Making Smarter Decisions Faster: Systems Engineering to Improve the Global Public Health Response to HIV

Wagner, Anjuli D.; Crocker, Jonny; Liu, Shan; Cherutich, Peter; Gimbel, Sarah; Fernandes, Quinhas; Mugambi, Melissa Latigo; Ásbjörnsdóttir, Kristjana; Masyuko, Sarah; Wagenaar, Bradley H.; Nduati, Ruth; Sherr, Kenneth

doi:10.1007/s11904-019-00449-2

Cited by 28 publications

(32 citation statements)

References 75 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Implementation outcome reporting will center on later stage costs, fidelity, penetration, and sustainability of both interventions and implementation strategies. Clinical researchers will have to be re-trained or partner with various disciplinary experts to implement analytical designs focused more on high-quality quasi-experimental approaches, continuous improvement and systems optimization borrowing from industrial engineering and business domains, along with novel systems modeling approaches (Royston, 2011; Sherr et al ., 2014; Wagner et al ., 2019). These methods will be of increasing importance due to the need to model, test, and continuously improve complex webs of multiple evidence-based interventions and implementation strategies for depression operating across contexts and in non-linear pathways (Galea et al ., 2010; Kemp et al ., 2019 b ).…”

Section: Discussionmentioning

confidence: 99%

Implementation outcomes and strategies for depression interventions in low- and middle-income countries: a systematic review

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background. We systematically reviewed implementation research targeting depression interventions in low-and middle-income countries (LMICs) to assess gaps in methodological coverage. Methods. PubMed, CINAHL, PsycINFO, and EMBASE were searched for evaluations of depression interventions in LMICs reporting at least one implementation outcome published through March 2019. Results. A total of 8714 studies were screened, 759 were assessed for eligibility, and 79 studies met inclusion criteria. Common implementation outcomes reported were acceptability (n = 50; 63.3%), feasibility (n = 28; 35.4%), and fidelity (n = 18; 22.8%). Only four studies (5.1%) reported adoption or penetration, and three (3.8%) reported sustainability. The Sub-Saharan Africa region (n = 29; 36.7%) had the most studies. The majority of studies (n = 59; 74.7%) reported outcomes for a depression intervention implemented in pilot researcher-controlled settings. Studies commonly focused on Hybrid Type-1 effectivenessimplementation designs (n = 53; 67.1), followed by Hybrid Type-3 (n = 16; 20.3%). Only 21 studies (26.6%) tested an implementation strategy, with the most common being revising professional roles (n = 10; 47.6%). The most common intervention modality was individual psychotherapy (n = 30; 38.0%). Common study designs were mixed methods (n = 27; 34.2%), quasi-experimental uncontrolled pre-post (n = 17; 21.5%), and individual randomized trials (n = 16; 20.3). Conclusions. Existing research has focused on early-stage implementation outcomes. Most studies have utilized Hybrid Type-1 designs, with the primary aim to test intervention effectiveness delivered in researcher-controlled settings. Future research should focus on testing and optimizing implementation strategies to promote scale-up of evidence-based depression interventions in routine care. These studies should use high-quality pragmatic designs and focus on later-stage implementation outcomes such as cost, penetration, and sustainability.

show abstract

Section: Discussionmentioning

confidence: 99%

Implementation outcomes and strategies for depression interventions in low- and middle-income countries: a systematic review

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Enabling facility-level staff to identify and gain consensus on bottlenecks to address in their hypertension system is essential to defining innovations to implement. SAIA-HTN applies sequential process flow mapping procedures [35,42], coupled with workflow observation, to identify bottlenecks and guide discussion on opportunities for workflow modifications.…”

Section: Methodsmentioning

confidence: 99%

“…patient outcomes is conditional on successful progression through all service steps. Robust systems engineering methods (e.g., cascade analysis, process mapping, and continuous quality improvement) can optimize poorly functioning cascades by (1) identifying main drivers for system inefficiency, (2) supporting locally informed provider decision-making to prioritize intervention, and (3) improving integration of services to meet patient needs across diverse chronic care contexts [28,35]. Low-cost, systems-level interventions are effective and efficient approaches to improve linked cascade services, and may be effective for routinizing hypertension diagnosis and management within existing ambulatory services; addressing both individual and systemlevel barriers; improving flow through the hypertension care cascade; and ultimately improving patient-level outcomes.…”

