Enhancing the Implementation of the Virtual Pediatric Trauma Center Using Practical, Robust, Implementation and Sustainability Model: A Mixed-Methods Study - PubMed (original) (raw)

Enhancing the Implementation of the Virtual Pediatric Trauma Center Using Practical, Robust, Implementation and Sustainability Model: A Mixed-Methods Study

Jennifer L Rosenthal et al. Telemed Rep. 2022.

Abstract

Background: This article describes factors related to adoption, implementation, and effectiveness of the Virtual Pediatric Trauma Center intervention, which uses telehealth for trauma specialist consultations for seriously injured children. We aimed at (1) measuring RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) implementation outcomes and (2) identifying PRISM (Practical, Robust, Implementation, and Sustainability Model) contextual factors that influenced the implementation outcomes.

Methods: This interim implementation evaluation of our telehealth trial used a convergent mixed-methods design. The quantitative component was a cross-sectional analysis of pediatric trauma encounters using electronic health records. The qualitative component was a thematic analysis of written and verbal feedback from providers and family advisory board meetings. We compared the quantitative and qualitative data by synthesizing them in a joint display table, organized by RE-AIM dimensions. We categorized these key findings into the PRISM domains.

Results: During the first 10 months of this trial, 246 subjects were randomized, with 177 assigned to standard care and 69 assigned to telehealth. Four referring sites transitioned from standard care into their intervention period. PRISM contextual factors that influenced RE-AIM implementation outcomes included the following findings: Providers struggle to remember, interpret, and navigate intervention workflows; providers have preconceived ideas about the intervention purpose; the intervention mitigates parents' anxieties about the transfer process.

Discussion: This study revealed implementation challenges that influence the overall success of this telehealth trial. Early identification of these challenges allows our team the opportunity to address them now to optimize the intervention reach, adoption, and implementation. This early action will ultimately enhance the success of our trial and the ability of our intervention to achieve broad impact.

Keywords: child; communication implementation; patient transfers; science; telemedicine; trauma centers.

© Jennifer L. Rosenthal et al., 2022; Published by Mary Ann Liebert, Inc.

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Conflict of interest statement

No competing financial interests exist.

Figures

FIG. 1.

FIG. 1.

Logic model of the relationships among the intervention's activities and its outcomes. VPTC, virtual pediatric trauma center.

References

    1. Hsia R, Shen YC. Possible geographical barriers to trauma center access for vulnerable patients in the United States: An analysis of urban and rural communities. Arch Surg 2011;146(1):46–52; doi: 10.1001/archsurg.2010.299. -DOI -PMC -PubMed
    1. Segui-Gomez M, Chang DC, Paidas CN, et al. Pediatric trauma care: An overview of pediatric trauma systems and their practices in 18 US states. J Pediatr Surg 2003;38(8):1162–1169; doi: 10.1016/s0022-3468(03)00262-8. -DOI -PubMed
    1. Curran GM, Bauer M, Mittman B, et al. Effectiveness-implementation hybrid designs: Combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care 2012;50(3):217; doi: 10.1097/MLR.0b013e3182408812. -DOI -PMC -PubMed
    1. McCreight MS, Rabin BA, Glasgow RE, et al. Using the Practical, Robust Implementation and Sustainability Model (PRISM) to qualitatively assess multilevel contextual factors to help plan, implement, evaluate, and disseminate health services programs. Transl Behav Med. 2019;9(6):1002–1011; doi: 10.1093/tbm/ibz085. -DOI -PubMed
    1. Feldstein AC, Glasgow RE. A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice. Jt Comm J Qual Patient Saf 2008;34(4):228–243; doi: 10.1016/s1553-7250(08)34030-6. -DOI -PubMed

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