Evaluating an organization-wide disparity reduction program: Understanding what works for whom and why.
Evaluating an organization-wide disparity reduction program: Understanding what works for whom and why.
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DOI：
10.1371/journal.pone.0193179
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Balicer RD
中科院分区：
文献类型：
--
作者：
Spitzer-Shohat S;Shadmi E;Goldfracht M;Key C;Hoshen M;Balicer RD
差异减少计划已经被证明在实现目标的程度上有所不同，但这些变化的原因很少被研究。我们调查了以色列最大的健康计划中的一个大规模项目，该项目旨在通过七项健康和医疗保健指标的综合衡量来减少社会弱势群体的差距。一个现实的评估进行评估计划在26个诊所及其相关的管理水平。首先，我们与主要利益相关者进行了访谈，并对一次区域会议进行了人种学观察，以得出基本的计划理论。接下来，对109个诊所小组、次区域总部和区域总部的人员进行了半结构化访谈。社会网络分析，以获得团队的相互关系的措施。评估感知的团队有效性（TE）和临床特征，以引出背景特征。通过访谈确定了诊所实施的干预措施，并根据每个诊所采用的机制进行编码。在基线和3年后，对每个诊所的七项指标综合指标进行评估。最后，我们回顾了不同的情境-机制-结果（CMO）配置，以了解在什么情况下可以减少差异。诊所的内部背景特征在网络密度和感知TE方面都有所不同。成功的CMO配置包括：（1）高度密集的诊所团队，具有高感知TE，只有一个小的差距，以最大限度地减少，并采用广泛的干预措施;（2）诊所有很大的差距，以最大限度地减少高诊所密度和高感知TE，重点努力为他们的登记者量身定制服务;（3）诊所有中到低密度和感知TE，以及强大的中层管理支持。实现差距缩小的诊所具有较高的诊所密度，与中层管理人员关系密切，并针对其服务人群的独特需求采取了量身定制的干预措施。
Disparity-reduction programs have been shown to vary in the degree to which they achieve their goal; yet the causes of these variations is rarely studied. We investigated a broad-scale program in Israel’s largest health plan, aimed at reducing disparities in socially disadvantaged groups using a composite measure of seven health and health care indicators. A realistic evaluation was conducted to evaluate the program in 26 clinics and their associated managerial levels. First, we performed interviews with key stakeholders and an ethnographic observation of a regional meeting to derive the underlying program theory. Next, semi-structured interviews with 109 clinic teams, subregional headquarters, and regional headquarters personnel were conducted. Social network analysis was performed to derive measures of team interrelations. Perceived team effectiveness (TE) and clinic characteristics were assessed to elicit contextual characteristics. Interventions implemented by clinics were identified from interviews and coded according to the mechanisms each clinic employed. Assessment of each clinic’s performance on the seven-indicator composite measure was conducted at baseline and after 3 years. Finally, we reviewed different context-mechanism-outcome (CMO) configurations to understand what works to reduce disparity, and under what circumstances. Clinics’ inner contextual characteristics varied in both network density and perceived TE. Successful CMO configurations included 1) highly dense clinic teams having high perceived TE, only a small gap to minimize, and employing a wide range of interventions; (2) clinics with a large gap to minimize with high clinic density and high perceived TE, focusing efforts on tailoring services to their enrollees; and (3) clinics having medium to low density and perceived TE, and strong middle-management support. Clinics that achieved disparity reduction had high clinic density, close ties with middle management, and tailored interventions to the unique needs of the populations they serve.
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影响因子：
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作者：
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发表时间：
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影响因子：
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