Development and usability testing of a multifaceted intervention to reduce low-value injury care
Abstract Background Multifaceted interventions that address barriers and facilitators have been shown to be most effective for increasing the adoption of high-value care, but there is a knowledge gap on this type of intervention for the de-implementation of low-value care. Trauma is a high-risk sett...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-01-01
|
| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-024-12153-y |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1841544914789203968 |
|---|---|
| author | Mélanie Bérubé Alexandra Lapierre Michael Sykes Jeremy Grimshaw Alexis F. Turgeon François Lauzier Monica Taljaard Henry Thomas Stelfox Holly Witteman Simon Berthelot Éric Mercier Catherine Gonthier Jérôme Paquet Robert Fowler Natalie Yanchar Barbara Haas Paule Lessard-Bonaventure Patrick Archambault Belinda Gabbe Jason R. Guertin Yougdong Ouyang Lynne Moore the Canadian Traumatic Brain Injury Research Consortium |
| author_facet | Mélanie Bérubé Alexandra Lapierre Michael Sykes Jeremy Grimshaw Alexis F. Turgeon François Lauzier Monica Taljaard Henry Thomas Stelfox Holly Witteman Simon Berthelot Éric Mercier Catherine Gonthier Jérôme Paquet Robert Fowler Natalie Yanchar Barbara Haas Paule Lessard-Bonaventure Patrick Archambault Belinda Gabbe Jason R. Guertin Yougdong Ouyang Lynne Moore the Canadian Traumatic Brain Injury Research Consortium |
| author_sort | Mélanie Bérubé |
| collection | DOAJ |
| description | Abstract Background Multifaceted interventions that address barriers and facilitators have been shown to be most effective for increasing the adoption of high-value care, but there is a knowledge gap on this type of intervention for the de-implementation of low-value care. Trauma is a high-risk setting for low-value care, such as unnecessary diagnostic imaging and the use of specialized resources. The aim of our study was to develop and assess the usability of a multifaceted intervention to reduce low-value injury care. Methods We used the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change tool as theoretical foundations to identify barriers and facilitators, and strategies for the reduction of low-value practices. We designed an initial prototype of the intervention using the items of the Template for Intervention Description and Replication. The prototype’s usability was iteratively tested through four focus groups and four think-aloud sessions with trauma decision-makers (n = 18) from seven Level I to Level III trauma centers. We conducted an inductive analysis of the audio-recorded sessions to identify usability issues and other barriers and facilitators to refine the intervention. Results We identified barriers and facilitators related to individual characteristics, including knowledge and beliefs about low-value practices and the de-implementation process, such as the complexity of changing practices and difficulty accessing performance feedback. Accordingly, the following intervention strategies were selected: involving governing structures and leaders, distributing audit & feedback reports on performance, and providing educational materials, de-implementation support tools and educational/facilitation visits. A total of 61 issues were identified during the usability testing, of which eight were critical, 33 were moderately important, and 18 were minor. These issues led to numerous improvements, including the addition of information on the drivers and benefits of reducing low-value practices, changes in the definition of these practices, the addition of proposed strategies to facilitate de-implementation, and the tailoring of educational/facilitation visits. Conclusions We designed and refined a multifaceted intervention to reduce low-value injury care using a process that increases the likelihood of its acceptability and sustainability. The next step will be to evaluate the effectiveness of implementing this intervention using a pragmatic cluster randomized controlled trial. Trial registration This protocol has been registered on ClinicalTrials.gov (February 24th 2023, #NCT05744154, https://clinicaltrials.gov/ct2/show/NCT05744154 ). |
| format | Article |
| id | doaj-art-f59df33f0eee40978d1cf4a7efee07ad |
