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Background: Over 80% of people who experience a stroke present with residual impairment of the upper extremity, such as the shoulder, elbow, wrist, and hand. However, rarely do stroke rehabilitation practitioners (e.g., occupational therapists) use standardized outcome measures to objectively evaluate upper extremity function. Accordingly, the purpose of this project was to develop a bundle of implementation strategies that supports practitioners' adoption of the Fugl-Meyer Assessment of the Upper Extremity in stroke rehabilitation practice. Methods: We used tenets of Implementation Mapping to guide the development of our implementation strategy bundle. We partnered with one, large academic health system serving over 200 stroke patients annually through intensive rehabilitation care. Strategies were selected and developed through a multi-method process that included a review of the literature, qualitative input from our health system's practitioners and managers, and expert consultation. We also specified the hypothesized implementation "mechanisms" our strategies intended to change. Practitioners' adoption (yes/no) of the Fugl-Meyer Assessment was calculated by analyzing electronic health record documentation of the 6-month time frame before strategies were deployed compared to the 6-month time frame after deployment. Results: Practitioners were exposed to the following implementation strategies to support Fugl-Meyer adoption: conduct educational meetings, prepare outcome measure champions, provide equipment, develop training materials, and adapt documentation systems. In the 6-months before deployment of our implementation strategies, practitioners implemented the Fugl-Meyer with 14.8% of stroke patients. In the six months after deployment, adoption of the Fugl-Meyer increased to 73.8% (p <.001). Conclusions: When systematically developed in collaboration with health system partners, a bundle of implementation strategies may support outcome measure adoption in stroke rehabilitation. Improving the use of standardized outcome measures is of paramount importance in stroke rehabilitation to objectively monitor patients' progress or decline, to demonstrate the value of rehabilitation services for enhancing patients' recovery, and to advocate for continued reimbursement for rehabilitation care. Future opportunities lie in further specifying the mechanisms through which implementation strategies are intended to work and how those mechanisms contribute to strategy effectiveness. Trial registration: NCT registration: NCT04888416; May 06, 2021. [ABSTRACT FROM AUTHOR]

Background and Objectives Approximately 60% of people living with dementia at home are unable to routinely participate in mealtime activities (e.g. eating, safe food preparation), warranting assistance to ensure people with dementia meet their health and nutritional needs. The purpose of this study was to characterize these barriers to mealtime participation and identify potential caregiver-led strategies to enhance mealtime activities. Research Design and Methods We used a qualitative descriptive approach and obtained semistructured interview data from (a) allied health professionals and (b) community-based nutrition program providers who frequently serve people with dementia. Interview data were examined by means of directed content analysis and framework methodology until data saturation was reached. Codes from our analysis were categorized according to constructs drawn from the Socio-Ecological Model for Developing and Implementing Comprehensive Dementia Care. Results Data were obtained from 20 participants who attributed common mealtime participation barriers to: impairments in functional status, cognitive status deficits, a lack of caregiver knowledge and skills, and unsafe living conditions. Caregiver-led strategies to overcome these barriers included: reducing auditory and visual distractions, providing written cues to perform mealtime activities, eliminating clutter and fall risk hazards, and leveraging community-based nutrition program providers (e.g. home-delivered meal providers). Discussion and Implications People with dementia face several eating and mealtime participation obstacles. Caregiver-led strategies implemented by family, friends, or community-based nutrition program providers may enhance mealtime activities at home. Findings point to opportunities to develop decision-making tools and resources for caregivers to optimize the health and nutrition of people with dementia. [ABSTRACT FROM AUTHOR]

Patient-reported outcome measures (PROMs) are seen as increasingly beneficial to patient-centered clinical practice, but implementation of routine collection and utilization into clinical care can be challenging. Our interdisciplinary quality improvement (QI) team used the Institute for Health Care Improvement Model for Improvement methodology to address this problem in our outpatient neurorehabilitation program. We used a participatory approach to identify the PROM rehabilitation stakeholders found to be most appropriate to implement in the outpatient settings; chart audits were conducted to determine the extent to which clinicians implemented the PROM and documented a PROM-related goal. Opportunistic clinician feedback was collected to determine single PROM usefulness and acceptability. Our 4-month initiative demonstrated increased collection of a PROM, the Patient-Specific Functional Scale (PSFS), and incorporation into patient-centered goal. Use of QI methodology was beneficial when planning and executing our initiative. Future work is needed to examine factors to sustain PSFS use, incorporation into patient-centered goal setting, and maximize meaningful patient outcomes. [ABSTRACT FROM AUTHOR]