Section: Contributions To the Literaturementioning

confidence: 99%

Systems analysis and improvement approach to optimize the hypertension diagnosis and care cascade for PLHIV individuals (SAIA-HTN): a hybrid type III cluster randomized trial

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background: Across sub-Saharan Africa, evidence-based clinical guidelines to screen and manage hypertension exist; however, country level application is low due to lack of service readiness, uneven health worker motivation, weak accountability of health worker performance, and poor integration of hypertension screening and management with chronic care services. The systems analysis and improvement approach (SAIA) is an evidence-based implementation strategy that combines systems engineering tools into a five-step, facility-level package to improve understanding of gaps (cascade analysis), guide identification and prioritization of low-cost workflow modifications (process mapping), and iteratively test and redesign these modifications (continuous quality improvement). As hypertension screening and management are integrated into chronic care services in sub-Saharan Africa, an opportunity exists to test whether SAIA interventions shown to be effective in improving efficiency and coverage of HIV services can be effective when applied to the non-communicable disease services that leverage the same platform. We hypothesize that SAIA-hypertension (SAIA-HTN) will be effective as an adaptable, scalable model for broad implementation. Methods: We will deploy a hybrid type III cluster randomized trial to evaluate the impact of SAIA-HTN on hypertension management in eight intervention and eight control facilities in central Mozambique. Effectiveness outcomes include hypertension cascade flow measures (screening, diagnosis, management, control), as well as hypertension and HIV clinical outcomes among people living with HIV. Cost-effectiveness will be estimated as the incremental costs per additional patient passing through the hypertension cascade steps and the cost per additional disability-adjusted life year averted, from the payer perspective (Ministry of Health). SAIA-HTN implementation fidelity will be measured, and the Consolidated Framework for Implementation Research will guide qualitative evaluation of the implementation process in high-and low-performing facilities to identify determinants of intervention success and failure, and define core and adaptable components of the SAIA-HTN intervention. The Organizational Readiness for Implementing Change scale will measure facility-level readiness for adopting SAIA-HTN.

show abstract

“…Process mapping or visualization is an important approach to understanding how behaviors and activities need to change to support implementation of new practices [1][2][3]. We provide a brief case study illustrating approaches to making visual process maps to support implementation efforts.…”

Section: Introductionmentioning

confidence: 99%

Visual process maps to support implementation efforts: a case example

Kononowech

Landis-Lewis

Carpenter

et al. 2020

Implement Sci Commun

View full text Add to dashboard Cite

Background Process mapping is often used in quality improvement work to examine current processes and workflow and to identify areas to intervene to improve quality. Our objective in this paper is to describe process maps as a visual means of understanding modifiable behaviors and activities, in this case example to ensure that goals of care conversations are part of admitting a veteran in long-term care settings. Methods We completed site visits to 6 VA nursing homes and reviewed their current admission processes. We conducted interviews to document behaviors and activities that occur when a veteran is referred to a long-term care setting, during admission, and during mandatory VA reassessments. We created visualizations of the data using process mapping approaches. Process maps for each site were created to document the admission activities for each VA nursing home and were reviewed by the research team to identify consistencies across sites and to identify potential opportunities for implementing goals of care conversations. Results We identified five consistent behaviors that take place when a veteran is referred and admitted in long-term care. These behaviors are assessing, discussing, decision-making, documenting, and re-assessing. Conclusions Based on the process maps, it seems feasible that the LST note and order template could be completed along with other routine assessment processes. However, this will require more robust multi-disciplinary collaboration among both prescribing and non-prescribing health care providers. Completing the LST template during the current admission process would increase the likelihood that the template is completed in a timely manner, potentially alleviate the perceived time burden, and help with the provision of veteran-centered care.

show abstract

Making Smarter Decisions Faster: Systems Engineering to Improve the Global Public Health Response to HIV

Cited by 28 publications

References 75 publications

Implementation outcomes and strategies for depression interventions in low- and middle-income countries: a systematic review

Implementation outcomes and strategies for depression interventions in low- and middle-income countries: a systematic review

Systems analysis and improvement approach to optimize the hypertension diagnosis and care cascade for PLHIV individuals (SAIA-HTN): a hybrid type III cluster randomized trial

Visual process maps to support implementation efforts: a case example

Contact Info

Product

Resources

About