss innovative practice models that leverage pharmacists’ cognitive skills to manage pharmacotherapy for persons with OUD. Recent policy changes and emerging evidence suggest that pharmacists are better positioned than ever to provide low-barrier access to treatment for OUD and to show their value in this practice area by actively engaging patients with prescribed buprenorphine.

Chinese Immigrants’ Perceptions of Community Justice in the USA: An Exploratory Study

Abstract An increasing body of research has highlighted the significance of coll aboration between criminal justice practitioners and residents to enhance the quality of life in communities. As an innovative practice model, this collaborative concept maximizes the effectiveness of three core factors of community justice (community policing, community courts, and community corrections) by maintaining community order and enhancing neighbourhood quality of life. However, as many cities and municipalities have invested time and resources into developing positive relationships with immigrants, little research has been focused on the nexus between immigrant communities within the community justice movement model. Using data collected from Chinese immigrants in the US, the current study is the first pilot investigation on perceptions of the new pattern of Chinese immigrants toward their communities and their collaboration with the criminal justice system. This study suggests positive attitudes of immigrants toward community justice, but criminal justice agencies must tailor their interaction to the unique characteristics of each immigrant community. What constitutes good community justice practices in one community may not be effective in another.

Facilitating OPAT in rural areas

A sizable portion of the United States’ population lives in a rural setting. Coupled with a limited number of infectious diseases providers, this has created a need for innovative practice models to deliver outpatient antimicrobial therapy and clinical monitoring in rural settings. This article reviews existing literature regarding outpatient parenteral antimicrobial therapy in rural settings and explores existing barriers and potential solutions that may be of assistance to providers looking to provide these services.

Office-based psychosomatic medicine with a focus on acute care

Objectives: In Germany, the office-based psychosomatic medicine with focus on acute care offers psychosomatic treatment besides primary care by general practitioners and regular psychotherapy. The aim of this study is to determine specific characteristics of these innovative office-based practices. Methods: In a qualitative cross-sectional study, twelve board-certified specialists in psychosomatic medicine, practicing office-based psychosomatic medicine were surveyed by means of semi-structured telephone-interviews. After transcription and coding in MAXQDA 2020, a content analysis was conducted. Results: The innovative practice model was characterized by high numbers of initial contacts in walk-in or pre-planned consultation hours. Besides regular psychotherapy long-term and low-threshold treatment was offered. Physician assistants organised the workflow and administrative tasks. For settlement the EBM-number psychosomatic interview or short-term treatment was used. Focusses were set on somatopsychic and socio-medical treatment and consultant support. Psychotherapy often was realised in form of group sessions by integrating behavioural and psychodynamic psychotherapy. Discussion: The innovative psychosomatic practice model with focus on acute care shows an independent profile. A treatment based on medical understanding of complex somatic disease processes can be provided to somatopsychic patients. Future studies should compare this practice model to psychosomatic practices receiving a treatment by guideline psychotherapy. Conclusions: In Germany, the practices of psychosomatic medicine with a focus on acute care closes an increasing gap in psychosomatic care and augments treatment possibilities, especially for elderly and multimorbid patients.

Creating a Culture of Breastfeeding Support and Continuity of Care in Central Illinois.

Central Illinois breastfeeding rates fall short of the recommendation to breastfeed exclusively through 6 months, and Black, low-income, and rural families disproportionately experience low rates. A continuity of care framework, which emphasizes interdisciplinary coordination from the prenatal period through weaning, can support breastfeeding. This case study describes an innovative practice model informed by the Collective Impact Model (CIM) designed to promote breastfeeding continuity of care and community support in Central Illinois. Development and maintenance of the Central Illinois Breastfeeding Professional Network (CIBPN), a network of diverse public health practitioners, leveraged CIM principles. The CIBPN began with influential Breastfeeding Champions, identified through the Illinois State Physical Activity and Nutrition program. Champions convened Central Illinois breastfeeding allies and led the CIBPN to coalesce around a common agenda and engage in mutually reinforcing activities. Linked breastfeeding data for families giving birth at a Central Illinois hospital and receiving postnatal care at a health center were analyzed as a snapshot of CIBPN initiatives. The CIBPN engaged at least 135 practitioners and more than 27 organizations. At least 33 people received advanced breastfeeding training, and many professional development opportunities were offered. Numerous breastfeeding support improvements were made at and between CIBPN sites. Breastfeeding rates at the birthing hospital and health center were stable, including during the COVID-19 pandemic. This article contributes to the practice-based evidence for breastfeeding support by strengthening continuity of care through a successful application of the CIM by public health practitioners.

