Implementing the MOVE! Weight-Management Program in the Veterans Health Administration, 2007-2010: A Qualitative Study
Implementing the MOVE! Weight-Management Program in the Veterans Health Administration, 2007-2010: A Qualitative Study
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DOI：
10.5888/pcd9.110127
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发表时间：
2012-01-01
影响因子：
5.5
通讯作者：
Campbell, Marci K.
中科院分区：
文献类型：
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作者：
Weiner, Bryan J.;Haynes-Maslow, Lindsey;Campbell, Marci K.
在退伍军人健康管理局(VHA)医疗机构接受护理的美国退伍军人中，有三分之一患有肥胖症，因此患多种慢性病的风险更高。为了解决这个问题，VHA设计并在全国范围内传播了一项基于证据的体重管理计划(Move！)。这项研究的目的是检查有助于或抑制MOVE实施的组织因素！方法采用多个整体病例研究设计，对医疗中心项目协调员、被正式任命为项目带头人的医生、直接负责项目监督的经理、项目多学科团队的临床医生以及被项目协调员确定为当地意见领袖的初级保健医生进行了68次访谈。定性数据分析包括编码、编写备忘录和构建数据显示。结果组织对变革的准备和拥有创新冠军是与Move相关的两个因素！实施。管理支助和资源可获得性等其他组织因素是执行的障碍，或对执行产生好坏参半的影响。障碍并没有阻止设施实施搬家！然而，这些障碍必须被克服、解决或接受为项目范围或规模的限制。结论以政策为导向在卫生保健机构实施临床体重管理项目是具有挑战性的，特别是在没有新资源可用的情况下。制定强有力的、相辅相成的组织政策和做法可能是一致、高质量执行的必要条件。
IntroductionOne-third of US veterans receiving care at Veterans Health Administration (VHA) medical facilities are obese and, therefore, at higher risk for developing multiple chronic diseases. To address this problem, the VHA designed and nationally disseminated an evidence-based weight-management program (MOVE!). The objective of this study was to examine the organizational factors that aided or inhibited the implementation of MOVE! in 10 VHA medical facilities.MethodsUsing a multiple, holistic case study design, we conducted 68 interviews with medical center program coordinators, physicians formally appointed as program champions, managers directly responsible for overseeing the program, clinicians from the program's multidisciplinary team, and primary care physicians identified by program coordinators as local opinion leaders. Qualitative data analysis involved coding, memorandum writing, and construction of data displays.ResultsOrganizational readiness for change and having an innovation champion were most consistently the 2 factors associated with MOVE! implementation. Other organizational factors, such as management support and resource availability, were barriers to implementation or exerted mixed effects on implementation. Barriers did not prevent facilities from implementing MOVE! However, they were obstacles that had to be overcome, worked around, or accepted as limits on the program's scope or scale.ConclusionPolicy-directed implementation of clinical weight-management programs in health care facilities is challenging, especially when no new resources are available. Instituting powerful, mutually reinforcing organizational policies and practices may be necessary for consistent, high-quality implementation.