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Challenge 3: Developing a D&I Template for Sustainability Across Settings
Mary Daly England, Kelli Gora, Jose Daniel Navarro, Jill Weinstein
NURS 738 – Group 8College of Nursing, University of Arizona
November 11, 2013
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Translational Research Template
Problem
Evidence
DevelopmentImplementation
Evaluation
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Factors affecting adoption
• Innovations penetrate homophilous groups more readily
Homophilous verses heterophilous groups
• Active dissemination is more effective
Passive dissemination verses active dissemination
• Relative advantage and compatibility
Characteristics of the intervention or innovation
• Norms and attitudes, organizational structure and process, resources
Contextual factors
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Methods to measure penetration and adoption
•Individual provider/consumer
•Service providers’ acceptance of EBP aimed at reducing child neglect
SurveysInterviews
Administrative data
•Individual provider
•Organization or setting
SurveysInterviews
Administrative dataObservation
•RE-AIM/Reach
Case audits Checklists
•Change in knowledge, attitude, behavior, quality of life
•Change in organizational policies and practice
Outcome Indicators
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sample
POWER TO REDUCE TYPE I
& TYPE II ERRORS
SIGNIFICANCE
LEVEL OF CONFIDENCE
EFFECT SIZEMARGIN OF
RANDOM ERROR
COST
Variability
Factors to be Considered in Determining Sample Size
(Fox, Hunn & Mathers, 2009;Bacchetti, McCullouch & Segal, 2008)
SAMPLE SIZE IS CRITICAL AND SHOULD BE REPRESENTITIVE AND GERNERALIZABLE TO THE WIDER WORLD.
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Organization population size 1000Confidence interval 5%Confidence level 95%
n=286
(Israel, 2009)
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Criteria for Determining Effectiveness of the Translational Intervention(s)
EFFECTIVENESS
APPROPRIATENESS
Practicability (focus groups)
ADOPTION
Uptake (survey)
ACCEPTABILITYSatisfaction
of the innovation (survey)
FEASIBILITY
Suitable for everyday use
(survey)
FIDELITY
Adherence (check-lists)
SUSTAINABILITY
Continuation (interviews)
PENETRATION
Level of utilization (case audit)
Taxonomy of implementation outcomes (Proctor et al., 2011)
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Organizational Sustainability
Sustainability
Culture
Effectiveness
Stakeholders/ Champions
Integration
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Dynamic Sustainability Framework
Ecological System
Practice Setting
Intervention
• Other Practice Settings• Policy• Regulations• Market Forces• Population Charateristics
• Staffing• Org Culture• Models• Education
• Components• Practitioners• Outcomes• Delivery Platform
FIT
FIT
FIT
Adapted from Chambers et al, DSF Model (2013)
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Sustainability Strategies
SUSTAINABILITY STRATEGIES
Initial Planning
Key Participants
Integration with
Established Systems
ResourcesFinancial
Time Human
Ongoing Evaluation
Integration With EDSS
(Chambers et al., 2013; Shediac-Rizkallah & Bone, 1998; Scheirer, 2005)
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ReferencesAarons, G. A., & Palinkas, L. A. (2007). Implementation of evidence-based practice in child welfare: Service provider perspectives. Administration and Policy in Mental Health and Mental Health Services Research, 34(4), 411-419. Bakken, S., & Ruland, C. M. (2009). Translating clinical informatics interventions into routine clinical care: How can the
RE-AIM framework help? Journal of the American Medical Informatics Association : JAMIA, 16(6), 889-897. doi:10.1197/jamia.M3085; 10.1197/jamia.M3085
Bachetti, P., McCulloch, C.E., & Segal, M.R. (2008). Simple, defensible sample sizes based on cost efficiency. Biometrics, 64, 577-594. doi: 10.1111/j.1541-0420.2008.01004.x
Bowen, D. J., Kreuter, M., Spring, B., Cofta-Woerpel, L., Linnan, L., Weiner, D., . . . Fernandez, M. (2009). How we design feasibility studies. American Journal of Preventive Medicine, 36(5), 452-457. doi:http://dx.doi.org.ezproxy2.library.arizona.edu/10.1016/j.amepre.2009.02.002Brownson, R. C., & Jones, E. (2009). Bridging the gap: Translating research into policy and practice. Preventive Medicine, 49(4), 313-315. doi:10.1016/j.ypmed.2009.06.008; 10.1016/j.ypmed.2009.06.008
Cain, M., & Mittman, R. (2002). Diffusion of innovation in health care. Retrieved from http://faculty.mercer.edu/thomas_bm/classes/641/Diffusion%20of%20Innovations%20in%20Health care.pdf Cain, M., & Mittman, R. (2002). Diffusion of innovation in health care. Retrieved from http://faculty.mercer.edu/thomas_bm/classes/641/Diffusion%20of%20Innovations%20in%20Health care.pdf Chambers, d., Glasgow, R. & Stange, K. (2013). The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implementation Science; 8:17.Fox, N., Hunn, A., & Mathers, N. (2009) Sampling and sample size calculation. Retrieved from National Institute for Health Research website: rds- eastmidlands.nihr.ac.uk/.../9-sampling-and-sample-size-calculation.ht.
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References
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Gladwell, M. (2000). The Tipping Point, How Little Things Can Make a Big Difference. Boston: Little, Brown & Company.Glasgow, R. E., McKay, H. G., Piette, J. D., & Reynolds, K. D. (2001). The RE-AIM framework for evaluating interventions: What
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Mendel, P., Meredith, L. S., Schoenbaum, M., Sherbourne, C. D., & Wells, K. B. (2008). Interventions in organizational and community context: a framework for building evidence on dissemination and implementation in health services research. Administration and Policy in Mental Health and Mental Health Services Research, 35(1-2), 21-37.
Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A.,… Henesly, M. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health, 38(2), 65-76. doi: 10.1007/s10488-010-0319-7
Rabin, B. A., Glasgow, R. E., Kerner, J. F., Klump, M. P., & Brownson, R. C. (2010). Dissemination and Implementation Research on Community-Based Cancer Prevention: A Systematic Review. American Journal of Preventive Medicine, 38(4), 443-456. doi: http://dx.doi.org/10.1016/j.amepre.2009.12.035
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Rabin, B. A., Brownson, R. C., Haire-Joshu, D., Kreuter, M. W., & Weaver, N. L. (2008). A glossary for dissemination and implementation research in health. Journal of Public Health Management and Practice, 14(2), 117-123.
Rabin, B. A., Brownson, R. C., Kerner, J. F., & Glasgow, R. E. (2006). Methodologic Challenges in Disseminating Evidence-Based Interventions to Promote Physical Activity. American Journal of Preventive Medicine, 31(4, Supplement), 24-34. doi: http://dx.doi.org/10.1016/j.amepre.2006.06.009
Scheirer, M. (2005) Is Sustainability possible? A review and commentary on Empirical studies of program sustainability. American Journal of Evaluation. 26,(320). Retrieved from http://aje.sagepub.com/content/26/3/320
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