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1.
Clin Orthop Relat Res ; 479(7): 1417-1425, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1511052

ABSTRACT

BACKGROUND: Healthcare disparities are well documented across multiple subspecialties in orthopaedics. The widespread implementation of telemedicine risks worsening these disparities if not carefully executed, despite original assumptions that telemedicine improves overall access to care. Telemedicine also poses unique challenges such as potential language or technological barriers that may alter previously described patterns in orthopaedic disparities. QUESTIONS/PURPOSES: Are the proportions of patients who use telemedicine across orthopaedic services different among (1) racial and ethnic minorities, (2) non-English speakers, and (3) patients insured through Medicaid during a 10-week period after the implementation of telemedicine in our healthcare system compared with in-person visits during a similar time period in 2019? METHODS: This was a retrospective comparative study using electronic medical record data to compare new patients establishing orthopaedic care via outpatient telemedicine at two academic urban medical centers between March 2020 and May 2020 with new orthopaedic patients during the same 10-week period in 2019. A total of 11,056 patients were included for analysis, with 1760 in the virtual group and 9296 in the control group. Unadjusted analyses demonstrated patients in the virtual group were younger (median age 57 years versus 59 years; p < 0.001), but there were no differences with regard to gender (56% female versus 56% female; p = 0.66). We used self-reported race or ethnicity as our primary independent variable, with primary language and insurance status considered secondarily. Unadjusted and multivariable adjusted analyses were performed for our primary and secondary predictors using logistic regression. We also assessed interactions between race or ethnicity, primary language, and insurance type. RESULTS: After adjusting for age, gender, subspecialty, insurance, and median household income, we found that patients who were Hispanic (odds ratio 0.59 [95% confidence interval 0.39 to 0.91]; p = 0.02) or Asian were less likely (OR 0.73 [95% CI 0.53 to 0.99]; p = 0.04) to be seen through telemedicine than were patients who were white. After controlling for confounding variables, we also found that speakers of languages other than English or Spanish were less likely to have a telemedicine visit than were people whose primary language was English (OR 0.34 [95% CI 0.18 to 0.65]; p = 0.001), and that patients insured through Medicaid were less likely to be seen via telemedicine than were patients who were privately insured (OR 0.83 [95% CI 0.69 to 0.98]; p = 0.03). CONCLUSION: Despite initial promises that telemedicine would help to bridge gaps in healthcare, our results demonstrate disparities in orthopaedic telemedicine use based on race or ethnicity, language, and insurance type. The telemedicine group was slightly younger, which we do not believe undermines the findings. As healthcare moves toward increased telemedicine use, we suggest several approaches to ensure that patients of certain racial, ethnic, or language groups do not experience disparate barriers to care. These might include individual patient- or provider-level approaches like expanded telemedicine schedules to accommodate weekends and evenings, institutional investment in culturally conscious outreach materials such as advertisements on community transport systems, or government-level provisions such as reimbursement for telephone-only encounters. LEVEL OF EVIDENCE: Level III, therapeutic study.


Subject(s)
Health Services Accessibility , Healthcare Disparities/statistics & numerical data , Minority Groups/statistics & numerical data , Orthopedic Procedures/statistics & numerical data , Telemedicine/statistics & numerical data , Adult , Female , Health Plan Implementation , Healthcare Disparities/ethnology , Humans , Insurance Coverage/statistics & numerical data , Language , Male , Medicaid , Middle Aged , Odds Ratio , Retrospective Studies , Telemedicine/methods , United States
2.
J Nurs Adm ; 51(11): 573-578, 2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-1504564

ABSTRACT

The ability to respond effectively and efficiently during times of crisis, including a pandemic, has emerged as a competency for nurse leaders. This article describes one institution's experience using the American Organization of Nurse Leaders Competencies for Nurse Executives in operationalizing the concept of surge capacity.


Subject(s)
Communication , Health Plan Implementation , Nurse Administrators/organization & administration , Professional Competence , Surge Capacity/organization & administration , COVID-19 , Chicago , Humans , United States
3.
Am J Public Health ; 111(S3): S204-S207, 2021 10.
Article in English | MEDLINE | ID: covidwho-1496721

ABSTRACT

At the onset of the COVID-19 pandemic, neither government officials nor members of the news media fully grasped what was happening in the Latino community. Underreporting of COVID-19 cases led to a systematic neglect of the Latino population and resulted in disproportionately high rates of infection, hospitalization, and death. Illinois Unidos was formed to engage in community mobilization, health communication, advocacy, and policy work in response to inequalities exacerbated by COVID-19 in Latino communities in Illinois. (Am J Public Health. 2021;111(S3):S204-S207. https://doi.org/10.2105/AJPH.2021.306407).


