Publications by authors named "Russell E Glasgow"

272 Publications

Closed-Loop Electronic Referral From Primary Care Clinics to a State Tobacco Cessation Quitline: Effects Using Real-World Implementation Training.

Am J Prev Med 2021 03;60(3 Suppl 2):S113-S122

Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Wisconsin Hospitals and Clinics, Madison, Wisconsin.

Introduction: Patients who use tobacco are too rarely connected with tobacco use treatment during healthcare visits. Electronic health record enhancements may increase such referrals in primary care settings. This project used the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to assess the implementation of a healthcare system change carried out in an externally valid manner (executed by the healthcare system).

Methods: The healthcare system used their standard, computer-based training approach to implement the electronic health record and clinic workflow changes for electronic referral in 30 primary care clinics that previously used faxed quitline referral. Electronic health record data captured rates of assessment of readiness to quit and quitline referral 4 months before implementation and 8 months (May-December 2017) after implementation. Data, analyzed from October 2018 to June 2019, also reflected intervention reach, adoption, and maintenance.

Results: For reach and effectiveness, from before to after implementation for electronic referral, among adult patients who smoked, assessment of readiness to quit increased from 24.8% (2,126 of 8,569) to 93.2% (11,163 of 11,977), quitline referrals increased from 1.7% (143 of 8,569) to 11.3% (1,351 of 11,977), and 3.6% were connected with the quitline after implementation. For representativeness of reach, electronic referral rates were especially high for women, African Americans, and Medicaid patients. For adoption, 52.6% of staff who roomed at least 1 patient who smoked referred to the quitline. For maintenance, electronic referral rates fell by approximately 60% over 8 months but remained higher than pre-implementation rates.

Conclusions: Real-world implementation of an electronic health record-based electronic referral system markedly increased readiness to quit assessment and quitline referral rates in primary care patients. Future research should focus on implementation methods that produce more consistent implementation and better maintenance of electronic referral.
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http://dx.doi.org/10.1016/j.amepre.2019.12.026DOI Listing
March 2021

Shared Decision-Making for Left Ventricular Assist Devices: Rationale and Design of a Nationwide Dissemination and Implementation Project.

Circ Cardiovasc Qual Outcomes 2021 Feb 3;14(2):e007256. Epub 2021 Feb 3.

Adult and Child Consortium for Health Outcomes Research and Delivery Science (J.S.T., M.D.F., L.A.A., C.K.M., R.E.G., M.A.M., D.D.M.), University of Colorado School of Medicine, Aurora, CO.

Background The left ventricular assist device (LVAD) has become a common medical option for patients with end-stage heart failure. Although patients' chances of survival may increase with an LVAD compared with medical therapy, the LVAD poses many risks and requires major lifestyle changes, thus making it a complex medical decision. Our prior work found that a decision aid for LVADs significantly increased decision quality for both patients and caregivers and was successfully implemented at 6 LVAD programs. Methods In follow-up, we are conducting a nationwide dissemination and implementation project, with the goal of implementing the decision aid at as many of the 176 LVAD programs in the United States as possible. Guided by the Theory of Diffusion of Innovations, the project consists of 4 phases: (1) building a network; (2) promoting adoption; (3) supporting implementation; and (4) encouraging maintenance. Developing an LVAD network of contacts occurs by using a national baseline survey of LVAD clinicians, existing professional relationships, and an internet-based strategy. A suite of resources targeted to promote adoption and support implementation of the decision aid into standard LVAD education processes are provided to the network. Evaluation is guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance framework, where clinician and patient surveys and qualitative interviews determine the reach, effectiveness, adoption, implementation, and maintenance achieved. Conclusions This project is a true dissemination study in that it targets the entire population of LVAD programs in the United States and is unique in its use of social marketing principles to promote adoption and implementation. The implementation plan is intended to serve as a test case and model for dissemination and implementation of other evidence-based decision support aids and strategies.
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http://dx.doi.org/10.1161/CIRCOUTCOMES.120.007256DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887063PMC
February 2021

Motivational Interviewing for Maternal Immunisation (MI4MI) study: a protocol for an implementation study of a clinician vaccine communication intervention for prenatal care settings.

BMJ Open 2020 11 17;10(11):e040226. Epub 2020 Nov 17.

Adult and Child Consortium for Health Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.

Introduction: Vaccination against influenza and pertussis in pregnancy offers a 'two-for-one' opportunity to protect mother and child. Pregnant patients have increased risk of severe disease from influenza and newborns have increased risk of severe disease from both influenza and pertussis. Obstetricians need communication tools to support their self-efficacy and effectiveness in communicating the importance of immunisation during pregnancy and ultimately improving maternal vaccination rates.

Methods And Analysis: We describe the protocol for a pragmatic study testing the feasibility and potential impact of a clinician communication strategy on maternal vaccination uptake. This study will be conducted in five prenatal care settings in Colorado, USA. The Motivational Interviewing for Maternal Immunisation strategy involves training prenatal care providers to use motivational interviewing in the vaccine conversation with pregnant patients. Our primary outcomes will be the adoption and implementation of the intervention measured using the Enhanced RE-AIM/Practical Robust Implementation and Sustainability Model for dissemination and implementation. Secondary outcomes will include provider time spent, fidelity to Motivational Interviewing and self-efficacy measured through audio recorded visits and provider surveys, patients' visit experience based on audio recorded visits and follow-up interviews, and maternal vaccine uptake as measured through chart reviews.

Ethics And Dissemination: This study is approved by the following institutional review boards: Colorado Multiple Institutional Review Board. Results will be disseminated through peer-reviewed manuscripts and conference presentations.

