A5045280731- Health Policy Implementation Science
- Health Systems, Economic Evaluations, Quality of Life
- Organ Donation and Transplantation
- Primary Care and Health Outcomes
- Healthcare cost, quality, practices
- Diabetes Management and Education
- Health Sciences Research and Education
- Palliative Care and End-of-Life Issues
- Organ Transplantation Techniques and Outcomes
- Patient Satisfaction in Healthcare
- Cardiac, Anesthesia and Surgical Outcomes
- Acute Ischemic Stroke Management
- Infection Control in Healthcare
- Workplace Violence and Bullying
- Retinal Diseases and Treatments
- Infection Control and Ventilation
- Antibiotic Use and Resistance
- Musculoskeletal pain and rehabilitation
- Clinical practice guidelines implementation
- Nursing Diagnosis and Documentation
- Transplantation: Methods and Outcomes
- Chronic Disease Management Strategies
- Mental Health and Patient Involvement
- Medication Adherence and Compliance
- Grief, Bereavement, and Mental Health
Ottawa Hospital
2014-2025
Ottawa Hospital Research Institute
2013-2025
University of Ottawa
2016-2023
Society for Healthcare Epidemiology of America
2014
Choosing Wisely (CW) campaigns globally have focused attention on the need to reduce low-value care, which can represent up 30% of costs healthcare. Despite early enthusiasm for CW initiative, few large-scale changes in rates care been reported since launch these campaigns. Recent commentaries suggest that focus campaign should be implementation evidence-based strategies effectively care. This paper describes De-Implementation Framework (CWDIF), a novel framework builds previous work field...
Audit and feedback (A&F) is a commonly used quality improvement (QI) approach. A Cochrane review indicates that A&F generally effective leads to modest improvements in professional practice but with considerable variation the observed effects. While we have some understanding of factors enhance effects A&F, further research needs explore when most likely be how optimise it. To do this, need move away from two-arm trials compared control favour head-to-head different ways...
There is growing recognition that "context" can and does modify the effects of implementation interventions aimed at increasing healthcare professionals' use research evidence in clinical practice. However, conceptual clarity about what exactly comprises lacking. The purpose this program to develop, refine, validate a framework identifies key domains context (and their features) facilitate or hinder (1) practice (2) effectiveness interventions. A multi-phased investigation using mixed...
To identify the behavioral determinants--both barriers and enablers--that may impact physician hand hygiene compliance.A qualitative study involving semistructured key informant interviews with staff physicians residents.An urban, 1,100-bed multisite tertiary care Canadian hospital.A total of 42 residents in internal medicine surgery.Semistructured were conducted using an interview guide that was based on theoretical domains framework (TDF), a behavior change comprised 14 explain...
Despite evidence-based recommendations, adherence with secondary prevention medications post-myocardial infarction (MI) remains low. Taking medication requires behaviour change, and using behavioural theories to identify what factors determine could help develop novel interventions.Compare the utility of different theory-based approaches for identifying modifiable determinants post-MI that be targeted by interventions.Two studies were conducted patients 0-2, 3-12, 13-24 or 25-36 weeks...
Healthcare-associated infections affect 10% of patients in Canadian acute-care hospitals and are significant preventable causes morbidity mortality among hospitalized patients. Hand hygiene is the simplest most effective preventive measures to reduce these infections. However, compliance with hand healthcare workers, specifically physicians, consistently suboptimal. We aim first identify barriers enablers physician compliance, then develop pilot a theory-based knowledge translation...
Abstract Aim To conduct a concept analysis of clinical practice contexts (work environments) that facilitate or militate against the uptake research evidence by healthcare professionals in practice. This will involve developing clear definition context describing its features, domains and defining characteristics. Background The where care is delivered influences care. While shows important to knowledge translation (implementation), we lack conceptual clarity on what context, which...
Deceased donation rates in Canada remain below the predicted potential and lag behind leading countries. Missing a donor leads to preventable death disability of transplant candidates increased healthcare costs. Stakeholders were invited national consensus conference on improving deceased organ identification referral (ID&R) system accountability. In advance, participants received evidence-based, background documents addressing audits, clinical triggers, required legislation, ethics,...
