Remember me
Implementation Science 2023, 18(2):O16
Background
Genomic mainstreaming is the implementation of genomic testing as routine practice within nongenetic settings. The aim of this body of work was to conduct a holistic implementation needs assessment that would guide the development of evidence-informed implementation strategies in support of real-world genomic mainstreaming efforts within nongenetic paediatric settings via an integrated model of care involving clinical genetics services.
Methods
A sequence of three studies were conducted via a mixed method methodology and structured by the process model Implementation Mapping (IM) to guide the development of implementation strategies. The research approach was informed by a complex adaptive systems lens and guided by transdisciplinary co-production.
Results
Study one began with an implementation needs assessment within genetics services via qualitative semi-structured interviews (n=14 participants, clinical genetics professionals), with resultant data analysed using (1) the Interactive Systems Framework (ISF) for mapping the implementation system, (2) pathway mapping techniques to visualise changes required in processes and practices, and (3) the Consolidated Framework for Implementation Research (CFIR) to assess the barriers and facilitators to implementation within genetic services. In study two an implementation needs assessment was conducted within paediatric services via a cross-sectional survey (n=114 respondents, paediatricians) analysed using descriptive statistics and semi-structured interviews (n=22) analysed using the TDF framework.
Conclusions
In study three, using a combination of five implementation science tools, the findings from studies one and two were integrated to develop forty evidence-informed, discrete implementation strategies with specifications ready to be used by groups across health systems involved in real-world implementation efforts.
O17 Developing an implementation strategy for routine collection of patient-reported outcome measures (PROMS) in multidisciplinary teamsLaura Jolliffe, Nadine Andrew, Velandai Srikanth, Richard Beare, Kate Noeske, David SnowdonPeninsula Health, VIC, AustraliaImplementation Science 2023, 18(2):O17
Background
Little is known about implementing patient reported outcome measures (PROMs) in multidisciplinary settings. To date, developing implementation approaches for PROMs have largely focused on single-disciplines with an assumption that clinicians can forecast potential implementation barriers and enablers. Our study aimed to develop a large-scale theory-informed implementation approach after 12 months of routine PROM collection.
Methods
Semi-structured interviews were completed with allied health clinicians who were involved in the routine collection of PROMs in a multidisciplinary community rehabilitation program (across three sites of a large public health service). Data from interviews were independently coded by two authors, and mapped against the Theoretical Domains Framework (TDF) and the Behaviour Change Wheel (BCW). We applied the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) criteria and used a consensus approach to refine the multifaceted strategies.
Results
21 interviews were conducted, and four themes emerged: 1) The Impact of PROMS on patient centred-care; 2) Considerations for validity of PROMS; 3) Service-level impact of embedding PROMS; and, 4) Practical issues of embedding PROMS within the service. These mapped against seven TDF domains, and five hypothetical strategies were developed. Key behaviour change techniques underpinning the strategies include: restructuring the physical environment, incentivisation, persuasion and education, enablement, and, social support.
Conclusions
The implementation approach highlights the importance of automating processes, engaging with site champions, routinely reporting PROM data to clinical teams, and empowering clinicians to use this data to inform service provision.
O18 Development of an implementation-focused logic model framework: a practical example of use to design and support complex care provision for children with a hard-to-treat-cancerSkye McKay1, Carolyn Mazariego1, Mark Dobson2, Elijah Tyedmers1, Lauren Kelada3,4, Brittany McGill3,4, Rebecca Daly3,4, Claire E. Wakefield4,5, David Ziegler2,5, Natalie Taylor1 1School of Population Health, UNSW Medicine and Health, UNSW Sydney, NSW, Australia; 2Kids Cancer Centre, Sydney Children’s Hospital, NSW, Australia; 3Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney; 4Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW, Australia; 5School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, NSW, AustraliaImplementation Science 2023, 18(2):O18
Background
Usage of implementation research logic models (IRLMs) enable better transparency of implementation science research and intended outcomes. Complex clinical interventions can benefit from novel resources to support implementation, with some requiring a granular level of strategy development. Existing IRLMs do not capture all three layers, making it challenging to delineate between influencing factors and mechanistic effects. Here we demonstrate a novel IRLM designed for ProCure, a database to streamline the novel medicines access pathways for paediatric oncology healthcare professionals (HCPs)
Methods
The implementation science team used a consensus-based approach to amend a Smith, JD et al (2020) IRLM template to demonstrate inter-relationships between the clinical intervention, implementation intervention, and implementation strategies. Analysis of 17 HCP interviews enabled coding of contextual barriers and facilitators (i.e., determinants) to the Consolidated Framework for Implementation Research (CFIR).