Trial Registration Number: NCT04302675.
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http://dx.doi.org/10.1136/bmjopen-2020-040226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7674098PMC
November 2020

Integrating the Practical Robust Implementation and Sustainability Model With Best Practices in Clinical Decision Support Design: Implementation Science Approach.

J Med Internet Res 2020 10 29;22(10):e19676. Epub 2020 Oct 29.

Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.

Background: Clinical decision support (CDS) design best practices are intended to provide a narrative representation of factors that influence the success of CDS tools. However, they provide incomplete direction on evidence-based implementation principles.

Objective: This study aims to describe an integrated approach toward applying an existing implementation science (IS) framework with CDS design best practices to improve the effectiveness, sustainability, and reproducibility of CDS implementations.

Methods: We selected the Practical Robust Implementation and Sustainability Model (PRISM) IS framework. We identified areas where PRISM and CDS design best practices complemented each other and defined methods to address each. Lessons learned from applying these methods were then used to further refine the integrated approach.

Results: Our integrated approach to applying PRISM with CDS design best practices consists of 5 key phases that iteratively interact and inform each other: multilevel stakeholder engagement, designing the CDS, design and usability testing, thoughtful deployment, and performance evaluation and maintenance. The approach is led by a dedicated implementation team that includes clinical informatics and analyst builder expertise.

Conclusions: Integrating PRISM with CDS design best practices extends user-centered design and accounts for the multilevel, interacting, and dynamic factors that influence CDS implementation in health care. Integrating PRISM with CDS design best practices synthesizes the many known contextual factors that can influence the success of CDS tools, thereby enhancing the reproducibility and sustainability of CDS implementations. Others can adapt this approach to their situation to maximize and sustain CDS implementation success.
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http://dx.doi.org/10.2196/19676DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7661234PMC
October 2020

Enhancing Success of Medicare's Shared Decision Making Mandates Using Implementation Science: Examples Applying the Pragmatic Robust Implementation and Sustainability Model (PRISM).

MDM Policy Pract 2020 Jul-Dec;5(2):2381468320963070. Epub 2020 Oct 15.

VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado.

The Centers for Medicare and Medicaid Services (CMS) has mandated shared decision making (SDM) using patient decision aids for three conditions (lung cancer screening, atrial fibrillation, and implantable defibrillators). These forward-thinking approaches are in response to a wealth of efficacy data demonstrating that decision aids can improve patient decision making. However, there has been little focus on how to implement these approaches in real-world practice. This article demonstrates how using an implementation science framework may help programs understand multilevel challenges and opportunities to improve adherence to the CMS mandates. Using the PRISM (Pragmatic Robust Implementation and Sustainability Model) framework, we discuss general challenges to implementation of SDM, issues specific to each mandate, and how to plan for, enhance, and assess SDM implementation outcomes. Notably, a theme of this discussion is that successful implementation is context-specific and to truly have successful and sustainable changes in practice, context variability, and adaptation to context must be considered and addressed.
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http://dx.doi.org/10.1177/2381468320963070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7570787PMC
October 2020

What Can Implementation Science Do for You? Key Success Stories from the Field.

J Gen Intern Med 2020 11;35(Suppl 2):783-787

Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.

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http://dx.doi.org/10.1007/s11606-020-06174-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652953PMC
November 2020

A Scoping Review and General User's Guide for Facilitating the Successful Use of eHealth Programs for Diabetes in Clinical Care.

Diabetes Technol Ther 2021 Feb 31;23(2):133-145. Epub 2020 Aug 31.

Virtual Diabetes Center, Division of General Internal Medicine, Center for Women's Health Research, and ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.

The vast eHealth literature in diabetes can provide a useful foundation to aid in the selection, adoption, and implementation of eHealth methodologies in clinical care. Despite clear potential to enhance reach, efficiency, and clinical effectiveness, research has yielded mixed and often contradictory results, and wide-spread adoption and maintenance of eHealth programs in clinical care has been limited. Furthermore, few reports have identified the unique challenges that clinicians and health systems face when attempting to incorporate eHealth systems into clinical care. To address these gaps, we address two goals in this report: first, to summarize and integrate the major findings of the diabetes-related eHealth literature based on currently available systematic and narrative reviews; and second, based on the review, to provide practical guidelines to assist clinicians and health systems in selecting and implementing eHealth programs into diabetes care using dissemination and implementation science principles and perspectives.
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http://dx.doi.org/10.1089/dia.2020.0383DOI Listing
February 2021

VA Care Coordination Program Increased Primary Care Visits and Improved Transitional Care for Veterans Post Non-VA Hospital Discharge.

Am J Med Qual 2020 Aug 10:1062860620946362. Epub 2020 Aug 10.

Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora, CO.

Veterans are increasingly eligible for non-VA care through the Veteran Health Administration (VA) Maintaining Internal Systems and Strengthening Integrated Outside Networks Act while maintaining care in the VA. Continuity of care is challenging when delivered across multiple systems resulting in avoidable complications. The Community Hospital Transitions Program (CHTP) intervention was developed to address challenges veterans face post non-VA hospitalization. Propensity score-matched analysis was used to compare outcomes between 334 intervention and matched control patients who were discharged from non-VA hospitals. Veterans in CHTP were more likely than matched controls to receive a follow-up appointment within 14 days (mean: 0.43 vs 0.34, < .05) and 30 days (mean: 0.62 vs 0.50, < .05). There were no significant differences in 30-day readmissions or 30-day emergency department visits. CHTP veterans received timely follow-up care post discharge in VA facilities. Providing quality care to dual-use veterans is dependent on coordinated transitional care.
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http://dx.doi.org/10.1177/1062860620946362DOI Listing
August 2020

Characterizing evolving frameworks: issues from Esmail et al. (2020) review.

