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Table 4 Logic model for implementation of guideline-based clinical practice at ORCI

From: Development of a theory-driven implementation strategy for cancer management guidelines in sub-Saharan Africa

InputsOutputs of activities and participantsOutcomes and impact
 • Project leaders (ORCI/UCSF)
 • Co-Investigators (ORCI/UCSF)
 • Implementation Champions (ORCI)
 • Research Coordinators (MUHAS)
 • Research Consultants (MUHAS/UCSF)
 • Hard copies of guidelines
 • Soft copies of guidelines (AgileMD)
 • Publicity materials (flyers, texts)
 • ORCI-specific DST forms
 • Training materials
 • Hard and soft copies of questionnaires
 • Data collection forms for observation
Experience and expertise
 • Training and consultation in implementation science and program evaluation
 • Consultation with biostatistician for questionnaire design and analysis
 • Experience implementing clinical protocols and DST forms at a different regional site
 • Existing MUHAS/ORCI/UCSF Cancer Collaboration infrastructure and experience
Distribution of materials
 • Hard copies to every unit and clinic room
 • Soft copies to every provider via smartphone application (AgileMD)
 • Publicity campaign with flyers and texts
Education and training
 National Guideline Training Summit:
  • Raise awareness of international efforts to develop resource-stratified guidelines
  • Teach providers guideline content and benefits of guideline-based practice
  • Train providers in guideline-based practice, DST completion, documentation of rationale for treatment decisions
  • Train Champions to promote guideline-based practice on an ongoing basis
  • Integrate guidelines into existing training curricula
Environmental restructuring
 • Champions will model and promote guideline-based practice
 • Integration of DST forms into clinical workflow
 • Assignment of one consultant per patient for greater accountability
 • Monthly forum to evaluate implementation and “safe space” to discuss deviations
 • Increased knowledge of guidelines and skills in guideline-based practice among providers
 • Proficiency in completing DSTs
 • Shift in attitudes and beliefs toward preference for guidelines over individual experience and expertise
 • Increased comfort to ask peers and superiors about guideline concordance of treatment plans
 • Increase in clincial decision-making based on guidelines
 • Routine completion of DSTs
 • Routine reference to guidelines in case discussions at conference
 • Increase in rates of guideline-concordant treatment plans made
 • Increase in rates of guideline-concordant treatment plans completed
 • Increase in cancer survival outcomes
 • Increase in palliative benefit and quality of life
 • Improved resource utilization