Integrating CFIR-ERIC and e-Delphi Methods to Increase Telegeriatrics Uptake.
Integrating CFIR-ERIC and e-Delphi Methods to Increase Telegeriatrics Uptake.
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整合 CFIR-ERIC 和 e-Delphi 方法以提高远程老年医学的采用率。
DOI：
10.1093/geront/gnac107
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Pimentel,CamillaB
中科院分区：
文献类型：
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作者：
Kernan,LauraM;Dryden,EileenM;Nearing,Kathryn;Kennedy,MeaghanA;Hung,Will;Moo,Lauren;Pimentel,CamillaB
背景和目标老年保健需要采用参与式实施方法，以改善对不断增长的老年人口的护理和服务。我们描述了一种有效的参与式方法，以提高老年研究教育和临床中心 (GRECC) Connect 的采用率，GRECC Connect 是一项国家老年病学门诊咨询服务，利用远程医疗技术，通过社区诊所将老年病学专家与农村老年退伍军人联系起来。研究设计和方法我们设计了一个三阶段的参与式方法，以确定支持 GRECC Connect 采用的高优先级实施策略。我们使用实施变革综合实施研究框架-专家建议 (CFIR-ERIC) 策略匹配工具，通过对 GRECC Connect 工作人员和社区诊所临床医生的定性访谈得出专家推荐的实施策略。我们让专家小组成员参与了一个参与式两步修改电子德尔菲流程，使用保密调查和讨论来确定全国战略的优先顺序。结果定性访谈揭示了计划采用的障碍、促进因素和建议。 CFIR-ERIC 推荐的许多策略解决了多重障碍，但需要根据我们的具体情况进行调整。在我们的两步电子德尔菲流程中，专家小组成员分享了所提出的战略的先前经验，对每个战略的重要性和可行性的看法，并就哪些战略在全国范围内优先考虑达成了共识。讨论和启示我们展示了聘请主题专家来确定要在国家层面进行测试的战略的可行性和好处。未来的考虑因素包括调查答复的权重、地区差异的解释以及电子德尔菲流程中使用的李克特量表的敏感性。
Background and ObjectivesParticipatory implementation methods are needed in geriatric health care to improve care and services for a growing population of older adults. We describe an efficient participatory approach to improve uptake of Geriatric Research Education and Clinical Center (GRECC) Connect, a national geriatrics outpatient consultation service using telehealth technology to connect geriatric specialists to rural, older veterans though community-based clinics.Research Design and MethodsWe designed a three-phase participatory method to identify high-priority implementation strategies to support the uptake of GRECC Connect. We used the Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change (CFIR-ERIC) Strategy Matching Tool to derive expert-recommended implementation strategies informed by qualitative interviews with both GRECC Connect staff and clinicians at community-based clinics. We engaged expert panelists in a participatory two-step modified e-Delphi process using confidential surveys and discussion to prioritize strategies nationally.ResultsQualitative interviews revealed barriers, facilitators, and recommendations for program uptake. Many strategies recommended by CFIR-ERIC addressed multiple barriers but needed to be tailored to our specific context. In our two-step e-Delphi process, expert panelists shared previous experience with the strategies presented, views on the importance and feasibility of each, and arrived at a consensus about which strategies to prioritize nationally.Discussion and ImplicationsWe demonstrate the feasibility and benefits of engaging subject matter experts to identify strategies to be tested on a national level. Future considerations include weighting of survey responses, accounting for regional differences, and sensitivity of Likert scales used in the e-Delphi process.