Towards a Synthesised Directional Map of the Stages of Innovation in Children’s Social Care

Abstract There has been substantial investment by governments and charities in the UK in the development, diffusion and evaluation of innovative practice models and systems to safeguard and support vulnerable children, young people and families. However, understandings of the processes of innovation within the sector are still at a relatively early stage—for example, in relation to what might be expected or planned for at each stage of an innovation journey. As a result, best use may not always be made of opportunities to address deficiencies in provision. To inform this knowledge gap, the literature was reviewed regarding innovation processes and trajectories within children’s social care (statutory and voluntary settings) and within the field of social innovation more widely. Ten modellings of the stages of innovation were identified and synthesised into a directional map of six stages that might be commonly expected: mobilising, designing, developing, integrating, growing and system change. This trajectory framework poses key questions for innovators to consider at each stage to inform planning and determine if, when and how an innovation should progress further.

Collaborative Social Engagement (CSE) Model – A Best Practice of Srinivas University, India

Purpose: To introduce the Collaborative Social Engagement (CSE) model as one of the best practices useful to higher education institutions for creating their social footprints of Service. The paper showcases the practice framework of the model by showcasing its impact on skill development, social service, social welfare and sustainability. The study carry out an outcome analysis of the best practice with the help of ABCD analysis framework. Methodology: It is a Case study prepared on the reports published in the Srinivas University website. The requisite data is collected from the respective Coordinators appointed by the University to carry out the projects of Unnat Bharat Abhiyan Forum, Bosch Industry Academia Collaboration Centre, Srinivas Institute of Rural Reconstruction Agency, School Adoption Programme and Centre for Popularisation of Science and Technology. The content is analysed by review of literature and ABCD analysis framework. Results & Outcome: The study recommends an innovative best practice model for the higher education institutions to carry out ‘Social Engagement’ as a service model to reach out to Society. Originality: The paper introduces the ‘Collaborative Social Engagement’ model suitable for Institutions of Higher Education to carry out social responsibility by blending the outcomes of NGO interventions, Industry-Academia Collaboration, Village and School Adoption, public sensitization, and social service initiatives, etc. Type of Paper: Case study on Best Practice.

Implementation of pharmacist‐led HIV pre‐exposure prophylaxis management to increase access to care at an academic internal medicine practice

AbstractIntroductionThe ongoing human immunodeficiency virus (HIV) epidemic continues to require attention to reduce the number of new infections. HIV pre‐exposure prophylaxis (PrEP) has emerged as a highly effective strategy. Although its overall use in the United States has increased since initial approval, it is still underutilized, especially in populations disproportionately affected by HIV. One method for overcoming barriers to PrEP uptake includes utilizing pharmacists to increase access to care.MethodsFor this initiative, a pharmacist‐led PrEP service within a primary care practice was developed utilizing a collaborative practice agreement to enable ordering medications, lab tests, and immunizations. Following the sustainable initial implementation at the first site, expansion occurred to a second location. Data on referrals, patient demographics, and PrEP persistence were collected. Challenges, lessons learned, and future opportunities were also considered.ResultsSince initiating services at both practice sites, a total of 76 patients were referred from August 2018 through March 2022. The majority of patients had their sex listed as male (96%) within the electronic health record and was white (69.7%). The mean age of patients was 33 years (range, 20‐71). Of those who engaged with pharmacist‐led PrEP management, 33.9% (20/59) were retained in care for at least 1 year. There were no occurrences of seroconversion during pharmacist management. Throughout the course of implementation, areas of improvement were identified and addressed for process improvement.ConclusionOur experience supports that pharmacist‐led PrEP management in an outpatient primary care practice is a sustainable option to address certain barriers to care. However, the ability for pharmacist‐provided services may be limited by state pharmacy practice laws and/or lack of reimbursement opportunities for clinical services. Developing innovative practice models that integrate pharmacists in a variety of settings is imperative for further reducing HIV transmission.

An Innovative Academic Practice Model for Clinical Nursing Education During the COVID-19 Pandemic.

