A mixed-methods observational study of strategies for success in implementation science: overcoming emergency departments hurdles
Abstract Background Heart failure is a major public health concern, affecting 6.7 million Americans. An estimated 16% of emergency department (ED) patients with acute heart failure (AHF) are discharged home. Our Get with the Guidelines in Emergency Department Patients with Heart Failure (GUIDED-HF)...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s12913-024-12102-9 |
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| author | Deonni P. Stolldorf Alan B. Storrow Dandan Liu Cathy A. Jenkins Rachel A. Hilton Karen F. Miller Joy Kim Deepika Boopathy Satheesh Gunaga Bory Kea Joseph Miller Sean P. Collins |
| author_facet | Deonni P. Stolldorf Alan B. Storrow Dandan Liu Cathy A. Jenkins Rachel A. Hilton Karen F. Miller Joy Kim Deepika Boopathy Satheesh Gunaga Bory Kea Joseph Miller Sean P. Collins |
| author_sort | Deonni P. Stolldorf |
| collection | DOAJ |
| description | Abstract Background Heart failure is a major public health concern, affecting 6.7 million Americans. An estimated 16% of emergency department (ED) patients with acute heart failure (AHF) are discharged home. Our Get with the Guidelines in Emergency Department Patients with Heart Failure (GUIDED-HF) toolkit aims to improve AHF self-care and facilitate safer transitions in care for these patients. We describe implementation barriers and facilitators, and the selection and refinement of implementation strategies, to facilitate future GUIDED-HF implementation. Methods A mixed-methods cross-sectional observational study was conducted in four United States EDs in two diverse healthcare systems in the Pacific West and Midwest. Data were collected using a survey and interviews with ED providers, nurses, and leaders. The survey assessed the ED context using the context scale of the Organizational Readiness to Change Assessment (ORCA). The Consolidated Framework for Implementation Research informed interviews. Quantitative data were summarized using medians (interquartile ranges) or percentages (frequencies). Wilcoxon rank-sum tests and Kruskal–Wallis tests were used to assess differences in the healthcare system and profession. Qualitative data were analyzed and summarized using rapid qualitative analysis. Convergence of quantitative and qualitative data was used to inform specific refining of implementation strategies to the local context (e.g., who should serve as champions, how best practice alerts should be implemented). Results Participants were predominately white (76%) with median (IQR) age 37.0 (32.0, 41.0). ED leaders/administrators, providers, and nurses comprised 15%, 55%, and 29% of participants, respectively. Sites reported an ORCA context scale score of 3.7 [3.4, 4.0] (scale of 1 = strongly disagree to 5 = strongly agree). Comparison of scores by profession showed a significant difference in the context score among providers (3.9 [3.5, 4.0]), leaders (3.7 [3.5, 4.0]), and nurses (3.6 [3.0, 3.9]) (p = 0.048). Qualitative data indicated implementation barriers (e.g., resource limitations, patient health literacy), facilitators (e.g., GUIDED-HF is patient-centric; site and intervention congruent values, norms, and goals), and site-specific needs due to contextual factors (e.g., education needs, feedback mechanisms, champions). Conclusions Specific determinants of implementation exist in ED settings and require the refining of implementation strategies to overcome site-specific barriers and enhance facilitators. Trial registration n/a. |
| format | Article |
| id | doaj-art-673f960c0f4a468486fb018e4ae2eff5 |
| institution | Kabale University |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | BMC Health Services Research |
| spelling | doaj-art-673f960c0f4a468486fb018e4ae2eff52025-02-02T12:14:22ZengBMCBMC Health Services Research1472-69632025-01-0125111510.1186/s12913-024-12102-9A mixed-methods observational study of strategies for success in implementation science: overcoming emergency departments hurdlesDeonni P. Stolldorf0Alan B. Storrow1Dandan Liu2Cathy A. Jenkins3Rachel A. Hilton4Karen F. Miller5Joy Kim6Deepika Boopathy7Satheesh Gunaga8Bory Kea9Joseph Miller10Sean P. Collins11Vanderbilt University School of NursingEmergency Medicine, Vanderbilt University Medical CenterDepartment of Biostatistics, Vanderbilt University Medical CenterDepartment of Biostatistics, Vanderbilt University Medical CenterVanderbilt University School of NursingVanderbilt University Medical CenterDepartment of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science