Factors influencing implementation of a care coordination intervention for cancer survivors with multiple comorbidities in a safety-net system: an application of the Implementation Research Logic Model.
Factors influencing implementation of a care coordination intervention for cancer survivors with multiple comorbidities in a safety-net system: an application of the Implementation Research Logic Model.
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影响安全网系统中多种合并症的癌症幸存者的护理协调干预实施的因素：实施研究逻辑模型的应用。
DOI：
10.1186/s13012-023-01326-8
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发表时间：
2023-12-04
影响因子：
7.2
通讯作者：
Balasubramanian, Bijal A.
中科院分区：
文献类型：
--
作者：
Rodriguez, Serena A.;Lee, Simon Craddock;Higashi, Robin T.;Chen, Patricia M.;Eary, Rebecca L.;Sadeghi, Navid;Santini, Noel;Balasubramanian, Bijal A.
关键词：
未投保和未投保的癌症幸存者具有显著的医疗，社会和经济复杂性。对于这些幸存者，肿瘤科和初级保健团队之间的有效护理协调对于高质量的综合护理至关重要。虽然存在以证据为基础的干预措施来改善医疗团队之间的协调，但在现实世界的安全网环境中看到的癌症幸存者对这些干预措施的测试实施有限。本研究旨在（1）确定影响实施多组分护理协调干预（护士协调员加患者登记）的因素，重点关注综合安全网系统中患有多种合并症的癌症幸存者，（2）确定影响实施结果的因素的机制。我们进行了半结构化访谈（患者，提供者和系统领导者），对初级保健和肿瘤手术进行了结构化观察，并在2016年至2020年期间进行了干预实施期间的文件分析。实践变革模式指导数据收集，以确定实施的障碍和促进因素;实践变革模式、实施研究综合框架和实施研究逻辑模式指导四个沉浸/结晶数据分析和综合周期，以确定机制和评估成果。实施结果包括适当性、可接受性、采用性和渗透性。根据报告的患者需求和资源以及支持干预成分的证据强度，干预是适当的，并且是初级保健和肿瘤学团队可接受的。与系统领导人建立积极和持续的伙伴关系有助于取得这些成果。在实施早期，采用和渗透有限，因为该研究仅限于乳腺癌和结直肠癌患者。这为所有癌症类型的患者接受护理的现实实践创造了障碍。随着时间的推移，干预措施实施中有意设计的灵活性促进了采用和渗透。系统合作伙伴的定期反馈以及快速的实施和评估周期导致了实时调整，增加了采用和渗透。当系统领导者积极参与并有意嵌入实施灵活性以持续促进整个卫生系统的采用和渗透时，可以成功实施循证干预措施，以协调肿瘤和初级保健团队中服务不足的癌症幸存者的护理。在线版本包含补充材料，可通过10.1186/s13012-023-01326-8获得。
Under- and uninsured cancer survivors have significant medical, social, and economic complexity. For these survivors, effective care coordination between oncology and primary care teams is critical for high-quality, comprehensive care. While evidence-based interventions exist to improve coordination between healthcare teams, testing implementation of these interventions for cancer survivors seen in real-world safety-net settings has been limited. This study aimed to (1) identify factors influencing implementation of a multicomponent care coordination intervention (nurse coordinator plus patient registry) focused on cancer survivors with multiple comorbidities in an integrated safety-net system and (2) identify mechanisms through which the factors impacted implementation outcomes. We conducted semi-structured interviews (patients, providers, and system leaders), structured observations of primary care and oncology operations, and document analysis during intervention implementation between 2016 and 2020. The practice change model (PCM) guided data collection to identify barriers and facilitators of implementation; the PCM, Consolidated Framework for Implementation Research, and Implementation Research Logic Model guided four immersion/crystallization data analysis and synthesis cycles to identify mechanisms and assess outcomes. Implementation outcomes included appropriateness, acceptability, adoption, and penetration. The intervention was appropriate and acceptable to primary care and oncology teams based on reported patient needs and resources and the strength of the evidence supporting intervention components. Active and sustained partnership with system leaders facilitated these outcomes. There was limited adoption and penetration early in implementation because the study was narrowly focused on just breast and colorectal cancer patients. This created barriers to real-world practice where patients with all cancer types receive care. Over time, flexibility intentionally designed into intervention implementation facilitated adoption and penetration. Regular feedback from system partners and rapid cycles of implementation and evaluation led to real-time adaptations increasing adoption and penetration. Evidence-based interventions to coordinate care for underserved cancer survivors across oncology and primary care teams can be implemented successfully when system leaders are actively engaged and with flexibility in implementation embedded intentionally to continuously facilitate adoption and penetration across the health system. The online version contains supplementary material available at 10.1186/s13012-023-01326-8.
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影响因子：
2.4
作者：
Glasgow, Russell E.;Klesges, Lisa M.;Vogt, Thomas M.
通讯作者：
Vogt, Thomas M.
DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
5.7
作者：
Jolles, Monica Perez;Lengnick-Hall, Rebecca;Mittman, Brian S.
通讯作者：
Mittman, Brian S.
影响因子：
2.5
作者：
Fiechtner, Lauren;Castro, Ines;Taveras, Elsie M.
通讯作者：
Taveras, Elsie M.
影响因子：
--
作者：
通讯作者：
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