"Part of getting to where we are is because we have been open to change" integrating community health workers on care teams at ten Ryan White HIV/AIDS program recipient sites.
"Part of getting to where we are is because we have been open to change" integrating community health workers on care teams at ten Ryan White HIV/AIDS program recipient sites.
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DOI：
10.1186/s12889-021-10943-1
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发表时间：
2021-05-14
影响因子：
4.5
通讯作者：
Drainoni ML
中科院分区：
文献类型：
--
作者：
Sprague Martinez L;Davoust M;Rajabiun S;Baughman A;Bachman SS;Bowers-Sword R;Campos Rojo M;Sullivan M;Drainoni ML
长期以来，社区卫生工作者（CHWs）一直被纳入中低收入国家提供艾滋病毒护理的工作中。然而，在美国，人们对CHW融入艾滋病毒护理团队的情况知之甚少。迄今为止，美国的CHW整合研究已经探索了初级保健和以患者为中心的医疗家庭背景下的整合。有必要进行与促进卫生工作者成功融入艾滋病毒护理提供系统的策略相关的研究。2016年，卫生资源和服务管理局艾滋病毒/艾滋病局启动了一项为期三年的倡议，为瑞安·怀特艾滋病毒/艾滋病计划（RWHAP）的受助点提供培训、技术援助和评估，将卫生工作者纳入其多学科护理团队，从而加强他们接触有色人种社区的能力，减少艾滋病毒不平等现象。从8个州选出了10个RWHAP站点。多站点项目评估包括RE-AIM指导下的流程评估，以了解组织如何将卫生工作者融入其护理团队。现场团队成员参加了小组访谈，在早期实施和项目后期进行了流程演练。采用定向内容分析来检查方案实施情况。使用实施变革项目专家建议中概述的实施战略制定的代码应用于小组访谈（n = 20）。实施策略最常由站点描述，与组织层面的适应相关联，以便将CHW纳入艾滋病毒护理团队。其中包括修改、定义和区分专业角色以及改变组织政策。用于实施的战略，如网络编织、监督和促进适应性，是第二大最常被引用的战略，其次是培训和技术援助战略。在这些站点的实现经验中，有一些潜在的问题给医疗保健组织带来了挑战。组织政策和适应能力在促进CHW项目实施方面被证明是重要的。要将卫生保健员纳入提供艾滋病毒护理的工作中，就需要将他们的角色与医疗保健服务团队其他成员的角色明确区分开来。
Community Health Workers (CHWs) have long been integrated in the delivery of HIV care in middle- and low-income countries. However, less is known about CHW integration into HIV care teams in the United States (US). To date, US-based CHW integration studies have studies explored integration in the context of primary care and patient-centered medical homes. There is a need for research related to strategies that promote the successful integration of CHWs into HIV care delivery systems. In 2016, the Health Resources and Services Administration HIV/AIDS Bureau launched a three-year initiative to provide training, technical assistance and evaluation for Ryan White HIV/AIDS Program (RWHAP) recipient sites to integrate CHWs into their multidisciplinary care teams, and in turn strengthen their capacity to reach communities of color and reduce HIV inequities. Ten RWHAP sites were selected from across eight states. The multi-site program evaluation included a process evaluation guided by RE-AIM to understand how the organizations integrated CHWs into their care teams. Site team members participated in group interviews to walk-the-process during early implementation and following the program period. Directed content analysis was employed to examine program implementation. Codes developed using implementation strategies outlined in the Expert Recommendations for Implementing Change project were applied to group interviews (n = 20). Implementation strategies most frequently described by sites were associated with organizational-level adaptations in order to integrate the CHW into the HIV care team. These included revising, defining, and differentiating professional roles and changing organizational policies. Strategies used for implementation, such as network weaving, supervision, and promoting adaptability, were second most commonly cited strategies, followed by training and Technical Assistance strategies. Wrapped up in the implementation experience of the sites there were some underlying issues that pose challenges for healthcare organizations. Organizational policies and the ability to adapt proved significant in facilitating CHW program implementation. The integration of the CHWs in the delivery of HIV care requires clearly distinguishing their role from the roles of other members of the healthcare delivery team.
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影响因子：
3.7
作者：
Han HR;Kim K;Murphy J;Cudjoe J;Wilson P;Sharps P;Farley JE
通讯作者：
Farley JE
影响因子：
3.2
作者：
Hsieh, HF;Shannon, SE
通讯作者：
Shannon, SE
影响因子：
4.4
作者：
Rogers, Elizabeth A.;Manser, Sarah Turcotte;Call, Kathleen T.
通讯作者：
Call, Kathleen T.
影响因子：
2.8
作者：
Verhagen I;Steunenberg B;de Wit NJ;Ros WJ
通讯作者：
Ros WJ
影响因子：
5.9
作者：
Payne, Julianne;Razi, Sima;Tardif-Douglin, Miriam
通讯作者：
Tardif-Douglin, Miriam