Inpatient adoption of medications for alcohol use disorder: A mixed-methods formative evaluation involving key stakeholders.

BACKGROUND: Although the inpatient setting presents an important opportunity for medications for alcohol use disorder (MAUD) adoption, this infrequently occurs. We aimed to develop a comprehensive understanding of barriers and facilitators of inpatient MAUD adoption. METHODS: A convergent mixed-method study conducted from April to September 2018 of non-prescribing (registered nurse, pharmacist, and social work) and prescribing (physician or advanced practice provider hospitalist, general internist, and psychiatrist) professionals at a large urban academic medical center. Survey assessed organizational readiness to adopt MAUD and focus groups guided by the Consolidated Framework for Implementation Research (CFIR) analyzed using directed content analysis. RESULTS: Fifty-seven participants completed surveys and one of seven focus groups. Health professionals perceived clinical evidence (mean 4.0, 95 % confidence interval [CI]: 3.9, 4.2) as supportive and patient preferences (mean 3.4, 95 % CI: 3.2, 3.6) and availability of resources (mean 3.1, 95 % CI: 2.8, 3.3) as less supportive of MAUD adoption. Stakeholders identified barriers across CFIR constructs; 1) Intervention characteristics: limited knowledge of MAUD effectiveness and concerns about side effects, 2) Outer setting: perceived patient vulnerability to care interruptions and a lack of external incentives, 3) Inner setting: a lack of organizational prioritization, and 4) Characteristics of individuals: stigma of people with AUD. Facilitators included: 1) Intervention characteristics: adaptation of workflows and 2) Characteristics of individuals: harm reduction as treatment goal. CONCLUSIONS: This study identified multiple intersecting barriers and facilitators of inpatient MAUD adoption. Implementation interventions should prioritize strategies that increase health professional knowledge of MAUD and organizational prioritization of treating AUD.

Evaluating the surgery literature: can standardizing peer-review today predict manuscript impact tomorrow?

OBJECTIVE: Evidence-based surgery is predicated on the quality of published literature. We measured the quality of surgery manuscripts selected by peer review and identified predictors of excellence. METHODS: One hundred twenty clinical surgery manuscripts were randomly selected from 1998 in 5 eminent peer-reviewed surgery and medical journals. Manuscripts were blinded for author, institution, and journal of origin. Four surgeons and 4 methodologists evaluated the quality using novel instruments based on subject selection, study protocol, statistical analysis/inference, intervention description, outcome assessments, and results presentation. Predictors of quality and impact factor were identified using bivariate and multivariate regression. RESULTS: Oncology was the most common subject (26%), followed by general surgery/gastrointestinal (24%). The average number of study subjects was 417; the majority of manuscripts were American (53%), from a single institution (59%). Eighteen percent had a statistician author. Mean number of citations was 128. Surgery manuscripts from medical, compared with surgery journals, had better total quality scores (3.8 vs. 5.2, P < 0.001). They had more subjects and were more likely to have a statistician as coauthor (43% vs. 10%, P < 0.001), multi-institutional, international collaboration (30% vs. 8%, P < 0.001), and higher citation index (mean: 350 vs. 54, P < 0.001). They were more often foreign (70% vs. 40%, P < 0.001). Independent predictors of quality were having a statistician coauthor, study funding, European origin, and more study subjects. Quality assessment using our instruments predicted the number of citations after 10 years (P < 0.01), along with having a statistician coauthor, international multi-institutional collaboration, and more subjects. CONCLUSION: The quality of surgery manuscripts can be improved by including a statistician as coauthor, with efforts directed toward implementing multi-institutional/interdisciplinary trials. Peer-review across journals can be standardized through the use of instruments measuring methodologic and clinical quality.