What Drives Greater Assimilation of Telestroke in Emergency Departments?
What Drives Greater Assimilation of Telestroke in Emergency Departments?
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DOI：
10.1016/j.jstrokecerebrovasdis.2020.105310
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发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Mehrotra A
中科院分区：
文献类型：
--
作者：
Uscher-Pines L;Sousa J;Zachrison K;Guzik A;Schwamm L;Mehrotra A
尽管许多急诊科 (ED) 具有远程治疗能力，但尚不清楚为什么有些急诊室始终使用远程治疗，而另一些则不使用。我们将 ED 的特征和实践与远程中风的稳健和低同化进行了比较。我们对来自 10 个不同网络的远程治疗服务并且使用远程治疗至少两年的急诊室代表进行了半结构化访谈。我们使用最大多样性抽样来选择纳入的 ED，并应用正偏差方法，比较具有稳健性和低同化性的程序。数据收集是根据实施研究综合框架提供的。对于定性分析，我们创建了站点摘要并进行了补充矩阵分析来确定主题。来自 21 名患有远程卒中的 ED 的代表参加了会议，其中 11 名具有强同化能力，10 名具有低同化能力。在具有强大同化能力的急诊室中，远程中风工作流程是高度协议化的，项目得到了领导层的支持，远程中风的使用和结果得到了测量，个体提供者收到了关于他们远程中风使用的反馈。在同化程度较低的急诊室，远程中风被认为会增加复杂性，而急诊室医生认为远程中风不会增加价值，或者除了电话咨询之外没有什么价值。具有强大同化能力的急诊室确定了四套改善同化的策略：加强中风专家和急诊室提供者之间的关系，改进和标准化流程，解决抗拒提供者的问题，以及扩大该计划的目标和作用。在急诊室中，通过标准化工作流程、领导支持、持续评估和质量改进工作以及解决耐药提供者的机制，可以观察到远程卒中的同化程度更高。
Although many emergency departments (EDs) have telestroke capacity, it is unclear why some EDs consistently use telestroke and others do not. We compared the characteristics and practices of EDs with robust and low assimilation of telestroke. We conducted semi-structured interviews with representatives of EDs that received telestroke services from 10 different networks and had used telestroke for a minimum of two years. We used maximum diversity sampling to select EDs for inclusion and applied a positive deviance approach, comparing programs with robust and low assimilation. Data collection was informed by the Consolidated Framework for Implementation Research. For the qualitative analysis, we created site summaries and conducted a supplemental matrix analysis to identify themes. Representatives from 21 EDs with telestroke, including 11 with robust assimilation and 10 with low assimilation, participated. In EDs with robust assimilation, telestroke workflow was highly protocolized, programs had the support of leadership, telestroke use and outcomes were measured, and individual providers received feedback about their telestroke use. In EDs with low assimilation, telestroke was perceived to increase complexity, and ED physicians felt telestroke did not add value or had little value beyond a telephone consult. EDs with robust assimilation identified four sets of strategies to improve assimilation: strengthening relationships between stroke experts and ED providers, improving and standardizing processes, addressing resistant providers, and expanding the goals and role of the program. Greater assimilation of telestroke is observed in EDs with standardized workflow, leadership support, ongoing evaluation and quality improvement efforts, and mechanisms to address resistant providers.
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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
DOI：
10.1161/circoutcomes.119.005903
发表时间：
2020-03-01
影响因子：
6.9
作者：
Sharma, Richa;Zachrison, Kori S.;Schwamm, Lee H.
通讯作者：
Schwamm, Lee H.
影响因子：
4.7
作者：
Zachrison, Kori S.;Boggs, Krislyn M.;Camargo, Carlos A.
通讯作者：
Camargo, Carlos A.
影响因子：
3.4
作者：
Rose, Adam J.;McCullough, Megan B.
通讯作者：
McCullough, Megan B.
影响因子：
3.2
作者：
Averill, JB
通讯作者：
Averill, JB