Applying the EPIS framework to policy-level considerations: Tobacco cessation policy implementation among California Medicaid managed care plans.
Applying the EPIS framework to policy-level considerations: Tobacco cessation policy implementation among California Medicaid managed care plans.
复制标题
将EPIS框架应用于政策级别的考虑：加利福尼亚医疗补助托管护理计划中的烟草戒烟政策实施。
DOI：
10.1177/26334895221096289
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发表时间：
2022-01
影响因子：
--
通讯作者：
McMenamin, Sara B.
中科院分区：
文献类型：
--
作者：
Economou, Melina A.;Kaiser, Bonnie N.;Yoeun, Sara W.;Crable, Erika L.;McMenamin, Sara B.
2016年，加州医疗服务部（DHCS）向其医疗补助管理式医疗计划（MCP）发布了一份“所有计划信函”（APL 16-014），为医疗补助受益人实施戒烟覆盖提供指导。然而，执行情况仍然很差。我们应用探索、准备、实施和维持（EPIS）框架，以确定加州医疗补助MCP中实现APL 16-014的障碍和促进因素。我们通过与MCP健康教育工作者（N = 24）的半结构化访谈评估了保真度。对访谈进行了记录、转录和审查，以确定关于执行障碍和促进因素的初步主题。讨论了初步的专题摘要，并将其映射到环境规划信息系统的结构中。APL（创新）被描述为其指导方针缺乏明确性和具体性，阻碍了实施。关于内部环境，MCP认为APL超出了他们的资源范围，指出他们自己缺乏教育材料、人力资源和技术基础设施差是实施障碍。在外部环境中，MCP发现缺乏激励措施，以鼓励提供者和受益者分别提供和参与戒烟计划。国家和MCP之间缺乏沟通，教育材料和培训资源（缺少桥接因素）是阻止MCP确定吸烟率或衡量戒烟工作成功的障碍。促进者包括几个相互合作并利用外部资源促进戒烟的MCP。此外，一些MCP使用忠诚度监测人员作为桥接因素，以促进提供者培训，跟踪提供者对吸烟者的识别，并对参与戒烟计划的受益人进行随访。加州DHCS发布的基于证据的APL 16-014是促进Medicaid MCP受益人戒烟服务的重要一步。为了充分实现政策目标，需要改善在不同环境中执行政策的沟通，并改善桥接因素，如对提供者和患者的激励措施。 2016年，位于加州的加州医疗服务部（DHCS）向其医疗补助管理式医疗计划（MCP）发布了一份“所有计划信函”（APL 16-014），为实施戒烟覆盖范围提供指导，以解决医疗补助受益人的烟草使用问题。我们对加州Medicaid MCP的健康教育工作者进行了半结构化访谈，以探讨使用探索、准备、实施和维持框架实施APL的障碍和促进因素。据多学科专业人员称，这些障碍包括：禁止烟草使用的指导方针不够明确;缺乏资源，包括教育材料、识别吸烟者的基础设施和人力资源;以及缺乏对向受益人提供戒烟材料的供应商的激励或惩罚措施。促进者包括MCP与州和/或国家公共卫生计划之间的合作。总的来说，我们的研究结果可以为改善医疗补助MCP内戒烟服务的实施提供途径。
In 2016, the California Department of Healthcare Services (DHCS) released an “All Plan Letter” (APL 16-014) to its Medicaid managed care plans (MCPs) providing guidance on implementing tobacco-cessation coverage among Medicaid beneficiaries. However, implementation remains poor. We apply the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to identify barriers and facilitators to fidelity to APL 16-014 across California Medicaid MCPs. We assessed fidelity through semi-structured interviews with MCP health educators (N = 24). Interviews were recorded, transcribed, and reviewed to develop initial themes regarding barriers and facilitators to implementation. Initial thematic summaries were discussed and mapped onto EPIS constructs. The APL (Innovation) was described as lacking clarity and specificity in its guidelines, hindering implementation. Related to the Inner Context, MCPs described the APL as beyond the scope of their resources, pointing to their own lack of educational materials, human resources, and poor technological infrastructure as implementation barriers. In the Outer Context, MCPs identified a lack of incentives for providers and beneficiaries to offer and participate in tobacco-cessation programs, respectively. A lack of communication, educational materials, and training resources between the state and MCPs (missing Bridging Factors) were barriers to preventing MCPs from identifying smoking rates or gauging success of tobacco-cessation efforts. Facilitators included several MCPs collaborating with each other and using external resources to promote tobacco cessation. Additionally, a few MCPs used fidelity monitoring staff as Bridging Factors to facilitate provider training, track providers’ identification of smokers, and follow-up with beneficiaries participating in tobacco-cessation programs. The release of the evidence-based APL 16-014 by California's DHCS was an important step forward in promoting tobacco-cessation services for Medicaid MCP beneficiaries. Improved communication on implementation in different environments and improved Bridging Factors such as incentives for providers and patients are needed to fully realize policy goals. In 2016, the California Department of Healthcare Services (DHCS) in California released an “All Plan Letter” (APL 16-014) to its Medicaid managed care plans (MCPs) providing guidance on implementing tobacco-cessation coverage to address tobacco use among Medicaid beneficiaries. We conducted semi-structured interviews with health educators in California Medicaid MCPs to explore the barriers and facilitators to implementing the APL using the Exploration, Preparation, Implementation, Sustainment framework. According to MCPs, barriers included a lack of clarity in the APL guidelines; a lack of resources, including educational materials, infrastructure to identify smokers, and human resources; and a lack of incentives or penalties for providers to provide tobacco-cessation materials to beneficiaries. Facilitators included collaboration between MCPs and state and/or national public health programs. Overall, our findings can provide avenues for improving the implementation of tobacco-cessation services within Medicaid MCPs.
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影响因子：
2.8
作者：
Strandberg-Larsen M;Schiøtz ML;Silver JD;Frølich A;Andersen JS;Graetz I;Reed M;Bellows J;Krasnik A;Rundall T;Hsu J
通讯作者：
Hsu J
影响因子：
8.4
作者：
Flodgren, Gerd;Eccles, Martin P.;Shepperd, Sasha;Scott, Anthony;Parmelli, Elena;Beyer, Fiona R.
通讯作者：
Beyer, Fiona R.
影响因子：
5.5
作者：
McMenamin, Sara B.;Yoeun, Sara W.;Zhu, Shu-Hong
通讯作者：
Zhu, Shu-Hong
影响因子：
4.2
作者：
Crable, Erika;Jones, David K.;Walley, Alexander Y.;Hicks, Jacqueline Milton;Benintendi, Allyn;Drainoni, Mari -Lynn
通讯作者：
Drainoni, Mari -Lynn
影响因子：
7.2
作者：
Hysong, Sylvia J.;Esquivel, Adol;Singh, Hardeep
通讯作者：
Singh, Hardeep