Operationalizing an Implementation Framework to Disseminate a Care Coordination Program for Rural Veterans
Operationalizing an Implementation Framework to Disseminate a Care Coordination Program for Rural Veterans
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DOI：
10.1007/s11606-019-04964-1
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发表时间：
2019-05-01
影响因子：
5.7
通讯作者：
Burke, Robert E.
中科院分区：
文献类型：
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作者：
Leonard, Chelsea;Gilmartin, Heather;Burke, Robert E.
目的：了解如何在不同环境中成功实施护理协调计划对于传播最佳实践至关重要。我们描述了我们如何操作的实用稳健的实施和可持续发展模型（PRISM），以指导评估当地的情况之前，在五个设施在退伍军人健康管理局（VHA）的农村过渡护士计划（TNP）的实施。我们操作PRISM来创建定性数据收集技术（访谈指南，半结构化的意见，和一组脑写死前），以评估当地的情况下，目前的护理协调状态，并在五个设施实施前的TNP的看法。我们使用演绎-归纳框架分析来分析数据，以确定与PRISM相关的主题。我们适应在每个站点使用这些findings.RESULTS的实施策略：我们确定了可操作的主题内PRISM域在实施过程中解决。最常见的PRISM领域是组织特征、实施和可持续性基础设施。主题包括初级保健和医院住院团队之间的脱节，对工作重复的担忧，以及对一名护士无法满足该计划需求的担忧。这些主题通知TNP implementation.CONCLUSIONS：使用PRISM实施前现场评估产生了重要的研究结果，指导适应我们的实施方法。此外，TNP实施的障碍和促进因素可能与其他护理协调干预措施相同。在护理协调举措的障碍和促进者产生一个共同的语言将提高普遍性，并建立最佳practices.IMPACT声明：TNP是一个国家重症监护协调计划，针对农村退伍军人。我们将PRISM投入运作，以指导实施工作。我们有效地阐明了不同VHA设施的促进者，障碍和独特的背景因素。PRISM的使用提高了整个护理环境的调查结果的普遍性，并可能优化VHA中护理协调干预措施的实施。
OBJECTIVE: Understanding how to successfully implement care coordination programs across diverse settings is critical for disseminating best practices. We describe how we operationalized the Practical Robust Implementation and Sustainability Model (PRISM) to guide the assessment of local context prior to implementation of the rural Transitions Nurse Program (TNP) at five facilities across the Veterans Health Administration (VHA).METHODS: We operationalized PRISM to create qualitative data collection techniques (interview guides, semi-structured observations, and a group brainwriting premortem) to assess local context, the current state of care coordination, and perceptions of TNP prior to implementation at five facilities. We analyzed data using deductive-inductive framework analysis to identify themes related to PRISM. We adapted implementation strategies at each site using these findings.RESULTS: We identified actionable themes within PRISM domains to address during implementation. The most commonly occurring PRISM domains were organizational characteristics and implementation and sustainability infrastructure. Themes included a disconnect between primary care and hospital inpatient teams, concerns about work duplication, and concerns that one nurse could not meet the demand for the program. These themes informed TNP implementation.CONCLUSIONS: The use of PRISM for pre-implementation site assessments yielded important findings that guided adaptations to our implementation approach. Further, barriers and facilitators to TNP implementation may be common to other care coordination interventions. Generating a common language of barriers and facilitators in care coordination initiatives will enhance generalizability and establish best practices.IMPACT STATEMENTS: TNP is a national intensive care coordination program targeting rural Veterans. We operationalized PRISM to guide implementation efforts. We effectively elucidated facilitators, barriers, and unique contextual factors at diverse VHA facilities. The use of PRISM enhances the generalizability of findings across care settings and may optimize implementation of care coordination interventions in the VHA.