A Method for Tracking Implementation Strategies: An Exemplar Implementing Measurement-Based Care in Community Behavioral Health Clinics
A Method for Tracking Implementation Strategies: An Exemplar Implementing Measurement-Based Care in Community Behavioral Health Clinics
复制标题
DOI：
10.1016/j.beth.2017.11.012
复制
发表时间：
2018-07-01
期刊：
影响因子：
3.7
通讯作者：
Lewis, Cara C.
中科院分区：
文献类型：
--
作者：
Boyd, Meredith R.;Powell, Byron J.;Lewis, Cara C.
执行专家建议，根据预期情况调整战略可能会提高成果。然而，目前尚不清楚哪些策略最适合解决实施的具体障碍，部分原因是几乎没有符合报告建议的衡量方法。在一项动态分组随机试验的背景下，比较了实施基于测量的护理（MBC）的标准化方法与定制方法，本研究旨在（a）描述一种跟踪实施策略的方法，（B）通过跟踪负责在其诊所实施MBC的团队在定制条件下生成的策略来演示该方法，以及（c）对战略使用与实施结果之间的关系进行初步审查（即，对MBC的自我报告忠诚度）。该方法由基于普罗克特、Powell和McMillen（2013）实施策略报告指南和Powell等人的编码表组成。（2012）的分类法，以促进战略的规范。一名经过培训的研究专家对执行小组会议进行数字化编码。该方法允许对策略使用进行以下表征。每个网站在五个月内平均举行六次会议，制定了39项独特的战略。各研究中心采用的实施策略类型差异不大，其流行程度依次为：质量管理（50.00%）、重组（16.53%）、沟通（15.68%）、教育（8.90%）、规划（7.20%）和融资（1.69%）。我们确定了一个新的策略类别，它被称为“沟通”，而这是现有分类法所没有的。“没有证据表明，实施战略的数量与自我报告的对MBC忠诚度的变化有统计学意义，但是，融资战略与忠诚度的增加有关。这种方法能够产生丰富的数据，为调查量身定制的实施方法提供信息。
Implementation experts suggest tailoring strategies to the intended context may enhance outcomes. However, it remains unclear which strategies are best suited to address specific barriers to implementation, in part because few measurement methods exist that adhere to recommendations for reporting. In the context of a dynamic cluster randomized trial comparing a standardized to tailored approach to implementing measurement-based care (MBC), this study aimed to (a) describe a method for tracking implementation strategies, (b) demonstrate the method by tracking strategies generated by teams tasked with implementing MBC at their clinics in the tailored condition, and (c) conduct preliminary examinations of the relation between strategy use and implementation outcomes (i.e., self-reported fidelity to MBC). The method consisted of a coding form based on Proctor, Powell, and McMillen (2013) implementation strategy reporting guidelines and Powell et al.'s (2012) taxonomy to facilitate specification of the strategies. A trained research specialist coded digitally recorded implementation team meetings. The method allowed for the following characterization of strategy use. Each site generated 39 unique strategies across an average of six meetings in five months. There was little variability in the use of types of implementation strategies across sites with the following order of prevalence: quality management (50.00%), restructuring (16.53%), communication (15.68%), education (8.90%), planning (7.20%), and financing (1.69%). We identified a new category of strategies not captured by the existing taxonomy, labeled "communication." There was no evidence that number of implementation strategies enacted was statistically significantly associated with changes in self-reported fidelity to MBC however, financing strategies were associated with increased fidelity. This method has the capacity to yield rich data that will inform investigations into tailored implementation approaches.