Subject(s)
COVID-19/epidemiology , Community Health Workers , Health Communication , Health Equity , Health Plan Implementation , Social Justice , COVID-19/mortality , COVID-19/prevention & control , Humans , Illinois/epidemiology , Medically Underserved Area
4.
South Med J ; 114(9): 597-602, 2021 09.
Article in English | MEDLINE | ID: covidwho-1478683

ABSTRACT

OBJECTIVES: Coronavirus disease 2019 (COVID-19) threatens vulnerable patient populations, resulting in immense pressures at the local, regional, national, and international levels to contain the virus. Laboratory-based studies demonstrate that masks may offer benefit in reducing the spread of droplet-based illnesses, but few data are available to assess mask effects via executive order on a population basis. We assess the effects of a county-wide mask order on per-population mortality, intensive care unit (ICU) utilization, and ventilator utilization in Bexar County, Texas. METHODS: We used publicly reported county-level data to perform a mixed-methods before-and-after analysis along with other sources of public data for analyses of covariance. We used a least-squares regression analysis to adjust for confounders. A Texas state-level mask order was issued on July 3, 2020, followed by a Bexar County-level order on July 15, 2020. We defined the control period as June 2 to July 2 and the postmask order period as July 8, 2020-August 12, 2020, with a 5-day gap to account for the median incubation period for cases; longer periods of 7 and 10 days were used for hospitalization and ICU admission/death, respectively. Data are reported on a per-100,000 population basis using respective US Census Bureau-reported populations. RESULTS: From June 2, 2020 through August 12, 2020, there were 40,771 reported cases of COVID-19 within Bexar County, with 470 total deaths. The average number of new cases per day within the county was 565.4 (95% confidence interval [CI] 394.6-736.2). The average number of positive hospitalized patients was 754.1 (95% CI 657.2-851.0), in the ICU was 273.1 (95% CI 238.2-308.0), and on a ventilator was 170.5 (95% CI 146.4-194.6). The average deaths per day was 6.5 (95% CI 4.4-8.6). All of the measured outcomes were higher on average in the postmask period as were covariables included in the adjusted model. When adjusting for traffic activity, total statewide caseload, public health complaints, and mean temperature, the daily caseload, hospital bed occupancy, ICU bed occupancy, ventilator occupancy, and daily mortality remained higher in the postmask period. CONCLUSIONS: There was no reduction in per-population daily mortality, hospital bed, ICU bed, or ventilator occupancy of COVID-19-positive patients attributable to the implementation of a mask-wearing mandate.


Subject(s)
COVID-19/mortality , COVID-19/prevention & control , Communicable Disease Control/legislation & jurisprudence , Health Resources/statistics & numerical data , Hospitalization/statistics & numerical data , Communicable Disease Control/methods , Health Plan Implementation , Health Policy , Humans , Local Government , Masks , SARS-CoV-2 , Texas/epidemiology
5.
J Occup Health ; 63(1): e12273, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1406069

ABSTRACT

OBJECTIVES: It is unclear how many workplace COVID-19 preventive measures were maintained during repeated outbreaks. The aim of this study was to investigate a longitudinal change of implementation of workplace preventive measures responding to COVID-19 in Japan. METHODS: An online longitudinal study was conducted using a cohort of full-time employees in Japan, starting in March 2020 (T1), with follow-up surveys in May (T2), August (T3), and November (T4) 2020. A repeated measures analysis of variance was performed to compare the difference among the four surveys in the mean number of 23 predetermined items of the measures implemented. RESULTS: The final sample comprised 800 employees. The mean number of the implemented measures increased from T1 to T2, but did not change from T2 to T3, then decreased from T3 to T4. The number of workplace preventive measures significantly increased from T1 to T2 for 21 items (P < .001), and significantly decreased from T3 to T4 for 14 items (P < .001 to P = .005). CONCLUSIONS: While the preventive measures responding to COVID-19 in the workplace were well-implemented during the earlier phase of the outbreak, they seem to have been relaxed after a huge outbreak (T3 to T4: August to November 2020). Workplaces should be encouraged to continue the preventive measures over repeated outbreaks.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control/statistics & numerical data , Health Plan Implementation/statistics & numerical data , Occupational Diseases/prevention & control , Workplace/statistics & numerical data , Adult , COVID-19/epidemiology , COVID-19/virology , Disease Outbreaks , Employment/statistics & numerical data , Female , Follow-Up Studies , Humans , Japan , Longitudinal Studies , Male , Middle Aged , Occupational Diseases/epidemiology , Occupational Diseases/virology , Occupational Health/statistics & numerical data , SARS-CoV-2 , Young Adult
6.
PLoS One ; 16(9): e0256073, 2021.
Article in English | MEDLINE | ID: covidwho-1403299