Implement Sci 2020 07 2;15(1):53. Epub 2020 Jul 2.

Environmental and Occupational Health, School of Public Health, Texas A&M University, SPH Administration Building, 212 Adriance Lab Rd., TAMU Bldg #1518 | TAMU MS 1266, College Station, TX, 77843, USA.

There are complex issues in understanding and categorizing implementation science theories, models, and frameworks. Systematic reviews of these models are important undertakings for synthesizing current knowledge. The issues involved are even more challenging when reviewing a large number of frameworks and when some of the frameworks have evolved significantly over time. This paper addresses how the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was described in the recent Esmail (2020) review and identifies four mischaracterizations. This is followed by a more general discussion of how advances or extensions of frameworks after an original source publication or influential review tend to be overlooked. We discuss why inadvertent mischaracterization of what a framework is and is not, and what it can and cannot be used for, can have deleterious consequences. Finally, we suggest initial ideas about what could be done to prevent or alleviate some of these problems by reviewers, framework developers, and scholars at large.
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http://dx.doi.org/10.1186/s13012-020-01009-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7331253PMC
July 2020

Suggestions for Advancing Pragmatic Solutions for Dissemination: Potential Updates to Evidence-Based Repositories.

Am J Health Promot 2021 02 30;35(2):289-294. Epub 2020 Jun 30.

Department of Health Promotion, College of Public Health, 12284University of Nebraska Medical Center, Omaha, NE, USA.

Evidence-based program repositories (EBPR) report intervention characteristics and how to implement the intervention. These EBPR are a dissemination strategy to address questions such as, "I have cancer, what programs can I join?" or "What evidence-based programs for weight loss are a good fit for my community?" However, these EBPR fall short of realizing their potential and are not seen as particularly interactive, robust, or relevant to stakeholders who may benefit from their content. We propose 2 solutions for existing EBPR to enhance dissemination of evidence-based information. Addressing this critical dissemination need is one strategy for health promotion.
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http://dx.doi.org/10.1177/0890117120934619DOI Listing
February 2021

A multicenter trial of a shared DECision Support Intervention for Patients offered implantable Cardioverter-DEfibrillators: DECIDE-ICD rationale, design, Medicare changes, and pilot data.

Am Heart J 2020 08 20;226:161-173. Epub 2020 Apr 20.

Adult and Child Consortium for Outcomes Research and Delivery Science, Aurora, CO; VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO; Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO.

Shared decision making (SDM) facilitates delivery of medical therapies that are in alignment with patients' goals and values. Medicare national coverage decision for several interventions now includes SDM mandates, but few have been evaluated in nationwide studies. Based upon a detailed needs assessment with diverse stakeholders, we developed pamphlet and video patient decision aids (PtDAs) for implantable cardioverter/defibrillator (ICD) implantation, ICD replacement, and cardiac resynchronization therapy with defibrillation to help patients contemplate, forecast, and deliberate their options. These PtDAs are the foundation of the Multicenter Trial of a Shared Decision Support Intervention for Patients Offered Implantable Cardioverter-Defibrillators (DECIDE-ICD), a multicenter, randomized trial sponsored by the National Heart, Lung, and Blood Institute aimed at understanding the effectiveness and implementation of an SDM support intervention for patients considering ICDs. Finalization of a Medicare coverage decision mandating the inclusion of SDM for new ICD implantation occurred shortly after trial initiation, raising novel practical and statistical considerations for evaluating study end points. METHODS/DESIGN: A stepped-wedge randomized controlled trial was designed, guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) planning and evaluation framework using an effectiveness-implementation hybrid type II design. Six electrophysiology programs from across the United States will participate. The primary effectiveness outcome is decision quality (defined by knowledge and values-treatment concordance). Patients with heart failure who are clinically eligible for an ICD are eligible for the study. Target enrollment is 900 participants. DISCUSSION: Study findings will provide a foundation for implementing decision support interventions, including PtDAs, with patients who have chronic progressive illness and are facing decisions involving invasive, preference-sensitive therapy options.
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http://dx.doi.org/10.1016/j.ahj.2020.04.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442619PMC
August 2020

Making Implementation Science More Rapid: Use of the RE-AIM Framework for Mid-Course Adaptations Across Five Health Services Research Projects in the Veterans Health Administration.

Front Public Health 2020 27;8:194. Epub 2020 May 27.

Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, San Diego, CA, United States.

Implementation science frameworks have helped advance translation of research to practice. They have been widely used for planning and evaluation, but seldom to inform and guide mid-course adjustments to intervention and implementation strategies. This study developed an innovative methodology using the RE-AIM framework and related tools to guide mid-course assessments and adaptations across five diverse health services improvement projects in the Veterans Health Administration (VA). Using a semi-structured guide, project team members were asked to assess the importance of and progress on each RE-AIM dimension (i.e., reach, effectiveness, adoption, implementation, maintenance) at the current phase of their project. Based on these ratings, each team identified one or two RE-AIM dimensions for focused attention. Teams developed proximal goals and implementation strategies to improve progress on their selected dimension(s). A follow-up meeting with each team occurred approximately 6 weeks after the goal setting meeting to evaluate the usefulness of the iterative process. Results were evaluated using both descriptive quantitative analyses and qualitative assessments from interviews and meeting notes. A median of seven team members participated in the two meetings. Qualitative and descriptive data revealed that the process was feasible, understandable and useful to teams in adjusting their interventions and implementation strategies. The RE-AIM dimensions identified as most important were adoption and effectiveness, and the dimension that had the largest gap between importance and rated progress was reach. The dimensions most frequently selected for improvement were reach and adoption. Examples of action plans were summarizing stakeholder interviews for leadership, revising exclusion criteria, and conducting in-service trainings. Follow-up meetings indicated that teams found the process very useful and were able to implement the action plans they set. The iterative use of RE-AIM to support adjustments during project implementation proved feasible and useful across diverse projects in the VA setting. Building on this and related examples, future research should replicate these findings and further develop the methodology, as well as explore the optimal frequency and timing for these iterative applications of RE-AIM. More generally, greater focus on more rapid and iterative use of implementation science frameworks is encouraged to facilitate successful translation of research to practice.
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http://dx.doi.org/10.3389/fpubh.2020.00194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266866PMC
May 2020

Evaluating a multicomponent program to improve hypertension control in Guatemala: study protocol for an effectiveness-implementation cluster randomized trial.