In March of 2020, Columbia University School of Nursing (CUSON) Masters Direct Entry (MDE) program and New York Presbyterian Hospital (NYPH) created an innovative academic partnership to address the clinical needs of students and to help alleviate the burden of surging COVID-19 cases on nurses and the health care system. Through this partnership, students were hired as nurse technicians to assist with patient care during the first wave of the COVID-19 pandemic. As a result of this enhanced relationship, a pipeline of well-qualified graduate nurses with unique skills to adapt to a rapidly changing practice environment was created. Student participants in this opportunity developed an understanding of the organizational and leadership structures of the health care institution. The understanding of organizational and leadership structures will help transform the delivery of care.

Redefining ‘advanced’: Supporting and promoting practice change through community advanced pharmacy practice experiences

IntroductionCommunity pharmacy practice in the United States (US) has faced several external pressures, threatening traditional practice models. Schools and colleges of pharmacy (S/COP), particularly through experiential rotations, are perfectly poised to help these practices create new sustainable business models. The purpose of this article is to highlight demonstrated, reproducible successes of community advanced pharmacy practice experience (APPE) advancement initiatives. PerspectiveDespite community pharmacists being highly-trained health care providers with roughly equivalent educational backgrounds, community-based practices in the US are not all the same. Student pharmacists can contribute to the design and implementation of revenue-generating services helping individual pharmacies elevate their practice. Doing so involves new models for staffing, workflow, billing, and documentation. Students can help support practice change by focusing on implementation and sustainability. Example APPE integrations focused on community pharmacy practice transformation are described in detail from the University of Arkansas for Medical Sciences College of Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, and Idaho State University. ImplicationsEstablishing intentional connections that focus on new sustainable community business models is a responsibility for S/COP. The examples provided serve to demonstrate the feasibility of these partnerships. Training students on innovative practice models and utilizing them is critical in moving community practice forward. As academicians, we must prepare students to be agents of change for the profession and intentionally integrate them into a systematic plan to help promote and change practice activities wherever possible, but especially in community practice.

Roles, barriers and behavioral determinants related to community pharmacists' involvement in optimizing opioid therapy for chronic pain: a qualitative study

Background Opioid are currently widely used to manage chronic non-malignant pain (CNMP), but there is a growing concern about harm resulting from opioid misuse and the need for medicine optimization, in which pharmacists could potentially play a key role. Objective This study explored pharmacists' roles, barriers and determinants related to their involvement in optimizing prescribed opioids for patients with chronic pain. Setting Community pharmacies in the United Kingdom. Method Semi-structured interviews based on the Theoretical Domains Framework were conducted between January and May 2020 with 20 community pharmacists recruited through professional networks. Data were analysed thematically. Main outcome measure: Pharmacists’ perceived roles, barriers and behavioural determinants in relation to opioid therapy optimization. Result Pharmacists demonstrated desire to contribute to opioid therapy optimization. However, they described that they were often challenged by the lack of relevant knowledge, skills and training, inadequate time and resources, systemic constraints (such as lack of access to medical records and information about diagnosis), and other barriers including relationships with doctors and patients. Conclusion The contribution of community pharmacists to optimize opioid therapy in CNMP is unclear and impeded by lack of appropriate training and systemic constraints. There is a need to develop innovative practice models by addressing the barriers identified in this study to enhance the contribution of community pharmacists in optimization of opioid therapy for chronic pain.

An Operational Perspective of The Changing Prosthetics & Orthotics Landscape.

Leading the growth of a private prosthetic and orthotic (P&O) practice, as clinician and founder, I developed a unique perspective of this rapidly changing profession. Many positive influences from my early career shaped my vison toward an innovative practice model, as well as the need to elevate the standard of care through education and the use of outcome measures. As the practice model expanded, advancements were made in electronic health records (EHR), best-in-class outsource fabrication, and clinical research. To better support clinicians and patients served, an organizational structure with an executive team was built. The practice model achieved operational efficiency through documenting best practices, developing a hiring and onboarding process, and establishing key performance indicators aligned with quality clinical care. As a regional clinical care organization, the practice model seized an opportunity to reach more patients through a partnership that brought the optimal strategic and cultural fit. Bringing our innovative P&O practice model together with expertise in lean facility design, scanning, fabrication, sensor technology, product development and clinical care experience from around the world, we can advance care standards and improve the patient experience in exciting new ways.