A realistic evaluation: the case of protocol-based care.
A realistic evaluation: the case of protocol-based care.
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DOI：
10.1186/1748-5908-5-38
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发表时间：
2010-05-26
期刊：
影响因子：
--
通讯作者：
Seers K
中科院分区：
文献类型：
--
作者：
Rycroft-Malone J;Fontenla M;Bick D;Seers K
“基于协议的护理”被政策制定者设想为一种实现英格兰服务改进议程的机制。现实评估是一种日益流行的方法，但很少有出版的例子存在，特别是在实施研究方面。为了填补这一空白，在本文中，我们描述了一种现实评估方法在基于协议的护理研究中的应用，同时分享了通过使用协议、指南和途径来标准化护理的相关发现。现实评价介于实证主义和相对主义之间，关注的是识别潜在的因果机制，它们是如何起作用的，以及在什么条件下起作用。从根本上说，它把注意力集中在发现什么有效，对谁有效，如何有效，以及在什么情况下有效。在这项研究中，我们感兴趣的是了解在不同的临床环境（背景）中，基于协议的护理（机制）的特定方法的类型和性质之间的关系，以及这对结果的影响。使用现实主义综合原则的证据审查产生了许多命题，即背景，机制和结果线索（cmo）。然后通过多个案例研究，使用多种方法，包括非参与者观察，访谈和通过迭代分析过程的文件分析，对这些命题进行“测试”。最初的命题（推测的cmo）只是部分地与分析过程中出现的发现相对应。从审查机制、背景和结果的反复分析过程中，我们能够得出一些理论上可推广的特征，包括什么有效，对谁有效，如何有效，以及在什么情况下使用标准化护理方法（精炼cmo）。作为最早将现实评估应用于实施研究的研究之一，这是一个很好的选择，特别是考虑到越来越重视理解背景如何影响循证实践。考虑了该方法的优点和局限性，包括如何实施它和一些挑战。这种方法提供了一个有用的解释框架，通过它可以理解同时起作用并通过各种数据源观察到的多种因素，并可以发展关于在实践中使用标准化护理方法的解释理论。
'Protocol based care' was envisioned by policy makers as a mechanism for delivering on the service improvement agenda in England. Realistic evaluation is an increasingly popular approach, but few published examples exist, particularly in implementation research. To fill this gap, within this paper we describe the application of a realistic evaluation approach to the study of protocol-based care, whilst sharing findings of relevance about standardising care through the use of protocols, guidelines, and pathways. Situated between positivism and relativism, realistic evaluation is concerned with the identification of underlying causal mechanisms, how they work, and under what conditions. Fundamentally it focuses attention on finding out what works, for whom, how, and in what circumstances. In this research, we were interested in understanding the relationships between the type and nature of particular approaches to protocol-based care (mechanisms), within different clinical settings (context), and what impacts this resulted in (outcomes). An evidence review using the principles of realist synthesis resulted in a number of propositions, i.e., context, mechanism, and outcome threads (CMOs). These propositions were then 'tested' through multiple case studies, using multiple methods including non-participant observation, interviews, and document analysis through an iterative analysis process. The initial propositions (conjectured CMOs) only partially corresponded to the findings that emerged during analysis. From the iterative analysis process of scrutinising mechanisms, context, and outcomes we were able to draw out some theoretically generalisable features about what works, for whom, how, and what circumstances in relation to the use of standardised care approaches (refined CMOs). As one of the first studies to apply realistic evaluation in implementation research, it was a good fit, particularly given the growing emphasis on understanding how context influences evidence-based practice. The strengths and limitations of the approach are considered, including how to operationalise it and some of the challenges. This approach provided a useful interpretive framework with which to make sense of the multiple factors that were simultaneously at play and being observed through various data sources, and for developing explanatory theory about using standardised care approaches in practice.
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DOI：
10.1186/1748-5908-4-61
发表时间：
2009-09-23
期刊：
Implementation science : IS
影响因子：
--
作者：
Dobbins M;Hanna SE;Ciliska D;Manske S;Cameron R;Mercer SL;O'Mara L;DeCorby K;Robeson P
通讯作者：
Robeson P
影响因子：
2.5
作者：
Dopson, S;FitzGerald, L;Locock, L
通讯作者：
Locock, L
影响因子：
3.8
作者：
McCormack, B;Kitson, A;Seers, K
通讯作者：
Seers, K
影响因子：
7.2
作者：
Rycroft-Malone, Jo;Dopson, Sue;Estabrooks, Carole A.
通讯作者：
Estabrooks, Carole A.
影响因子：
4.2
作者：
Rycroft-Malone, J;Harvey, G;Titchen, A
通讯作者：
Titchen, A