| institution | Kabale University |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj-art-f59df33f0eee40978d1cf4a7efee07ad2025-01-12T12:13:09ZengBMCBMC Health Services Research1472-69632025-01-0125111510.1186/s12913-024-12153-yDevelopment and usability testing of a multifaceted intervention to reduce low-value injury careMélanie Bérubé0Alexandra Lapierre1Michael Sykes2Jeremy Grimshaw3Alexis F. Turgeon4François Lauzier5Monica Taljaard6Henry Thomas Stelfox7Holly Witteman8Simon Berthelot9Éric Mercier10Catherine Gonthier11Jérôme Paquet12Robert Fowler13Natalie Yanchar14Barbara Haas15Paule Lessard-Bonaventure16Patrick Archambault17Belinda Gabbe18Jason R. Guertin19Yougdong Ouyang20Lynne Moore21the Canadian Traumatic Brain Injury Research ConsortiumPopulation Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec (Hôpital de L’Enfant-Jésus), Université LavalPopulation Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec (Hôpital de L’Enfant-Jésus), Université LavalDepartment of Nursing, Midwifery, and Health, Northumbria UniversityOttawa Hospital Research InstitutePopulation Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec (Hôpital de L’Enfant-Jésus), Université LavalPopulation Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec (Hôpital de L’Enfant-Jésus), Université LavalOttawa Hospital Research InstituteFaculty of Medicine & Dentistry, University of AlbertaDepartment of Family and Emergency Medicine, Université LavalPopulation Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec (Hôpital de L’Enfant-Jésus), Université LavalPopulation Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec (Hôpital de L’Enfant-Jésus), Université LavalInstitut national d’excellence en santé et en services sociauxDepartment of Surgery, Division of Neurosurgery, Université LavalSunnybrook Research InstituteDepartment of Surgery, University of CalgaryDepartment of Surgery, University of TorontoDepartment of Surgery, Division of Neurosurgery, Université LavalPopulation Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec (Hôpital de L’Enfant-Jésus), Université LavalSchool of Public Health and Preventive Medicine, Monash UniversityPopulation Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec (Hôpital de L’Enfant-Jésus), Université LavalOttawa Hospital Research InstitutePopulation Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec (Hôpital de L’Enfant-Jésus), Université LavalAbstract Background Multifaceted interventions that address barriers and facilitators have been shown to be most effective for increasing the adoption of high-value care, but there is a knowledge gap on this type of intervention for the de-implementation of low-value care. Trauma is a high-risk setting for low-value care, such as unnecessary diagnostic imaging and the use of specialized resources. The aim of our study was to develop and assess the usability of a multifaceted intervention to reduce low-value injury care. Methods We used the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change tool as theoretical foundations to identify barriers and facilitators, and strategies for the reduction of low-value practices. We designed an initial prototype of the intervention using the items of the Template for Intervention Description and Replication. The prototype’s usability was iteratively tested through four focus groups and four think-aloud sessions with trauma decision-makers (n = 18) from seven Level I to Level III trauma centers. We conducted an inductive analysis of the audio-recorded sessions to identify usability issues and other barriers and facilitators to refine the intervention. Results We identified barriers and facilitators related to individual characteristics, including knowledge and beliefs about low-value practices and the de-implementation process, such as the complexity of changing practices and difficulty accessing performance feedback. Accordingly, the following intervention strategies were selected: involving governing structures and leaders, distributing audit & feedback reports on performance, and providing educational materials, de-implementation support tools and educational/facilitation visits. A total of 61 issues were identified during the usability testing, of which eight were critical, 33 were moderately important, and 18 were minor. These issues led to numerous improvements, including the addition of information on the drivers and benefits of reducing low-value practices, changes in the definition of these practices, the addition of proposed strategies to facilitate de-implementation, and the tailoring of educational/facilitation visits. Conclusions We designed and refined a multifaceted intervention to reduce low-value injury care using a process that increases the likelihood of its acceptability and sustainability. The next step will be to evaluate the effectiveness of implementing this intervention using a pragmatic cluster randomized controlled trial. Trial registration This protocol has been registered on ClinicalTrials.gov (February 24th 2023, #NCT05744154, https://clinicaltrials.gov/ct2/show/NCT05744154 ).https://doi.org/10.1186/s12913-024-12153-yLow-value practiceTrauma systemIntervention developmentMultifaceted intervention |