UniversityDepartment of Public Health Sciences, Henry Ford HealthDepartment of Emergency Medicine, Henry Ford Wyandotte HospitalDepartment of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science UniversityEmergency Medicine, Henry Ford Health and Michigan State UniversityEmergency Medicine, Vanderbilt University Medical Center and, Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC)Abstract Background Heart failure is a major public health concern, affecting 6.7 million Americans. An estimated 16% of emergency department (ED) patients with acute heart failure (AHF) are discharged home. Our Get with the Guidelines in Emergency Department Patients with Heart Failure (GUIDED-HF) toolkit aims to improve AHF self-care and facilitate safer transitions in care for these patients. We describe implementation barriers and facilitators, and the selection and refinement of implementation strategies, to facilitate future GUIDED-HF implementation. Methods A mixed-methods cross-sectional observational study was conducted in four United States EDs in two diverse healthcare systems in the Pacific West and Midwest. Data were collected using a survey and interviews with ED providers, nurses, and leaders. The survey assessed the ED context using the context scale of the Organizational Readiness to Change Assessment (ORCA). The Consolidated Framework for Implementation Research informed interviews. Quantitative data were summarized using medians (interquartile ranges) or percentages (frequencies). Wilcoxon rank-sum tests and Kruskal–Wallis tests were used to assess differences in the healthcare system and profession. Qualitative data were analyzed and summarized using rapid qualitative analysis. Convergence of quantitative and qualitative data was used to inform specific refining of implementation strategies to the local context (e.g., who should serve as champions, how best practice alerts should be implemented). Results Participants were predominately white (76%) with median (IQR) age 37.0 (32.0, 41.0). ED leaders/administrators, providers, and nurses comprised 15%, 55%, and 29% of participants, respectively. Sites reported an ORCA context scale score of 3.7 [3.4, 4.0] (scale of 1 = strongly disagree to 5 = strongly agree). Comparison of scores by profession showed a significant difference in the context score among providers (3.9 [3.5, 4.0]), leaders (3.7 [3.5, 4.0]), and nurses (3.6 [3.0, 3.9]) (p = 0.048). Qualitative data indicated implementation barriers (e.g., resource limitations, patient health literacy), facilitators (e.g., GUIDED-HF is patient-centric; site and intervention congruent values, norms, and goals), and site-specific needs due to contextual factors (e.g., education needs, feedback mechanisms, champions). Conclusions Specific determinants of implementation exist in ED settings and require the refining of implementation strategies to overcome site-specific barriers and enhance facilitators. Trial registration n/a.https://doi.org/10.1186/s12913-024-12102-9Heart failureSelf-careImplementationEmergency departmentCare transitions |
| spellingShingle | Deonni P. Stolldorf Alan B. Storrow Dandan Liu Cathy A. Jenkins Rachel A. Hilton Karen F. Miller Joy Kim Deepika Boopathy Satheesh Gunaga Bory Kea Joseph Miller Sean P. Collins A mixed-methods observational study of strategies for success in implementation science: overcoming emergency departments hurdles BMC Health Services Research Heart failure Self-care Implementation Emergency department Care transitions |
| title | A mixed-methods observational study of strategies for success in implementation science: overcoming emergency departments hurdles |
| title_full | A mixed-methods observational study of strategies for success in implementation science: overcoming emergency departments hurdles |
| title_fullStr | A mixed-methods observational study of strategies for success in implementation science: overcoming emergency departments hurdles |
| title_full_unstemmed | A mixed-methods observational study of strategies for success in implementation science: overcoming emergency departments hurdles |
| title_short | A mixed-methods observational study of strategies for success in implementation science: overcoming emergency departments hurdles |
| title_sort | mixed methods observational study of strategies for success in implementation science overcoming emergency departments hurdles |
| topic | Heart failure Self-care Implementation Emergency department Care transitions |
| url | https://doi.org/10.1186/s12913-024-12102-9 |
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