Using Iterative RE-AIM to enhance hospitalist adoption of lung ultrasound in the management of patients with COVID-19: an implementation pilot study
Abstract Background Lung ultrasound (LUS) is a clinician-performed evidence-based imaging modality that has multiple advantages in the evaluation of dyspnea caused by multiple disease processes, including COVID-19. Despite these advantages, few hospitalists have been trained to perform LUS. The aim...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-08-01
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| Series: | Implementation Science Communications |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43058-022-00334-x |
| _version_ | 1811321038240219136 |
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| author | Anna M. Maw Megan A. Morris Russell E. Glasgow Juliana Barnard P. Michael Ho Carolina Ortiz-Lopez Michelle Fleshner Henry R. Kramer Eric Grimm Kate Ytell Tiffany Gardner Amy G. Huebschmann |
| author_facet | Anna M. Maw Megan A. Morris Russell E. Glasgow Juliana Barnard P. Michael Ho Carolina Ortiz-Lopez Michelle Fleshner Henry R. Kramer Eric Grimm Kate Ytell Tiffany Gardner Amy G. Huebschmann |
| author_sort | Anna M. Maw |
| collection | DOAJ |
| description | Abstract Background Lung ultrasound (LUS) is a clinician-performed evidence-based imaging modality that has multiple advantages in the evaluation of dyspnea caused by multiple disease processes, including COVID-19. Despite these advantages, few hospitalists have been trained to perform LUS. The aim of this study was to increase adoption and implementation of LUS during the 2020 COVID-19 pandemic by using recurrent assessments of RE-AIM outcomes to iteratively revise our implementation strategies. Methods In an academic hospital, we implemented guidelines for the use of LUS in patients with COVID-19 in July 2020. Using a novel “RE-AIM dashboard,” we used an iterative process of evaluating the high-priority outcomes of Reach, Adoption, and Implementation at twice monthly intervals to inform revisions of our implementation strategies for LUS delivery (i.e., Iterative RE-AIM process). Using a convergent mixed methods design, we integrated quantitative RE-AIM outcomes with qualitative hospitalist interview data to understand the dynamic determinants of LUS Reach, Adoption, and Implementation. Results Over the 1-year study period, 453 LUSs were performed in 298 of 12,567 eligible inpatients with COVID-19 (Reach = 2%). These 453 LUS were ordered by 43 out of 86 eligible hospitalists (LUS order adoption = 50%). However, the LUSs were performed/supervised by only 8 of these 86 hospitalists, 4 of whom were required to complete LUS credentialing as members of the hospitalist procedure service (proceduralist adoption 75% vs 1.2% non-procedural hospitalists adoption). Qualitative and quantitative data obtained to evaluate this Iterative RE-AIM process led to the deployment of six sequential implementation strategies and 3 key findings including (1) there were COVID-19-specific barriers to LUS adoption, (2) hospitalists were more willing to learn to make clinical decisions using LUS images than obtain the images themselves, and (3) mandating the credentialing of a strategically selected sub-group may be a successful strategy for improving Reach. Conclusions Mandating use of a strategically selected subset of clinicians may be an effective strategy for improving Reach of LUS. Additionally, use of Iterative RE-AIM allowed for timely adjustments to implementation strategies, facilitating higher levels of LUS Adoption and Reach. Future studies should explore the replicability of these preliminary findings. |
| first_indexed | 2024-04-13T13:10:00Z |
| format | Article |
| id | doaj.art-c8eedb36688841df828b1d1b0474c2c3 |
| institution | Directory Open Access Journal |
| issn | 2662-2211 |
| language | English |
| last_indexed | 2024-04-13T13:10:00Z |
| publishDate | 2022-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science Communications |
| spelling | doaj.art-c8eedb36688841df828b1d1b0474c2c32022-12-22T02:45:38ZengBMCImplementation Science Communications2662-22112022-08-013111410.1186/s43058-022-00334-xUsing Iterative RE-AIM to enhance hospitalist adoption of lung ultrasound in the management of patients with COVID-19: an implementation pilot studyAnna M. Maw0Megan A. Morris1Russell E. Glasgow2Juliana Barnard3P. Michael Ho4Carolina Ortiz-Lopez5Michelle Fleshner6Henry R. Kramer7Eric Grimm8Kate Ytell9Tiffany Gardner10Amy G. Huebschmann11Division of Hospital Medicine, University of Colorado School of MedicineAdult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of MedicineAdult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of MedicineAdult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of