Multi-Level Stakeholder Perspectives on Determinants of Point of Care Ultrasound Implementation in a US Academic Medical Center.
Multi-Level Stakeholder Perspectives on Determinants of Point of Care Ultrasound Implementation in a US Academic Medical Center.
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在美国学术医学中心，有关护理点超声实施的决定因素的多层次利益相关者的观点。
DOI：
10.3390/diagnostics11071172
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发表时间：
2021-06-28
期刊：
影响因子：
--
通讯作者：
Ho PM
中科院分区：
文献类型：
--
作者：
Maw AM;Morris MA;Barnard JG;Wilson J;Glasgow RE;Huebschmann AG;Soni NJ;Fleshner M;Kaufman J;Ho PM
包括内科在内的多个专科对将诊断点超声(Pocus)纳入标准临床护理越来越感兴趣。然而，目前很少有内科医生使用Pocus。这项研究的目的是从多层次利益相关者的角度了解美国学术医学中心目前在卫生系统和临床医生层面采用Pocus的决定因素。我们在美国一家学术医学中心对包括住院医生、专家和医院领导在内的多层次利益相关者进行了半结构化访谈。研究参与者被问及采用PICUS的决定因素。使用框架方法，以实用的稳健实施和可持续发展模型(PRISM)的上下文域为指导，对访谈记录进行基于团队的分析。采访了31名在Pocus采用过程中扮演不同角色的利益相关者。对访谈的分析揭示了利益相关者认为对临床医生和卫生系统的采用很重要的三个主要主题：临床影响、效率和成本。次主题包括两个被认为对高保真执行至关重要的主题：制定认证政策和强有力的质量保证进程。这些发现确定了系统和临床医生水平采用的潜在决定因素，这些因素可以被用来实现PICUS应用程序的高保真实施，从而改善患者结果。
There is growing interest from multiple specialties, including internal medicine, to incorporate diagnostic point of care ultrasound (POCUS) into standard clinical care. However, few internists currently use POCUS. The objective of this study was to understand the current determinants of POCUS adoption at both the health system and clinician level at a U.S. academic medical center from the perspective of multi-level stakeholders. We performed semi-structured interviews of multi-level stakeholders including hospitalists, subspecialists, and hospital leaders at an academic medical center in the U.S. Questions regarding the determinants of POCUS adoption were asked of study participants. Using the framework method, team-based analysis of interview transcripts were guided by the contextual domains of the Practical Robust Implementation and Sustainability Model (PRISM). Thirty-one stakeholders with diverse roles in POCUS adoption were interviewed. Analysis of interviews revealed three overarching themes that stakeholders considered important to adoption by clinicians and health systems: clinical impact, efficiency and cost. Subthemes included two that were deemed essential to high-fidelity implementation: the development of credentialing policies and robust quality assurance processes. These findings identify potential determinants of system and clinician level adoption that may be leveraged to achieve high-fidelity implementation of POCUS applications that result in improved patient outcomes.
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