HealthPathways implementation in a New Zealand health region: a qualitative study using the Consolidated Framework for Implementation Research
HealthPathways implementation in a New Zealand health region: a qualitative study using the Consolidated Framework for Implementation Research
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DOI：
10.1136/bmjopen-2018-025094
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发表时间：
2018-12-01
期刊：
影响因子：
2.9
通讯作者：
Gauld, Robin
中科院分区：
文献类型：
--
作者：
Stokes, Tim;Tumilty, Emma;Gauld, Robin
目的探索在线健康信息网络门户和转诊系统的实施过程（HealthPathways）使用实施科学理论：实施研究综合框架（CFIR）。新西兰南部卫生区（奥塔哥和南部地区）。（医疗保健的提供者和规划者）（n=10），他们参与了实施健康途径的过程，或打算结束-健康途径的用户。方法进行半结构化访谈。使用CFIR的演绎主题分析进行了使用的框架method.Results CFIR假设，要成功地实施干预，必须考虑到干预的核心组成部分和适应外围。HealthPathways的核心组成部分-包含大量本地化临床护理路径的门户网站和转诊系统-已被产品开发人员很好地解决。然而，很少有人注意到解决可适应的外围问题（与健康途径有关的可适应的要素、结构和系统以及实施该途径的组织）;人们认为，只要提供门户网站和转诊系统以及为成功实施而制定的一套临床护理途径就足够了。在CFIR的“内部环境”企业和专业文化方面，执行气候和执行准备在执行过程中没有得到适当的处理。实施过程中也有多处失败（例如，缺乏规划和与临床医生的接触）。因此，实施HealthPathways.Conclusions的使用CFIR进一步加深了我们对成功实施一个复杂的健康干预（HealthPathways）在新西兰卫生系统中所需的因素的理解。负责实施复杂的卫生干预措施的人应始终考虑到实施这些措施的当地背景，并调整其实施战略以解决这些问题。
Objectives To explore the process of implementation of an online health information web-based portal and referral system (HealthPathways) using implementation science theory: the Consolidated Framework for Implementation Research (CFIR).Setting Southern Health Region of New Zealand (Otago and Southland).Participants Key Informants (providers and planners of healthcare) (n=10) who were either involved in the process of implementing HealthPathways or who were intended end-users of HealthPathways.Methods Semistructured interviews were undertaken. A deductive thematic analysis using CFIR was conducted using the framework method.Results CFIR postulates that for an intervention to be implemented successfully, account must be taken of the intervention's core components and the adaptable periphery. The core component of HealthPathways-the web portal and referral system that contains a large number of localised clinical care pathways-had been addressed well by the product developers. Little attention had, however, been paid to addressing the adaptable periphery (adaptable elements, structures and systems related to HealthPathways and the organisation into which it was being implemented); it was seen as sufficient just to deliver the web portal and referral system and the set of clinical care pathways as developed to effect successful implementation. In terms of CFIR's 'inner setting' corporate and professional cultures, the implementation climate and readiness for implementation were not properly addressed during implementation. There were also multiple failures of the implementation process (eg, lack of planning and engagement with clinicians). As a consequence, implementation of HealthPathways was highly problematic.Conclusions The use of CFIR has furthered our understanding of the factors needed for the successful implementation of a complex health intervention (HealthPathways) in the New Zealand health system. Those charged with implementing complex health interventions should always consider the local context within which they will be implemented and tailor their implementation strategy to address these.