Trials 2020 Jun 9;21(1):509. Epub 2020 Jun 9.

Tulane University School of Public Health and Tropical Medicine and Tulane University Translational Science Institute, New Orleans, LA, USA.

Background: Hypertension is a major risk factor for cardiovascular disease (CVD). Despite advances in hypertension prevention and treatment, the proportion of patients who are aware, treated and controlled is low, particularly in low-income and middle-income countries (LMICs). We will evaluate an adapted version of a multilevel and multicomponent hypertension control program in Guatemala, previously proven effective and feasible in Argentina. The program components are: protocol-based hypertension treatment using a standardized algorithm; team-based collaborative care; health provider education; health coaching sessions; home blood pressure monitoring; blood pressure audit; and feedback.

Methods: Using a hybrid type 2 effectiveness-implementation design, we will evaluate clinical and implementation outcomes of the multicomponent program in Guatemala over an 18-month period. Through a cluster randomized trial, we will randomly assign 18 health districts to the intervention arm and 18 to enhanced usual care across five departments, enrolling 44 participants per health district and 1584 participants in total. The clinical outcomes are (1) the difference in the proportion of patients with controlled hypertension (< 130/80 mmHg) between the intervention and control groups at 18 months and (2) the net change in systolic and diastolic blood pressure from baseline to 18 months. The context-enhanced Reach, Efficacy, Adoption, Implementation, Maintenance (RE-AIM)/Practical Robust Implementation and Sustainability Model (PRISM) framework will guide the evaluation of the implementation at the level of the patient, provider, and health system. Using a mixed-methods approach, we will evaluate the following implementation outcomes: acceptability, adoption, feasibility, fidelity, adaptation, reach, sustainability, and cost-effectiveness.

Discussion: We will disseminate the study findings, and promote scale up and scale out of the program, if proven effective. This study will generate urgently needed data on effective, adoptable, and sustainable interventions and implementation strategies to improve hypertension control in Guatemala and other LMICs.

Trial Registration: ClinicalTrials.gov: NCT03504124. Registered on 20 April 2018.
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http://dx.doi.org/10.1186/s13063-020-04345-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7281695PMC
June 2020

An Extension of RE-AIM to Enhance Sustainability: Addressing Dynamic Context and Promoting Health Equity Over Time.

Front Public Health 2020 12;8:134. Epub 2020 May 12.

School of Medicine, University of Colorado Denver, Aurora, CO, United States.

RE-AIM is a widely adopted, robust implementation science (IS) framework used to inform intervention and implementation design, planning, and evaluation, as well as to address short-term maintenance. In recent years, there has been growing focus on the longer-term sustainability of evidence-based programs, policies and practices (EBIs). In particular, investigators have conceptualized sustainability as the continued health impact and delivery of EBIs over a longer period of time (e.g., years after initial implementation) and incorporated the complex and evolving nature of context. We propose a reconsideration of RE-AIM to integrate recent conceptualizations of sustainability with a focus on addressing dynamic context and promoting health equity. In this Perspective, we present an extension of the RE-AIM framework to guide planning, measurement/evaluation, and adaptations focused on enhancing sustainability. We recommend consideration of: (1) extension of "maintenance" within RE-AIM to include recent conceptualizations of dynamic, longer-term intervention sustainability and "evolvability" across the life cycle of EBIs, including adaptation and potential de-implementation in light of changing and evolving evidence, contexts, and population needs; (2) iterative application of RE-AIM assessments to guide adaptations and enhance long-term sustainability; (3) explicit consideration of equity and cost as fundamental, driving forces that need to be addressed across RE-AIM dimensions to enhance sustainability; and (4) use or integration of RE-AIM with other existing frameworks that address key contextual factors and examine multi-level determinants of sustainability. Finally, we provide testable hypotheses and detailed research questions to inform future research in these areas.
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http://dx.doi.org/10.3389/fpubh.2020.00134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235159PMC
May 2020

Decision Aid Implementation among Left Ventricular Assist Device Programs Participating in the DECIDE-LVAD Stepped-Wedge Trial.

Med Decis Making 2020 04;40(3):289-301

Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA.

Despite demonstrated efficacy, patient decision aids (DAs) are rarely used in clinical practice in the absence of coverage mandates. Deciding whether to pursue a left ventricular assist device (LVAD) is a major, preference-sensitive decision-ideal for exploring implementation of a DA. We conducted a type II effectiveness-implementation hybrid trial at 6 LVAD programs using a stepped-wedge cluster-randomized design. Using the RE-AIM framework, we collected both quantitative and qualitative outcomes, including a checklist collected by study staff for each enrolled patient regarding DA use and interviews with LVAD program clinicians preintervention, 6 months postintervention, and at the conclusion of the study. From June 2015 to January 2017, 248 patients and their caregivers were enrolled. A total of 69 interviews were conducted with 48 clinicians at 3 time points. The DA reached 95% of eligible patients. Adoption was 100%, as all sites approached agreed to participate in the trial. Interviews revealed several themes related to the implementation of the DA: clinicians had a strong desire to ensure patients were informed and embraced the DA. Despite this, they reported communication challenges among their team that impeded implementation. Five of the 6 sites have maintained use of the DA following the trial; 1 site reported concerns about decreased procedural volume with use of the DA as a reason for discontinuation. In this hybrid trial, a DA for patients considering LVADs and their caregivers demonstrated high reach. Adoption and implementation were facilitated by a strong desire to ensure that patients were well informed. Future dissemination research and practice should attend to concerns about procedure volume and coverage mandates and facilitate ongoing communication at sites using the DA.
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http://dx.doi.org/10.1177/0272989X20915227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7243463PMC
April 2020

Correction to: The Invested in Diabetes Study Protocol: a cluster randomized pragmatic trial comparing standardized and patient-driven diabetes shared medical appointments.

