Implementation and modification of an organizational-level intervention: a prospective analysis.
Implementation and modification of an organizational-level intervention: a prospective analysis.
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DOI：
10.1186/s43058-022-00296-0
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发表时间：
2022-06-03
影响因子：
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干预措施的修改可能会危及干预措施的结果。在实施准备阶段出现的干预措施的预先存在的感知障碍和促进因素可能有助于解释为什么在实施阶段可能会发生干预措施的修改。这两个网站的比较案例研究描述了一个复杂的组织级干预措施的修改，并探讨如何已知的实施科学因素可能使这种变化发生。西北医学的TM西班牙裔肾移植计划（HKTP）是一个文化能力移植中心为基础的干预措施，旨在减少西班牙裔之间的活体肾移植的差异。与移植利益相关者（即，医生，管理人员，临床医生）在两个肾移植计划与大量西班牙裔人口在实施准备和实施阶段。实施研究的综合框架（CFIR）指导访谈设计和定性分析，斯特曼的框架报告适应和修改扩展（FRAME）指导修改分类。在各研究中心，57名利益相关者参与了访谈、小组讨论和/或学习协作讨论。位点B的修饰多于位点A（n = 29 vs n = 18）。站点在延迟/跳过（站点A 50%与站点B 28%）和添加（站点A 11%与站点B 28%）的比例上存在差异，但具有可比的替换（站点A 17%与站点B 17%）和调整（站点A 17%与站点B 14%）修改类型。在各个研究中心，移植团队始终启动了最多的修改（研究中心A 66%;研究中心B 62%）。虽然个人在站点B发起的修改略多（21%对站点A 17%），但机构在站点A发起的修改比例略多（17%对站点B 10%）。CFIR内部设置因子（即，结构特征、文化、可用资源、实施环境），解释了实施阶段站点修改数量、类型和代理的相似性和差异。实施文化能力护理干预的组织进行了修改。实施准备阶段出现的CFIR内部设置因素在很大程度上解释了研究中心修改的相似性和差异性。确定有助于修改的因素可能有助于机构通过提前解决已知因素来更好地准备实施干预措施，这可能会促进更大的忠诚度，从而产生预期的结果。 ClinicalTrials.govNCT03276390.我们于2017年9月7日回顾性登记了该研究。在线版本包含补充材料，可通过10.1186/s43058-022-00296-0获得。
Modifications to interventions can jeopardize intervention outcomes. Pre-existing perceived barriers and facilitators to the intervention arising in the implementation preparation phase may help explain why modifications to the intervention may occur during the implementation phase. This two-site comparative case study describes modifications made to a complex organizational-level intervention and examines how known implementation science factors may have enabled such changes to occur. Northwestern Medicine’sTM Hispanic Kidney Transplant Program (HKTP) is a culturally competent transplant center-based intervention designed to reduce disparities in living donor kidney transplantation among Hispanics. In-depth qualitative interviews and discussions were longitudinally conducted with transplant stakeholders (i.e., physicians, administrators, clinicians) at two kidney transplant programs with large Hispanic populations during implementation preparation and implementation phases. The Consolidated Framework for Implementation Research (CFIR) guided interview design and qualitative analysis, and Stirman’s Framework for Reporting Adaptations and Modifications-Expanded (FRAME) guided modification classification. Across sites, 57 stakeholders participated in an interview, group discussion, and/or learning collaborative discussion. Site-B made more modifications than Site-A (n = 29 versus n = 18). Sites differed in the proportions of delaying/skipping (Site-A 50% versus Site-B 28%) and adding (Site-A 11% versus Site-B 28%) but had comparable substituting (Site-A 17% versus Site-B 17%) and tweaking (Site-A 17% versus Site-B 14%) modification types. Across sites, the transplant team consistently initiated the most modifications (Site-A 66%; Site-B 62%). While individuals initiated slightly more modifications at Site-B (21% versus Site-A 17%), institutions instigated proportionately slightly more modifications at Site-A (17% versus Site-B 10%). CFIR inner setting factors (i.e., structural characteristics, culture, available resources, implementation climate) that prominently emerged during the implementation preparation phase explained similarities and differences in sites’ modification numbers, types, and agents in the implementation phase. Organizations implementing a culturally competent care intervention made modifications. CFIR inner setting factors emerging in the implementation preparation phase largely explained similarities and differences in study sites’ modifications. Identifying factors contributing to modifications may help institutions become better prepared to implement an intervention by addressing known factors in advance, which may foster greater fidelity leading to desired outcomes. ClinicalTrials.govNCT03276390. We registered the study retrospectively on 9-7-17. The online version contains supplementary material available at 10.1186/s43058-022-00296-0.
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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：
1.9
作者：
Becker, Deborah R.;Drake, Robert E.;Bond, Gary R.
通讯作者：
Bond, Gary R.
影响因子：
5.5
作者：
Cohen, Deborah J.;Crabtree, Benjamin F.;Green, Lawrence W.
通讯作者：
Green, Lawrence W.
影响因子：
7.2
作者：
Aarons, Gregory A.;Sklar, Marisa;Brown, C. Hendricks
通讯作者：
Brown, C. Hendricks
影响因子：
1.7
作者：
Cooper, Brittany Rhoades;Shrestha, Gitanjali;Hill, Laura
通讯作者：
Hill, Laura