Effective Strategies for Achieving Scope of Practice Reform in Pennsylvania.
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ABSTRACT:
SUBMITTER: Carthon JM
PROVIDER: S-EPMC5257206 | biostudies-other | 2016 May
REPOSITORIES: biostudies-other
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Project description:PURPOSE Practice facilitation is an evidence-informed implementation strategy to support quality improvement (QI) and aid practices in aligning with best evidence. Few studies, particularly of this size and scope, identify strategies that contribute to facilitator effectiveness. METHODS We conducted a sequential mixed methods study, analyzing data from EvidenceNOW, a large-scale QI initiative. Seven regional cooperatives employed 162 facilitators to work with 1,630 small or medium-sized primary care practices. Main analyses were based on facilitators who worked with at least 4 practices. Facilitators were defined as more effective if at least 75% of their practices improved on at least 1 outcome measure—aspirin use, blood pressure control, smoking cessation counseling (ABS), or practice change capacity, measured using Change Process Capability Questionnaire—from baseline to follow-up. Facilitators were defined as less effective if less than 50% of their practices improved on these outcomes. Using an immersion crystallization and comparative approach, we analyzed observational and interview data to identify strategies associated with more effective facilitators. RESULTS Practices working with more effective facilitators had a 3.6% greater change in the mean percentage of patients meeting the composite ABS measure compared with practices working with less effective facilitators (P <.001). More effective facilitators cultivated motivation by tailoring QI work and addressing resistance, guided practices to think critically, and provided accountability to support change, using these strategies in combination. They were able to describe their work in detail. In contrast, less effective facilitators seldom used these strategies and described their work in general terms. Facilitator background, experience, and work on documentation did not differentiate between more and less effective facilitators. CONCLUSIONS Facilitation strategies that differentiate more and less effective facilitators have implications for enhancing facilitator development and training, and can assist all facilitators to more effectively support practice changes.
| S-EPMC9512557 | biostudies-literature
Project description:Increased engagement of nurse practitioners (NPs) has been recommended as a way to address care delivery challenges in settings that struggle to attract physicians, such as primary care and rural areas. Nursing homes also face such physician shortages. We evaluated the role of state scope of practice regulations on NP practice in nursing homes in 2012-2019. Using linear probability models, we estimated the proportion of NP-delivered visits to patients in nursing homes as a function of state scope of practice regulations. Control variables included county demographic, socioeconomic, and health care workforce characteristics; state fixed effects; and year indicators. The proportion of nursing home visits conducted by NPs increased from 24% in 2012 to 42% in 2019. Expanded scope of practice regulation was associated with a greater proportion and total volume of nursing home visits conducted by NPs in counties with at least 1 NP visit. These relationships were concentrated among short-stay patients in urban counties. Removing scope of practice restrictions on NPs may address clinician shortages in nursing homes in urban areas where NPs already practice in nursing homes. However, improving access to advanced clinician care for long-term care residents and for patients in rural locations may require additional interventions and resources.
| S-EPMC10901290 | biostudies-literature
Project description:UnlabelledThe cell therapy industry has identified the inability to reliably characterize cells as possibly its greatest challenge and has called for standards and reference materials to provide assurance for measurements of cell properties. The challenges in characterization of cell therapy products can be largely addressed with systematic approaches for assessing sources of uncertainty and improving confidence in key measurements. This article presents the many strategies that can be used to ensure measurement confidence and discusses them in terms of how they can be applied to characterization of cell therapy products.SignificanceApplication of these strategies to cell measurements will help to establish qualified assays for cell characterization, which may help streamline regulatory approval and enable more efficient development of cell therapy products.