Trials 2020 Feb 18;21(1):195. Epub 2020 Feb 18.

University of Colorado School of Medicine, 13199 E Montview Blvd Ste 210, Aurora, CO, 80045, USA.

After publication of our article [1] the authors have notified us that the title for Figure 1 was incorrectly captioned.
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http://dx.doi.org/10.1186/s13063-020-4110-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026950PMC
February 2020

National Working Group on the RE-AIM Planning and Evaluation Framework: Goals, Resources, and Future Directions.

Front Public Health 2019 10;7:390. Epub 2020 Jan 10.

Adult and Child Consortium for Outcomes Research and Delivery Science Dissemination and Implementation Science Program and The Department of Family Medicine, School of Medicine, University of Colorado- Anschutz Medical Campus, Aurora, CO, United States.

The National Working Group on RE-AIM Planning and Evaluation Framework (herein Workgroup) was established in 2004 to support the application of the framework and advance dissemination and implementation science (D&I). Workgroup members developed and disseminated products and resources (and continue to do so) to advocate for consistent application of RE-AIM and allow for cross study comparisons. The purpose of this paper is to summarize key Workgroup activities, products, and services (e.g., webinars, consultations, planning tools) and enhance bidirectional communication between the Workgroup and RE-AIM users. The ultimate goal of this work is to serve as a forum for dissemination to improve the balance between RE-AIM user demand (needs) and the currently limited RE-AIM Workgroup supply (consultation and resources) to demonstrate and expand the utility of RE-AIM as a D&I planning and evaluation framework. A summary of resources is provided as well as specific examples of how the Workgroup has been responsive to user needs.
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http://dx.doi.org/10.3389/fpubh.2019.00390DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6965154PMC
January 2020

The Invested in Diabetes Study Protocol: a cluster randomized pragmatic trial comparing standardized and patient-driven diabetes shared medical appointments.

Trials 2020 Jan 10;21(1):65. Epub 2020 Jan 10.

University of Colorado School of Medicine, 13199 E Montview Blvd Ste 210, Aurora, CO, 80045, USA.

Background: Shared medical appointments (SMAs) have been shown to be an efficient and effective strategy for providing diabetes self-management education and self-management support. SMA features vary and it is not known which features are most effective for different patients and practice settings. The Invested in Diabetes study tests the comparative effectiveness of SMAs with and without multidisciplinary care teams and patient topic choice for improving patient-centered and clinical outcomes related to diabetes.

Methods: This study compares the effectiveness of two SMA approaches using the Targeted Training for Illness Management (TTIM) curriculum. Standardized SMAs are led by a health educator with a set order of TTIM topics. Patient-driven SMAs are delivered collaboratively by a multidisciplinary care team (health educator, medical provider, behavioral health provider, and a peer mentor); patients select the order and emphasis on TTIM topics. Invested in Diabetes is a cluster randomized pragmatic trial involving approximately 1440 adult patients with type 2 diabetes. Twenty primary care practices will be randomly assigned to either standardized or patient-driven SMAs. A mixed-methods evaluation will include quantitative (practice- and patient-level data) and qualitative (practice and patient interviews, observation) components. The primary patient-centered outcome is diabetes distress. Secondary outcomes include autonomy support, self-management behaviors, clinical outcomes, patient reach, and practice-level value and sustainability.

Discussion: Practice and patient stakeholder input guided protocol development for this pragmatic trial comparing SMA approaches. Implementation strategies from the enhanced Replicating Effective Programs framework will help ensure practices maintain fidelity to intervention protocols while tailoring workflows to their settings. Invested in Diabetes will contribute to the literature on chronic illness management and implementation science using the RE-AIM model.

Trial Registration: ClinicalTrials.gov, NCT03590041. Registered on 5 July 2018.
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http://dx.doi.org/10.1186/s13063-019-3938-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6954498PMC
January 2020

A single-site pilot implementation of a novel trauma training program for prehospital providers in a resource-limited setting.

Pilot Feasibility Stud 2019 5;5:143. Epub 2019 Dec 5.

1University of Colorado, School of Medicine, Aurora, CO USA.

Background: Prehospital (ambulance) care can reduce morbidity and mortality from trauma. Yet, there is a dearth of effective evidence-based interventions and implementation strategies. Emergency Medical Services Traumatic Shock Care (EMS-TruShoC) is a novel bundle of five core evidence-based trauma care interventions. High-Efficiency EMS Training (HEET) is an innovative training and sensitization program conducted during clinical shifts in ambulances. We assess the feasibility of implementing EMS-TruShoC using the HEET strategy, and feasibility of assessing implementation and clinical outcomes. Findings will inform a main trial.

Methods: We conducted a single-site, prospective cohort, multi-methods pilot implementation study in Western Cape EMS system of South Africa. Of the 120 providers at the study site, 12 were trainers and the remaining were eligible learners. Feasibility of implementation was guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Feasibility of assessing clinical outcomes was assessed using shock indices and clinical quality of care scores, collected via abstraction of patients' prehospital trauma charts. Thresholds for progression to a main trial were developed a priori.

