Quantitative approaches for the evaluation of implementation research studies
Original Bibliographic Citation:
Justin D. Smith and Mohamed Hasan, Psychiatry Research, https://doi.org/10.1016/j.psychres.2019.112521
Implementation research necessitates a shift from clinical trial methods in both the conduct of the study and in the way that it is evaluated given the focus on the impact of implementation strategies. That is, the methods or techniques to support the adoption and delivery of a clinical or preventive intervention, program, or policy. As strategies target one or more levels within the service delivery system, evaluating their impact needs to follow suit. This article discusses the methods and practices involved in quantitative evaluations of implementation research studies. We focus on evaluation methods that characterize and quantify the overall impacts of an implementation strategy on various outcomes. This article discusses available measurement methods for common quantitative implementation outcomes involved in such an evaluationadoption, fidelity, implementation cost, reach, and sustainmentand the sources of such data for these metrics using established taxonomies and frameworks. Last, we present an example of a quantitative evaluation from an ongoing randomized rollout implementation trial of the Collaborative Care Model for depression management in a large primary healthcare system.
Disaster and Mass Casualty Incident Responses by Intensive Care Units: A Scoping Review Protocol
An a priori scoping review protocol submission to the Northwestern DigitalHub (an institutional repository for the research and scholarly output of Northwestern Medicine) following Preferred Reporting Items for Systematic Review and Meta-analysis Protocols.
Critical care has displayed an interest in the field of disaster and mass casualty incident response (2). A disaster refers to a man-made or natural event requiring resources from outside a local community to return to pre-event status (3). An incident occurs secondary to similar hazards, requiring an emergency response to protect life, however, may not require resources from outside a local community (4). A mass casualty incident focuses on healthcare system capacity, where casualties rapidly exceed capabilities (5). Here we focus on the timeframe of acute response by intensive care units (ICUs) themselves: a relief phase - where lifesaving and mitigation efforts dominate - and a subsequent recovery phase - where efforts return systems to pre-event status. Significant infrastructure, personnel and equipment resources are required to operate ICUs (6). Disasters and mass casualty incidents are known to result in an influx of critically ill patients (2). Thus, ICU populations must be thought of as especially at risk.Yet, there remains a paucity of well-compiled data from the front-lines of ICU response initiatives, hampering evidence-based guideline production (2). Disaster research theory, though, is well-established (3). Categorical, continuous, or even narrative data reported by responders in the midst of response initiatives represent evidence (7). It is possible that through initial publication and valuating of such reports, we may illuminate intervention effects, variation in experience and practice, and identify gaps and inconsistencies in the literature.The purpose of this scoping review will be to compile and analyze ICU disaster and mass casualty incident response experiences. We intend to characterize ICU experiences - reported by ICUs themselves - to organize quantitative and qualitative data. Quantitative data, in the form of categorical and continuous items reported, will be assessed. Qualitative analyses will be undertaken through narrative inquiry of anecdotes. Outcomes of interest include identification of trends, analyses of existing reports for consistency, typical experience strengths or weaknesses, lessons learned, and best practices. This scoping review represents the first published data compilation and analysis of ICU disaster and mass casualty incident response initiatives.
Disaster, Mass casualty, Incident, Critical care, Intensive care unit, Response
Mass Casualty Incidents, Intensive Care Units, Critical Care
Moffet, Eric Warren
Wescott, Annie B
DigitalHub. Galter Health Sciences Library & Learning Center
An umbrella review comparing computer-assisted and conventional total joint arthroplasty: quality assessment and summary of evidence
Original Bibliographic Citation:
Hasan MM, Zhang M, Beal M, et al. An umbrella review comparing computer-assisted and conventional total joint arthroplasty: quality assessment and summaryof evidence. BMJ Surg Interv Health Technologies2020;2:e000016. doi:10.1136/bmjsit-2019-000016
Background Systematic reviews (SRs) of computer-assisted (CA) total knee arthroplasty (TKA) and total hip arthroplasty (THA) report conflicting evidence on its superiority over conventional surgery. Little is known about the quality of these SRs; variability in their methodological quality may be a contributing factor. We evaluated the methodological quality of all published SRs to date, summarized and examined the consistency of the evidence generated by these SRs.Methods We searched four databases through December 31, 2018. A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2) was applied to assess the methodological quality. Evidence from included meta-analyses on functional, radiological and patient-safety outcomes was summarized. The corrected covered area was calculated to assess the overlap between SRs in including the primary studies.Results Based on AMSTAR 2, confidence was critically low in 39 of the 42 included SRs and low in 3 SRs. Low rating was mainly due to failure in developing a review protocol (90.5%); providing a list of excluded studies (81%); accounting for risk of bias when discussing the results (67%); using a comprehensive search strategy (50%); and investigating publication bias (50%). Despite inconsistency between SR findings comparing functional, radiological and patient safety outcomes for CA and conventional procedures, most TKA meta-analyses favored CA TKA, whereas most THA meta-analyses showed no difference. Moderate overlap was observed among TKA SRs and high overlap among THA SRs.Conclusions Despite conclusions of meta-analyses favoring CA arthroplasty, decision makers adopting this technology should be aware of the low confidence in the results of the included SRs. To improve confidence in future SRs, journals should consider using a methodological assessment tool to evaluate the SRs prior to making a publication decision.
