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Exploring implementation and sustainability of models of care: can theory help?

Overview of attention for article published in BMC Public Health, November 2011
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Title
Exploring implementation and sustainability of models of care: can theory help?
Published in
BMC Public Health, November 2011
DOI 10.1186/1471-2458-11-s5-s8
Pubmed ID
Authors

Della A Forster, Michelle Newton, Helen L McLachlan, Karen Willis

Abstract

Research on new models of care in health service provision is complex, as is the introduction and embedding of such models, and positive research findings are only one factor in whether a new model of care will be implemented. In order to understand why this is the case, research design must not only take account of proposed changes in the clinical encounter, but the organisational context that must sustain and normalise any changed practices. We use two case studies where new models of maternity care were implemented and evaluated via randomised controlled trials (RCTs) to discuss how (or whether) the use of theory might inform implementation and sustainability strategies. The Normalisation Process Model is proposed as a suitable theoretical framework, and a comparison made using the two case studies - one where a theoretical framework was used, the other where it was not. CONTEXT AND APPROACH: In the maternity sector there is considerable debate about which model of care provides the best outcomes for women, while being sustainable in the organisational setting. We explore why a model of maternity care--team midwifery (where women have a small group of midwives providing their care)-- that was implemented and tested in an RCT was not continued after the RCT's conclusion, despite showing the same or better outcomes for women in the intervention group compared with women allocated to usual care. We then discuss the conceptualisation and rationale leading to the use of the 'Normalisation Process Model' as an aid to exploring aspects of implementation of a caseload midwifery model (where women are allocated a primary midwife for their care) that has recently been evaluated by RCT.

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X Demographics

The data shown below were collected from the profiles of 3 X users who shared this research output. Click here to find out more about how the information was compiled.
Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 159 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 4 3%
Canada 2 1%
Switzerland 1 <1%
India 1 <1%
Indonesia 1 <1%
Australia 1 <1%
Spain 1 <1%
Unknown 148 93%

Demographic breakdown

Readers by professional status Count As %
Researcher 29 18%
Student > Master 23 14%
Student > Ph. D. Student 22 14%
Student > Bachelor 13 8%
Other 10 6%
Other 32 20%
Unknown 30 19%
Readers by discipline Count As %
Medicine and Dentistry 41 26%
Nursing and Health Professions 32 20%
Social Sciences 17 11%
Psychology 14 9%
Business, Management and Accounting 8 5%
Other 17 11%
Unknown 30 19%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 2. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 13 January 2012.
All research outputs
#15,739,529
of 25,373,627 outputs
Outputs from BMC Public Health
#11,856
of 17,509 outputs
Outputs of similar age
#161,703
of 246,050 outputs
Outputs of similar age from BMC Public Health
#148
of 219 outputs
Altmetric has tracked 25,373,627 research outputs across all sources so far. This one is in the 37th percentile – i.e., 37% of other outputs scored the same or lower than it.
So far Altmetric has tracked 17,509 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 14.4. This one is in the 30th percentile – i.e., 30% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 246,050 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 33rd percentile – i.e., 33% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 219 others from the same source and published within six weeks on either side of this one. This one is in the 29th percentile – i.e., 29% of its contemporaries scored the same or lower than it.