Geoffrey M. Curran

Background: Many effective health interventions remain unimplemented, delaying patient benefits. This is true even within integrated health care systems such as the U.S. Veterans Health Administration (VHA). Little is known about how leaders decide to adopt new interventions. Purpose: This study explored organizational leaders’ thought choices to implement or forego new health interventions within VHA. Methodology: We conducted semi-structured interviews with 13 organizational leaders across local, regional, and national levels. Data were analyzed with content analysis and aligned to the Consolidated Framework for Implementation Research. Results: VHA leaders’ thought processes differed if health interventions were mandated versus discretionary. Participants described two implementation processes for successful change: top-down, usually featuring policy mandates, and bottom-up, driven by clinician-generated interest. Facilitators included intervention fit, alignment with performance measures, and effectiveness evidence. Barriers comprised upfront staffing and training costs and organizational challenges such as leadership turnover and resource limitations. Conclusions: Before implementing, organizational leaders wanted an intervention to have a positive impact on patients and considered budget impact and/or cost-effectiveness as a second priority. This decision-making process was balanced by circumstances for costly interventions addressing imminent needs, for example, pandemic ills and suicide risk. Practice Implications: VHA organizational leaders believed successful implementation required top-down directives and bottom-up clinician engagement, but approached the process differently depending on whether implementation was mandated or discretionary. Implementation, systems redesign, or quality improvement personnel might ease practice change by noting mandated versus discretionary context and addressing leaders’ needs explicitly. Organizational leaders wanted multiple types of information about intervention effectiveness, fit to context for nonresearch audiences.

The Medicare Part D Medication Therapy Management (MTM) program has several well-documented challenges, including restrictive eligibility criteria, low patient engagement, and difficulties integrating MTM services into pharmacy workflows and broader healthcare teams. These challenges are often driven by inadequate health information technology infrastructure, limited coordination between pharmacists and prescribers, and inefficiencies in standardized documentation for Comprehensive Medication Reviews (CMRs). This narrative review synthesized published literature to identify challenges and limitations of the Medicare Part D MTM program and used Purdue University’s MTM program design documentation to compare program features and describe the evidence and rationale underlying key design decisions. Purdue’s MTM program incorporated broader patient eligibility, more frequent MTM services, and provider-developed communication templates to address limitations in patient access, program uptake, and workflow feasibility identified in the Medicare Part D program. However, challenges related to optimization of standardized CMR documentation and integration with electronic health records (EHRs) remained unresolved. Overall, this review demonstrates how evidence-informed program design may strengthen MTM implementation while identifying opportunities for future refinement. Future evaluation of the Purdue MTM program will assess its acceptability, feasibility, adoption, reach, and fidelity.

The science of deimplementation—reducing harmful or ineffective practices—has focused almost exclusively on clinical prescribing, with no studi

Research to develop and test complex health interventions has traditionally followed a multistage process encompassing (1) efficacy research (i.e. explanatory trials), to confirm the intervention’s effects under tightly controlled conditions; (2) clinical effectiveness research (i.e. effectiveness or pragmatic trials), to confirm the intervention’s effectiveness within routine practice settings and populations; and finally, (3) implementation research, to assess barriers and facilitators to use of the intervention in routine practice and to test strategies that support the intervention’s uptake and integration into care. This chapter describes an alternative research paradigm, called the hybrid effectiveness–implementation approach, which blends characteristics of effectiveness research and implementation research within a set of hybrid effectiveness–implementation studies – referred to as hybrid studies. The goal of this approach is to speed the translation of scientific discoveries into practice and optimise the use of scientific resources.

