A stakeholder-driven method for selecting implementation strategies: a case example of pediatric hypertension clinical practice guideline implementation.
A stakeholder-driven method for selecting implementation strategies: a case example of pediatric hypertension clinical practice guideline implementation.
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DOI：
10.1186/s43058-022-00276-4
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发表时间：
2022-03-07
影响因子：
--
通讯作者：
Smith JD
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文献类型：
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作者：
Knapp AA;Carroll AJ;Mohanty N;Fu E;Powell BJ;Hamilton A;Burton ND;Coldren E;Hossain T;Limaye DP;Mendoza D;Sethi M;Padilla R;Price HE;Villamar JA;Jordan N;Langman CB;Smith JD
本文提供了一种基于共同设计和涉众参与的一般化方法，用于识别、指定和确定实现策略的优先级。为了说明这种方法，我们提出了一个案例，重点确定在社区卫生中心的初级保健实践中促进儿童高血压（pHTN）临床实践指南（CPG）实施的策略，涉及儿科临床医生、临床工作人员和患者/护理人员的有意义的参与。选择这个例子是基于临床医生和组织在实施pHTN CPG方面的困难，因为遵循指南的pHTN诊断和治疗率很低。我们召集了由6名儿科医生和5名学术合作伙伴组成的利益相关者咨询小组（SAP），进行了8次会议（总计约12小时），以严格确定pHTN CPG依从性的决定因素，并最终制定可测试的多层面，多组件实施策略。我们的方法在实施变更专家建议（ERIC）协议的基础上进行了扩展，结合了改进的德尔菲方法、以用户为中心的设计方法和实施研究逻辑模型（IRLM）。在SAP的建议下，我们进一步收集了患有或面临pHTN风险的青少年及其护理人员，以及负责执行实施战略各个方面的诊所工作人员的意见。首先，SAP确定了17个决定因素，并优先纳入了18个离散策略。这些策略主要针对干预特征、内部设置和实施者特征领域的决定因素。基于SAP对战略有效性、可行性和优先级的评级，出现了三层战略，其中7层战略包括顶层实施战略包。接下来，来自护理人员和诊所工作人员的意见确认了实施策略的可行性和可接受性，并在这些策略的定义和规范中提供了进一步的细节。这种方法是对ERIC协议的一种改编，它提供了一种实用的结构，可以与利益相关者一起有效地确定实施策略，特别是在补充了以用户为中心的设计活动和IRLM的直观组织框架之后。这种可推广的方法可以帮助研究人员确定并优先考虑与实施环境相一致的策略，从而增加采用和持续使用的可能性。在线版本包含补充材料，可在10.1186/s43058-022-00276-4获得。
This article provides a generalizable method, rooted in co-design and stakeholder engagement, to identify, specify, and prioritize implementation strategies. To illustrate this method, we present a case example focused on identifying strategies to promote pediatric hypertension (pHTN) Clinical Practice Guideline (CPG) implementation in community health center-based primary care practices that involved meaningful engagement of pediatric clinicians, clinic staff, and patients/caregivers. This example was chosen based on the difficulty clinicians and organizations experience in implementing the pHTN CPG, as evidenced by low rates of guideline-adherent pHTN diagnosis and treatment. We convened a Stakeholder Advisory Panel (SAP), comprising 6 pediatricians and 5 academic partners, for 8 meetings (~12 h total) to rigorously identify determinants of pHTN CPG adherence and to ultimately develop a testable multilevel, multicomponent implementation strategy. Our approach expanded upon the Expert Recommendations for Implementation Change (ERIC) protocol by incorporating a modified Delphi approach, user-centered design methods, and the Implementation Research Logic Model (IRLM). At the recommendation of our SAP, we gathered further input from youth with or at-risk for pHTN and their caregivers, as well as clinic staff who would be responsible for carrying out facets of the implementation strategy. First, the SAP identified 17 determinants, and 18 discrete strategies were prioritized for inclusion. The strategies primarily targeted determinants in the domains of intervention characteristics, inner setting, and characteristics of the implementers. Based on SAP ratings of strategy effectiveness, feasibility, and priority, three tiers of strategies emerged, with 7 strategies comprising the top tier implementation strategy package. Next, input from caregivers and clinic staff confirmed the feasibility and acceptability of the implementation strategies and provided further detail in the definition and specification of those strategies. This method—an adaptation of the ERIC protocol—provided a pragmatic structure to work with stakeholders to efficiently identify implementation strategies, particularly when supplemented with user-centered design activities and the intuitive organizing framework of the IRLM. This generalizable method can help researchers identify and prioritize strategies that align with the implementation context with an increased likelihood of adoption and sustained use. The online version contains supplementary material available at 10.1186/s43058-022-00276-4.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
2.6
作者：
Hwang, Soohyun;Birken, Sarah A.;Smith, Justin D.
通讯作者：
Smith, Justin D.
影响因子：
3.6
作者：
Dopp, Alex R.;Parisi, Kathryn E.;Lyon, Aaron R.
通讯作者：
Lyon, Aaron R.
影响因子：
8.3
作者：
Bell, Cynthia S.;Samuel, Joyce P.;Samuels, Joshua A.
通讯作者：
Samuels, Joshua A.
影响因子：
2.2
作者：
Bello, Jennifer K;Mohanty, Nivedita;Rao, Goutham
通讯作者：
Rao, Goutham