A mixed-method approach to generate and deliver rapid-cycle evaluation feedback: lessons learned from a multicenter implementation trial in pediatric surgery.
A mixed-method approach to generate and deliver rapid-cycle evaluation feedback: lessons learned from a multicenter implementation trial in pediatric surgery.
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DOI：
10.1186/s43058-023-00463-x
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发表时间：
2023-07-18
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快速循环反馈循环为医疗保健组织提供及时的信息和可操作的反馈，以加快干预措施的实施。我们的目标是(1)描述一种生成和提供快速周期反馈的混合方法，以及(2)探索在18个儿科手术中心实施增强恢复方案(ERP)时所学到的关键经验教训。所有中心都是儿科外科研究协作组(PedSRC，www.edsrc.org)的成员，参与了儿童手术后恢复增强(ENRICH-US)试验。为了评估实施工作，我们进行了一项混合方法的顺序解释性研究，在实施后6个月和12个月对每个中心的实施团队进行了调查和后续访谈。除了详细的记录和团队内的迭代讨论，我们使用这些数据来生成并向每个中心提供特定于中心的实施报告卡。报告卡使用红绿灯方法快速显示实施状态(绿色 = 优秀；黄色 = 需要改进；红色 = 需要显著改进)，并总结每个时间点的优势和机会。我们确定了评估儿科手术中心实施和使用快速周期反馈的几个好处、挑战和实际考虑因素。关于潜在的好处，这种方法使我们能够快速了解实施中的差异和跨中心的相应需求。它使我们能够有效地向中心提供关于实施的可操作反馈。与中心特定的实施团队保持一致也有助于促进中心和研究团队之间的伙伴关系。关于潜在的挑战，研究团队仍然必须分配大量资源，以迅速提供反馈。此外，团队成员之间需要就中心特定反馈的内容进行讨论和达成共识。实际考虑包括在提供快速周期反馈时仔细平衡及时性和全面性。此外，在儿科手术中，积极参与所有关键利益攸关方(包括医生、护士、患者、护理人员等)是至关重要的。并采用迭代的、反身性的方法来提供反馈。从方法学的角度，我们确定了三个关键的教训：(1)在儿科手术中使用快速、混合的方法评估方法是可行的，(2)可能是有益的，特别是在快速了解不同中心实施的差异方面；(3)需要解决几个方法学挑战和考虑因素，特别是在平衡反馈的及时性和全面性方面。美国国立卫生研究院国家医学图书馆临床试验。ClinicalTrials.gov标识：NCT04060303。注册于2019年8月7日，https://clinicaltrials.gov/ct2/show/NCT04060303
Rapid-cycle feedback loops provide timely information and actionable feedback to healthcare organizations to accelerate implementation of interventions. We aimed to (1) describe a mixed-method approach for generating and delivering rapid-cycle feedback and (2) explore key lessons learned while implementing an enhanced recovery protocol (ERP) across 18 pediatric surgery centers. All centers are members of the Pediatric Surgery Research Collaborative (PedSRC, www.pedsrc.org), participating in the ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) trial. To assess implementation efforts, we conducted a mixed-method sequential explanatory study, administering surveys and follow-up interviews with each center’s implementation team 6 and 12 months following implementation. Along with detailed notetaking and iterative discussion within our team, we used these data to generate and deliver a center-specific implementation report card to each center. Report cards used a traffic light approach to quickly visualize implementation status (green = excellent; yellow = needs improvement; red = needs significant improvement) and summarized strengths and opportunities at each timepoint. We identified several benefits, challenges, and practical considerations for assessing implementation and using rapid-cycle feedback among pediatric surgery centers. Regarding potential benefits, this approach enabled us to quickly understand variation in implementation and corresponding needs across centers. It allowed us to efficiently provide actionable feedback to centers about implementation. Engaging consistently with center-specific implementation teams also helped facilitate partnerships between centers and the research team. Regarding potential challenges, research teams must still allocate substantial resources to provide feedback rapidly. Additionally, discussions and consensus are needed across team members about the content of center-specific feedback. Practical considerations include carefully balancing timeliness and comprehensiveness when delivering rapid-cycle feedback. In pediatric surgery, moreover, it is essential to actively engage all key stakeholders (including physicians, nurses, patients, caregivers, etc.) and adopt an iterative, reflexive approach in providing feedback. From a methodological perspective, we identified three key lessons: (1) using a rapid, mixed method evaluation approach is feasible in pediatric surgery and (2) can be beneficial, particularly in quickly understanding variation in implementation across centers; however, (3) there is a need to address several methodological challenges and considerations, particularly in balancing the timeliness and comprehensiveness of feedback. NIH National Library of Medicine Clinical Trials. ClinicalTrials.gov Identifier: NCT04060303. Registered August 7, 2019, https://clinicaltrials.gov/ct2/show/NCT04060303