P. Paul Chandanabhumma

BACKGROUND: Infections following durable left ventricular assist device (dLVAD) implantation are common and associated with increased morbidity and mortality. Despite documented interhospital variability, few studies have identified strategies to mitigate their occurrence. This national study uses a multistage mixed methods design to develop a customizable and deployable toolkit of expert-guided recommendations to reduce infections post-dLVAD. METHODS: Using purposeful sampling, participants (eg, clinical and operational ventricular assist device [VAD] team members) from low, medium, and high-performance hospitals (based on their risk-adjusted, 90-day post-implantation infection rates) across the United States were interviewed to assess factors contributing to postdLVAD infections. Draft toolkit recommendations were iteratively developed after integrating thematically analyzed qualitative and quantitative data from a merged national registry with Medicare and hospital survey data. A national advisory team of VAD subject matter experts provided mixed methods input to refine the toolkit’s content and structure. RESULTS: Seventy-three clinical and operational VAD team members across 8 US hospitals were interviewed, spanning low (n=4), medium (n=1) and high (n=3) performance groups. Fourteen subject matter experts provided stakeholder feedback to refine the toolkit. The resulting toolkit contains 39 infection prevention recommendations that address VAD program care processes (eg, real-time provider communication), clinicians (eg, multidisciplinary protocol development), patients and caregivers (eg, engaging patient advisors in patient education), and VAD leadership (eg, unit and service level data reporting). Accompanying resources (eg, team-based exercises, data collection worksheets) support implementing and evaluating site-specific strategies. CONCLUSIONS: Using mixed methods approaches, an infection prevention toolkit was developed to enhance care coordination among VAD team members and mitigate postdLVAD infections. Future work should evaluate the effectiveness of implementing this infection prevention toolkit within the dLVAD setting.

The aim of this article is to characterize the methodological features and appraise the reporting quality of mixed methods research studies on racial and ethnic health inequities across the cancer control continuum (i.e., cancer prevention, detection, diagnosis, treatment, survivorship, or a combination of these domains) in the United States. A methodological review of relevant peer-reviewed articles in public health and allied fields published from 2003 to 2022 was conducted to describe the research context, reported mixed methods components, and incorporation of community perspectives in these studies. We conducted a systematic search of the Ovid MEDLINE, Scopus, Web of Science, CINAHL, and PsycINFO databases to identify relevant studies, and synthesized the findings using qualitative content analysis. We found 49 articles reporting mixed methods studies that involved participants from diverse racial and ethnic groups across the United States. We found that the majority of the articles provided a justification for using mixed methods research and detailed the qualitative and quantitative methods used. However, we noted that a minor portion of the articles explained distinctive insights gained from integrating qualitative and quantitative findings or adequately incorporated the perspectives of communities impacted by health inequities. Utilizing and reporting mixed methods procedures and insights gained through collaborative efforts will optimize the value of mixed methods research in realizing health equity across the cancer control continuum. The findings of this review suggest opportunities to elaborate on key defining procedures of mixed methods research, engaging with community perspectives, and gaining distinctive insights from the approach.

Background Infections following durable left ventricular assist device (dLVAD) implantation are common and associated with increased morbidity and mortality. Despite documented interhospital variability, few studies have identified strategies to mitigate their occurrence. This national study uses a multistage mixed methods design to develop a customizable and deployable toolkit of expert-guided recommendations to reduce infections post-dLVAD. Methods Representatives from low, medium, and high-performance hospitals across the U.S. were interviewed to assess factors contributing to post-dLVAD infections. Draft toolkit recommendations were iteratively developed after integrating thematically analyzed qualitative and quantitative data. A national advisory team of ventricular assist device (VAD) subject matter experts provided mixed methods input to refine the toolkit’s content and structure. Results Seventy-three clinical and operational VAD team members were interviewed, and 14 subject matter experts provided stakeholder feedback to refine the toolkit. The resulting toolkit contains 39 infection prevention recommendations that address VAD program care processes (e.g., real-time provider communication), clinicians (e.g., multidisciplinary protocol development), patients & caregivers (e.g., engaging patient advisors in patient education), and VAD leadership (e.g., unit and service level data reporting). Accompanying resources (e.g., team-based exercises, data collection worksheets) support implementing and evaluating site-specific strategies. Input from clinical and research experts provided preliminary evidence of the toolkit’s acceptability and considerations for enhancing the toolkit’s adoption and implementation. Conclusions Using mixed methods approaches, an infection prevention toolkit was developed to enhance care coordination among VAD team members and mitigate post-dLVAD infections. Future work should evaluate the effectiveness of implementing this infection prevention toolkit within the dLVAD setting. What is Known Six out of every 10 patients develop an infection within 2 years of durable left ventricular assist device (dLVAD) implantation. Infections contribute to an increased risk of major morbidity and mortality. Post-dLVAD infection rates vary across hospitals, even after risk adjustment. What the Study Adds A customizable toolkit of infection prevention recommendations was developed and pilot tested using mixed methods approaches. Recommendations focus on modifiable aspects of organizational structure, patient care, patient education, quality reporting.