ABSTRACT

STUDY OBJECTIVES: Heightened immigration enforcement may induce fear in undocumented patients when coming to the Emergency Department (ED) for care. Limited literature examining health system policies to reduce immigrant fear exists. In this multi-site qualitative study, we sought to assess provider and system-level policies on caring for undocumented patients in three California EDs. METHODS: We recruited 41 ED providers and administrators from three California EDs (in San Francisco, Oakland, and Sylmar) with large immigrant populations. Participants were recruited using a trusted gatekeeper and snowball sampling. We conducted semi-structured interviews and analyzed the transcripts using constructivist grounded theory. RESULTS: We interviewed 10 physicians, 11 nurses, 9 social workers, and 11 administrators, and identified 7 themes. Providers described existing policies and recent policy changes that facilitate access to care for undocumented patients. Providers reported that current training and communication around policies is limited, there are variations between who asks about and documents status, and there remains uncertainty around policy details, laws, and jurisdiction of staff. Providers also stated they are taking an active role in building safety and trust and see their role as supporting undocumented patients. CONCLUSIONS: This study introduces ED-level health system perspectives and recommendations for caring for undocumented patients. There is a need for active, multi-disciplinary ED policy training, clear policy details including the extent of providers' roles, protocols on the screening and documentation of status, and continual reassessment of our health systems to reduce fear and build safety and trust with our undocumented communities.


Subject(s)
Administrative Personnel/psychology , Emergency Service, Hospital/standards , Emigrants and Immigrants/psychology , Emigration and Immigration/legislation & jurisprudence , Fear , Health Policy , Trust , Emergency Service, Hospital/organization & administration , Emigrants and Immigrants/legislation & jurisprudence , Emigrants and Immigrants/statistics & numerical data , Health Plan Implementation , Humans , Qualitative Research
9.
J Infect Dev Ctries ; 15(7): 918-924, 2021 07 31.
Article in English | MEDLINE | ID: covidwho-1339631

ABSTRACT

INTRODUCTION: The ongoing COVID-19 pandemic has claimed hundreds of thousands of lives around the world. Health planners are seeking ways to forecast the evolution of the pandemic. In this study, a mathematical model was proposed for Saudi Arabia, the country with the highest reported number of COVID-19 cases in the Arab world. METHODOLOGY: The proposed model was adapted from the model used for the Middle East respiratory syndrome outbreak in South Korea. Using time-dependent parameters, the model incorporated the effects of both population-wide self-protective measures and government actions. Data before and after the government imposed control policies on 3 March 2020 were used to validate the model. Predictions for the disease's progression were provided together with the evaluation of the effectiveness of the mitigation measures implemented by the government and self-protective measures taken by the population. RESULTS: The model predicted that, if the government had continued to implement its strong control measures, then the scale of the pandemic would have decreased by 99% by the end of June 2020. Under the current relaxed policies, the model predicted that the scale of the pandemic will have decreased by 99% by 10 August 2020. The error between the model's predictions and actual data was less than 6.5%. CONCLUSIONS: Although the proposed model did not capture all of the effects of human behaviors and government actions, it was validated as a result of its time-dependent parameters. The model's accuracy indicates that it can be used by public health policymakers.


Subject(s)
COVID-19/epidemiology , Models, Theoretical , Public Health/methods , Forecasting/methods , Health Plan Implementation/legislation & jurisprudence , Health Plan Implementation/standards , Humans , Public Health/legislation & jurisprudence , Public Health/statistics & numerical data , Saudi Arabia/epidemiology
10.
Am J Infect Control ; 49(2): 151-157, 2021 02.
Article in English | MEDLINE | ID: covidwho-1336189