MedicineDivision of Cardiology, University of Colorado School of MedicineDivision of Hospital Medicine, University of Colorado School of MedicineDivision of Hospital Medicine, University of Colorado School of MedicineDivision of Hospital Medicine, University of Colorado School of MedicineDivision of Hospital Medicine, University of Colorado School of MedicineAdult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of MedicineInternal Medicine Residency Program, University of Colorado School of MedicineDivision of General Internal Medicine, University of Colorado School of MedicineAbstract Background Lung ultrasound (LUS) is a clinician-performed evidence-based imaging modality that has multiple advantages in the evaluation of dyspnea caused by multiple disease processes, including COVID-19. Despite these advantages, few hospitalists have been trained to perform LUS. The aim of this study was to increase adoption and implementation of LUS during the 2020 COVID-19 pandemic by using recurrent assessments of RE-AIM outcomes to iteratively revise our implementation strategies. Methods In an academic hospital, we implemented guidelines for the use of LUS in patients with COVID-19 in July 2020. Using a novel “RE-AIM dashboard,” we used an iterative process of evaluating the high-priority outcomes of Reach, Adoption, and Implementation at twice monthly intervals to inform revisions of our implementation strategies for LUS delivery (i.e., Iterative RE-AIM process). Using a convergent mixed methods design, we integrated quantitative RE-AIM outcomes with qualitative hospitalist interview data to understand the dynamic determinants of LUS Reach, Adoption, and Implementation. Results Over the 1-year study period, 453 LUSs were performed in 298 of 12,567 eligible inpatients with COVID-19 (Reach = 2%). These 453 LUS were ordered by 43 out of 86 eligible hospitalists (LUS order adoption = 50%). However, the LUSs were performed/supervised by only 8 of these 86 hospitalists, 4 of whom were required to complete LUS credentialing as members of the hospitalist procedure service (proceduralist adoption 75% vs 1.2% non-procedural hospitalists adoption). Qualitative and quantitative data obtained to evaluate this Iterative RE-AIM process led to the deployment of six sequential implementation strategies and 3 key findings including (1) there were COVID-19-specific barriers to LUS adoption, (2) hospitalists were more willing to learn to make clinical decisions using LUS images than obtain the images themselves, and (3) mandating the credentialing of a strategically selected sub-group may be a successful strategy for improving Reach. Conclusions Mandating use of a strategically selected subset of clinicians may be an effective strategy for improving Reach of LUS. Additionally, use of Iterative RE-AIM allowed for timely adjustments to implementation strategies, facilitating higher levels of LUS Adoption and Reach. Future studies should explore the replicability of these preliminary findings.https://doi.org/10.1186/s43058-022-00334-xImplementation scienceCOVID-19Lung ultrasoundRE-AIM |
| spellingShingle | Anna M. Maw Megan A. Morris Russell E. Glasgow Juliana Barnard P. Michael Ho Carolina Ortiz-Lopez Michelle Fleshner Henry R. Kramer Eric Grimm Kate Ytell Tiffany Gardner Amy G. Huebschmann Using Iterative RE-AIM to enhance hospitalist adoption of lung ultrasound in the management of patients with COVID-19: an implementation pilot study Implementation Science Communications Implementation science COVID-19 Lung ultrasound RE-AIM |
| title | Using Iterative RE-AIM to enhance hospitalist adoption of lung ultrasound in the management of patients with COVID-19: an implementation pilot study |
| title_full | Using Iterative RE-AIM to enhance hospitalist adoption of lung ultrasound in the management of patients with COVID-19: an implementation pilot study |
| title_fullStr | Using Iterative RE-AIM to enhance hospitalist adoption of lung ultrasound in the management of patients with COVID-19: an implementation pilot study |
| title_full_unstemmed | Using Iterative RE-AIM to enhance hospitalist adoption of lung ultrasound in the management of patients with COVID-19: an implementation pilot study |
| title_short | Using Iterative RE-AIM to enhance hospitalist adoption of lung ultrasound in the management of patients with COVID-19: an implementation pilot study |
| title_sort | using iterative re aim to enhance hospitalist adoption of lung ultrasound in the management of patients with covid 19 an implementation pilot study |
| topic | Implementation science COVID-19 Lung ultrasound RE-AIM |
| url | https://doi.org/10.1186/s43058-022-00334-x |
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