Results: The average of all implementation indices was 83% (standard deviation = 10.3). Reach of the HEET program was high, with 84% learners completing at least 75% of training modules. Comparing the proportion of learners attaining perfect scores in post- versus pre-implementation assessments, there was an 8-fold (52% vs. 6%) improvement in knowledge, 3-fold (39% vs. 12%) improvement in skills, and 2-fold (42% vs. 21%) increase in self-efficacy. Clinical outcomes data were successfully calculated-there were clinically significant improvements in shock indices and quality of prehospital trauma care in the post- versus pre-implementation phases. Adoption of HEET was good, evidenced by 83% of facilitator participation in trainings, and 100% of surveyed stakeholders indicating good programmatic fit for their organization. Stakeholders responded that HEET was a sustainable educational solution that aligned well with their organization. Implementation fidelity was very high; 90% of the HEET intervention and 77% of the implementation strategy were delivered as originally planned. Participants provided very positive feedback, and explained that on-the-job timing enhanced their participation. Maintenance was not relevant to assess in this pilot study.

Conclusions: We successfully implemented the EMS-TruShoC educational intervention using the HEET training strategy in a single-site pilot study conducted in a low-resource international setting. All clinical outcomes were successfully calculated. Overall, this pilot study suggests high feasibility of our future, planned experimental trial.
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http://dx.doi.org/10.1186/s40814-019-0536-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6896719PMC
December 2019

RE-AIM in the Real World: Use of the RE-AIM Framework for Program Planning and Evaluation in Clinical and Community Settings.

Front Public Health 2019 22;7:345. Epub 2019 Nov 22.

Department of Family Medicine and the Adult and Child Consortium of Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.

The RE-AIM framework has been widely used in health research but it is unclear the extent to which this framework is also used for planning and evaluating health-related programs in clinical and community settings. Our objective was to evaluate how RE-AIM is used in the "real-world" and identify opportunities for improving use outside of research contexts. We used purposive and snowball sampling to identify clinical and community health programs that used RE-AIM for planning and/or evaluation. Recruitment methods included surveys with email follow-up to funders, implementers, and RE-AIM working group members. We identified 17 programs and conducted structured in-depth interviews with key informants ( = 18). Across RE-AIM dimensions, respondents described motivations, uses, and measures; rated understandability and usefulness; discussed benefits and challenges, strategies to overcome challenges, and resources used. We used descriptive statistics for quantitative ratings, and content analysis for qualitative data. Program content areas included chronic disease management and prevention, healthy aging, mental health, or multiple, often behavioral health-related topics. During planning, most programs considered reach ( = 9), adoption ( = 11), and implementation ( = 12) while effectiveness ( = 7) and maintenance ( = 6) were considered less frequently. In contrast, most programs evaluated all RE-AIM dimensions, ranging from 13 programs assessing maintenance to 15 programs assessing implementation and effectiveness. On five-point scales, all RE-AIM dimensions were rated as easy to understand (Overall = 4.7 ± 0.5), but obtaining data was rated as somewhat challenging (Overall = 3.4 ± 0.9). Implementation was the most frequently used dimension to inform program design ( = 4.7 ± 0.6) relative to the other dimensions (3.0-3.9). All dimensions were considered similarly important for decision-making (average = 4.1 ± 1.4), with the exception of maintenance ( = 3.4 ± 1.7). Qualitative corresponded to the quantitative findings in that RE-AIM was reported to be a practical, easy to understand, and well-established implementation science framework. Challenges included understanding differences among RE-AIM dimensions and data acquisition. Valuable resources included the RE-AIM website and collaborating with an expert. RE-AIM is an efficient framework for planning and evaluation of clinical and community-based projects. It provides structure to systematically evaluate health program impact. Programs found planning for and assessing maintenance difficult, providing opportunities for further refinement.
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http://dx.doi.org/10.3389/fpubh.2019.00345DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883916PMC
November 2019

Dissemination and stakeholder engagement practices among dissemination & implementation scientists: Results from an online survey.

PLoS One 2019 13;14(11):e0216971. Epub 2019 Nov 13.

Adult and Child Consortium of Outcome Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, United States of America.

Introduction: There has been an increasing focus on disseminating research findings, but less about practices specific to disseminating and engaging non-researchers. The present project sought to describe dissemination practices and engagement of stakeholders among dissemination & implementation (D&I) scientists.

Methods: Methods to disseminate to and engage non-research stakeholders were assessed using an online survey sent to a broad, diverse sample of D&I scientists.

Results: Surveys were received from 210 participants. The majority of respondents were from university or research settings in the United States. (69%) or Canada (13%), representing a mix of clinical (28%) and community settings (34%). 26% had received formal training in D&I. Respondents indicated routinely engaging in a variety of dissemination-related activities, with academic journal publications (88%), conference presentations (86%), and reports to funders (74%) being the most frequent. Journal publication was identified as the most impactful on respondents' careers (94%), but face-to-face meetings with stakeholders were rated as most impactful on practice or policy (40%). Stakeholder involvement in research was common, with clinical and community-based researchers engaging stakeholder groups in broadly similar ways, but with critical differences noted between researchers with greater seniority, those with more D&I training, those based in the United States vs. Canada, and those in community vs. clinical research settings.

Conclusions: There have been increases in stakeholder engagement, but few other practices since the 2012 survey, and some differences across subgroups. Methods to engage different stakeholders deserve more in-depth investigation. D&I researchers report substantial misalignment of incentives and behaviors related to dissemination to non-research audiences.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216971PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6853327PMC
March 2020

Perspectives of Clinicians, Staff, and Veterans in Transitioning Veterans from non-VA Hospitals to Primary Care in a Single VA Healthcare System.