ABSTRACT

BACKGROUND: An outbreak of corona virus disease 2019 (COVID-19) in Wuhan, China has spread quickly across the world, the World Health Organization (WHO) has declared this a pandemic. COVID-19 can be transmitted from human to human and cause nosocomial infection that has brought great challenges to infection control in medical institutions. Due to the professional characteristics, the research hospital still received a large number of trauma emergency tasks during the outbreak. It is urgent to establish a graded prevention and control guidance of surgery. METHODS: Review the implementation of surgical grading control measures in this hospital during the epidemic of COVID-19. RESULTS: The surgical prevention measures based on patients with different risks included prescreening and preoperative risk assessment, preparation of operating room, medical staff protection and environmental disinfection measures, etc. From January 20 to March 5, 2020, a total of 4,720 operations had been performed in this hospital, of which 1,565 were emergency operations and 22 for medium-risk and high-risk patients who may have the 2019 severe acute respiratory syndrome coronavirus 2 infection. And there is no medical staff exposed during the implementation of protective measures. CONCLUSIONS: Through the risk assessment of surgical patients and adopting surgical grading control measures, the risk of severe acute respiratory syndrome coronavirus 2 spread during the surgical process can be reduced greatly.


Subject(s)
COVID-19/prevention & control , Emergency Service, Hospital/organization & administration , Infection Control/organization & administration , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Risk Management/methods , Surgical Procedures, Operative/statistics & numerical data , COVID-19/transmission , China/epidemiology , Health Plan Implementation , Humans , Risk Assessment , SARS-CoV-2 , Surgical Procedures, Operative/adverse effects
11.
Antimicrob Resist Infect Control ; 10(1): 113, 2021 07 31.
Article in English | MEDLINE | ID: covidwho-1334760

ABSTRACT

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic has again demonstrated the critical role of effective infection prevention and control (IPC) implementation to combat infectious disease threats. Standards such as the World Health Organization (WHO) IPC minimum requirements offer a basis, but robust evidence on effective IPC implementation strategies in low-resource settings remains limited. We aimed to qualitatively assess IPC implementation themes in these settings. METHODS: Semi-structured interviews were conducted with IPC experts from low-resource settings, guided by a standardised questionnaire. Applying a qualitative inductive thematic analysis, IPC implementation examples from interview transcripts were coded, collated into sub-themes, grouped again into broad themes, and finally reviewed to ensure validity. Sub-themes appearing ≥ 3 times in data were highlighted as frequent IPC implementation themes and all findings were summarised descriptively. RESULTS: Interviews were conducted with IPC experts from 29 countries in six WHO regions. Frequent IPC implementation themes including the related critical actions to achieve the WHO IPC core components included: (1) To develop IPC programmes: continuous advocacy with leadership, initial external technical assistance, stepwise approach to build resources, use of catalysts, linkages with other programmes, role of national IPC associations and normative legal actions; (2) To develop guidelines: early planning for their operationalization, initial external technical assistance and local guideline adaption; (3) To establish training: attention to methods, fostering local leadership, and sustainable health system linkages such as developing an IPC career path; (4) To establish health care-associated (HAI) surveillance: feasible but high-impact pilots, multidisciplinary collaboration, mentorship, careful consideration of definitions and data quality, and "data for action"; (5) To implement multimodal strategies: clear communication to explain multimodal strategies, attention to certain elements, and feasible but high-impact pilots; (6) To develop monitoring, audit and feedback: feasible but high-impact pilots, attention to methods such as positive (not punitive) incentives and "data for action"; (7) To improve staffing and bed occupancy: participation of national actors to set standards and attention to methods such as use of data; and (8) To promote built environment: involvement of IPC professionals in facility construction, attention to multimodal strategy elements, and long-term advocacy. CONCLUSIONS: These IPC implementation themes offer important qualitative evidence for IPC professionals to consider.


Subject(s)
COVID-19/prevention & control , Health Plan Implementation/standards , Infection Control/standards , World Health Organization , COVID-19/epidemiology , Cross Infection/prevention & control , Health Plan Implementation/statistics & numerical data , Health Resources/standards , Health Resources/statistics & numerical data , Humans , Infection Control/methods , Internationality , Qualitative Research
12.
Emerg Med J ; 38(9): 692-693, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1320446