While mixed methods research is increasingly used to examine determinants of unwarranted variability in healthcare delivery and outcomes, novel integrative approaches are required to meet the needs of mixed methods healthcare delivery research. This article describes novel refining strategies that enhance the linkage between qualitative and quantitative dimensions of a mixed methods healthcare delivery research study. Leveraging our study experiences, this paper demonstrates several refining strategies: (1) using mediated allocation concealment to facilitate qualitative sampling; (2) informing qualitative inquiry through quantitative analytics; and (3) training and immersing multidisciplinary researchers in qualitative data collection and analysis. Developing and implementing strategies in mixed methods healthcare delivery research could advance methodological rigor and strengthen multidisciplinary collaboration.

Learning Objectives: - Describe at least two social justice frameworks, including community engagement and antiracism, that can be applied in healthcare research and clinical care to address real-world problems and promote health equity. - Identify at least three ways in which family physicians and learners can meaningfully contribute to antiracist efforts to improve research, education, and clinical care. - Describe the potential harms that may result from newborn drug screening on families and ways to mitigate this harm through clinical practice and healthcare policy.

Conceptualizing and testing factors that contribute to the success of community–academic partnerships are critical to understanding their contributions to the health and well-being of communities. Most measures to date focus on factors that contribute to the development of new partnerships, and only a few have been adequately tested and validated. Methods. The Measurement Approaches to Partnership Success (MAPS) study followed a community-based participatory research (CBPR) approach and a multiphase process that included the construction and pilot testing of a questionnaire, and a national survey to validate the psychometric properties of the questionnaire in long-standing CBPR partnerships (existing ≥ six years). All members within partnerships were recruited to complete the survey (55 partnerships with 563 partners). We used confirmatory factor analysis (CFA), Cronbach’s alpha statistics, and a pairwise correlations approach to assess discriminant and convergent validity, and assessed internal consistency, and test–retest reliability. Results. All MAPS Questionnaire dimensions demonstrated strong validity and reliability and demonstrated agreement over time. Conclusion. The MAPS Questionnaire includes seven dimensions and 81 items related to the MAPS conceptual model and provides a scientific, in-depth measurement tool that allows long-standing CBPR partnerships to evaluate their work toward achieving health equity.

The care delivered to patients with cardiovascular disease involves coordination among a multitude of clinical team members spanning diverse inpatient and outpatient settings. The majority of quality improvement interventions in cardiovascular care have been developed based on quantitative evidence, which neither fully accounts for multilevel determinants (eg, patient, clinician, and institution) nor contextualization from key informants. The rigor and effectiveness of these interventions would be enhanced by mixed-methods studies whose strengths include (1) the use of qualitative research methodologies (eg, eliciting patient or clinician perspectives on barriers and facilitators of best practices) and (2) integrating qualitative and quantitative data and analyses to understand more fully effective strategies for achieving optimal care and outcomes for these patients across diverse settings. This article illustrates the application of a complex mixed-methods design to advance an evidence-based, customizable infection prevention toolkit for durable left ventricular assist device therapy. The study (1) uses quantitative clinical data merged with Medicare claims to evaluate interhospital variability in the incidence of infection; (2) uses qualitative methods to understand local practice patterns across low- and high-performing centers; and (3) integrates both data sources to gain a comprehensive understanding of the overall findings.

While sustainability is crucial to the success of community-based participatory research (CBPR) partnerships, there is a lack of conceptual clarity on what defines sustainability and what characterizes sustainability-promoting practices in long-standing (in existence ≥ 6 years) CBPR partnerships. The aim of this article is to explore the definition of sustainability, as well as practices that influence sustainability from the perspectives of academic and community experts in long-standing CBPR partnerships. This qualitative analysis is part of Measurement Approaches to Partnership Success (MAPS), a participatory mixed methods validity study that examined "success" and its contributing factors in long-standing CBPR partnerships. Thematic analysis of 21 semi-structured interviews was conducted, including 10 academic and 11 community experts of long-standing CBPR partnerships. The key defining components of sustainability we identified include: distinguishing between sustaining the work of the partnership and ongoing relationships among partners; working towards a common goal over time; and enduring changes that impact the partnership. We further identified strengthening and capacity building practices at multiple levels of the partnership that served to promote the sustainability of the partnership's work and of ongoing relationships among partners. Sustainability can be understood as supporting an ecosystem that surrounds the beneficial relationships between academic and community partners. Ongoing evaluation and application of practices that promote the sustainability of partnership activities and relationships may strengthen the long-term effectiveness of CBPR partnerships in advancing health equity.