Uncomplicated low-back pain (LBP), referring to LBP without symptoms that suggest an underlying medical or surgical cause, is a common and challenging problem for patients primary healthcare providers. Multiple guidelines discourage the use of diagnostic imaging uncomplicated due cost lack benefit; despite this, remains overused in this condition. Study providers suggests patient expectations contribute LBP. Dedicated study understanding experiences necessary design interventions reduce...
There is a worldwide shortage of organs available for transplant, leading to preventable mortality associated with end-stage organ disease. While most citizens in many countries an intent-to-donate “opt-in” system support donation, registration rates remain low. In Canada, Canadians donation but less than 25% provinces have registered their desire donate when they die. The family physician office promising yet underused setting which promote donor and address known barriers enablers...
A shortage of transplantable organs is a global problem. The purpose this study was to explore frontline intensive care unit professionals' and organ donor coordinators' perceptions beliefs around the process of, barriers enablers to, donation after circulatory determination death (DCDD).This qualitative descriptive used semistructured interview guide informed by Theoretical Domains Framework 55 key informants (physicians, nurses, coordinators) in units (hospitals) organizations across...
The evaluation of patient engagement in research is understudied and under-reported, making it difficult to know what strategies work best when. We provide the results an a large Canadian program focused on de-implementation low-value care. aimed evaluate experience impact study.An online cross-sectional survey was administered using Microsoft Forms (1) researchers study staff (2) partners. developed following iterative reviews by project's partnership council committee. Survey content areas...
Abstract Background While audit & feedback (A&F) is an effective implementation intervention, the design elements which maximize effectiveness are unclear. Partnering with a healthcare quality advisory organization already delivering feedback, we conducted pragmatic, 2 × factorial, cluster-randomized trial to test impact of variations in two factors: (A) benchmark used for comparison and (B) information framing. An embedded process evaluation explored hypothesized mechanisms effect....
A shortage of transplantable organs is a global problem. There are two types organ donation: living and deceased. Deceased donation can occur following neurological determination death (NDD) or cardiocirculatory death. Donation after (DCD) accounts for the largest increments in deceased worldwide. Variations use DCD exist, however, within Canada Reasons these discrepancies largely unknown. The purpose this study to develop, implement, evaluate theory-based knowledge translation intervention...
Immigrants to Canada belonging ethnocultural minority groups are at increased risk of developing diabetes and complications, including diabetic retinopathy, they also less likely be screened treated. Improved attendance retinopathy screening (eye tests) has the potential reduce permanent blindness.This study aims identify barriers enablers attending among immigrants living with in Quebec Ontario, Canada, inform development a behavior change intervention improve attendance.The research...
As part of their professional role, healthcare providers enact multiple competing goal-directed behaviours in time-constrained environments. Better understanding providers' motivation to engage the pursuit particular goals may help inform development implementation interventions. We investigated as a trial evaluating effectiveness an audit and feedback intervention supporting appropriate adjustment high-risk medication prescribing by physicians working nursing homes. Our objectives were...
Abstract Background Choosing Wisely Canada and most major anesthesia preoperative guidelines recommend against obtaining tests before low-risk procedures. However, these recommendations alone have not reduced low-value test ordering. In this study, the theoretical domains framework (TDF) was used to understand drivers of electrocardiogram (ECG) chest X-ray (CXR) ordering for patients undergoing surgery (‘low-value testing’) among anesthesiologists, internal medicine specialists, nurses,...
<title>Abstract</title> <bold>Background: </bold>Low value<bold> </bold>preoperative tests ordered for patients without any clinical indication undergoing low-risk surgery can lead to further unnecessary investigations or treatments of false-positives. Identified drivers ordering such low value preoperative include uncertainty about who should be responsible test ordering, perceived inability cancel by fellow physicians and being completed before anesthesiologists assess patients. These...
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<sec> <title>BACKGROUND</title> Immigrants to Canada belonging ethnocultural minority groups are at increased risk of developing diabetes and complications, including diabetic retinopathy, they also less likely be screened treated. Improved attendance retinopathy screening (eye tests) has the potential reduce permanent blindness. </sec> <title>OBJECTIVE</title> This study aims identify barriers enablers attending among immigrants living with in Quebec Ontario, Canada, inform development a...