Results
Precision medicine is the IRLM ‘Clinical Intervention’, directly impacting patient outcomes, implementation context, and ProCure design. As the ‘Implementation Intervention’, ProCure aims to facilitate the medicines access pathway in precision medicine. Factors influencing ProCure implementation are stratified as CFIR coded determinants and targeted by Expert Recommendations for Implementing Change (ERIC) implementation strategies. Relationships between hypothesised mechanism of action and intended outcome(s) are represented using superscripts.
Conclusions
This IRLM provides a tailored theoretical model to capture the complexity between a clinical intervention, an implementation intervention, and deployed implementation strategies, using ProCure as an example. The causal relationships will be tested and refined throughout the study and measured with meaningful outcomes to enhance transparency, reproducibility and scale-up.
O19 Process evaluation exploring implementation outcomes and barriers and facilitators of a Healthy Lifestyle for low back pain Program (HeLP) Intervention embedded in clinical careEmma Robson1,2, Cassandra Lane2, Steven Kamper3, Jenna Hollis2, Simon Davidson2, Christopher Williams3, Priscilla viana da Silva2, Connor Gleadhill2, Rebecca Hodder2 1Hunter New England Population Health, Hunter New England Local Health District, NSW, Australia; 2University of Newcastle, NSW, Australia; 3University of Sydney, NSW, AustraliaImplementation Science 2023, 18(2):O19
Background
We describe implementation outcomes of 1) fidelity; 2) adoption; 3) acceptability, appropriateness and feasibility; and 4) barriers and facilitators of engagement and delivery of a Healthy Lifestyle Program (HeLP) for low back pain.
Methods
The RCT included 346 adults with chronic low back pain and at least one health risk factor randomised to HeLP or guideline care. HeLP included: consultations, resources, and referral to telephone services for lifestyle risk factors, over 26 weeks. We used a sequential mixed methods design to evaluate HeLP participant and clinician data. We collected quantitative data via fidelity checklists, administrative records, and surveys. We collected qualitative data via semi-structured interviews and focus groups with participants and clinicians. We used descriptive statistics to analyse quantitative data, thematic analyses for qualitative data, and triangulation to integrate data and identify meta-themes.
Results
Intervention fidelity was high (>90% delivered). Participants attended a mean 3.2 consultations, 54% engaged with telephone services and 26% used online resources. Clinicians and participants found the intervention acceptable and addressing lifestyle factors was considered appropriate for back pain management. Perceptions varied on the acceptability and appropriateness of telephone services, and whether parts of the program met individual patient needs. Clinicians’ delivery barriers included low self-efficacy in behaviour change communication skills, while enablers were behaviour change communication skills training and practice observation and feedback.
Conclusions
Participants and clinicians appeared satisfied with HeLP, however adoption of discrete components varied. Adaptations to improve clinicians’ behaviour change communication skills and individualisation of care may optimise future implementation.
O20 A clinical implementation trial to inform successful genomic medicine strategies in practice: improving tumour testing and genetic services referral for Lynch syndrome at 7 major hospitals in AustraliaJulia Steinberg1, Priscilla Chan2, Sarsha Yap1, April Morrow2, Gabriella Tiernan2, Yoon-Jung Kang1, Emily He1, Rhiannon Edge 1, Deborah Debono3, Bonny Parkinson4, Hide and Seek Clinical Project Team1, Karen Canfell1, Finlay Macrae5, Kathy Tucker2,6, Emily Hogden2, Natalie Taylor2 1The Daffodil Centre, University of Sydney, NSW, Australia; 2University of NSW, NSW, Australia; 3University of Technology, Sydney, NSW, Australia; 4Macquarie University, NSW, Australia; 5The Royal Melbourne Hospital, Melbourne, VIC, Australia; Prince of Wales Hospital, Sydney, NSW, AustraliaImplementation Science 2023, 18(2):O20
Background
To inform implementation of effective genomic medicine, current gaps and successful strategies to support clinician practice change for well-established applications can provide important insights. Lynch syndrome (LS) causes 3-5% of colorectal cancers (CRCs), with long-standing guidelines recommending LS tumour testing of all CRC patients, but substantial heterogeneity in practice. Our trial compared the effectiveness of two structured implementation approaches (theory-based/non-theory-based) to improve risk-appropriate LS tumour testing and referral to genetics services.
