Dataset Information

Role of Co-creation for Large-Scale Sustainable Adoption of Digitally Supported Integrated Care: Prehabilitation as Use Case.

ABSTRACT:

Introduction

The efficacy-effectiveness gap constitutes a well-known limitation for adoption of digitally enabled integrated care services. The current report describes the co-creation process undertaken (2016-2021) to deploy a prehabilitation service at Hospital Clínic de Barcelona with the final aim of achieving sustainable adoption and facilitate site transferability.

Methods

An implementation research approach with a population-based orientation, combining experience-based co-design and quality improvement methodologies, was applied. We undertook several design-thinking sessions (Oct-Nov 2017, June 2021 and December 2021) to generate and follow-up a work plan fostering service scalability. The implementation process was assessed using the Comprehensive Framework for Implementation Research, leading to the identification of key performance indicators.

Discussion

Personalization and modularity of the intervention according to patients' surgical risk were identified as core traits to enhance patients' adherence and value generation. A digitally enabled service workflow, with an adaptive and collaborative case management approach, should combine face-to-face and remotely supervised sessions with intelligent systems for patients' and professionals' decision support. The business model envisages operational costs financed by savings generated by the service.

Conclusions

Evidence-based co-creation, combining appropriate methodologies and a structured evaluation framework, was key to address challenges associated with sustainable prehabilitation service adoption, scalability and transferability.

SUBMITTER: Baltaxe E

PROVIDER: S-EPMC9541166 | biostudies-literature | 2022 Oct-Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Role of Co-creation for Large-Scale Sustainable Adoption of Digitally Supported Integrated Care: Prehabilitation as Use Case.

Baltaxe Erik E Cano Isaac I Risco Raquel R Sebio Raquel R Dana Fernando F Laxe Sara S Martínez Ramon R Ozores Fernando F Roca Josep J Martínez-Pallí Graciela G

International journal of integrated care 20221007 4

<h4>Introduction</h4>The efficacy-effectiveness gap constitutes a well-known limitation for adoption of digitally enabled integrated care services. The current report describes the co-creation process undertaken (2016-2021) to deploy a prehabilitation service at Hospital Clínic de Barcelona with the final aim of achieving sustainable adoption and facilitate site transferability.<h4>Methods</h4>An implementation research approach with a population-based orientation, combining experience-based co- ...[more]

PMID: 36304784

Similar Datasets

Project description:ObjectiveFormative evaluation of the implementation process for a digitally supported intervention in polypharmacy in Germany. Qualitative research was conducted within a cluster randomized controlled trial (C-RCT). It focused on understanding how the intervention influences behavior-related outcomes in the prescription and medication review process.Methods/settingTwenty-seven general practitioners (GPs) were included in the study in the two groups of the C-RCT, the intervention, and the wait list control group. Behavior-related outcomes were investigated using three-step data analysis (content analytic approach, documentary method, and design of a model of implementation pathways).ResultsContent analysis showed that physicians were more intensely aware of polypharmacy-related risks, described positive learning effects of the digital technology on their prescribing behavior, and perceived a change in communication with patients and pharmacists. Conversely, they felt uncertain about their own responsibility when prescribing. Three main dimensions were discovered which influenced adoption behavior: (1) the physicians' interpretation of the relevance of pharmaceutical knowledge provided by the intervention in changing decision-making situations in polypharmacy; (2) their medical code of ethics for clinical decision making in the context of progressing digitalization; and (3) their concepts of evidence-based medicine on the basis of professional experiences with polypharmacy in primary care settings. In our sample, both simple and complex pathways from sensitization to adoption were observed. The resulting model on adoption behavior includes a paradigmatic description of different pathways and a visualization of different observed levels and applied methodological approaches. We assumed that the GP habitus can weaken or strengthen interventional effects towards intervention uptake. This formative evaluation strategy is beneficial for the identification of behavior-related implementation barriers and facilitators.ConclusionOur analyses of the adoption behavior of a digitally supported intervention in polypharmacy revealed both simple and complex pathways from awareness to adoption, which may impact the implementation of the intervention and therefore, its effectiveness. Future consideration of adoption behavior in the planning and evaluation of digitally supported interventions may enhance uptake and support the interpretation of effects.Trial registrationNCT03430336 , 12 February 2018.