ABSTRACT

BACKGROUND: Recent research suggests that between 20% and 50% of paediatric head injuries attending our emergency department (ED) could be safely discharged soon after triage, without the need for medical review, using a 'Head Injury Discharge At Triage' tool (HIDAT). We sought to implement this into clinical practice. METHODS: Paediatric ED triage staff underwent competency-based assessments for HIDAT with all head injury presentations 1 May to 31 October 2020 included in analysis. We determined which patients were discharged using the tool, which underwent CT of the brain and whether there was a clinically important traumatic brain injury or representation to the ED. RESULTS: Of the 1429 patients screened; 610 (43%) screened negative with 250 (18%) discharged by nursing staff. Of the entire cohort, 32 CTs were performed for head injury concerns (6 abnormal) with 1 CT performed in the HIDAT negative group (normal). Of those discharged using HIDAT, four reattended, two with vomiting (no imaging or admission) and two with minor scalp wound infections. Two patients who screened negative declined discharge under the policy with later medical discharge (no imaging or admission). Paediatric ED attendances were 29% lower than in 2018. CONCLUSION: We have successfully implemented HIDAT into local clinical practice. The number discharged (18%) is lower than originally described; this is likely multifactorial. The relationship between COVID-19 and paediatric ED attendances is unclear but decreased attendances suggest those for whom the tool was originally designed are not attending ED and may be accessing other medical/non-medical resources.


Subject(s)
Brain Injuries, Traumatic/diagnosis , COVID-19/prevention & control , Head Injuries, Closed/diagnosis , Head Injuries, Penetrating/diagnosis , Triage/methods , Brain Injuries, Traumatic/etiology , Brain Injuries, Traumatic/prevention & control , COVID-19/epidemiology , COVID-19/transmission , Child , Emergency Service, Hospital/organization & administration , Emergency Service, Hospital/standards , Head Injuries, Closed/complications , Head Injuries, Penetrating/complications , Health Plan Implementation , Hospitals, Pediatric/organization & administration , Humans , Nurses, Pediatric/organization & administration , Pandemics/prevention & control , Patient Discharge , Professional Role , Triage/organization & administration , Triage/standards
15.
J Neurooncol ; 153(3): 479-485, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1265544

ABSTRACT

PURPOSE: Neuro-oncology tumor boards (NTBs) hold an established function in cancer care as multidisciplinary tumor boards. However, NTBs predominantly exist at academic and/or specialized centers. In addition to increasing centralization throughout the healthcare system, changes due to the COVID-19 pandemic have arguably resulted in advantages by conducting clinical meetings virtually. We therefore asked about the experience and acceptance of (virtualized) NTBs and their potential benefits. METHODS: A survey questionnaire was developed and distributed via a web-based platform. Specialized neuro-oncological centers in Germany were identified based on the number of brain tumor cases treated in the respective institution per year. Only one representative per center was invited to participate in the survey. Questions targeted the structure/organization of NTBs as well as changes due to the COVID-19 pandemic. RESULTS: A total of 65/97 institutions participated in the survey (response rate 67%). In the context of the COVID-19 pandemic, regular conventions of NTBs were maintained by the respective centers and multi-specialty participation remained high. NTBs were considered valuable by respondents in achieving the most optimal therapy for the affected patient and in maintaining/encouraging interdisciplinary debate/exchange. The settings of NTBs have been adapted during the pandemic with the increased use of virtual technology. Virtual NTBs were found to be beneficial, yet administrative support is lacking in some places. CONCLUSIONS: Virtual implementation of NTBs was feasible and accepted in the centers surveyed. Therefore, successful implementation offers new avenues and may be pursued for networking between centers, thereby increasing coverage of neuro-oncology care.


Subject(s)
COVID-19/epidemiology , Health Plan Implementation , Neoplasms/therapy , Practice Patterns, Physicians'/standards , SARS-CoV-2/isolation & purification , Telemedicine , COVID-19/virology , Cross-Sectional Studies , Delivery of Health Care , Humans , Surveys and Questionnaires
16.
J Am Board Fam Med ; 34(3): 481-488, 2021.
Article in English | MEDLINE | ID: covidwho-1259322

ABSTRACT

As was experienced across the country, the COVID-19 pandemic reached Colorado in early spring 2020. Yet, unlike many of the early hotspots in other states, the initial cases in Colorado surfaced in rural areas. It was evident early on it would be a public health crisis unlike anything Colorado had ever faced. There was an urgent need for rapid dissemination of up-to-date information and practice support provided by a multidisciplinary task force of academic health center and state public health experts working collaboratively to meet these needs. This article provides a roadmap for the development of a similar model, a community-connected Extension for Community Health Outcomes (ECHO) program based at an academic medical center and its ability to facilitate the service rapidly and scale to need.


