DATA ANALYSIS

1. FIRE STUDY Facilitating Implementation of Research Evidence BACKGROUND Between 30-40% of patients do not benefit from care which complies with current scientific evidence (Schuster et al, 1998; Grol et al, 2001). Policy makers have responded with ways to address this and reduce the gap between research and practice. Despite this there are reports of a highly variable level of uptake ranging from no change to significant changes in practice in line with guidance (Sheldon et al, 2007). Failure to achieve uptake is resulting in patients being prevented from benefiting from the advances in biomedical sciences (Sung et al, 2003). Facilitating Implementation of Research Evidence (FIRE) is a four year programme of research to identify and validate key factors determining the successful implementation of research evidence in practice. The study is underpinned by a conceptual framework, the Promoting Action on Research Implementation in Health Services (PARiHS**) framework, which proposes that the successful implementation of research evidence is dependent on the complex interplay of the evidence, the context of implementation and the way the process is facilitated. The planned research will focus on evaluating the feasibility and effectiveness of facilitation as an implementation strategy. Collaboration between: University of Warwick (Seers K), Manchester Business School (Harvey G), University of Bangor (Rycroft-Malone J), University of Ulster (McCormack B), University College Cork (McCarthy G), Karolinska Institute (Wallin L), University of Alberta (Estabrooks C), Fontys University of Applied Sciences (Titchen A & Cox K), University of Adelaide (Kitson A) Research Fellows: Eldh A-C (Karolinska Institute), Hawkes C (Bangor University, Wales), Mockford C (University of Warwick), Niessen T and van der Zip T (Fontys, Netherlands), Slater P (University of Ulster) . Statistician – Crichton N.(London South Bank University,) Health Economists - Linck P, Edwards R. (Bangor University). Project Manager Kennedy D (University of Warwick) AIMS AND OBJECTIVES Phase 1– the development and implementation of two facilitation packages Phase 2– a pragmatic RCT and evaluative study to evaluate the impact of the different facilitation packages on processes and outcomes when implementing continence recommendations in nursing home settings for older people. Phase 3– a dissemination strategy, that runs concurrently with the first two phases. • DESIGN • Phase 1 • Objectives for Phase 1 – facilitation • 1.Develop and deliver a technical facilitation development programme, for the implementation and evaluation of continence care clinical recommendations in nursing home settings for older people • . Develop and deliver an enabling facilitation development programme for the implementation, evaluation and diffusion of continence care clinical recommendations in nursing home settings for older people. • Facilitation package – Type A • Technical facilitation will be informed by quality improvement, innovations and organisational theory literature, innovations literature. This focuses less on the person as the vehicle of transformation, more on the approaches to learning and activities. It focuses on the improvement of the system-organisation. • Facilitation package – Type B • Enabling facilitation will work with the individual to develop their capability and capacity to transform them, including the importance of the culture in which practice is happening. It is a collaborative, inclusive and participative approach. Its theoretical underpinnings come from critical creativity. The central concepts are praxis, undertaking mindful action with intent, and human flourishing. Phase 2 Objectives for Phase 2 – A randomised controlled trial with an integrated qualitative and quantitative evaluative and health economic component. 1. To ascertain whether facilitation can enhance the implementation of evidence into practice, improve clinical outcomes and be cost effective, using implementation of a clinical guideline as an exemplar 2. Compare the effects of two different levels of facilitation on implementation and clinical and cost effectiveness. Pragmatic Randomised Controlled Trial The RCT has 3 arms. 1) Standard dissemination of recommendations, including an implementation guide 2) technical facilitation 3) enabling facilitation. Evaluative Data 1) TheAlberta Context Tool (ACT) - a suite of survey instruments will be given to staff members to complete and which are designed to assess organizational context and knowledge translation behaviours. 2) Interviews Interviews (telephone and face-to-face) will be conducted with key informants at micro, macro, and meso levels of sites (including, facilitators, staff, local and regional stakeholders, patients & carers) during the lifetime of the project. Interviews will be conducted at critical points in the programme pre, during and post intervention to ascertain the likelihood of sustainable changes. 3) Quality of Life questionnairesi.e. EQ5D/EQ5D by proxy and IQOL will be completed with participating nursing home residents or key workers 4) Routinely collected data Any available routinely collected local data relevant to the delivery of continence care will be collected. 5) Documentation Relevant continence care specific documentation will be collected from each site such as policies, procedures, and guidelines. 6) Intervention specific process data Process data will be collected by facilitators as part of the enabling facilitation intervention, which willinclude reflective notes and the administration of the Context Assessment Index (CAI). Health Economic Data This will involve an annual collection of data referring to the costs of urinary incontinence to each nursing home e.g. pads, laundry, disposal of used pads and staff costs. The EQ5-D will be the quality of life measurement used. • Phase 3 • Objectives for Phase 3 – Dissemination • 1. To develop and implement a model of stakeholder involvement that complements the theory-driven approach to the study design and enables stakeholder involvement throughout the research process • . To develop a portfolio of networking and dissemination activities that will promote active diffusion of the study findings to key individuals and organisations in the EU, Europe and internationally. • . To support study participants to disseminate their experiences and learning as a result of their involvement in the research. • . To evaluate the effectiveness of stakeholder involvement and dissemination activities as the study progresses and revise accordingly. References 1. Schuster M, McGlynn E, Brook R H (1998) How good is the quality of health care in the United States? The Milbank Quarterly, 76: 517-563; 2. Grol R (2001) Successes and failures in the implementation of evidence-based guidelines for clinical practice. Medical Care, 39 (8 Supp 2): 1146-1154., 3. Sheldon T A, Cullum N, Dawson D, Lankshear A, Lowson K, Watt I et al (2007) What’s the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients’ notes, and interviews. British Medical Journal, 329: 4. Sung N S, Crowley W F, Genel M et al (2003) Central challenges facing the national clinical research enterprise. Journal of the American Medical Association, 289:1278-1287 5 5. The EuroQol Group (1990). EuroQol-a new facility for the measurement of health-related quality of life. Health Policy 16(3):199-208. 6. Patrick DL, Martin ML, Bushnell DM. The I-QOL: A Quality-of-Life Instrument Specific to Persons with Urinary Incontinence: User’s Manual and Scoring Diskette for United States Version. Seattle, Washington: Health Research Associates, Inc., 1999. 7. Sandelowski M (2000) Combining qualitative and quantitative sampling, data collection, and analysis techniques in mixed methods studies. Research in Nursing and Health, 23:246-255. • DATA ANALYSIS • Data analysis will be conducted within and across data sets and within and across sites. • Analysis of percentage compliance with guidelines and quantitative data will be managed in SPSS and analysed using descriptive and inferential statistics. • Qualitative data will be analysed using content analysis and managed through Atlas.ti. • Data analysis will be an iterative process between data sets and study phases. • Integration and synthesis of data will be guided by our theoretical framework and principles of conducting mixed methods research (Sandelowski 2000). This study is funded in the European Commission 7th framework programme. EU agreement 223646 For further information contact: kate.seers@warwick.ac.uk, carole.mockford@warwick.ac.uk or d.r.kennedy@warwick.ac.uk **Promoting Action on Research Implementation in Health Services www.parihs.org