Methods
Seven major Australian hospitals were randomly allocated to two trial arms. Hospital and genetics services data for 01/01/2017-31/12/2018 were used to identify hospital-specific practice gaps (total n=1,624 CRC patients). At each hospital, a health service professional was trained in evidence-based implementation to form stakeholder teams to identify target behaviours for change and associated barriers (using process mapping, questionnaires, focus groups), then co-design and implement targeted strategies. Trial arms differed only in the use of theory to identify barriers and design strategies.
Results
Pre-trial, risk-appropriate LS tumour testing and referral was complete 2 months post-resection for 76.5% and 74.9% of patients in theory-based and non-theory-based arms, respectively (aRR=1.02, 95%CI 0.74-1.41). Clinical practice differed in six key areas, including multidisciplinary input and application of testing guidelines. With implementation of site-specific strategies, risk-appropriate tumour testing and referral 2 months post-resection increased to 89.1% of patients in the theory-based arm but decreased to 65.9% in the non-theory arm (aRR 1.31, 95%CI 1.16-1.47). Hospital-level changes were variable and likely affected by COVID-19.
Conclusions
Findings suggest theory-based implementation science approaches might support successful integration of genomics into clinical care.
O21 Hey Vocera, call the doc: Evaluation of the Vocera Badge communication deviceJacky Hanh1, Tony Tu1, Olivia King1, Shona Hanson1, Adeola Bamgboje-Ayodele2, Melissa Baysari2, Aaron Jones1 1Sydney Local Health District, Sydney, NSW, Australia; 2University of Sydney, Sydney, NSW, AustraliaImplementation Science 2023, 18(2):O21
Background
Increased COVID-19 hospital admissions with greater clinical complexity during the Delta wave resulted in changes to ward layouts and reliance on isolation rooms. Maintaining infection control practices introduced challenges to existing communication methods and created complex barriers to effective patient care. The Vocera Badge was identified as a potential solution because it enables portable hands-free voice-activated communication to other staff, landlines and mobiles, while being worn underneath personal protective equipment. This project aimed to evaluate whether Vocera improved staff communication efficiency, user perceptions of the device, and device implementation strategies at a tertiary metropolitan hospital.
Methods
Vocera was implemented for medical, nursing and clerical staff within the emergency department. The facility Bed Manager and After-hours Operational Nurse Manager were also strategically included. Scenario-based usability testing was performed to measure communication efficiencies gained. User perceptions of Vocera and its implementation were evaluated with surveys, focus groups and usage data analyses.
Results
Preliminary results from usability testing found reductions in communication delay times from 70 seconds to 18 seconds. Communications with delays of less than 15 seconds improved from 0% to 46%. This equated to time savings of 92 hours over a 4-week period. Analyses of the surveys, focus groups and usage data are currently in progress.
Conclusions
This project demonstrated significant increases in communication efficiency with Vocera. Planned analyses of surveys, focus groups and Vocera usage data will elucidate effective implementation strategies. These findings will guide large-scale implementation across the health district and more broadly across NSW and Australia.
O22 Implementing improvements for complex rare conditions: the neurofibromatosis networked model of care in NSWHossai Gul1, Sue-Faye Siow2, Jane Fleming2, Suzana Milosjavic2, Martin Good2, Manoj Menezes3, Tina Gonzalez2, Sally Maspero2, Kristi Jones3, Yemima Berman2 1 SPHERE, TD School, University of Technology, Sydney, NSW, Australia; 2North Sydney Local Health District, NSW, Australia; 3Westmead Children’s Hospital, Sydney, NSW, AustraliaImplementation Science 2023, 18(2):O22
Background
The neurofibromatoses are a group of genetic conditions associated with multisystemic complications resulting in complex care needs. Delivery of care is fragmented due to local health district boundaries, and subspecialist services are unable to be duplicated due to the highly specialised nature of treatments. The aim of this study was to identify and implement the model of care that would provide neurofibromatosis patients in NSW the highest quality care.
