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Implementing immediate postpartum contraception: a comparative case study at 11 hospitals

BACKGROUND: Immediate postpartum long-acting reversible contraception (LARC) is an evidence-based practice, but hospitals face significant barriers to its adoption. Our objective was to examine how organizational context (e.g., size, employee attitudes toward the clinical practice) and implementatio...

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Autores principales: Moniz, Michelle H., Bonawitz, Kirsten, Wetmore, Marisa K., Dalton, Vanessa K., Damschroder, Laura J., Forman, Jane H., Peahl, Alex F., Heisler, Michele
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042857/
https://www.ncbi.nlm.nih.gov/pubmed/33845922
http://dx.doi.org/10.1186/s43058-021-00136-7
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author Moniz, Michelle H.
Bonawitz, Kirsten
Wetmore, Marisa K.
Dalton, Vanessa K.
Damschroder, Laura J.
Forman, Jane H.
Peahl, Alex F.
Heisler, Michele
author_facet Moniz, Michelle H.
Bonawitz, Kirsten
Wetmore, Marisa K.
Dalton, Vanessa K.
Damschroder, Laura J.
Forman, Jane H.
Peahl, Alex F.
Heisler, Michele
author_sort Moniz, Michelle H.
collection PubMed
description BACKGROUND: Immediate postpartum long-acting reversible contraception (LARC) is an evidence-based practice, but hospitals face significant barriers to its adoption. Our objective was to examine how organizational context (e.g., size, employee attitudes toward the clinical practice) and implementation strategies (i.e., the actions taken to routinize a clinical practice) drive successful implementation of immediate postpartum LARC services, with a goal of informing the design of future implementation interventions. METHODS: We conducted a comparative case study of the implementation of inpatient postpartum contraceptive care at 11 US maternity hospitals. In 2017–2018, we conducted site visits that included semi-structured key informant interviews informed by the Consolidated Framework for Implementation Research. Qualitative measures of implementation success included stakeholder satisfaction, routinization, and sustainability of immediate postpartum LARC services. Qualitative content analysis and cross-case synthesis explored relationships among organizational context, implementation strategies, and implementation success. RESULTS: We completed semi-structured interviews with 78 clinicians, nurses, residents, pharmacy and revenue cycle staff, and hospital administrators. Successful implementation required three essential conditions: effective implementation champions, an enabling financial environment, and hospital administrator engagement. Six other contextual conditions were influential: trust and effective communication, alignment with stakeholders’ professional values, perception of meeting patients’ needs, robust learning climate, compatibility with workflow, and positive attitudes and adequate knowledge about the clinical practice. On average, sites used 18 (range 11-22) strategies. Strategies to optimize the financial environment and train clinicians and staff were commonly used. Strategies to plan and evaluate implementation and to engage patients emerged as promising to address barriers to practice change, yet were often underused. CONCLUSIONS: Implementation efforts in maternity settings may be more successful if they select strategies to optimize local conditions for success. Our findings elucidate key contextual conditions to target and provide a menu of promising implementation strategies for incorporating recommended contraceptive services into routine maternity practice. Additional prospective research should evaluate whether these strategies effectively optimize local conditions for successful implementation in a variety of settings. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s43058-021-00136-7.
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spelling pubmed-80428572021-04-14 Implementing immediate postpartum contraception: a comparative case study at 11 hospitals Moniz, Michelle H. Bonawitz, Kirsten Wetmore, Marisa K. Dalton, Vanessa K. Damschroder, Laura J. Forman, Jane H. Peahl, Alex F. Heisler, Michele Implement Sci Commun Research BACKGROUND: Immediate postpartum long-acting reversible contraception (LARC) is an evidence-based practice, but hospitals face significant barriers to its adoption. Our objective was to examine how organizational context (e.g., size, employee attitudes toward the clinical practice) and implementation strategies (i.e., the actions taken to routinize a clinical practice) drive successful implementation of immediate postpartum LARC services, with a goal of informing the design of future implementation interventions. METHODS: We conducted a comparative case study of the implementation of inpatient postpartum contraceptive care at 11 US maternity hospitals. In 2017–2018, we conducted site visits that included semi-structured key informant interviews informed by the Consolidated Framework for Implementation Research. Qualitative measures of implementation success included stakeholder satisfaction, routinization, and sustainability of immediate postpartum LARC services. Qualitative content analysis and cross-case synthesis explored relationships among organizational context, implementation strategies, and implementation success. RESULTS: We completed semi-structured interviews with 78 clinicians, nurses, residents, pharmacy and revenue cycle staff, and hospital administrators. Successful implementation required three essential conditions: effective implementation champions, an enabling financial environment, and hospital administrator engagement. Six other contextual conditions were influential: trust and effective communication, alignment with stakeholders’ professional values, perception of meeting patients’ needs, robust learning climate, compatibility with workflow, and positive attitudes and adequate knowledge about the clinical practice. On average, sites used 18 (range 11-22) strategies. Strategies to optimize the financial environment and train clinicians and staff were commonly used. Strategies to plan and evaluate implementation and to engage patients emerged as promising to address barriers to practice change, yet were often underused. CONCLUSIONS: Implementation efforts in maternity settings may be more successful if they select strategies to optimize local conditions for success. Our findings elucidate key contextual conditions to target and provide a menu of promising implementation strategies for incorporating recommended contraceptive services into routine maternity practice. Additional prospective research should evaluate whether these strategies effectively optimize local conditions for successful implementation in a variety of settings. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s43058-021-00136-7. BioMed Central 2021-04-12 /pmc/articles/PMC8042857/ /pubmed/33845922 http://dx.doi.org/10.1186/s43058-021-00136-7 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Moniz, Michelle H.
Bonawitz, Kirsten
Wetmore, Marisa K.
Dalton, Vanessa K.
Damschroder, Laura J.
Forman, Jane H.
Peahl, Alex F.
Heisler, Michele
Implementing immediate postpartum contraception: a comparative case study at 11 hospitals
title Implementing immediate postpartum contraception: a comparative case study at 11 hospitals
title_full Implementing immediate postpartum contraception: a comparative case study at 11 hospitals
title_fullStr Implementing immediate postpartum contraception: a comparative case study at 11 hospitals
title_full_unstemmed Implementing immediate postpartum contraception: a comparative case study at 11 hospitals
title_short Implementing immediate postpartum contraception: a comparative case study at 11 hospitals
title_sort implementing immediate postpartum contraception: a comparative case study at 11 hospitals
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042857/
https://www.ncbi.nlm.nih.gov/pubmed/33845922
http://dx.doi.org/10.1186/s43058-021-00136-7
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