Implementation of clinical practice changes in the PICU: a qualitative study using and refining the iPARIHS framework.
Implementation of clinical practice changes in the PICU: a qualitative study using and refining the iPARIHS framework.
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DOI：
10.1186/s13012-021-01080-9
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发表时间：
2021-01-28
期刊：
影响因子：
--
通讯作者：
Proctor EK
中科院分区：
文献类型：
--
作者：
Steffen KM;Holdsworth LM;Ford MA;Lee GM;Asch SM;Proctor EK
像在许多环境中一样，循证实践的实施往往在儿科重症监护病房（PICU）中不足。以前很少有研究应用实施科学框架来了解如何在这种独特的环境中最好地改进实践。我们使用了相对较新的综合促进行动的研究实施卫生服务（iPARIHS）框架，以评估实践的改善，在儿科重症监护室，并探讨该框架本身的效用，为此目的。我们使用iPARIHS框架来指导半结构化访谈工具的开发，以检查PICU中的障碍、促进者和变化过程。围绕iPARIHS结构和子结构开发的定性分析框架方法有助于确定提供者访谈中的模式和主题。我们评估了iPARIHS的效用，以告知PICU实践的变化。在美国8个国家工作的50名多专业供应商PICU完成了访谈。iPARIHS结构塑造了一个过程模型的发展，包括规划，决定采取变化，实施和促进，可持续性的阶段，包括变化; PICU环境塑造了每个阶段。大型、复杂的多专业团队，以及高风险的近能力工作，削弱了对变化的接受能力。虽然单位领导人决定进行变革，但供应商接受变革的意愿取决于变革的证据，以及供应商的经验、信念和将变革纳入要求苛刻的工作流程的能力。有限的分析结构和资源阻碍了监测变化影响的努力。可变的提供者参与度、分配给变更工作的时间以及有限的协作影响了便利化。iPARIHS结构是有用的，在探索实施，但是，我们确定了子结构的相互关系，独特的概念没有捕获的框架，需要子结构，以进一步描述促进。PICU环境显著地塑造了实施。所描述的实施过程模型可能有助于指导整合变更和选择实施策略的工作。该伙伴关系足以确定变革的障碍和促进因素;然而，进一步阐述促进的次级结构将有助于该框架的运作。不适用，因为未进行医疗保健干预。在线版本包含补充材料，可通过10.1186/s13012-021-01080-9获得。
Like in many settings, implementation of evidence-based practices often fall short in pediatric intensive care units (PICU). Very few prior studies have applied implementation science frameworks to understand how best to improve practices in this unique environment. We used the relatively new integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework to assess practice improvement in the PICU and to explore the utility of the framework itself for that purpose. We used the iPARIHS framework to guide development of a semi-structured interview tool to examine barriers, facilitators, and the process of change in the PICU. A framework approach to qualitative analysis, developed around iPARIHS constructs and subconstructs, helped identify patterns and themes in provider interviews. We assessed the utility of iPARIHS to inform PICU practice change. Fifty multi-professional providers working in 8 U.S. PICUs completed interviews. iPARIHS constructs shaped the development of a process model for change that consisted of phases that include planning, a decision to adopt change, implementation and facilitation, and sustainability; the PICU environment shaped each phase. Large, complex multi-professional teams, and high-stakes work at near-capacity impaired receptivity to change. While the unit leaders made decisions to pursue change, providers’ willingness to accept change was based on the evidence for the change, and provider’s experiences, beliefs, and capacity to integrate change into a demanding workflow. Limited analytic structures and resources frustrated attempts to monitor changes’ impacts. Variable provider engagement, time allocated to work on changes, and limited collaboration impacted facilitation. iPARIHS constructs were useful in exploring implementation; however, we identified inter-relation of subconstructs, unique concepts not captured by the framework, and a need for subconstructs to further describe facilitation. The PICU environment significantly shaped the implementation. The described process model for implementation may be useful to guide efforts to integrate changes and select implementation strategies. iPARIHS was adequate to identify barriers and facilitators of change; however, further elaboration of subconstructs for facilitation would be helpful to operationalize the framework. Not applicable, as no health care intervention was performed. The online version contains supplementary material available at 10.1186/s13012-021-01080-9.
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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：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
DOI：
10.1186/s13012-015-0242-0
发表时间：
2015-04-21
期刊：
Implementation science : IS
影响因子：
--
作者：
Nilsen P
通讯作者：
Nilsen P
DOI：
10.1186/s13012-014-0190-0
发表时间：
2015-01-13
期刊：
Implementation science : IS
影响因子：
--
作者：
CHECKLIST-ICU Investigators and BRICNet;Machado F;Bozza F;Ibrain J;Salluh F;Campagnucci VP;Guimarães HP;Normilio-Silva K;Chiattone VC;Vendramim P;Carrara F;Lubarino J;da Silva AR;Viana G;Damiani LP;Romano E;Teixeira C;da Silva NB;Chang CC;Angus DC;Berwanger O
通讯作者：
Berwanger O
影响因子：
4.1
作者：
Pollack, Murray M.;Holubkov, Richard;Jenkins, Tammara L.
通讯作者：
Jenkins, Tammara L.
影响因子：
8.8
作者：
Cook, DJ;Meade, MO;McMullin, JP
通讯作者：
McMullin, JP