Pre-Implementation of the Age-Friendly Health Systems Evidence-Based 4Ms Framework in a Multi-State Convenient Care Practice
Pre-Implementation of the Age-Friendly Health Systems Evidence-Based 4Ms Framework in a Multi-State Convenient Care Practice
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DOI：
10.1111/wvn.12498
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发表时间：
2021-04-01
影响因子：
4.3
通讯作者：
Pino, Lilia
中科院分区：
文献类型：
--
作者：
Dolansky, Mary A.;Pohnert, Anne;Pino, Lilia
背景 向老年人提供医疗保健服务的质量问题和社会人口结构的变化要求开展社会运动，以改善各种医疗保健环境中老年人的护理，包括门诊护理和便民护理诊所。 目的 描述将老年友好型卫生系统 (AFHS) 4Ms（即重要事项、药物治疗、精神状态和活动性）框架整合到 1,100 分钟诊所（零售店）中的预实施阶段CVS Health 的医疗诊所）使用实施研究综合框架 (CFIR) 和 RE-AIM（评估实施框架）。方法 CFIR 和 RE-AIM 模型指导数据收集。在 15 个月的时间内，通过观察、调查、访谈、焦点小组、组织准备情况评估、利益相关者评估和工作流程映射，从所有利益相关者（患者、医疗保健提供者、管理人员、教育工作者、信息学人员、沟通人员和实施顾问）收集数据，以确定潜在的障碍、促进因素和其他实施机会。 结果 CFIR 和 RE-AIM 实施框架提供了一种全面的方法来指导 AFHS 4Ms 框架的预实施阶段分钟诊所。 CFIR 指导的基线评估揭示了在实施前阶段开发和测试的实施策略选择方面的重要见解，RE-AIM 指导了逻辑模型开发的有意义的组成部分。将行动与证据联系起来随着越来越多的医疗保健系统集成 AFHS 4Ms 框架，该质量改进项目中报告的方法可以在其他环境中使用，以促进全面实施。
Background Quality issues in the delivery of healthcare services to older adults and changes in societal demographics call for a social movement to improve the care of older adults in a variety of healthcare settings, including ambulatory care and convenient care clinics.Aims To describe the pre-implementation phase to integrate the Age-Friendly Health Systems (AFHS) 4Ms (i.e., What Matters, Medication, Mentation, and Mobility) Framework in 1,100 MinuteClinics (the retail medical clinic of CVS Health) using the Consolidated Framework for Implementation Research (CFIR) and RE-AIM (an evaluation implementation framework).Methods The CFIR and RE-AIM models guided data collection. Data were collected from all stakeholders (patients, healthcare providers, managers, educators, informatics staff, communications staff, and implementation consultants) via observations, surveys, interviews, focus groups, organizational readiness assessment, stakeholder assessment, and workflow mapping during a 15-month period to identify potential barriers, facilitators, and other opportunities for implementation.Results The CFIR and RE-AIM implementation frameworks provided a comprehensive approach to guide the pre-implementation phase of the AFHS 4Ms Framework at the MinuteClinic. The baseline assessments guided by the CFIR revealed important insights in the choice of implementation strategies that were developed and tested in the pre-implementation phase, and the RE-AIM guided meaningful components to the development of the logic model.Linking Action to Evidence As more healthcare systems integrate the AFHS 4Ms Framework, the approach reported in this quality improvement project can be used in other settings to facilitate a comprehensive implementation.