Pragmatic Trials in Long-Term Care: Implementation and Dissemination Challenges and Opportunities

Randomized controlled trials are considered the most rigorous research design in efficacy and effectiveness research; however, such trials present numerous challenges that limit their applicability in real-world settings. As a consequence, pragmatic trials are increasingly viewed as a research design that overcomes some of these barriers with the potential to produce findings that are more reproducible. Although pragmatic methodology in long-term care is receiving increasing attention as an approach to improve successful dissemination and implementation, pragmatic trials present complexities of their own. To address these complexities and related issues, experts with experience conducting pragmatic trials, developing nursing home policy, participating in advocacy efforts, and providing clinical care in long-term care settings participated in a virtual consensus conference funded by the National Institute on Aging in Spring 2021. Participants identified 4 cross-cutting principles key to dissemination and implementation of pragmatic trial interventions: (1) stakeholder engagement, (2) diversity and inclusion, (3) organizational strain and readiness, and (4) learn from adaptations. Participants emphasized that implementation processes must be grounded in the perspectives of the people who will ultimately be responsible for implementing the intervention once it is proven to be effective. In addition, messaging must speak to long-term care staff and all others who have a stake in its outcomes. Although our understanding of dissemination and implementation strategies remains underdeveloped, this article is designed to guide long-term care researchers and community providers who are increasingly aware of the need for pragmatism in disseminating and implementing evidence-based care interventions.     

Improving Radiology Report Quality by Rapidly Notifying Radiologist of Report Errors

Radiology report errors occur for many reasons including the use of pre-filled report templates, wrong-word substitution, nonsensical phrases, and missing words. Reports may also contain clinical errors that are not specific to the speech recognition including wrong laterality and gender-specific discrepancies. Our goal was to create a custom algorithm to detect potential gender and laterality mismatch errors and to notify the interpreting radiologists for rapid correction. A JavaScript algorithm was devised to flag gender and laterality mismatch errors by searching the text of the report for keywords and comparing them to parameters within the study’s HL7 metadata (i.e., procedure type, patient sex). The error detection algorithm was retrospectively applied to 82,353 reports 4 months prior to its development and then prospectively to 309,304 reports 15 months after implementation. Flagged reports were reviewed individually by two radiologists for a true gender or laterality error and to determine if the errors were ultimately corrected. There was significant improvement in the number of flagged reports (pre, 198/82,353 [0.24 %]; post, 628/309,304 [0.20 %]; P = 0.04) and reports containing confirmed gender or laterality errors (pre, 116/82,353 [0.014 %]; post, 285/309,304 [0.09 %]; P < 0.0001) after implementing our error notification system. The number of flagged reports containing an error that were ultimately corrected improved dramatically after implementing the notification system (pre, 17/116 [15 %]; post, 239/285 [84 %]; P < 0.0001). We developed a successful automated tool for detecting and notifying radiologists of potential gender and laterality errors, allowing for rapid report correction and reducing the overall rate of report errors.     

Bowling Together: Promoting the Identity,Brand, and Value of the Society of Clinical Psychology

The declining trends in membership within the American Psychological Association (APA) and APA divisions reviewed by Robiner, Fossum, and Hong (2015) are startling and provide a wake‐up call to professional psychology. In this commentary, Karlin (the President‐Elect of APA Division 12, the Society of Clinical Psychology [SCP]) identifies important issues associated with membership needs and declines within SCP and critical areas of focus for ensuring its future success. In identifying current needs and providing a vision for the future of SCP, Karlin stresses the importance of and future plans for promoting the identity, brand, and value of SCP.     

