Core implementation strategies for improving cirrhosis care in the Veterans Health Administration.
Core implementation strategies for improving cirrhosis care in the Veterans Health Administration.
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DOI：
10.1002/hep.32395
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发表时间：
2022-08
期刊：
影响因子：
13.5
通讯作者：
Rogal, Shari S.
中科院分区：
文献类型：
--
作者：
Yakovchenko, Vera;Morgan, Timothy R.;Miech, Edward J.;Neely, Brittney;Lamorte, Carolyn;Gibson, Sandra;Beste, Lauren A.;McCurdy, Heather;Scott, Dawn;Gonzalez, Rachel, I;Park, Angela M.;Powell, Byron J.;Bajaj, Jasmohan S.;Dominitz, Jason A.;Chartier, Maggie;Ross, David B.;Chinman, Matthew J.;Rogal, Shari S.
退伍军人健康管理局(VHA)为8万多名患有肝硬变的退伍军人提供护理。这项对一项新的肝硬变护理质量改进计划的纵向、多方法评估旨在1)确定与循证的、指南一致的随着时间推移的肝硬变护理相关的实施策略，以及2)使用定性访谈来操作用于手动干预的策略。VHA提供者在2018财年(FY18)和2019财年(FY19)每年都会就73项实施战略的使用情况进行调查，以改善肝硬变护理。使用双变量统计和比较构型方法确定与指南一致的肝硬变护理相关的实施策略。对12家机构进行了半结构化访谈，以明确成功的实施策略及其改变的机制。共有106家VHA机构(82%)在两年期间至少响应一次(18财年：63家，19财年：100家)。报告的设施在18财年使用了中位数12(IQR 20)实施战略，在19财年使用了10(IQR 19)实施战略。在73项策略中，35项(48%)与循证肝硬变护理的提供呈正相关。构型分析确定了与更符合指南的肝硬变护理直接相关的多条策略路径。在这两种方法中，八种策略的子集被确定为改善肝硬变护理的核心，并通过定性访谈进行了详细说明。在一项全国性的肝硬变护理改善计划中，多方法方法确定了成功实施策略组合的核心子集。这种经验性地确定和指定实施策略的过程可能适用于肝病学中的其他实施挑战。
The Veterans Health Administration (VHA) provides care for more than 80,000 Veterans with cirrhosis. This longitudinal, multi-method evaluation of a novel cirrhosis care quality improvement program aimed to 1) identify implementation strategies associated with evidence-based, guideline-concordant cirrhosis care over time, and 2) use qualitative interviews to operationalize strategies for a manualized intervention. VHA providers were surveyed annually about the use of 73 implementation strategies to improve cirrhosis care in fiscal years 2018 (FY18) and 2019 (FY19). Implementation strategies linked to guideline-concordant cirrhosis care were identified using bivariate statistics and comparative configurational methods. Semi-structured interviews were conducted with 12 facilities in the highest quartile of cirrhosis care to specify the successful implementation strategies and their mechanisms of change. A total of 106 VHA facilities (82%) responded at least once over the 2-year period (FY18: n=63, FY19: n=100). Facilities reported using a median of 12 (IQR 20) implementation strategies in FY18 and 10 (IQR 19) in FY19. Of 73 strategies, 35 (48%) were positively correlated with provision of evidence-based cirrhosis care. Configurational analysis identified multiple strategy pathways directly linked to more guideline-concordant cirrhosis care. Across both methods, a subset of eight strategies was determined to be core to cirrhosis care improvement and specified using qualitative interviews. In a national cirrhosis care improvement initiative, a multi-method approach identified a core subset of successful implementation strategy combinations. This process of empirically identifying and specifying implementation strategies may be applicable to other implementation challenges in hepatology.
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影响因子：
--
作者：
Coury J;Miech EJ;Styer P;Petrik AF;Coates KE;Green BB;Baldwin LM;Shapiro JA;Coronado GD
通讯作者：
Coronado GD
影响因子：
4
作者：
Bunger AC;Powell BJ;Robertson HA;MacDowell H;Birken SA;Shea C
通讯作者：
Shea C
DOI：
10.1186/1748-5908-6-42
发表时间：
2011-04-23
期刊：
Implementation science : IS
影响因子：
--
作者：
Michie S;van Stralen MM;West R
通讯作者：
West R
影响因子：
2.5
作者：
Goldberg, D. S.;Valderrama, A.;Lewis, J. D.
通讯作者：
Lewis, J. D.
影响因子：
--
作者：
Powell, Byron J;Haley, Amber D;Weinberger, Morris
通讯作者：
Weinberger, Morris