CIIS researchers engage in diverse implementation and improvement science projects, employing rigorous but practical methods. We work with a variety of stakeholders from different clinical departments including the intensive care unit, surgery, endocrinology, and radiology, amongst others. We conduct research on a diverse array of topics that have included implementation science theory and methods development, substance use, diabetes, and incidental findings. Please contact us with questions, or to discuss your project.
Implementation of a Phenobarbital-based Pathway for Severe Alcohol Withdrawal
Several institutions have implemented phenobarbital-based pathways to treat alcohol withdrawal syndrome. Our current study examines the simultaneous implementation of a phenobarbital-based pathway and de-implementation of a benzodiazepine-based protocol. This mixed methods analysis will use an interrupted time series design to compare rates of mechanical ventilation before and after implementation of the new protocol, and describe clinician acceptability and feasibility of the protocols.
Establishing Consensus Definitions and Measures of Culture Change in Implementation Research
Defining sustainability, and creating or evaluating measures that adequately capture this concept, remains a relatively unexplored area in implementation science. Similarly, describing the process of culture change and identifying markers of “standard of care” merit further attention. We are conducting a Delphi panel to identify consensus definitions and metrics for culture change in medical care.
Examining the Effectiveness of Clinical Decision Support Systems for Delivering Care to Hospitalized Adults
Clinical decision support systems (CDSS) aim to support clinical decision-making by providing guidance, often evidence-based, by integrating clinical and patient information to make case-specific recommendations. This study aims to systematically review published studies measuring the effectiveness of CDSS used in delivering care to hospitalized, adult patients. We are also conducting a meta-analysis to determine whether the effectiveness of CDSS on healthcare delivery or patient outcomes has changed over time.
Assessing Interventions to Increase Appointment Attendance in Safety Net Health Centers
Missed appointments (‘no shows’) are a common problem across healthcare settings, and persist in safety net settings. Missed appointments contribute to increased healthcare costs and delayed patient care. This systematic review and meta-analysis aims to systematically review published studies and identify the most effective strategies to increase appointment attendance in safety net settings. Check out our publication in the Journal of Evaluation in Clinical Practice.
Management Strategies to Promote Follow-Up Care for Incidental Findings
Incidental findings are frequently identified during diagnostic imagine studies, and may require timely follow-up care to determine if they are benign or malignant. However, many incidental findings do not receive post-identification diagnosis. We are partnering with surgical colleagues to conduct two studies to improve follow-up care. One study aims to identify management strategies and performance used to promote guideline-concordant follow-up care for incidental findings. Another study examines the effectiveness of a boilerplate radiology reporting template to improve patient outcomes. Check out our publication in the Journal of the American College of Radiology.
Evaluating a Continuous Glucose Monitoring and Endocrinology eConsult for Adults with Type 2 Diabetes in Primary Care
Type 2 diabetes is increasingly prevalence and carries significant economic and personal healthcare burden. Continuous glucose monitoring (CGM) has been shown to improve clinical outcomes, but it is unclear if CGM may help mitigate healthcare delivery challenges for safety-net patients. This pilot study examines the acceptability and clinical effectiveness of a CGM-enhanced eConsult healthcare delivery model as compared to routine in-person endocrinology consultation.
Barriers and Facilitators to Implementing Priority Initiatives in a Safety Net Hospital
Safety net hospitals, which serve vulnerable and underserved populations and often operate on smaller budgets than non-safety net hospitals, may experience unique implementation challenges. We sought to describe common barriers and facilitators that affect the implementation of improvement initiatives in a safety net hospital, and identify potentially transferable lessons to enhance implementation efforts in similar settings. We used the Consolidated Framework for Implementation Research to guide our qualitative analysis. Check out our publication in Implementation Science Communications.
Developing a New Tool to Standardize the Evaluation of Implementation Science Proposals
The fields of implementation and improvement sciences have experienced rapid growth in recent years. However, research that seeks to inform health care change may have difficulty translating core components of implementation and improvement sciences within the traditional paradigms used to evaluate efficacy and effectiveness research. We operationalized existing recommendations for writing implementation science proposals as the ImplemeNtation and Improvement Science Proposals Evaluation CriTeria (INSPECT) scoring system. We scored pilot grant proposals using INSPECT to evaluate its reliability and utility in measuring the quality of proposed research. Check out our publication in Implementation Science.
Advancing Quality Improvement with Regression Discontinuity Designs
Robust implementation of process change is critically important to driving evidence uptake and quality, however routine methods to improve healthcare delivery often lack causal inference, and it can be difficult to know whether such efforts are improving patient care. Regression discontinuity designs can be paired with traditional implementation science approaches, such as evaluation of implementation fidelity (the degree to which implementation is delivered as intended), to increase the value of both approaches. Check out our publication in Annals of the American Thoracic Society.
Combined Difference-in-Difference/Regression Discontinuity Approach to Evaluate Effectiveness of a Re-admissions Reduction Initiative
Current methods used to evaluate the effectiveness of healthcare improvement efforts are limited by design complexity or feasibility issues (e.g. randomized controlled trails) or the inability to infer causal relationships (e.g. pre/post designs). This study examined the utility of a novel design in implementation and improvement research – a hybrid regression discontinuity/difference-in-difference design – to evaluate the impact of a re-admissions reduction initiative. Check out our publication in BMJ Quality & Safety.