Methods
A sequential mixed method of survey and semi-structured interviews were conducted with identified health professionals delivering adult and/or paediatric services for patients with NF1, NF2 and schwannomatosis. Survey results were analysed using descriptive statistics and qualitative data was analysed using thematic analysis.
Results
Surveys were completed by 47 participants, representing a diverse cohort of health professionals from specialist physicians, specialist surgeons, to allied health professionals covering services across 17 local health districts within NSW. Of these 21 opted-in for semi-structured interviews. The findings showed a pre-existing networked model of care whereby a variety of health professionals conversant with neurofibromatosis deliver subspecialist services across the lifetime and across the different types of neurofibromatoses with two concentrations of services (1 adult and 1 children) within the state. The main areas in need of improvement were identified: transition from paediatric care to adult care, a need for a centralised platform for resources and services, and better referral pathways/protocols. Interventions were put in place across the model of care and data is being collected on effectiveness and implementation in parallel.
Conclusions
Improvements within rare complex models of care requires mapping of the system and intervening within key leverage points to develop and implement evidence-informed interventions on a continuous basis.
O23 Lung cancer screening in Australia: using implementation science frameworks to accelerate translationNicole Rankin1, Rachael H. Dodd2,3, Kate L.A. Dunlop2,3, Henry M. Marshall4,5, Joel Rhee6, Mei Ling Yap7, Sue McCullough6, Sarah York8, Emily Stone6,9 1University of Melbourne, VIC, Australia; 2 Daffodil Centre, University of Sydney and Cancer Council NSW, NSW, Australia; 3 University of Sydney, NSW, Australia; 4The University of Queensland, QLD, Australia; 5The Prince Charles Hospital, QLD, Australia; 6The University of New South Wales, NSW, Australia; 7Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute, The University of New South Wales, NSW, Australia; 8Sydney School of Public Health, the University of Sydney, Sydney, NSW, Australia; St Vincent's Hospital, Sydney, NSW, AustraliaImplementation Science 2023, 18(2):O23
Background
Lung cancer screening in high-risk populations, using low dose computed tomography has the potential to save thousands of lives by detecting early-stage curable disease. Significant progress towards implementation includes a recommendation that the Australian Government fund a national program, feasibility trials, government-commissioned scoping work and implementation research. This presentation aims to describe how implementation science frameworks are being utilised in generating pre-implementation evidence.
Methods
We conducted two qualitative studies about lung cancer screening acceptability and feasibility. Study 1) semi-structured telephone interviews were completed with 39 individuals from the International Lung Screening Trial who had participated or declined to screen; we used the COM-B model of behaviour change for analysis. Study 2) we conducted 24 focus groups with 84 key stakeholders (e.g., healthcare professionals); we used the Consolidated Framework for Implementation Research for analysis. The CFIR-ERIC matching tool was used to identify potential implementation strategies.
Results
The COM-B framework showed that motivation alone is insufficient to engage high-risk participants in screening; opportunity and capability must inform selection of implementation strategies that target individual behaviour change. The focus groups analysis elicited determinants that were mapped to CFIR constructs, of which “readiness for implementation”, “planning” and “executing” were most relevant. The matching tool identified at least 12 potential implementation strategies at health system, provider, participant and policy levels that should be considered.
Conclusions
Implementation science frameworks should be utilised in pre-implementation research. The findings provide an evidence-based foundation for selecting and designing implementation strategies for a national lung cancer screening program.
O24 Using process mapping to capture variability within paediatric cancer survivorship services: understanding factors influencing implementation of the Engage programSkye McKay1, Carolyn Mazariego1, Joseph Elias1, Jordana McLoone2,3, Christina Signorelli2,3, Claire E Wakefield2,3, Richard Cohn2,3, Natalie Taylor1 1School of Population Health, UNSW Medicine and Health, UNSW Sydney, NSW, Australia; 2Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia; 3School of Clinical Medicine, UNSW Medicine & Health, Discipline of Paediatrics, UNSW Sydney, NSW, AustraliaImplementation Science 2023, 18(2):O24
Background
Process mapping can provide an in-depth understanding of clinical processes, necessary for successful implementation of evidence-based clinical interventions. The Engage program innovates a distance-delivered multi-disciplinary model of survivorship care. Process mapping was applied at three hospital sites to understand existing survivorship care delivery and identify factors influencing implementation of Engage at each stage of the care pathway.