The growing number of people living with dementia (PLWD) requires a coordinated clinical response to deliver pragmatic, evidence‐based interventions in frontline care settings. However, infrastructure to support such a response is lacking. Moreover, there are too few researchers conducting rigorous embedded pragmatic clinical trials (ePCTs) to make the vision of high quality, widely accessible dementia care a reality. National Institute on Aging (NIA) Imbedded Pragmatic Alzheimer's disease and Related Dementias Clinical Trials (IMPACT) Collaboratory seeks to improve the pipeline of early career researchers qualified to lead ePCTs by funding career development awards. Even with support from the Collaboratory, awardees face practical and methodological challenges to success, recently exacerbated by the COVID‐19 pandemic. We first describe the training opportunities and support network for the IMPACT CDA recipients. This report then describes the unique career development challenges faced by early‐career researchers involved in ePCTs for dementia care. Topics addressed include challenges in establishing a laboratory, academic promotion, mentoring and professional development, and work‐life balance. Concrete suggestions to address these challenges are offered for early‐career investigators, their mentors, and their supporting institutions. While some of these challenges are faced by researchers in other fields, this report seeks to provide a roadmap for expanding the work of the IMPACT Collaboratory and initiating future efforts to recruit, train, and retain talented early‐career researchers involved in ePCTs for dementia care. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Background: Falls in and following hospitalization are common and problematic. Little is understood about the factors that impede or promote effective implementation of fall prevention practices. Purpose and Relevance: Physical therapists are commonly consulted for acute care patients at risk for falling. The purpose of this study is to understand therapist perceptions of their effectiveness in fall prevention and to explore the impact of contextual factors on practice patterns to prevent falls surrounding hospitalization. Methods: Survey questions were tailored to the constructs of hospital culture, structural characteristics, networks and communications, and implementation climate, in addition to inquiries regarding practice patterns and attitudes/beliefs. Results: Overall, 179 surveys were analyzed. Most therapists (n = 135, 75.4%) affirmed their hospital prioritizes best practices for fall prevention, although fewer agreed that therapists other than themselves provide optimal fall prevention intervention (n = 105, 58.7%). Less practice experience was associated with greater odds of affirming that contextual factors influence fall prevention practice (odds ratio 3.90, p <.001). Respondents who agreed that their hospital system prioritizes best practices for fall prevention had 14 times the odds of believing that their system prioritizes making improvements (p =.002). Conclusions/Implications: As experience influences fall prevention practice, quality assurance and improvement initiatives should be used to ensure minimum specifications of practice. [ABSTRACT FROM AUTHOR]

The article discusses the improvement of equitable implementation of evidence-based innovations to promote successful Aging In Place in the U.S. as of 2023. Topics covered include identifying implementation determinants, selecting equitable implementation strategies, identifying hypothesized mechanisms of change, and evaluating outcomes. Also noted is the guidance provided by the equitable implementation logic model in developing empirical studies and a broad application of Aging-in-Place.

Evidence-based intergenerational (IG) programs bring youth and older adults together in shared activities and promote socioemotional health across age-groups. The core components of these IG programs include 14 IG "best practices" that should be implemented during IG program sessions to optimize program effectiveness for both youth and older adult participants. Despite the proliferation of IG programs across the United States, it is unclear the extent to which these IG best practices have been implemented in the community. This preliminary study assesses the implementation of IG best practices at two community-based sites by program leaders who participated in a multifaceted professional education intervention for IG best practice use. Implementation of best practices was measured through the Best Practices Checklist completed by program leaders and trained coders as well as through narrative written comments. Program leaders indicated that they were able to consistently implement six out of the 14 IG best practices in 46 IG sessions, whereas the best practice named "Adaptations to equipment were made" was least likely to be implemented. Analysis of narrative comments indicated that (a) the group arrangement of participants and (b) program leaders' familiarity with activities also influenced implementation. While many IG best practices can be implemented in the community, some best practices can be implemented with greater ease and consistency. Training resources can support IG best practice implementation; however, our multifaceted professional education intervention may benefit from the addition of case examples or vignettes to depict potential strategies for optimizing evidence-based IG practices. [ABSTRACT FROM AUTHOR]

