Using implementation facilitation to foster clinical practice quality and adherence to evidence in challenged settings: a qualitative study.
Using implementation facilitation to foster clinical practice quality and adherence to evidence in challenged settings: a qualitative study.
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DOI：
10.1186/s12913-017-2217-0
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发表时间：
2017-04-20
影响因子：
2.8
通讯作者：
Kirchner JE
中科院分区：
文献类型：
--
作者：
Ritchie MJ;Parker LE;Edlund CN;Kirchner JE
我们评估了一项促进战略，以帮助可能遇到挑战的临床站点在退伍军人事务部(VA)倡议的背景下实施基于证据的初级保健-精神卫生一体化(PC-MHI)护理模式。本文描述了我们对实施促进(IF)是否可以促进高质量PC-MHI计划的发展的评估，这些计划符合证据，是可持续的，并可能改善临床实践和结果。利用配对设计，我们对16个退伍军人初级保健诊所的IF策略进行了定性描述性评估。为了评估项目质量和对证据的依从性，我们在两个时间点进行了一小时的结构化电话采访，采访了最了解诊所项目的临床医生和领导人。然后，我们创建了结构化的访谈摘要，VA国家PC-MHI专家利用这些访谈从四个维度(总体质量、对证据的坚持程度、可持续性和改进水平)对项目进行评级。在第一次评估中，8个IF站点中的7个和8个比较站点中的4个实施了PC-MHI计划。我们的定性评估表明，专家对IF网站的程序的评分高于比较网站的程序，但有一个例外。在最终评估中，所有8个IF但只有5个比较站点都实施了PC-MHI计划。再一次，专家们给IF网站的程序打出了高于其匹配比较网站的分数，但有一个例外。随着时间的推移，七个IF网站中的五个和三个比较网站中的两个的所有评级都有所提高。实施复杂的循证方案，特别是在缺乏基础设施、资源和此类努力支持的情况下，是具有挑战性的。研究结果表明，实施科学家开发和测试的外部专家和内部区域促进策略的混合可以提高初级保健诊所对PC-MHI计划的接受度、质量和对证据的依从性。然而，并不是所有的网站都有这些改进。为了取得成功，调解人可能至少需要适度的领导人支持，包括提供基本资源。此外，我们发现，领导结构的IF和强度可能会对实施更高质量和循证项目的能力产生协同效应。本文的在线版本(doi：10.1186/s12913-0172217-0)包含补充材料，授权用户可以使用。
We evaluated a facilitation strategy to help clinical sites likely to experience challenges implement evidence-based Primary Care-Mental Health Integration (PC-MHI) care models within the context of a Department of Veterans Affairs (VA) initiative. This article describes our assessment of whether implementation facilitation (IF) can foster development of high quality PC-MHI programs that adhere to evidence, are sustainable and likely to improve clinical practices and outcomes. Utilizing a matched pair design, we conducted a qualitative descriptive evaluation of the IF strategy in sixteen VA primary care clinics. To assess program quality and adherence to evidence, we conducted one-hour structured telephone interviews, at two time points, with clinicians and leaders who knew the most about the clinics’ programs. We then created structured summaries of the interviews that VA national PC-MHI experts utilized to rate the programs on four dimensions (overall quality, adherence to evidence, sustainability and level of improvement). At first assessment, seven of eight IF sites and four of eight comparison sites had implemented a PC-MHI program. Our qualitative assessment suggested that experts rated IF sites’ programs higher than comparison sites’ programs with one exception. At final assessment, all eight IF but only five comparison sites had implemented a PC-MHI program. Again, experts rated IF sites’ programs higher than their matched comparison sites with one exception. Over time, all ratings improved in five of seven IF sites and two of three comparison sites. Implementing complex evidence-based programs, particularly in settings that lack infrastructure, resources and support for such efforts, is challenging. Findings suggest that a blend of external expert and internal regional facilitation strategies that implementation scientists have developed and tested can improve PC-MHI program uptake, quality and adherence to evidence in primary care clinics with these challenges. However, not all sites showed these improvements. To be successful, facilitators likely need at least a moderate level of leaders’ support, including provision of basic resources. Additionally, we found that IF and strength of leadership structure may have a synergistic effect on ability to implement higher quality and evidence-based programs. The online version of this article (doi:10.1186/s12913-017-2217-0) contains supplementary material, which is available to authorized users.
平衡医疗保健证据和艺术以满足临床需求：决策者的观点。
影响因子：
2.4
作者：
Parker LE;Ritchie MJ;Kirchner JE;Owen RR
通讯作者：
Owen RR