J Hosp Med 2019 Oct 23;14:E1-E7. Epub 2019 Oct 23.

Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, Colorado.

Background: Veterans with healthcare needs utilize both Veterans Health Administration (VA) and non-VA hospitals. These dual-use veterans are at high risk of adverse outcomes due to the lack of coordination for safe transitions.

Objectives: The aim of this study was to understand the barriers and facilitators to providing high-quality continuum of care for veterans transitioning from non-VA hospitals to the VA primary care setting.

Design: Guided by the practical robust implementation and sustainability model (PRISM) and the ideal transitions of care, we conducted a qualitative assessment using semi-structured interviews with clinicians, staff, and patients.

Setting: This study was conducted at a single urban VA medical center and two non-VA hospitals.

Participants: A total of 70 participants, including 52 clinicians and staff (23 VA and 29 non-VA) involved in patient transition and 18 veterans recently discharged from non-VA hospitals, were included in this study.

Approach: Data were analyzed using a conventional content analysis and managed in Atlas.ti (Berlin, Germany).

Results: Four major themes emerged where participants consistently discussed that transitions were delayed when they were not able to (1) identify patients as veterans and notify VA primary care of discharge, (2) transfer non-VA hospital medical records to VA primary care, (3) obtain follow-up care appointments with VA primary care, and (4) write VA formulary medications for veterans that they could fill at VA pharmacies. Participants also discussed factors involved in smooth transition and recommendations to improve care coordination.

Conclusions: All participants perceived the current transition-of-care process across healthcare systems to be inefficient. Efforts to improve quality and safety in transitional care should address the challenges clinicians and patients experience when transitioning from non-VA hospitals to VA primary care.
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http://dx.doi.org/10.12788/jhm.3320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7064299PMC
October 2019

An Adaptive, Contextual, Technology-Aided Support (ACTS) System for Chronic Illness Self-Management.

Milbank Q 2019 09 19;97(3):669-691. Epub 2019 Aug 19.

University of Colorado School of Medicine.

Policy Points Fundamental changes are needed in how complex chronic illness conditions are conceptualized and managed. Health management plans for chronic illness need to be integrated, adaptive, contextual, technology aided, patient driven, and designed to address the multilevel social environment of patients' lives. Such primary care-based health management plans are feasible today but will be even more effective and sustainable if supported by systems thinking, technological advances, and policies that create and reinforce home, work, and health care collaborations.

Context: The current health care system is failing patients with chronic illness, especially those with complex comorbid conditions and social determinants of health challenges. The current system combined with unsustainable health care costs, lack of support for primary care in the United States, and aging demographics create a frightening probable future.

Methods: Recent developments, including integrated behavioral health, community resources to address social determinants, population health infrastructure, patient-centered digital-health self-management support, and complexity science have the potential to help address these alarming trends. This article describes, first, the opportunity to integrate these trends and, second, a proposal for an integrated, patient-directed, adaptive, contextual, and technology-aided support (ACTS) system, based on a patient's life context and home/primary care/work-setting "support triangle."

Findings: None of these encouraging trends is a panacea, and although most have been described previously, they have not been integrated. Here we discuss an example of integration using these components and how our proposed model (termed My Own Health Report) can be applied, along with its strengths, limitations, implications, and opportunities for practice, policy, and research.

Conclusions: This ACTS system builds on and extends the current chronic illness management approaches. It is feasible today and can produce even more dramatic improvements in the future.
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http://dx.doi.org/10.1111/1468-0009.12412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739607PMC
September 2019

Psychiatry's stance towards scientifically implausible therapies: are we losing ground?

Lancet Psychiatry 2019 10 17;6(10):802-803. Epub 2019 Jul 17.

University of Colorado School of Medicine, Aurora, CO, USA.

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http://dx.doi.org/10.1016/S2215-0366(19)30276-7DOI Listing
October 2019

Online Resources for Dissemination and Implementation Science: Meeting Demand and Lessons Learned.

J Clin Transl Sci 2018 Oct 14;2(5):259-266. Epub 2019 Jan 14.

ACCORDS Dissemination and Implementation Science Program; School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.

A dramatically increased interest in dissemination and implementation (D&I) science, with relatively few training programs for D&I scientists, highlights the need for innovative ways to deliver educational materials, training, and resources. We described nine interactive, web-based D&I science resources appropriate for trainees and CTSAs. We used audience feedback and design thinking to develop resources iteratively. Primary target users are T3-T4 researchers, although T2 researchers can benefit from 'designing for dissemination' resources. Workforce development resources were used in D&I science workshops, as stand-alone, self-directed resources, and for consultations and trainings. We assessed resource design (purpose, functionality), usage, user experience and engagement. Educational resources addressed included: , . We reviewed the purpose, functionality, status, and usage of these interactive resources. All resources engaged users; provided interactive feedback for learners; and linked users to additional learning resources. Online resources can be valuable for preparing clinical and translational mentees for research consultations, as follow-up training activities, and as D&I workforce development resources. The resources described are publicly available and we encourage their use, further development, and evaluation by CTSAs and other programs.
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http://dx.doi.org/10.1017/cts.2018.337DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585983PMC
October 2018

Using the Practical, Robust Implementation and Sustainability Model (PRISM) to qualitatively assess multilevel contextual factors to help plan, implement, evaluate, and disseminate health services programs.

Transl Behav Med 2019 11;9(6):1002-1011

Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO, USA.

