Barriers and Facilitators to the Implementation of Family-Centered Technology in Complex Care: Feasibility Study.
Barriers and Facilitators to the Implementation of Family-Centered Technology in Complex Care: Feasibility Study.
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DOI：
10.2196/30902
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发表时间：
2022-08-23
影响因子：
7.4
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中科院分区：
文献类型：
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护理协调是具有挑战性的，但对于医学复杂性（CMC）儿童至关重要。基于技术的解决方案越来越普遍，但很少有人知道如何在CMC的护理中成功部署它们。本研究的目的是评估GoalKeeper（GK）的可行性和可接受性，这是一个基于互联网的系统，用于引出和监测以家庭为中心的CMC目标，并确定实施的障碍和促进因素。我们使用了实施研究的综合框架（CFIR），以探讨实施GK的障碍和促进因素，作为GK在儿童医院门诊临床试验的一部分（NCT 03620071）。该研究分3个阶段进行：实施前、实施（试验）和实施后。在试验中，我们招募了参与诊所的医疗服务提供者和12岁以下CMC的英语父母，他们可以在家中上网。所有参与者在首次临床访视期间和3个月后使用GK。我们进行了实施前的焦点小组和实施后的半结构化离职面谈使用CFIR面试指南。参与者退出调查评估GK的可行性和可接受性的5点李克特量表。对于每次访谈，3名独立编码员使用基于CFIR定性分析计划的内容分析和序列编码审查，并为每个CFIR结构分配定量评级（-2强障碍+2强促进者）。实施前焦点小组包括2名家长（1名男性参与者和1名女性参与者）和3名供应商（1名复杂护理，1名临床信息学和1名神经学）。从焦点小组中，我们开发了3种实施策略：教育（父母：5分钟演示;提供者：30分钟的教程和5分钟的诊所访问视频;两者：指导手册），技术支持（面对面，虚拟）和自动电子邮件提醒父母。对于实施（2019年4月1日至2020年12月21日），我们招募了11名提供者（7名女性参与者，5名复杂护理人员）和35名父母（平均年龄38.3岁，SD 7.8岁; n=28，80%女性; n=17，49%白人; n=16，46%西班牙裔; n=30，86%至少有一些大学）。一对父母-提供者在诊所就诊时没有使用GK，就诊后也很少有人使用GK。在18个家长和9个供应商退出访谈中，关键的促进因素是共同的目标设定，GK的互联网可访问性和电子邮件提醒（家长），以及GK的能力，以设定长期目标和使用在访问结束时（供应商）。一个关键的障碍是GK缺乏与电子健康记录或患者门户网站的集成。大多数家长（13/19）和供应商（6/9）会向他们的同龄人推荐GK。像GK这样以家庭为中心的技术对于CMC的护理是可行和可接受的，但持续使用取决于集成到电子健康记录中。ClinicalTrials.gov NCT03620071; https://clinicaltrials.gov/ct2/show/NCT03620071
Care coordination is challenging but crucial for children with medical complexity (CMC). Technology-based solutions are increasingly prevalent but little is known about how to successfully deploy them in the care of CMC. The aim of this study was to assess the feasibility and acceptability of GoalKeeper (GK), an internet-based system for eliciting and monitoring family-centered goals for CMC, and to identify barriers and facilitators to implementation. We used the Consolidated Framework for Implementation Research (CFIR) to explore the barriers and facilitators to the implementation of GK as part of a clinical trial of GK in ambulatory clinics at a children’s hospital (NCT03620071). The study was conducted in 3 phases: preimplementation, implementation (trial), and postimplementation. For the trial, we recruited providers at participating clinics and English-speaking parents of CMC<12 years of age with home internet access. All participants used GK during an initial clinic visit and for 3 months after. We conducted preimplementation focus groups and postimplementation semistructured exit interviews using the CFIR interview guide. Participant exit surveys assessed GK feasibility and acceptability on a 5-point Likert scale. For each interview, 3 independent coders used content analysis and serial coding reviews based on the CFIR qualitative analytic plan and assigned quantitative ratings to each CFIR construct (–2 strong barrier to +2 strong facilitator). Preimplementation focus groups included 2 parents (1 male participant and 1 female participant) and 3 providers (1 in complex care, 1 in clinical informatics, and 1 in neurology). From focus groups, we developed 3 implementation strategies: education (parents: 5-minute demo; providers: 30-minute tutorial and 5-minute video on use in a clinic visit; both: instructional manual), tech support (in-person, virtual), and automated email reminders for parents. For implementation (April 1, 2019, to December 21, 2020), we enrolled 11 providers (7 female participants, 5 in complex care) and 35 parents (mean age 38.3, SD 7.8 years; n=28, 80% female; n=17, 49% Caucasian; n=16, 46% Hispanic; and n=30, 86% at least some college). One parent-provider pair did not use GK in the clinic visit, and few used GK after the visit. In 18 parent and 9 provider exit interviews, the key facilitators were shared goal setting, GK’s internet accessibility and email reminders (parents), and GK’s ability to set long-term goals and use at the end of visits (providers). A key barrier was GK’s lack of integration into the electronic health record or patient portal. Most parents (13/19) and providers (6/9) would recommend GK to their peers. Family-centered technologies like GK are feasible and acceptable for the care of CMC, but sustained use depends on integration into electronic health records. ClinicalTrials.gov NCT03620071; https://clinicaltrials.gov/ct2/show/NCT03620071
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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
DOI：
10.1186/s13012-015-0242-0
发表时间：
2015-04-21
期刊：
Implementation science : IS
影响因子：
--
作者：
Nilsen P
通讯作者：
Nilsen P
影响因子：
7.4
作者：
Mackert M;Mabry-Flynn A;Champlin S;Donovan EE;Pounders K
通讯作者：
Pounders K
影响因子：
3.5
作者：
Garth, Belinda;Murphy, Gregory C.;Reddihough, Dinah S.
通讯作者：
Reddihough, Dinah S.
影响因子：
8
作者：
Nkoy, Flory L.;Fassl, Bernhard A.;Stone, Bryan L.
通讯作者：
Stone, Bryan L.