Implementation of a community health worker-focused team-based model of care: What modifications do clinics make?
Implementation of a community health worker-focused team-based model of care: What modifications do clinics make?
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实施以社区卫生工作者为中心、基于团队的护理模式：诊所做了哪些修改？
DOI：
10.3389/frhs.2023.989157
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Coker, Tumaini R
中科院分区：
文献类型：
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作者：
Sotelo Guerra, Laura J;Ortiz, Janette;Liljenquist, Kendra;Szilagyi, Peter G;Fiscella, Kevin;Porras-Javier, Lorena;Johnson, Gina;Friesema, Lisa;Coker, Tumaini R
以团队为基础的护理提供了将非临床医生（如社区卫生工作者）纳入初级保健团队的潜力，以确保患者和家属获得与文化相关的护理，以满足他们的身体、社会和行为健康和保健需求。我们描述了两个联邦合格的健康中心（FQHC）组织如何采用基于证据的、基于团队的儿童保健（WCC）模式，以确保0-3岁幼儿的父母在WCC就诊时得到全面的预防保健需求。每个FQHC都成立了一个由临床医生、工作人员和家长组成的项目工作组，以确定在实施PARENT（以家长为中心的相遇重新设计，新生儿到幼儿）的过程中需要做出哪些调整。PARENT是一种以团队为基础的护理干预，由CHW担任预防护理教练。我们使用基于证据的干预措施适应和修改报告框架（FRAME）来记录各种干预措施的修改和适应过程，重点关注修改发生的时间和方式，是计划中的还是计划外的，以及修改的原因和目标。项目工作组根据诊所优先事项、工作流程、人员配备、空间和人口需求调整了干预措施的几个要素。修改是有计划和主动的，并在组织、诊所和个人提供者层面进行。修改决定由项目工作组作出，并由项目领导小组实施。修改的例子包括：(1)将家长教练的教育要求从硕士学位改为学士学位或同等学历，以反映教练角色的需要；(2)在电子健康档案中使用fqhc专用模板作为教练员的访前筛查文件；(3)利用电子社会需求转介工具帮助教练员跟踪和跟进社会需求转介。这些修改并没有改变核心要素（即家长教练提供预防保健服务）或干预目标。对于实施以团队为基础的护理干预的诊所来说，早期和经常参与干预适应和实施过程的关键临床利益相关者的参与，以及在组织层面和临床层面对干预修改的规划，对于地方实施至关重要。
Team-based care offers potential for integrating non-clinicians, such as community health workers (CHWs), into the primary care team to ensure that patients and families receive culturally relevant care to address their physical, social, and behavioral health and wellness needs. We describe how two federally qualified health center (FQHC) organizations adapted an evidence-based, team-based model of well-child care (WCC) designed to ensure that the parents of young children, aged 0–3, have their comprehensive preventive care needs met at WCC visits. Each FQHC formed a Project Working Group composed of clinicians, staff, and parents to determine what adaptations to make in the process of implementation of PARENT (Parent-Focused Redesign for Encounters, Newborns to Toddlers), a team-based care intervention that uses a CHW in the role of a preventive care coach. We use the Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME) to chronicle the various intervention modifications and the adaptation process, focusing on when and how modifications occurred, whether it was planned or unplanned, and the reasons and goals for the modification. The Project Working Groups adapted several elements of the intervention in response to clinic priorities, workflow, staffing, space, and population need. Modifications were planned and proactive, and were made at the organization, clinic, and individual provider level. Modification decisions were made by the Project Working Group and operationalized by the Project Leadership Team. Examples of modifications include the following: (1) changing the parent coach educational requirement from a Master's degree to a bachelor's degree or equivalent experience to reflect the needs of the coach role; (2) the use of FQHC-specific templates for the coach's documentation of the pre-visit screening in the electronic health record; and (3) the use of electronic social needs referral tools to help the coach track and follow up on social need referrals. The modifications did not change the core elements (i.e., parent coach provision of preventive care services) or intervention goals. For clinics implementing team-based care interventions, the engagement of key clinical stakeholders early and often in the intervention adaptation and implementation process, and planning for intervention modifications at both at an organizational level and at a clinical level are critical for local implementation.