There is consensus in dissemination and implementation (D&I) science that addressing contextual factors is critically important for understanding translation of health care delivery interventions but little agreement on which contextual factors are key determinants of implementation outcomes. We describe the application of the Practical Robust Implementation and Sustainability Model (PRISM), which expands the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to identify contextual factors across four diverse programs. Multiple qualitative methods were used to collect multilevel, multistakeholder perspectives from the adopting organizations and staff. We identified measures for evaluating context through the various domains of PRISM to guide health services research across the phases of program implementation. The PRISM domains of Recipients, Implementation and Sustainability Infrastructure, and External Environment identified important multilevel contextual factors, including variability in operational processes and available resources. These domains helped to facilitate planning and implementation phases of the four interventions and guide purposeful adaptations. We found assessments of PRISM domains useful to systematically assess multilevel contextual factors across various content areas as well as phases of program implementation. Additionally, these contextual factors were found to be relevant to RE-AIM outcomes. Lessons learned can be applied to future research as there is a need to investigate the measurement properties of PRISM and continue to test which contextual factors are most important to successful implementation and for which outcomes.
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http://dx.doi.org/10.1093/tbm/ibz085DOI Listing
November 2019

RE-AIM Planning and Evaluation Framework: Adapting to New Science and Practice With a 20-Year Review.

Front Public Health 2019 29;7:64. Epub 2019 Mar 29.

Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States.

The RE-AIM planning and evaluation framework was conceptualized two decades ago. As one of the most frequently applied implementation frameworks, RE-AIM has now been cited in over 2,800 publications. This paper describes the application and evolution of RE-AIM as well as lessons learned from its use. RE-AIM has been applied most often in public health and health behavior change research, but increasingly in more diverse content areas and within clinical, community, and corporate settings. We discuss challenges of using RE-AIM while encouraging a more pragmatic use of key dimensions rather than comprehensive applications of all elements. Current foci of RE-AIM include increasing the emphasis on cost and adaptations to programs and expanding the use of qualitative methods to understand "how" and "why" results came about. The framework will continue to evolve to focus on contextual and explanatory factors related to RE-AIM outcomes, package RE-AIM for use by non-researchers, and integrate RE-AIM with other pragmatic and reporting frameworks.
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http://dx.doi.org/10.3389/fpubh.2019.00064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6450067PMC
March 2019

Making Health Research Matter: A Call to Increase Attention to External Validity.

Annu Rev Public Health 2019 04 21;40:45-63. Epub 2019 Jan 21.

Dissemination and Implementation Science Program of Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Aurora, Colorado 80045, USA.

Most of the clinical research conducted with the goal of improving health is not generalizable to nonresearch settings. In addition, scientists often fail to replicate each other's findings due, in part, to lack of attention to contextual factors accounting for their relative effectiveness or failure. To address these problems, we review the literature on assessment of external validity and summarize approaches to designing for generalizability. When investigators conduct systematic reviews, a critical need is often unmet: to evaluate the pragmatism and context of interventions, as well as their effectiveness. Researchers, editors, and grant reviewers can implement key changes in how they consider and report on external validity issues. For example, the recently published expanded CONSORT figure may aid scientists and potential program adopters in summarizing participation in and representativeness of a program across different settings, staff, and patients. Greater attention to external validity is needed to increase reporting transparency, improve program dissemination, and reduce failures to replicate research.
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http://dx.doi.org/10.1146/annurev-publhealth-040218-043945DOI Listing
April 2019

Designing Shared Decision-Making Interventions for Dissemination and Sustainment: Can Implementation Science Help Translate Shared Decision Making Into Routine Practice?

MDM Policy Pract 2018 Jul-Dec;3(2):2381468318808503. Epub 2018 Dec 7.

VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO.

Shared decision making (SDM) is not widely practiced in routine care due to a variety of organizational, provider, patient, and contextual factors. This article explores how implementation science-which encourages attention to the multilevel contextual factors that influence the adoption, implementation, and sustainment of health care practices-can provide useful insights for increasing SDM use in routine practice. We engaged with stakeholders representing different organizations and geographic locations over three phases: 1) multidisciplinary workgroup meeting comprising researchers and clinicians ( = 11); 2) survey among a purposive sample of 47 patient advocates, clinicians, health care system leaders, funders, policymakers, and researchers; and 3) working session among diverse stakeholders ( = 30). The workgroup meeting identified priorities for action and research, which included targeting multiple audiences and levels, shifting culture toward valuing and supporting SDM, and considering contextual factors influencing SDM implementation. Survey respondents provided recommendations for increasing adoption, implementation, and maintenance of SDM in practice including providing tools to support SDM, obtaining stakeholders' involvement, and raising awareness of the importance of SDM. Stakeholders in the working session provided recommendations on the design of a guide for implementation of SDM in clinical settings, strategies to disseminate educational curricula on SDM, and strategies to influence policies to increase SDM use. These specific recommendations serve as a call to action to pursuing specific promising strategies aimed at increasing SDM use in practice and enhance understanding of the perspectives of diverse stakeholders at multiple levels from an implementation science perspective that appear fruitful for further study and application.
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http://dx.doi.org/10.1177/2381468318808503DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6291870PMC
December 2018

Realizing the full potential of precision health: The need to include patient-reported health behavior, mental health, social determinants, and patient preferences data.

J Clin Transl Sci 2018 Jun 13;2(3):183-185. Epub 2018 Sep 13.

Dissemination and Implementation Science Program of ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, CO, USA.

Precision health and big data approaches have great potential, yet such benefits will be realized only when social and behavioral determinants of health and patient preferences are combined with genomic information. Literature review and co-author experiences informed this commentary. Validated health behavior, mental health, and patient preference measures were collected and summarized in real time. Integration of such data into existing data sets will advance precision health, patient-centered care, research, and policy.
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http://dx.doi.org/10.1017/cts.2018.31DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6202010PMC
June 2018