overview of systematic review, total joint arthroplasty, computer-assisted surgery, meta-analysis
Is there variation in utilization of preoperative tests among patients undergoing total hip and knee replacement in the US, and does it affect outcomes? A population-based analysis
Original Bibliographic Citation:
Hasan, M.M., Kang, R., Lee, J. et al. Is there variation in utilization of preoperative tests among patients undergoing total hip and knee replacement in the US, and does it affect outcomes? A population-based analysis. BMC Musculoskelet Disord 23, 972 (2022). https://doi.org/10.1186/s12891-022-05945-y
Study objectiveTo describe recent practice patterns of preoperative tests and to examine their association with 90-day all-cause readmissions and length of stay.DesignRetrospective cohort study using the New York Statewide Planning and Research Cooperative System (SPARCS).SettingSPARCS from March 1, 2016, to July 1, 2017.ParticipantsAdults undergoing Total Hip Replacement (THR) or Total Knee Replacement (TKR) had a preoperative screening outpatient visit within two months before their surgery.InterventionsElectrocardiogram (EKG), chest X-ray, and seven preoperative laboratory tests (RBCs antibody screen, Prothrombin time (PT) and Thromboplastin time, Metabolic Panel, Complete Blood Count (CBC), Methicillin Resistance Staphylococcus Aureus (MRSA) Nasal DNA probe, Urinalysis, Urine culture) were identified.Primary and secondary outcome measuresRegression analyses were utilized to determine the association between each preoperative test and two postoperative outcomes (90-day all-cause readmission and length of stay). Regression models adjusted for hospital-level random effects, patient demographics, insurance, hospital TKR, THR surgical volume, and comorbidities. Sensitivity analysis was conducted using the subset of patients with no comorbidities.ResultsFifty-five thousand ninety-nine patients (60% Female, mean age 66.1+/9.8 SD) were included. The most common tests were metabolic panel (74.5%), CBC (66.8%), and RBC antibody screen (58.8%). The least common tests were MRSA Nasal DNA probe (13.0%), EKG (11.7%), urine culture (10.7%), and chest X-ray (7.9%). Carrying out MRSA testing, urine culture, and EKG was associated with a lower likelihood of 90-day all-cause readmissions. The length of hospital stay was not associated with carrying out any preoperative tests. Results were similar in the subset with no comorbidities.ConclusionsWide variation exists in preoperative tests before THR and TKR. We identified three preoperative tests that may play a role in reducing readmissions. Further investigation is needed to evaluate these findings using more granular clinical data.
Preoperative testing, Preoperative EKG, Total knee replacement, Total hip replacement, MRSA screening, Asymptomatic bacteriuria
Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, Knee, Preoperative Care, Patient Readmission, Length of Stay
Subject: Geographic Name:
New York (State)
Hasan, Mohamed Mosaad Ismail, Kang, Raymond H, Lee, Julia, Beal, Matthew D, Ahmed, Abdalrahman G, Tian, Yao, Ghomrawi, Hassan
NO WAIT: new organised well-adapted immediate triage: a lean improvement project
Original Bibliographic Citation:
Elkholi A, Althobiti H, Al Nofeye J, et al. NO WAIT: new organised well-adapted immediate triage: a lean improvement project. BMJ Open Quality 2021;10:e001179. doi:10.1136/bmjoq-2020-001179
Long waiting times in the emergency department (ED) are associated with decreased patient satisfaction and increased morbidity and mortality. Triage may be a contributing factor to prolonged wait times in the ED. At Alhada Armed Forces Hospital (Taif, Saudi Arabia), patients other than level 1 and 2 on the Canadian Triage and Acuity Scale are requested to wait until triage. During peak hours (08:0022:00), the waiting time prior to triage is prolonged, and several patients leave the ED before triage. In this project, a multidisciplinary team was assembled to revise patient flow from the time of arrival at the ED to the time of triage. Lean methodology was used to identify the redundancies and design a seamless flow process for ED patients. Through reorganising the triage area using minimal additional resources, the project team devised a novel floor plan for the triage area which provided a unique patient flow in the ED. The median patient wait time from arrival to triage was reduced from 27 min to 4.09 min and the percentage of patients leaving the ER before triage was reduced to 0%. This project is the first of its kind in Saudi Arabia, as well as in the Gulf region, and provides a radical solution to the problem of patient waiting in the ED during peak hours.