The relationship between baseline Organizational Readiness to Change Assessment subscale scores and implementation of hepatitis prevention services in substance use disorders treatment clinics: a case study.
The relationship between baseline Organizational Readiness to Change Assessment subscale scores and implementation of hepatitis prevention services in substance use disorders treatment clinics: a case study.
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DOI：
10.1186/1748-5908-5-46
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发表时间：
2010-06-14
期刊：
影响因子：
--
通讯作者：
Heideman PW
中科院分区：
文献类型：
--
作者：
Hagedorn HJ;Heideman PW
组织变革准备程度评估 (ORCA) 是衡量组织在医疗保健环境中实施实践变革的准备程度的指标，该评估是根据卫生服务研究实施促进行动 (PARIHS) 框架的核心要素和子要素进行组织的。据报道，ORCA 的可靠性和因子结构得到了普遍支持。然而，尚无已发表的研究检验 ORCA 在临床环境中的实用性。本研究的目的是检查基线 ORCA 评分与物质使用障碍 (SUD) 诊所实施肝炎预防服务之间的关系。来自美国各地退伍军人健康管理局 SUD 诊所的九个诊所团队参加了为期六个月的培训计划，以促进肝炎预防的循证实践。每个团队的代表在基线上完成了 ORCA 证据和背景分量表。九家诊所中有八家报告在完成六个月的培训计划后实施了至少一种新的肝炎预防实践。临床团队根据完成培训计划后将多少肝炎预防实践纳入其诊所，按实施水平进行分类——高（n = 4）与低（n = 5）。与低实施团队相比，高实施团队在 ORCA 的患者体验和领导文化分量表上得分显着更高。虽然在这个小样本中没有达到显着性，但与低实施诊所相比，高实施诊所在研究、临床经验、员工文化、领导行为和测量子量表方面的得分也更高。这项研究的结果表明，ORCA 能够测量在随访时报告实践建议实施率高和低的诊所之间基线组织因素的差异。这支持使用 ORCA 来描述与在临床环境中实施实践建议相关的因素。未来利用更大样本量的研究对于支持这些初步发现至关重要。
The Organizational Readiness to Change Assessment (ORCA) is a measure of organizational readiness for implementing practice change in healthcare settings that is organized based on the core elements and sub-elements of the Promoting Action on Research Implementation in Health Services (PARIHS) framework. General support for the reliability and factor structure of the ORCA has been reported. However, no published study has examined the utility of the ORCA in a clinical setting. The purpose of the current study was to examine the relationship between baseline ORCA scores and implementation of hepatitis prevention services in substance use disorders (SUD) clinics. Nine clinic teams from Veterans Health Administration SUD clinics across the United States participated in a six-month training program to promote evidence-based practices for hepatitis prevention. A representative from each team completed the ORCA evidence and context subscales at baseline. Eight of nine clinics reported implementation of at least one new hepatitis prevention practice after completing the six-month training program. Clinic teams were categorized by level of implementation-high (n = 4) versus low (n = 5)-based on how many hepatitis prevention practices were integrated into their clinics after completing the training program. High implementation teams had significantly higher scores on the patient experience and leadership culture subscales of the ORCA compared to low implementation teams. While not reaching significance in this small sample, high implementation clinics also had higher scores on the research, clinical experience, staff culture, leadership behavior, and measurement subscales as compared to low implementation clinics. The results of this study suggest that the ORCA was able to measure differences in organizational factors at baseline between clinics that reported high and low implementation of practice recommendations at follow-up. This supports the use of the ORCA to describe factors related to implementing practice recommendations in clinical settings. Future research utilizing larger sample sizes will be essential to support these preliminary findings.
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