| S-EPMC4878336 | biostudies-literature
Project description:PurposeThe impact of scope of practice of providers (predominantly adult versus predominantly pediatric) on the outcomes of cerebrovascular procedures in children remains an issue of debate. We investigated the association of scope of practice with the outcomes of cerebrovascular interventions.MethodsWe performed a cohort study of all pediatric patients (younger than 18 years old) who underwent cerebrovascular procedures from 2009 to 2013 and were registered in the Statewide Planning and Research Cooperative System (SPARCS) database. In order to control for confounding, we used propensity score conditioning and mixed effects analysis to account for clustering at the hospital level.ResultsDuring the study period, there were 1243 pediatric patients who underwent cerebrovascular procedures and met the inclusion criteria. Of these, 631 (50.7 %) underwent treatment by providers with predominantly adult practices and 612 (49.3 %) by physicians who operated predominantly on children. The mixed-effects multivariable regression analysis demonstrated lack of association of predominantly adult practice with inpatient mortality (OR, 1.20; 95 % CI, 0.61-2.38), discharge to a facility (OR, 1.50; 95 % CI, 0.73-3.09), and length of stay (LOS) (adjusted difference, 0.003; 95 % CI, -0.09 to 0.10). These associations persisted in propensity-adjusted models.ConclusionsIn a cohort of pediatric patients undergoing cerebrovascular procedures from a comprehensive all-payer database, we did not demonstrate a difference in mortality, discharge to a facility, and LOS between providers with predominantly adult and predominantly pediatric practices.
| S-EPMC5469360 | biostudies-literature
Project description:BackgroundPractice facilitation is an implementation strategy used to build practice capacity and support practice changes to improve health care outcomes. Yet, few studies have investigated how practice facilitation strategies are tailored to different primary care contexts.ObjectiveTo identify contextual factors that drive facilitators' strategies to meet practice improvement goals, and how these strategies are tailored to practice context.DesignSemi-structured, qualitative interviews analyzed using inductive (open coding) and deductive (thematic) approaches. This study was conducted as part of a larger study, HealthyHearts New York City, which evaluated the impact of practice facilitation on adoption of cardiovascular disease prevention and treatment guidelines.Participants15 facilitators working in two practice contexts: small independent practices (SIPs) and Federally Qualified Health Centers (FQHCs).Main measuresStrategies facilitators use to support and promote practice changes and contextual factors that impact this approach.Key resultsContextual factors were described similarly across settings and included the policy environment, patient needs, site characteristics, leadership engagement, and competing priorities. We identified four facilitation strategies used to tailor to contextual factors and support practice change: (a) remain flexible to align with practice and organizational priorities; (b) build relationships; (c) provide value through information technology expertise; and (d) build capacity and create efficiencies. Facilitators in SIPs and FQHCs described using the same strategies, often in combination, but tailored to their specific contexts.ConclusionsDespite significant infrastructure and resource differences between SIPs and FQHCs, the contextual factors that influenced the facilitator's change process and the strategies used to address those factors were remarkably similar. The findings emphasize that facilitators require multidisciplinary skills to support sustainable practice improvement in the context of varying complex health care delivery settings.
| S-EPMC7080927 | biostudies-literature
Project description:BackgroundA supportive patient safety culture is considered to be an essential condition for improving patient safety. Assessing the current safety culture in general practice may be a first step to target improvements. To that end, we studied internal consistency and construct validity of a safety culture questionnaire for general practice (SCOPE) which was derived from a comparable questionnaire for hospitals (Dutch-HSOPS).MethodsThe survey was conducted among caregivers of Dutch general practice as part of an ongoing quality accreditation process using a 46 item questionnaire. We conducted factor analyses and studied validity by calculating correlations between the subscales and testing the hypothesis that respondents' patient safety grade of their practices correlated with their scores on the questionnaire.ResultsOf 72 practices 294 respondents completed the questionnaire. Eight factors were identified concerning handover and teamwork, support and fellowship, communication openness, feedback and learning from error, intention to report events, adequate procedures and staffing, overall perceptions of patient safety and expectations and actions of managers. Cronbach's alpha of the factors rated between 0.64 and 0.85. The subscales intercorrelated moderately, except for the factor about intention to report events. Respondents who graded patient safety highly scored significantly higher on the questionnaire than those who did not.ConclusionsThe SCOPE questionnaire seems an appropriate instrument to assess patient safety culture in general practice. The clinimetric properties of the SCOPE are promising, but future research should confirm the factor structure and construct of the SCOPE and delineate its responsiveness to changes in safety culture over time.
