Facilitators and barriers of implementing the chronic care model in primary care: a systematic review.
Facilitators and barriers of implementing the chronic care model in primary care: a systematic review.
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DOI：
10.1186/s12875-014-0219-0
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发表时间：
2015-02-06
影响因子：
2.9
通讯作者：
Stolee P
中科院分区：
文献类型：
--
作者：
Kadu MK;Stolee P
慢性护理模式(CCM)是一个框架，旨在重新设计初级保健中慢性病患者的护理服务。CCM及其各个组成部分已被广泛采用和评估，然而，关于其实施的不同初级保健经验以及影响其成功采用的因素，人们知之甚少。本审查的目的是综合在初级保健中实施CCM的研究结果，以确定在实施过程中遇到的促进者和障碍。这项研究确定了描述初级保健环境中CCM的英文同行评议研究文章。在三个数据库中进行搜索：Web of Knowledge、Pubmed和Scope。文章摘要和标题的阅读依据是它们是否符合以下纳入标准：1)2003年后发表的描述或评估CCM实施情况的研究；2)护理环境是初级保健；3)研究的目标人群是18岁以上患有慢性病的成年人。研究按参考文献、研究设计和方法、参与者和设置、研究目标、使用的CCM成分和干预说明进行分类。数据提取的下一阶段包括利用研究实施综合框架对所列举的障碍和促进者进行定性分析。这项审查在22项研究中确定了在不同初级保健环境中实施的障碍和促进者。新出现的主要主题是与组织的内部环境、实施过程和个别保健提供者的特点有关的主题。这些因素包括：组织文化、其结构特征、网络和沟通、实施环境和准备情况、支持性领导的存在以及提供者的态度和信念。这些调查结果强调了在实施CCM之前和期间评估组织能力和需求的重要性，以及更好地了解卫生保健提供者和组织视角的重要性。
The Chronic Care Model (CCM) is a framework developed to redesign care delivery for individuals living with chronic diseases in primary care. The CCM and its various components have been widely adopted and evaluated, however, little is known about different primary care experiences with its implementation, and the factors that influence its successful uptake. The purpose of this review is to synthesize findings of studies that implemented the CCM in primary care, in order to identify facilitators and barriers encountered during implementation. This study identified English-language, peer-reviewed research articles, describing the CCM in primary care settings. Searches were performed in three data bases: Web of Knowledge, Pubmed and Scopus. Article abstracts and titles were read based on whether they met the following inclusion criteria: 1) studies published after 2003 that described or evaluated the implementation of the CCM; 2) the care setting was primary care; 3) the target population of the study was adults over the age of 18 with chronic conditions. Studies were categorized by reference, study design and methods, participants and setting, study objective, CCM components used, and description of the intervention. The next stage of data abstraction involved qualitative analysis of cited barriers and facilitators using the Consolidating Framework for Research Implementation. This review identified barriers and facilitators of implementation across various primary care settings in 22 studies. The major emerging themes were those related to the inner setting of the organization, the process of implementation and characteristics of the individual healthcare providers. These included: organizational culture, its structural characteristics, networks and communication, implementation climate and readiness, presence of supportive leadership, and provider attitudes and beliefs. These findings highlight the importance of assessing organizational capacity and needs prior to and during the implementation of the CCM, as well as gaining a better understanding of health care providers’ and organizational perspective.
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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：
120.7
作者：
Bodenheimer, T;Wagner, EH;Grumbach, K
通讯作者：
Grumbach, K
影响因子：
3.4
作者：
Bonomi, AE;Wagner, EH;VonKorff, M
通讯作者：
VonKorff, M
影响因子：
7.2
作者：
Kirsh, Susan R.;Lawrence, Renee H.;Aron, David C.
通讯作者：
Aron, David C.
影响因子：
9.7
作者：
Coleman, Katie;Austin, Brian T.;Wagner, Edward H.
通讯作者：
Wagner, Edward H.