Background and Objectives Nutrition education programs implemented in congregate dining service (CDS) settings have the potential to improve healthy eating behaviors among older adult populations. However, little is understood about the types of nutrition education programs that are implemented at CDS sites and the factors that impede or promote implementation efforts. The purpose of this scoping review was to examine the characteristics of CDS nutrition education programs, barriers and supports to program implementation, and opportunities to enhance implementation of programming. Research Design and Methods We adopted a scoping review methodology to assess the relevant literature published between January 2000 and 2020 by accessing CINAHL, SocINDEX, MEDLINE, AgeLine, and Academic Search Complete. Results We identified 18 studies that met our inclusion criteria. The majority of nutrition education programs were led by trained facilitators, included the use of interactive activities, and also incorporated written or video materials. Programs that were adapted to the needs of older participants were perceived as supports to implementation whereas participants' needs and resources (e.g. lack of resources and lower health literacy) were occasionally found to limit the effective implementation of programming. Discussion and Implications As the older adult population continues to access CDS sites to address their health and nutritional needs, purposeful efforts are needed to examine the specific approaches that can support nutrition education program implementation. Future opportunities lie in assessing strategies that are effective for mitigating barriers to implementing nutrition education programming in the CDS setting. [ABSTRACT FROM AUTHOR]

Intergenerational practitioners responding to a 2018 national survey identified a need for evidence-informed evaluation tools to measure program impact. The Best Practices (BP) Checklist, a 14-item (yes/no) measure assessing the extent to which an intergenerational program session maintained effective intergenerational strategies, may help meet this need. Yet, researchers have not validated the measure. In this study, we begin the empirical validation process by completing an exploratory factor analysis (EFA) of the BP Checklist to offer insight into possible item reduction and an underlying latent factor structure. Using BP Checklist data from 132 intergenerational activities, we found a 13-item, 3-factor structure, reflecting dimensions of: (a) pairing intergenerational participants, (b) person-centered strategies (e.g., selecting activities reflecting participants' interests), and (c) staff knowledge of participants. Our study represents a foundational step toward optimizing intergenerational program evaluation, thereby enhancing programming quality. [ABSTRACT FROM AUTHOR]

In the current policy context, the occupational therapy profession must act to promote and sustain high-value care. Stakeholders have delineated efforts, such as defining and measuring high-quality care processes or promoting the adoption of evidence into practice, that can enhance the value of occupational therapy services. There is a growing recognition, however, that low-value care is the product of deficiencies within health care systems and is therefore most amenable to system-level solutions. To date, the specific nature of system-level changes capable of identifying and rectifying low-value occupational therapy has yet to be elucidated. In this "The Issue Is..." column, we introduce occupational therapy to the Learning Health System concept and its essential functions. Moreover, we discuss action steps for occupational therapy stakeholders to lay the foundation for Learning Health Systems in their own professional contexts. What This Article Adds: This article is the first to outline concrete action steps needed to transform occupational therapy practice contexts into Learning Health Systems. Such a transformation would represent a system-level change capable of fostering the delivery of high-value occupational therapy services to clients in a variety of practice settings. The authors introduce the Learning Health System (LHS) concept and provide action steps for occupational therapy stakeholders to lay the foundation for LHSs in their own professional contexts. [ABSTRACT FROM AUTHOR]

Keywords: Evidence; based practice; Home; and community; based services; Stakeholder engagement EN Evidence based practice Home and community based services Stakeholder engagement 25 30 6 02/03/22 20220101 NES 220101 The Older Americans Act (OAA) is the federal legislation that supports a broad range of social services for older adults - age 60 and over - to optimize health and to delay or prevent the need for institutionalized care ([6]). Malnutrition screenings can be beneficial for "flagging" older adults who may be at risk of malnutrition-related health decline, alerting service providers to connect at-risk older adults to food and nutrition programming (e.g. nutrition counseling services; [10]). While establishing an ACL-endorsed social isolation screen and intervention repository may also benefit Aging Network providers, we encourage the ACL to invest in stakeholder-engaged strategies that build providers' capacity in screening and intervention implementation. The OAA does I not i require service providers to implement specific malnutrition screening tools with older adults, giving individual providers and organizations the latitude to select their own screens and determine the time points at which screens are to be administered ([14]). [Extracted from the article]