Project description:BackgroundHealth and social care standards are multi-faceted interventions that promote quality and safe care in health systems. There is a need to apply evidence-based, rigorous and transparent methods when selecting strategies to support the implementation of standards. We aimed to develop an evidence- and theory-informed intervention to guide researchers in identifying appropriate implementation strategies and then selecting tailored support tools and actions for use when implementing a set of standards.MethodsOur intervention is a digital tool entitled 'Selecting Implementation Tools and Actions for Standards (SITAS).' The Medical Research Council Framework for Developing and Evaluating Complex Interventions guided the design of SITAS. Co-design of SITAS, using a multi-stage and multi-methods approach included developing programme theory; identifying and prioritising enablers and barriers to implementing standards; identifying the best fit implementation framework using the Theory Comparison and Selection Tool; mapping enablers and barriers to the Consolidated Framework for Implementation Research (CFIR); identifying matching implementation strategies using the CFIR-ERIC (Expert Recommendations for Implementing Change) matching tool; mapping enablers and barriers to the Behaviour Change Wheel (BCW). The enablers and barriers, outputs from the CFIR-ERIC matching tool and the BCW were used to develop a prototype of the content and interactive logic within a digital tool. The prototype was refined following feedback from intended users (n = 7) at three design workshops.ResultsProgramme theory was developed and refined following feedback from intended users of SITAS. Twenty-three enablers and barriers were prioritised. CFIR was identified as the best fit framework with the majority of enablers and barriers (n = 15) mapped to the 'Inner Setting' domain. 'Conduct educational meetings' was the most common strategy retrieved using the CFIR-ERIC matching tool. 'Physical opportunity' was the component of the BCW with the most enablers and barriers (n = 8). A prototype of SITAS was designed in Microsoft Excel based on the aforementioned steps. Workshops with intended users provided key insights about the content, functionality and user experience for SITAS which resulted in refinements to SITAS.ConclusionWe developed a practical intervention enhanced by user involvement. SITAS guides users through the process of selecting and tailoring implementation strategies to specific contexts, using core concepts of implementation science. SITAS will need to undergo formal piloting before spread and scale-up.

Project description:Small-scale fisheries account for 90% of global fishers and 40% of the global catch. Effectively managing small-scale fisheries is, therefore, crucial to progressing the United Nations Sustainable Development Goals (SDGs). Co-management and community-based fisheries management are widely considered the most appropriate forms of governance for many small-scale fisheries. We outlined relationships between small-scale fisheries co-management and attainment of the SDGs, including evidence for impacts and gaps in dominant logic. We identified 11 targets across five SDGs to which small-scale fisheries co-management (including community-based fisheries management) can contribute; the theory of change by which these contributions could be achieved; and the strength of evidence for progress toward SDG targets related to various co-management strategies. Our theory of change links the 11 SDG targets by qualifying that progress toward some targets is contingent on others being achieved first. We then reviewed 58 case studies of co-management impacts from the Pacific Islands--a region rich in local marine governance--to evaluate evidence of where, to what degree, and with how much certainty different co-management strategies conferred positive impacts to each SDG target. These strategies included access restrictions, permanent area closures, periodic closures, and gear and species restrictions. Although many studies provide evidence linking multiple co-management strategies to improvements in resource status (SDG 14.4), there was limited evidence of follow-on effects, such as improvements in catch (SDG 2.3, 2.4), livelihoods (SDG 1.2), consumption (SDG 2.1), and nutrition (SDG 2.2). Our findings suggest that leaps of logic and assumptions are prevalent in co-management planning and evaluation. Hence, when evaluating co-management impacts against the SDGs, consideration of ultimate goals is required, otherwise, there is a risk of shortfalls between aspirations and impact.

Dataset Information

Role of Co-creation for Large-Scale Sustainable Adoption of Digitally Supported Integrated Care: Prehabilitation as Use Case.

Introduction

Methods

Discussion

Conclusions

Publications

Role of Co-creation for Large-Scale Sustainable Adoption of Digitally Supported Integrated Care: Prehabilitation as Use Case.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets