Barriers to Implementing the Kidney Disease Outcomes Quality Initiative End-Stage Kidney Disease Life Plan Guideline.
Barriers to Implementing the Kidney Disease Outcomes Quality Initiative End-Stage Kidney Disease Life Plan Guideline.
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DOI：
10.1007/s11606-023-08290-5
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发表时间：
2023-11
影响因子：
5.7
通讯作者：
Woo, Karen
中科院分区：
文献类型：
--
作者：
Keller, Michelle S.;Mavilian, Christine;Altom, Keaton L.;Erickson, Kevin F.;Drudi, Laura M.;Woo, Karen
更新后的2019年国家肾脏基金会肾脏病结局质量倡议血管通路指南建议以患者为中心，多学科建设和定期更新每位患者的个性化终末期肾脏病（ESKD）生命计划（LP），这与以前的建议和政策有很大的转变。本研究的目的是审查在主要利益攸关方中实施LP的障碍和促进因素。半结构化的个人访谈进行了分析，使用归纳和演绎编码。将守则映射到实施研究综合框架的相关领域。我们采访了34名参与者：11名终末期肾病患者，2名护理伙伴和21名护理终末期肾病患者的临床医生。在临床医生和患者/护理伙伴类别中，8名参与者达到饱和（未确定新主题）。我们确定了在三个CFIR领域实施ESKD LP的重大障碍和促进因素：创新，外部环境和内部环境。关于创新领域，患者和护理合作伙伴重视与其护理团队共同决策的概念（CFIR结构：创新设计）。然而，临床医生和患者都非常关注肾脏替代品决策的复杂性，以及患者消化有效参与创建LP（创新复杂性）所需的大量信息的能力。临床医生对缺乏现有证据基础表示担忧，这限制了他们有效咨询患者的能力（创新证据基础）和实施成本（创新成本）。在外部环境中，临床医生和患者都担心现有的“瘘管第一”政策下的绩效衡量压力，并对报销（融资）表示担忧。在内部环境中，临床医生和患者强调缺乏可用资源以及获取知识和信息的途径。鉴于围绕肾脏替代品和血管通路的决策的复杂性，我们的研究结果指出，需要实施战略，基础设施建设和政策变化，以促进ESKD LP的发展。在线版本包含补充材料，可通过10.1007/s11606-023-08290-5获得。
The updated 2019 National Kidney Foundation Kidney Disease Outcomes Quality Initiative vascular access guidelines recommend patient-centered, multi-disciplinary construction and regular update of an individualized end-stage kidney disease (ESKD) Life-Plan (LP) for each patient, a dramatic shift from previous recommendations and policy. The objective of this study was to examine barriers and facilitators to implementing the LP among key stakeholders. Semi-structured individual interviews were analyzed using inductive and deductive coding. Codes were mapped to relevant domains in the Consolidated Framework for Implementation Research (CFIR). We interviewed 34 participants: 11 patients with end-stage kidney disease, 2 care partners, and 21 clinicians who care for patients with end-stage kidney disease. In both the clinician and the patient/care partner categories, saturation (where no new themes were identified) was reached at 8 participants. We identified significant barriers and facilitators to implementation of the ESKD LP across three CFIR domains: Innovation, Outer setting, and Inner setting. Regarding the Innovation domain, patients and care partners valued the concept of shared decision-making with their care team (CFIR construct: innovation design). However, both clinicians and patients had significant concerns about the complexity of decision-making around kidney substitutes and the ability of patients to digest the overwhelming amount of information needed to effectively participate in creating the LP (innovation complexity). Clinicians expressed concerns regarding the lack of existing evidence base which limits their ability to effectively counsel patients (innovation evidence base) and the implementation costs (innovation cost). Within the Outer Setting, both clinicians and patients were concerned about performance measurement pressure under the existing “Fistula First” policies and had concerns about reimbursement (financing). In the Inner Setting, clinicians and patients stressed the lack of available resources and access to knowledge and information. Given the complexity of decision-making around kidney substitutes and vascular access, our findings point to the need for implementation strategies, infrastructure development, and policy change to facilitate ESKD LP development. The online version contains supplementary material available at 10.1007/s11606-023-08290-5.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
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作者：
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10.1186/s12875-023-02050-4
发表时间：
2023-04-12
期刊：
BMC primary care
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