Subject(s)
COVID-19 , Primary Health Care/organization & administration , Public Health Administration , Telemedicine , Colorado/epidemiology , Health Plan Implementation , Humans , Pandemics , Public Health
17.
Arch Phys Med Rehabil ; 102(9): 1840-1847, 2021 09.
Article in English | MEDLINE | ID: covidwho-1252450

ABSTRACT

This article outlines a multidisciplinary approach to implementing a telehealth program in the acute care hospital setting during the coronavirus disease 2019 (COVID-19) pandemic. Telehealth has been used in many practice areas, although it can be a particular challenge to establish in an acute care hospital given the fast-paced environment. However, the COVID-19 pandemic presented a unique situation. In-person treatment interactions became increasingly high risk for both patient and provider, and there was an emerging need to conserve personal protective equipment and limit exposure. In response to these developments, physical therapists, occupational therapists, and speech language pathologists treating an adult population turned to telehealth to supplement in-person treatment. This article outlines the clinical reasoning and practical application to implementing a telehealth program in an acute care hospital and includes regulations, identified successful strategies, barriers, considerations, decision-making algorithms, and discipline-specific interventions.


Subject(s)
COVID-19 , Hospitals, Rehabilitation , Infection Control/methods , Patient Care Team , Telerehabilitation/methods , Adult , Female , Health Plan Implementation , Humans , Male , Occupational Therapy/methods , Physical Therapy Modalities , Program Evaluation , SARS-CoV-2 , Speech Therapy/methods
19.
J Int Assoc Provid AIDS Care ; 20: 23259582211017742, 2021.
Article in English | MEDLINE | ID: covidwho-1236537

ABSTRACT

BACKGROUND: Maintaining essential HIV services has being a Global challenge during the COVID-19 crises. Myanmar has 54 million inhabitants. Neighbor of China, Thailand, India and Bangladesh it was impacted by COVID-19, but came up with a comprehensive and effective response, following WHO recommendations. The HIV Prevalence is 0.58% and it is concentrated among key population. A HIV Contingency Plan was developed to face this challenge. METHODOLOGY: The programme-based cross-sectional descriptive study with analysis of routinely collected data from MoHS data system, between 2019 and 2020 was conducted, comparing first six months of 2019 and 2020. RESULTS: HIV outreach activities and HIV testing were slightly affected after detection of first COVID-19 case, till mid May 2020. After that, outreach activities resumed. Introduction of HIV self-testing was initiated. 72% of more than 21,000 PWID on MMT were receiving take home dose up to 14 days and 60% of ART patients were receiving 6 months ARV dispensing. CONCLUSION: Essential HIV services were maintained.


Subject(s)
COVID-19/epidemiology , Community Health Services/methods , HIV Infections/prevention & control , HIV Infections/diagnosis , HIV Infections/drug therapy , HIV Infections/epidemiology , Health Plan Implementation , Humans , Myanmar/epidemiology , SARS-CoV-2
20.
Fam Syst Health ; 39(1): 7-18, 2021 03.
Article in English | MEDLINE | ID: covidwho-1236068

ABSTRACT

OBJECTIVE: For implementation of an evidence-based program to be effective, efficient, and equitable across diverse populations, we propose that researchers adopt a systems approach that is often absent in efficacy studies. To this end, we describe how a computer-based monitoring system can support the delivery of the New Beginnings Program (NBP), a parent-focused evidence-based prevention program for divorcing parents. METHOD: We present NBP from a novel systems approach that incorporates social system informatics and engineering, both necessary when utilizing feedback loops, ubiquitous in implementation research and practice. Examples of two methodological challenges are presented: how to monitor implementation, and how to provide feedback by evaluating system-level changes due to implementation. RESULTS: We introduce and relate systems concepts to these two methodologic issues that are at the center of implementation methods. We explore how these system-level feedback loops address effectiveness, efficiency, and equity principles. These key principles are provided for designing an automated, low-burden, low-intrusive measurement system to aid fidelity monitoring and feedback that can be used in practice. DISCUSSION: As the COVID-19 pandemic now demands fewer face-to-face delivery systems, their replacement with more virtual systems for parent training interventions requires constructing new implementation measurement systems based on social system informatics approaches. These approaches include the automatic monitoring of quality and fidelity in parent training interventions. Finally, we present parallels of producing generalizable and local knowledge bridging systems science and engineering method. This comparison improves our understanding of system-level changes, facilitates a program's implementation, and produces knowledge for the field. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Subject(s)
Consumer Health Informatics , Divorce , Health Plan Implementation/methods , Parenting , Parents/education , Adult , COVID-19 , Child , Child Health , Child Rearing , Female , Humans , Male , Parent-Child Relations , Program Evaluation , SARS-CoV-2
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