Background: Delirium is frequently unrecognised, and healthcare professionals lack knowledge and confidence in recognition and management of the condition. Increased delirium education within pre-registration healthcare profession curricula may help to address this. A modified Delphi approach was utilised to develop a set of education priorities associated with delirium education for healthcare profession students. Methods: An initial list of 72 education priorities were identified from a literature review, stakeholder focus groups, and a review of available clinical guidelines. Priorities were grouped into eight domains ‘assessment and diagnosis’, ‘aetiology and risk factors’, ‘pathophysiology’, ‘treatment of delirium’, ‘prevention’, ‘delirium and dementia’, ‘impact on people with delirium, informal caregivers and family’ and ‘health promotion and public education’. Academic experts and healthcare professionals were invited to rank each priority and each domain across two rounds. Round one consisted of a survey including the list of 72 potential education priorities which participants were asked to rank from one (not a priority) to five (essential priority). Items which did not reach consensus criteria following round one were re-distributed as round two of the survey and participants were asked to repeat this exercise for the shorter list of items. Additionally, in round two, participants were asked to rank the eight domains from most important to least important. Results: Eighty participants completed round one of the Delphi survey and 55 (68.75%) also completed round two. Following round one, 41 priorities were considered highly relevant and therefore met the criteria to be included in the final set of education priorities. An additional four items reached these criteria following round two and so the final set consists of 45 items. Priorities related to prevention, diagnosis, and treatment were consistently ranked highly whereas priorities related to pathophysiology and health promotion were consistently ranked lowest. Discussion: This Delphi study identified areas of education viewed as the highest priorities for healthcare profession students’ delirium education, drawn from a range of academics and healthcare professionals. The final set may help to inform the development of delirium education reflecting these priorities.

This article describes the Implementation Science (IS) Scholars Program at the University of Arkansas for Medical Sciences (UAMS). The program’s goal is to translate knowledge, approaches, and methods from IS to front-line clinicians in an academic medical center, thereby supporting its goals as a learning health system and promoting a dynamic workforce of IS-informed change leaders. Initiated in 2020, the program is relatively unique in that it attempts to translate concepts and knowledge from IS to clinicians to improve their skills as implementers and change agents. The program is supported by the Translational Research Institute, the UAMS’ awardee of the Clinical and Translational Science Award Program. The two-year program provides 20% salary coverage, bespoke didactics, and close mentoring on a Scholar-initiated project to improve care in their clinical context. The program has trained four cohorts of Scholars over the program’s initial five years. We describe the program, our evaluation of it thus far, and future plans. The program has contributed to numerous healthcare improvements and served as a gateway to future implementation and other research activities among some Scholars.

Background: Delirium is a complex neuropsychiatric syndrome characterised by an acute state of confusion, with a substantial impact on medical inpatients. Despite its growing recognition as a global healthcare concern, delirium remains underdiagnosed, partly due to a lack of awareness among healthcare professionals. The aim of this study was to explore how healthcare professional students experience caring for individuals experiencing delirium, the influence of their current pre-registration healthcare education, and importance of interprofessional teamwork in their role. Methods: This qualitative study used a focus group approach to collect data from 40 healthcare professional students, including nursing, pharmacy, and medical students, across two universities in Ireland. The focus groups explored participants’ experiences of caring for people with delirium, their delirium education, and their collaboration with interdisciplinary teams. The data were analysed using a reflexive thematic analysis approach. Results: Following thematic analysis, three themes are reported. The first is “The Upside Down,” revealing student perceptions of caring for people with delirium who are facing distressing situations. The second team reported is, “Teamwork Makes the Dream Work,” emphasising the critical role of interprofessional collaboration in delirium management and patient outcomes. Finally, the theme of “A Little Is Not Enough,” highlighted students’ critiques of current delirium education in their pre-registration training. Collectively, these themes illuminate challenges in delirium care, advocate for teamwork in healthcare settings, and call for improvements in educational preparation for future healthcare professionals. Conclusions: This study contributes to the existing literature by providing insights into the perspectives of healthcare professional students on delirium care. The findings also highlight the challenging nature of caring for individuals with delirium and the need for improved delirium education and interdisciplinary collaboration.