| spellingShingle | Mélanie Bérubé Alexandra Lapierre Michael Sykes Jeremy Grimshaw Alexis F. Turgeon François Lauzier Monica Taljaard Henry Thomas Stelfox Holly Witteman Simon Berthelot Éric Mercier Catherine Gonthier Jérôme Paquet Robert Fowler Natalie Yanchar Barbara Haas Paule Lessard-Bonaventure Patrick Archambault Belinda Gabbe Jason R. Guertin Yougdong Ouyang Lynne Moore the Canadian Traumatic Brain Injury Research Consortium Development and usability testing of a multifaceted intervention to reduce low-value injury care BMC Health Services Research Low-value practice Trauma system Intervention development Multifaceted intervention |
| title | Development and usability testing of a multifaceted intervention to reduce low-value injury care |
| title_full | Development and usability testing of a multifaceted intervention to reduce low-value injury care |
| title_fullStr | Development and usability testing of a multifaceted intervention to reduce low-value injury care |
| title_full_unstemmed | Development and usability testing of a multifaceted intervention to reduce low-value injury care |
| title_short | Development and usability testing of a multifaceted intervention to reduce low-value injury care |
| title_sort | development and usability testing of a multifaceted intervention to reduce low value injury care |
| topic | Low-value practice Trauma system Intervention development Multifaceted intervention |
| url | https://doi.org/10.1186/s12913-024-12153-y |
| work_keys_str_mv | AT melanieberube developmentandusabilitytestingofamultifacetedinterventiontoreducelowvalueinjurycare AT alexandralapierre developmentandusabilitytestingofamultifacetedinterventiontoreducelowvalueinjurycare AT michaelsykes developmentandusabilitytestingofamultifacetedinterventiontoreducelowvalueinjurycare AT jeremygrimshaw developmentandusabilitytestingofamultifacetedinterventiontoreducelowvalueinjurycare AT alexisfturgeon developmentandusabilitytestingofamultifacetedinterventiontoreducelowvalueinjurycare AT francoislauzier developmentandusabilitytestingofamultifacetedinterventiontoreducelowvalueinjurycare AT monicataljaard developmentandusabilitytestingofamultifacetedinterventiontoreducelowvalueinjurycare AT henrythomasstelfox developmentandusabilitytestingofamultifacetedinterventiontoreducelowvalueinjurycare AT hollywitteman developmentandusabilitytestingofamultifacetedinterventiontoreducelowvalueinjurycare AT simonberthelot developmentandusabilitytestingofamultifacetedinterventiontoreducelowvalueinjurycare AT ericmercier developmentandusabilitytestingofamultifacetedinterventiontoreducelowvalueinjurycare AT catherinegonthier developmentandusabilitytestingofamultifacetedinterventiontoreducelowvalueinjurycare AT jeromepaquet developmentandusabilitytestingofamultifacetedinterventiontoreducelowvalueinjurycare AT robertfowler developmentandusabilitytestingofamultifacetedinterventiontoreducelowvalueinjurycare AT natalieyanchar developmentandusabilitytestingofamultifacetedinterventiontoreducelowvalueinjurycare AT barbarahaas developmentandusabilitytestingofamultifacetedinterventiontoreducelowvalueinjurycare AT paulelessardbonaventure developmentandusabilitytestingofamultifacetedinterventiontoreducelowvalueinjurycare AT patrickarchambault developmentandusabilitytestingofamultifacetedinterventiontoreducelowvalueinjurycare AT belindagabbe developmentandusabilitytestingofamultifacetedinterventiontoreducelowvalueinjurycare AT jasonrguertin developmentandusabilitytestingofamultifacetedinterventiontoreducelowvalueinjurycare AT yougdongouyang developmentandusabilitytestingofamultifacetedinterventiontoreducelowvalueinjurycare AT lynnemoore developmentandusabilitytestingofamultifacetedinterventiontoreducelowvalueinjurycare AT thecanadiantraumaticbraininjuryresearchconsortium developmentandusabilitytestingofamultifacetedinterventiontoreducelowvalueinjurycare |