Methods
Survivorship-service healthcare professionals (HCPs) were invited to participate in semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR). A draft process map facilitated step-by-step discussion of the clinical practices involved from the time a patient completes treatment to commences survivorship care. Interviews explored how core components of Engage could be integrated into existing practices.
Results
Data from 16 HCPs interviews produced three distinct survivorship service process maps and identified unique and shared factors impacting implementation of Engage. Common barriers include: patient identification; obtaining GP referrals; scheduling multidisciplinary team (MDT) meetings and compiling the MDT letter. However, underlying contextual causes for these shared barriers often differed between sites, requiring implementation strategies to be tailored to fit site-specific needs. Key facilitators to implementation included an experienced survivorship care team and established telehealth services.
Conclusions
Process mapping successfully identifies site-specific variation in complex clinical processes and facilitates a shared understanding of the current systems and factors that affect implementation. This deeper knowledge allows for the development of a suite of implementation strategies, which can be adapted to support implementation and scale-up at additional sites.
O25 Capturing variability in the Lynch syndrome genetic referral pathwayApril Morrow1, Julia Steinberg2, Priscilla Chan1, Gabriella Tiernan1, Elizabeth Kennedy2, Natasha Erogoff3, Desiree Hilton4, Lucien Sankey5, Rebecca Venchiarutti2, Anne Hayward7, Amy Pearne2, Skye McKay1, Deborah Debono8, Emily Hogden1, Natalie Taylor1 1University of NSW, Sydney, NSW, Australia; 2Daffodil Centre, University of Sydney, NSW, Australia; 3The University of Newcastle, NSW, Australia; 4Westmead Hospital, NSW, Australia; 5Monash Health, VIC, Australia; 6The University of Sydney, Sydney, NSW, Australia; 7Royal Melbourne Hospital, VIC, Australia; 8University of Technology, NSW, AustraliaImplementation Science 2023, 18(2):O25
https://doi.org/10.1093/tbm/ibad009
O26 How to effectively implement preoperative anaemia and iron deficiency screening, evaluation and management pathways using the CFIR-ERIC approachAlana Delaforce1, Shannon Farmer2, Jed Duff 3, Judy Munday3, Kristin Miller4, Lynne Glover4, Chris Corney4, Gareth Ansell4, Naadir Gutta4, Haitham Tuffaha5, Janet Hardy4, Cameron Hurst6 1Commonwealth Scientific and Industrial Research Organisation (CSIRO), ACT, Australia; 2Department of Haematology, Royal Perth Hospital, WA, Australia; 3Centre for Healthcare Transformation/School of Nursing, Queensland University of Technology, QLD, Australia; 4Mater Health Services, QLD, Australia; 5Centre for the Business and Economics of Health, University of Queensland, QLD, Australia; 6Charles Sturt University, NSW, AustraliaImplementation Science 2023, 18(2):O26
https://doi.org/10.1111/trf.17287
O27 Impact of core versus enhanced implementation strategies on adherence to a clinical pathway for managing anxiety and depression in cancer patients in routine care: A cluster randomised controlled trialHeather L Sheperd1,2, Phyllis Butow2, Mona Faris2, Joanne Shaw2, Patrick Kelly3, Marnie Harris2, Jessica Cuddy2, Lindy Masya2, Liesbeth Geerligs2, Brian Kelly4, Afaf Girgis5, Nicole Rankin6, Philip Beale7, Thomas Hack8, Laura Kirsten9, Haryana Dhillon2, Peter Grimison10, Rosalie Viney11, Josephine Clayton12, Tim Schlub2, and the ADAPT Program Group 1Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; 2School of Psychology, Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, NSW, Australia; 3Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; 4School of Medicine and Public Health, University of Newcastle, NSW, Australia; 5South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Kensington, NSW, Australia; 6Centre for Health Policy, Faculty of Medicine, Dentistry and Health Sciences, Melbourne, NSW, Australia; 7Concord Hospital, Sydney Local Health District, NSW, Australia; 8College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; 9Nepean Blue Mountains Local Health District, NSW, Australia; 10Chris O’Brien Lifehouse, Camperdown, NSW, Australia; 11Centre for Health Economics Research and Evaluation, University of Technology, Sydney, NSW Australia; 12The Palliative Centre, Greenwich Hospital, NSW, AustraliaImplementation Science 2023, 18(2):O27
Background
Optimal strategies to facilitate implementation of evidence-based clinical pathways are unclear. We evaluated a core and an enhanced implementation strategy to facilitate implementation of a clinical pathway for the management of anxiety and depression (A/D) in patients with cancer (ADAPT CP).
