Evaluation of multi-level barriers and facilitators in a large diabetic retinopathy screening program in federally qualified health centers: a qualitative study.
Evaluation of multi-level barriers and facilitators in a large diabetic retinopathy screening program in federally qualified health centers: a qualitative study.
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DOI：
10.1186/s43058-021-00157-2
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发表时间：
2021-05-22
影响因子：
--
通讯作者：
Studts CR
中科院分区：
文献类型：
--
作者：
Bastos de Carvalho A;Lee Ware S;Belcher T;Mehmeti F;Higgins EB;Sprang R;Williams C;Studts JL;Studts CR
在美国，推荐的糖尿病患者年度糖尿病视网膜病变（DR）筛查率较低，尤其是在服务不足的人群中。初级保健诊所的远程医疗DR筛查（TDRS）可以扩大可及性并提高依从性。尽管有这种潜力，但研究观察到，随着时间的推移，不同诊所的TDRS率存在很大差异，这突出表明需要实施支持。以往关于TDRS影响因素的研究主要集中在患者的角度，很少有针对上游多层次障碍和促进因素的研究。为了解决这一差距，这项定性研究旨在识别和评估联邦合格卫生中心（FQHC）中TDRS的多层次感知决定因素，为制定有针对性的实施策略提供信息。我们开发了一个基于理论的半结构化访谈工具的基础上实施研究的综合框架（CFIR）。我们与参与TDRS的专业人员（管理人员，临床医生，工作人员）进行了22次关键的线人访谈。访谈都有录音和逐字记录。报告的障碍和促进者被组织成紧急主题，并根据CFIR结构进行分类。研究者对每个研究中心影响TDRS实施的结构进行了评级，并在研究中心之间进行了比较。专业人士确定了21个主要的障碍和促进因素下的五个CFIR域的十二个结构。几个确定的主题是新颖的，而另一些则证实了文献中先前的发现（例如，缺乏时间和人力资源，没有倡导者）。在21个确定的主题中，有13个被归类在CFIR的内部设置域下，特别是在兼容性和可用资源的结构下。外部设置域（结构外部激励和成本）下的主题主要被认为是由管理员，而在其他领域的主题被认为是在所有专业类别。两个内部设置（领导参与，目标和反馈）和两个过程（冠军，参与）的结构被发现强烈区分高与低TDRS性能的网站。本研究将TDRS的障碍和促进因素进行了分类，这些障碍和促进因素是由管理人员、临床医生和CNOHC工作人员感知的，然后确定了区分高绩效和低绩效诊所的CFIR结构。因此，实施战略，如学术细节和收集和沟通的方案数据和成功的领导，通过参与实施规划的利益攸关方的参与，并任命干预冠军可以改善中继卫星的实施和维持在资源有限的设置。在线版本包含补充材料，可通过10.1186/s43058-021-00157-2获得。
Recommended annual diabetic retinopathy (DR) screening for people with diabetes has low rates in the USA, especially in underserved populations. Telemedicine DR screening (TDRS) in primary care clinics could expand access and increase adherence. Despite this potential, studies have observed high variability in TDRS rates among clinics and over time, highlighting the need for implementation supports. Previous studies of determinants of TDRS focus on patients’ perspectives, with few studies targeting upstream multi-level barriers and facilitators. Addressing this gap, this qualitative study aimed to identify and evaluate multi-level perceived determinants of TDRS in Federally Qualified Health Centers (FQHCs), to inform the development of targeted implementation strategies. We developed a theory-based semi-structured interview tool based on the Consolidated Framework for Implementation Research (CFIR). We conducted 22 key informant interviews with professionals involved in TDRS (administrators, clinicians, staff). The interviews were audio-recorded and transcribed verbatim. Reported barriers and facilitators were organized into emergent themes and classified according to CFIR constructs. Constructs influencing TDRS implementation were rated for each study site and compared across sites by the investigators. Professionals identified 21 main barriers and facilitators under twelve constructs of the five CFIR domains. Several identified themes were novel, whereas others corroborated previous findings in the literature (e.g., lack of time and human resources, presence of a champion). Of the 21 identified themes, 13 were classified under the CFIR’s Inner Setting domain, specifically under the constructs Compatibility and Available Resources. Themes under the Outer Setting domain (constructs External Incentives and Cost) were primarily perceived by administrators, whereas themes in other domains were perceived across all professional categories. Two Inner Setting (Leadership Engagement, Goals and Feedback) and two Process (Champion, Engaging) constructs were found to strongly distinguish sites with high versus low TDRS performance. This study classified barriers and facilitators to TDRS as perceived by administrators, clinicians, and staff in FQHCs, then identified CFIR constructs that distinguished high- and low-performance clinics. Implementation strategies such as academic detailing and collection and communication of program data and successes to leadership; engaging of stakeholders through involvement in implementation planning; and appointment of intervention champions may therefore improve TDRS implementation and sustainment in resource-constrained settings. The online version contains supplementary material available at 10.1186/s43058-021-00157-2.
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影响因子：
3.2
作者：
Hsieh, HF;Shannon, SE
通讯作者：
Shannon, SE
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
影响因子：
4.2
作者：
Cavallerano, AA;Cavallerano, JD;Aiello, LM
通讯作者：
Aiello, LM
影响因子：
8.1
作者：
Keenum, Zachary;McGwin, Gerald, Jr.;Owsley, Cynthia
通讯作者：
Owsley, Cynthia
DOI：
10.1682/jrrd.2005.08.0146
发表时间：
2006-09-01
影响因子：
--
作者：
Conlin, Paul R.;Fisch, Barry M.;Darkins, Adam W.
通讯作者：
Darkins, Adam W.