Implementing culturally competent transplant care and implications for reducing health disparities: A prospective qualitative study.
Implementing culturally competent transplant care and implications for reducing health disparities: A prospective qualitative study.
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DOI：
10.1111/hex.13124
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发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Shumate M
中科院分区：
文献类型：
--
作者：
Gordon EJ;Romo E;Amórtegui D;Rodas A;Anderson N;Uriarte J;McNatt G;Caicedo JC;Ladner DP;Shumate M
尽管现有的基于证据的干预措施减少了健康差距，但这些干预措施往往没有得到实施。西北医学的西班牙裔肾脏移植计划（HKTP）是一项文化和语言能力的干预措施，旨在减少西班牙裔/拉丁裔人活体肾脏移植（LDKT）的差异。香港移植计划于2016年在两个移植项目中引入，以评估其有效性。本研究评估香港贸易计划实施准备工作的障碍和促进因素。在实施准备期间，与移植利益相关者（即管理人员、护士、医生）进行了访谈和小组讨论。综合实施研究框架（CFIR）指导访谈设计和定性分析。44位利益相关者参加了24次访谈和/或27次小组讨论。在以前的卫生保健环境实施准备研究中没有发现的新因素，成为实施文化主管保健的促进因素和障碍。促进实施的因素包括：持份者对实施香港移植计划的道德责任的关注、与西班牙裔血统有关的个人动机，以及对西班牙裔患者移植教育需求的看法。实施障碍包括：利益攸关方认为拉美裔医疗保险付款人组合会对收入产生负面影响，对拉美裔医疗保险付款人差异和按族裔/种族分类的患者数据缺乏了解，以及认为家庭讨论部分不道德，因为可能存在胁迫。我们的研究确定了文化主管护理干预实施准备的新障碍和促进因素。医疗保健管理人员可以通过了解挑战护理交付过程的因素和提高临床团队对LDKT差异的认识，促进组织实施符合文化的护理干预措施。
Despite available evidence‐based interventions that decrease health disparities, these interventions are often not implemented. Northwestern Medicine's® Hispanic Kidney Transplant Program (HKTP) is a culturally and linguistically competent intervention designed to reduce disparities in living donor kidney transplantation (LDKT) among Hispanics/Latinos. The HKTP was introduced in two transplant programs in 2016 to evaluate its effectiveness. This study assessed barriers and facilitators to HKTP implementation preparation. Interviews and group discussions were conducted with transplant stakeholders (ie administrators, nurses, physicians) during implementation preparation. The Consolidated Framework for Implementation Research (CFIR) guided interview design and qualitative analysis. Forty‐four stakeholders participated in 24 interviews and/or 27 group discussions. New factors, not found in previous implementation preparation research in health‐care settings, emerged as facilitators and barriers to the implementation of culturally competent care. Implementation facilitators included: stakeholders’ focus on a moral imperative to implement the HKTP, personal motivations related to their Hispanic heritage, and perceptions of Hispanic patients’ transplant education needs. Implementation barriers included: stakeholders’ perceptions that Hispanics’ health insurance payer mix would negatively impact revenue, a lack of knowledge about LDKT disparities and patient data disaggregated by ethnicity/race, and a perception that the family discussion component was immoral because of the possibility of coercion. Our study identified novel barriers and facilitators to the implementation preparation of a culturally competent care intervention. Healthcare administrators can facilitate organizations’ implementation of culturally competent care interventions by understanding factors challenging care delivery processes and raising clinical team awareness of disparities in LDKT.
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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：
120.7
作者：
Giacomini, MK;Cook, DJ
通讯作者：
Cook, DJ
DOI：
10.1186/s13012-017-0666-9
发表时间：
2017-11-14
期刊：
Implementation science : IS
影响因子：
--
作者：
Guerrero EG;Fenwick K;Kong Y
通讯作者：
Kong Y
影响因子：
7
作者：
Davis, A. M.;Kennedy, D.;Roos, E.
通讯作者：
Roos, E.
影响因子：
2.8
作者：
Gordon, Elisa J.;Lee, Jungwha;Shumate, Michelle D.
通讯作者：
Shumate, Michelle D.