Methods
Twelve cancer services were cluster randomised to a Core versus Enhanced implementation strategy for 12 months. Core strategy included a Lead Team with champions, awareness campaigns, staff training, feedback reports, telephone/online support. Enhanced strategy added monthly meetings, proactive advice, tailored awareness campaigns. Patients were introduced to the ADAPT CP as routine care, completed screening, and allocated an A/D step of 1-5 (minimal/mild/moderate/severe/very severe), with referral for additional support. Multi-level mixed-effect regression analyses examined impact of implementation strategy on ADAPT CP adherence (binary primary outcome: adherent: ≥70% ADAPT CP components achieved; or non-adherent: <70% achieved), continuous adherence was a secondary outcome. Interaction between implementation strategies and A/D step severity was explored.
Results
Of 1,280 registered patients, 696 (54%) completed screening, 1,323 screening events in total (883 Core, 440 Enhanced). The main effect of implementation strategy on adherence was non-significant in binary and continuous analyses, however, A/D step was significant. Adherence was higher for Step 2 than other steps (p=0.001). Interaction between implementation strategy and A/D step was significant (p=0.02) in the continuous adherence analysis: adherence with the enhanced strategy was significantly higher (7.5%points) for Step 3 (p=0.048) and trending to significance for Step 4.
Conclusions
Results support ongoing implementation effort for the first year of implementation to ensure uptake and sustainment of clinical pathways in over-burdened clinical services.
O28 How actionable are infection prevention and control guidelines in residential aged care? A document analysis based on a behaviour specification frameworkJoanne Tropea1,2, Jill Francis3, Lyn-li Lim4, Noleen Bennett4, Kwang Lim1,2, Kirsty Buising1,2, Deirdre Fetherstonhaugh5, Sanne Peters3 1Royal Melbourne Hospital, Melbourne, VIC, Australia; 2Department of Medicine, Royal Melbourne Hospital, University of Melbourne, VIC, Australia; 3School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia; 4VICNISS, Peter Doherty Institute, University of Melbourne, VIC, Australia; 5Australian Centre for Evidence Based Aged Care, La Trobe University, VIC, AustraliaImplementation Science 2023, 18(2):O28
Background
Older people living in residential aged care are susceptible to transmissible infections such as influenza, COVID-19, and gastroenteritis. Effective infection prevention and control (IPC) practice in residential aged care is therefore imperative. To enable this, national and aged care provider-level IPC guidelines need to be specific enough to be actionable by residential aged care staff and organisations. The aim of this study was to assess the actionability of IPC national guidelines and residential aged care policies and procedures. We chose to examine the guidelines around healthcare associated infection (HAI) surveillance in residential aged care.
Methods
A content analysis of the Australian IPC guidelines, and IPC policies and procedures from Victorian residential aged care facilities was conducted. Data extraction, coding and interpretation of findings were directed by the action-actor-context-target-time (AACTT) framework.
Results
National guidelines did not specify recommendations related to HAI surveillance but include general statements of support for data collection on HAI and outbreaks, suggest best epidemiologic principles that should be applied in data collection, and suggest that data should be fed back to appropriate staff groups and administrators. Provider-level policies and procedures varied in specificity.
Conclusions
While it is recommended that aged care providers undertake HAI surveillance, national guideline recommendations are open to interpretation and are not specific or actionable. Provider-level guidelines also need improving to facilitate actionability. To increase uptake of effective HAI surveillance in residential aged care, local policies and procedures need to be written with greater behavioural specificity.