| S-EPMC3228702 | biostudies-literature
Project description:Aims and objectivesTo describe the nature and scope of nurse-midwifery practice in Texas and to determine legislative priorities and practice barriers.BackgroundAcross the globe, midwives are the largest group of maternity care providers despite little known about midwifery practice. With a looming shortage of midwives, there is a pressing need to understand midwives' work environment and scope of practice.DesignMixed methods research utilising prospective descriptive survey and interview.MethodsAn online survey was administered to nurse-midwives practicing in the state of Texas (N = 449) with a subset (n = 10) telephone interviewed. Descriptive and inferential statistics and content analysis was performed.ResultsThe survey was completed by 141 midwives with eight interviewed. Most were older, Caucasian and held a master's degree. A majority worked full-time, were in clinical practice in larger urban areas and were employed by a hospital or physician group. Care was most commonly provided for Hispanic and White women; approximately a quarter could care for greater numbers of patients. Most did not clinically teach midwifery students. Physician practice agreements were believed unnecessary and prescriptive authority requirements restrictive. Legislative issues were typically followed through the professional organisation or social media sites; most felt a lack of competence to influence health policy decisions. While most were satisfied with current clinical practice, a majority planned a change in the next 3 to 5 years.ConclusionsAn ageing midwifery workforce, not representative of the race/ethnicity of the populations served, is underutilised with practice requirements that limit provision of services. Health policy changes are needed to ensure unrestricted practice.Relevance to clinical practiceRobust midwifery workforce data are needed as well as a midwifery board which tracks availability and accessibility of midwives. Educators should consider training models promoting long-term service in underserved areas, and development of skills crucial for impacting health policy change.
| S-EPMC7992184 | biostudies-literature
Project description:The study of optimal best practice within the context of academia has produced both empirical and theoretical contributions. Optimal best practice, also coined as optimal functioning, is concerned with a person's personal best-that is, "what is the best that I can do for this academic subject?" Research in the social sciences has, to date, explored different types of optimal best-physical, cognitive, emotional, and social. What is of considerable interest, as a related matter, is a question of how a person reaches and experiences a level of optimal best practice. Recent research development, for example, has explored various conceptualizations of optimal best practice-for example, one distinctive theoretical model, the Framework of Achievement Bests [1, 2], makes a concerted effort to explore the underlying process of optimization-that is, in this case, how an optimal level of best practice is achieved. The present study, as detailed below, investigates via means of non-experimental data a theoretical model pertaining to the achievement of optimal best practice. This examination, we postulate, would enable us to add clarity and provide additional theoretical insights the operational nature of the process of optimization. The operational nature of optimization, as described in our recent research [1, 3], emphasizes three major tenets: (i) the main sources of a person's optimal best practice, (ii) the potential 'optimizing' influences of three comparable agencies on the achievement of optimal best practice (i.e., personal resolve, social relationship, and personal self-efficacy), and (iii) the impact of optimal best practice on future adaptive outcomes (i.e., academic striving and personal well-being). We explored this topic via means of the use of a non-experimental, correlational design with participants drawn from Taiwanese university students (N = 1010). Structural equation modelling (SEM) produced evidence, which empirically supported existing research [1, 3] and substantiated our knowledge of the concept of optimal best practice. Evidence established from the present study has also assisted us to identify one pervasive issue, which we call for further research development-namely, to consider, design, and develop an appropriate methodological approach that would enable researchers to accurately measure and assess the process of optimization. Finally, in terms of teaching and learning, we acknowledge that our research investigation has provided some insights into potential educational practices for implementation.
| S-EPMC6483225 | biostudies-literature
Project description:This SuperSeries is composed of the SubSeries listed below.
2023-02-09 | GSE216583 | GEO
Project description:Although often perceived to be a problem of the young, violence commonly affects older adults, a rapidly growing segment of the population. Violence can be directed toward older adults (elder abuse and intimate partner violence), self-directed (suicide), or perpetrated by older adults against others (intimate partner violence and violence in dementia). Across forms of violence, firearm access increases lethality, and veterans may be a particularly high-risk population. The forms of violence in older adults have some common risk factors (such as medical or psychiatric illness) and common challenges for prevention (such as balancing autonomy and well-being in vulnerable adults). The integration of prevention strategies across the life span, disciplines, and forms of violence offers promise for promoting older adult health and well-being. Looking forward, key areas for attention will include raising awareness about these topics and prioritizing funding for the implementation and evaluation of violence prevention interventions in health care settings and the community.
| S-EPMC7327526 | biostudies-literature