Adaptation and Implementation of the STarT Back Risk Stratification Strategy in a US Health Care Organization: A Process Evaluation
Adaptation and Implementation of the STarT Back Risk Stratification Strategy in a US Health Care Organization: A Process Evaluation
复制标题
DOI：
10.1093/pm/pny170
复制
发表时间：
2019-06-01
期刊：
影响因子：
3.1
通讯作者：
Cherkin, Dan
中科院分区：
文献类型：
--
作者：
Hsu, Clarissa;Evers, Sarah;Cherkin, Dan
Objective.为了支持实施有效的治疗背痛，可以提供给一系列的人，我们总结了我们的过程评估的MATCH试验的实施适应STartT背部风险分层护理模型的学习。设计我们的逻辑模型驱动的评估主要集中在定性数据源。设置.这项研究发生在美国的医疗保健提供系统，适应和实施STartBack分层护理方法。这是该战略在美国环境中的首次正式测试。方法.数据收集包括观察执行活动、工作人员/提供者访谈和培训后评价问卷。数据分析采用定性数据的主题分析和问卷调查数据的描述性统计。结果我们发现，初级保健团队和干预诊所的物理治疗师在评估问卷上给培训打了高分，并在访谈中报告说，他们认为培训很吸引人，很有用。然而，有显着的变化，在何种程度上的风险分层策略纳入护理。一些初级保健提供者报告说，干预改变了他们与患者的对话，增加了他们与背痛患者合作的信心。使用STartT Back工具的提供者没有改变推荐匹配治疗的转诊率。结论.这些见解为今后调整和实施STartT Back战略和其他复杂的实践变革干预措施提供了指导。他们强调需要采取以初级保健为基础的干预措施，以尽量减少复杂性，并需要不断进行监测和反馈。
Objective. To support implementation of effective treatments for back pain that can be delivered to a range of people, we summarize learnings from our process evaluation of the MATCH trial's implementation of an adaptation of the STarT Back risk-stratified care model. Design. Our logic model-driven evaluation focused primarily on qualitative data sources. Setting. This study took place in a US-based health care delivery system that had adapted and implemented the STarT Back stratified care approach. This was the first formal test of the strategy in a US setting. Methods. Data collection included observation of implementation activities, staff/provider interviews, and post-training evaluation questionnaires. Data were analyzed using thematic analysis of qualitative data and descriptive statistics for questionnaire data. Results. We found that both primary care teams and physical therapists at intervention clinics gave the training high scores on evaluation questionnaires and reported in the interviews that they found the training engaging and useful. However, there was significant variation in the extent to which the risk stratification strategy was incorporated into care. Some primary care providers reported that the intervention changed their conversations with patients and increased their confidence in working with patients with back pain. Providers using the STarT Back tool did not change referral rates for recommended matched treatments. Conclusions. These insights provide guidance for future efforts to adapt and implement the STarT Back strategy and other complex practice change interventions. They emphasize the need for primary care-based interventions to minimize complexity and the need for ongoing monitoring and feedback.