Person:

Bradley, Elizabeth

To describe the process of adoption of an evidence‐based, multifaceted, innovative program into the hospital setting, with particular attention to issues that promoted or impeded its implementation. This study examined common challenges faced by hospitals implementing the Hospital Elder Life Program (HELP) and strategies used to address these challenges. Qualitative study design based on in‐depth, open‐ended telephone interviews. Nine hospitals implementing HELP throughout the United States. Thirty‐two key staff members (physician, nursing, volunteer, and administrative staff) who were directly involved with the HELP implementation. Staff experiences implementing the program, including challenges and strategies they viewed as successful in overcoming challenges of implementation. Six common challenges faced hospital staff: (1) gaining internal support for the program despite differing requirements and goals of administration and clinical staff, (2) ensuring effective clinician leadership, (3) integrating with existing geriatric programs, (4) balancing program fidelity with hospital‐specific circumstances, (5) documenting positive outcomes of the program despite limited resources for data collection and analysis, and (6) maintaining the momentum of implementation in the face of unrealistic time frames and limited resources. Strategies perceived to be successful in addressing each challenge are described. Translating research into clinical practice is challenging for staff across disciplines. Developing strategies to address common challenges identified in this study may facilitate the adoption of innovative programs within healthcare organizations.

Background: The effective translation of scientific evidence into clinical practice is paramount to improving the quality and safety of patient care. However, little is known about the patterns of diffusion of evidence-based programmes in healthcare. Objectives: To study the pattern of diffusion of an evidence-based programme to improve the quality and safety of care for hospitalised older adults. Methods: The diffusion of the Hospital Elder Life Program (HELP), a multifaceted programme to reduce delirium in hospitalised adults, was examined. Using a survey of all hospitals that contacted the HELP Dissemination Project for more than 2 years, the proportion of hospitals that adopted the programme, the programme fidelity to the original design in terms of structure and process, and the perceived reasons for non-adoption were identified. Results: Programme fidelity was highest among structural features (eg, staffing levels); programme modifications were more commonplace in processes of care (eg, the participation of volunteers in patient care interventions). Senior management support and the programme expense were the most commonly cited reasons for non-adoption of HELP. Conclusion: Diffusion and take-up rates for this evidence-based programme were substantial; however, programme fidelity was not complete and some hospitals did not adopt the programme at all. Clinicians, researchers and funding agents seeking to promote effective translation of research should be realistic about diffusion rates and recognise the critical ingredient of senior management support to propel adoption of evidence-based programmes to improve quality and safety.

OBJECTIVES: To examine key factors that influence sustainability in the diffusion of the Hospital Elder Life Program (HELP) as an example of an evidence-based, multifaceted, innovative program to improve care for hospitalized older adults. DESIGN: Longitudinal, qualitative study between November 2000 and November 2003 based on 102 in-depth interviews every 6 months during HELP implementation. SETTING: Thirteen hospitals implementing HELP. PARTICIPANTS: Forty-two hospital staff members (physician, nursing, volunteer, and administrative staff) implementing HELP, conducted 102 interviews. MEASUREMENTS: Staff experiences sustaining the program, including challenges and strategies that they viewed as successful in addressing these challenges. RESULTS: Of the 13 hospitals studied, 10 were sustaining HELP at the end of the study period; three terminated the program (after 24 months, 12 months, and 6 months). Critical factors were identified as influencing whether the program was sustained: the presence of clinical leadership, the ability and willingness to adapt the original HELP protocols to local hospital circumstances and constraints, and the ability to obtain longer-term resources and funding for HELP. CONCLUSION: Recognizing the need for sustained clinical leadership and funding as well as the inevitable modifications required to sustain innovative programs can promote more-realistic goals and expectations for health services researchers, clinicians, and policy makers in their laudable efforts to translate research into practice.

Objectives: To determine predictors of recommendation adherence and goal attainment of family caregivers of patients at a geriatric assessment center. Design: One‐year prospective cohort study. Setting: Outpatient geriatric assessment center in Connecticut. Participants: Two hundred consecutive new patients and their family caregivers. Measurements: Family caregivers were interviewed after geriatric assessment to ascertain their treatment goals for the patient. Medical records were reviewed to identify treatment recommendations. Family caregivers were interviewed 1 year later to assess adherence to recommendations and attainment of goals. Results: Follow‐up interviews were completed with 176 (88%) family caregivers. Common recommendations pertained to physician referral (71%), medications (46%), counseling/education (31%), diagnostic tests (30%), residential planning (26%), healthcare planning (21%), and community services (21%). Goal attainment was reported in 44% to 67% of the patient cases, depending on goal category. Caregiver agreement with recommendations predicted adherence to recommendations (adjusted relative risk (ARR)=1.99, 95% confidence interval (CI)=1.04–5.92) after adjusting for available clinical and demographic factors. In addition, adherence to recommendations predicted goal attainment in adjusted analyses (ARR=1.70, 95% CI=1.09–2.64). Conclusion: This study revealed a broad range of treatment recommendations in geriatric assessment and suggests that agreeing with recommendations can promote adherence and that adherence can promote goal attainment. Taken together, the results imply that articulating shared treatment recommendations may improve the quality of health care.