Proposed Performance Measures and Strategies for Implementation of the Fatigue Risk Management Guidelines for Emergency Medical Services

Abstract

Background: Performance measures are a key component of implementation, dissemination, and evaluation of evidence-based guidelines (EBGs). We developed performance measures for Emergency Medical Services (EMS) stakeholders to enable the implementation of guidelines for fatigue risk management in the EMS setting. Methods: Panelists associated with the Fatigue in EMS Project, which was supported by the National Highway Traffic Safety Administration (NHTSA), used an iterative process to develop a draft set of performance measures linked to 5 recommendations for fatigue risk management in EMS. We used a cross-sectional survey design and the Content Validity Index (CVI) to quantify agreement among panelists on the wording and content of draft measures. An anonymous web-based tool was used to solicit the panelists' perceptions of clarity and relevance of draft measures. Panelists rated the clarity and relevance separately for each draft measure on a 4-point scale. CVI scores ≥0.78 for clarity and relevance were specified a priori to signify agreement and completion of measurement development. Results: Panelists judged 5 performance measures for fatigue risk management as clear and relevant. These measures address use of fatigue and/or sleepiness survey instruments, optimal duration of shifts, access to caffeine as a fatigue countermeasure, use of napping during shift work, and the delivery of education and training on fatigue risk management for EMS personnel. Panelists complemented performance measures with suggestions for implementation by EMS agencies. Conclusions: Performance measures for fatigue risk management in the EMS setting will facilitate the implementation and evaluation of the EBG for Fatigue in EMS.     

Implementation of selective prevention for cardiometabolic diseases; are Dutch general practices adequately prepared?

Objective: Current guidelines acknowledge the need for cardiometabolic disease (CMD) prevention and recommend five-yearly screening of a targeted population. In recent years programs for selective CMD-prevention have been developed, but implementation is challenging. The question arises if general practices are adequately prepared. Therefore, the aim of this study is to assess the organizational preparedness of Dutch general practices and the facilitators and barriers for performing CMD-prevention in practices currently implementing selective CMD-prevention.

Design: Observational study.

Setting: Dutch primary care.

Subjects: General practices.

Main outcome measures: Organizational characteristics.

Results: General practices implementing selective CMD-prevention are more often organized as a group practice (49% vs. 19%, p?=?.000) and are better organized regarding chronic disease management compared to reference practices. They are motivated for performing CMD-prevention and can be considered as ‘frontrunners’ of Dutch general practices with respect to their practice organization. The most important reported barriers are a limited availability of staff (59%) and inadequate funding (41%).

Conclusions: The organizational infrastructure of Dutch general practices is considered adequate for performing most steps of selective CMD-prevention. Implementation of prevention programs including easily accessible lifestyle interventions needs attention. All stakeholders involved share the responsibility to realize structural funding for programmed CMD-prevention. Aforementioned conditions should be taken into account with respect to future implementation of selective CMD-prevention.

• Key Points

• There is need for adequate CMD prevention. Little is known about the organization of selective CMD prevention in general practices.

• ??The organizational infrastructure of Dutch general practices is adequate for performing most steps of selective CMD prevention.

• ??Implementation of selective CMD prevention programs including easily accessible services for lifestyle support should be the focus of attention.

• ??Policy makers, health insurance companies and healthcare professionals share the responsibility to realize structural funding for selective CMD prevention.

     

The self-reported use of research in clinical practice: A survey of occupational therapists in Sweden

Background: Today, healthcare providers and occupational therapists are increasingly required to rely on evidence-based practices. In both outpatient and inpatient settings, the use of research-based practices can be identified using the Research Utilization Measure questionnaire. Aim: This study explores how occupational therapists in Sweden perceive research utilization. Method: The Research Utilization Measure was sent to 807 randomly selected occupational therapists in Sweden, and the response rate was 59% (n = 472). Results: The majority of respondents (56%, n = 256) reported use of research-based knowledge in their practice “very or rather often”, although 49% (n = 225) of the therapists noted that they “very seldom or never” discussed research findings with their managers. Differences in answers for most items were related to degree of education and length of experience. Occupational therapists with higher education levels more often reported use of research in their clinical practice and therapists with greater experience less often reported use of research in their clinical practice. Conclusion: Education seems to influence the degree to which occupational therapists rely on research to inform their practices. A future challenge for managers and occupational therapists is to create strategic discussions on how to implement treatment that is based on current research.