O29 The expected value of implementation: The use of iterative expert elicitation and scenario analyses within decision-analytic models of health servicesAndrew Partington1,2, Jonathan Karnon1 1Flinders Health and Medical Research Institute, Flinders University, SA, Australia; 2Australian Institute of Health Innovation, Macquarie University, NSW, AustraliaImplementation Science 2023, 18(2):O29
Background
Health economists can inform the management of integrated services, rather than merely the adoption of discrete and disjointed products e.g., pharmaceuticals and devices. But this is not so simple. During ex-ante value-based planning of interventions, consideration is required of implementation fidelity within complex and dynamic systems. Potential misalignments require adaptations to resourcing, but also our expectations of effects and, therefore, cost-effectiveness i.e., value and success.
Methods
While embedded within Local Health Networks in South Australia, we conducted interviews and retroductive analyses to conceptualise decision problems and the logic behind interventions. We then conducted expert elicitation of quantitative estimates of expected future effects, which were used to model the expected cost-effectiveness of theorised service interventions. Finally, scenario analyses were used to explore the implementation costs necessary to minimise the likelihood of poor fidelity and sustainability.
Results
Expected effects include non-inferior outcomes, financial savings, and repurposed capacity. There have been moderate levels of disagreement among stakeholders regarding the scale and uncertainty of expected effects ex-ante. Theorised adaptations included the need for unscheduled meetings, backup/redundant equipment, and “exceptional circumstance” responsibilities. Steep learning effects are also expected regarding the “risk appetite” of referrers. Modelled cost-effectiveness is sensitive to scenarios of poor adaptation and patient selection.
Conclusions
Modelled evaluations feed into business cases and living analytical models. While value is context-dependent, methods are generalisable. We highlight the potential of a Value of Implementation equation to price-in resources or “operational slack” for expected adaptations based on acceptable likelihoods of realised and sustained costs and effects.
O30 Designing for implementation: co-design of a paediatric oncology medicines database (ProCure) to support complex care provision for children with a hard-to-treat cancerElijah Tyedmers1, Carolyn Mazariego1, Mark Dobson2, Skye McKay1, Lauren Kelada2,3, Brittany McGill2,3, Rebecca Daly2,3, Claire Wakefield2, David Ziegler2,3, Natalie Taylor1 1School of Population Health, University of NSW Medicine and Health, Sydney, NSW, Australia; 2Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW, Australia; 3School of Clinical Medicine, University of NSW Medicine and Health, University of NSW, Sydney, NSW, AustraliaImplementation Science 2023, 18(2):O30
Background
Co-design of technological interventions uses creative and participatory methods. In pediatric precision-medicine, treatment options identified by trials are often not approved and associated with ambiguous and time-consuming access pathways. This study aimed to use co-design methodologies to develop “ProCure”, a novel medicines access database that streamlines the application process for compassionate-use cancer therapies.
Methods
To promote ProCure’s implementation and ensure scalability, implementation science methodologies were used to guide the development and co-design process. Process mapping and implementation science frameworks were combined to explore healthcare professionals’ (HCP) perceived barriers and facilitators to current access pathways and their perceived acceptability to ProCure. HCPs participated in semi-structured interviews, guided by a process map depicting current novel medicine access pathways. Qualitative interview data were coded to the Consolidated Framework for Implementation Research (CFIR) to identify contextual barriers, explore perceived acceptability of ProCure and identify end-user needs.
Results
Key barriers to the current process were identified (e.g., resource-intensive applications to access medicines, time-sensitive decision-making, complicated pharmaceutical information), informing the co-design of ProCure. Most HCPs expressed perceived value in ProCure and intention to use it. Implementation strategies will be developed using the CFIR-ERIC (Expert Recommendations for Implementing Change) matching tool to guide implementation at the pilot site.
Conclusions
ProCure is perceived as an acceptable resource with potential to streamline off-label medicines access. End-user testing will use a mixed-methods approach to evaluate implementation determinants of ProCure. Combining process mapping and CFIR succeeded in informing ProCure’s co-design and readying the database for implementation and national scale-up.
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