Barriers and enablers in the implementation of a quality improvement program for acute coronary syndromes in hospitals: a qualitative analysis using the consolidated framework for implementation research.
Barriers and enablers in the implementation of a quality improvement program for acute coronary syndromes in hospitals: a qualitative analysis using the consolidated framework for implementation research.
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实施医院急性冠状动脉综合征质量改进计划的障碍和推动因素：使用实施研究综合框架的定性分析
DOI：
10.1186/s13012-022-01207-6
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发表时间：
2022-06-01
影响因子：
7.2
通讯作者：
Zheng, Zhi-Jie
中科院分区：
文献类型：
--
作者：
Zhou, Shuduo;Ma, Junxiong;Dong, Xuejie;Li, Na;Duan, Yuqi;Wang, Zongbin;Gao, Liqun;Han, Lu;Tu, Shu;Liang, Zhisheng;Liu, Fangjing;LaBresh, Kenneth A.;Smith, Sidney C. Jr Jr;Jin, Yinzi;Zheng, Zhi-Jie
缺血性心脏病在全球造成很高的疾病负担，在治疗方面面临诸多挑战，特别是在中国等发展中国家。国家胸痛中心项目（NCPCP）在中国启动，是第一个全国性的、以医院为基础的、全面的、持续质量改进（QI）项目，旨在改善急性冠状动脉综合征（ACS）的早期诊断和标准化治疗，并改善患者的临床结果。随着NCPCP的实施和扩大，我们调查了NCPCP实施过程中的障碍和推动因素，并提供了克服这些障碍的例子和想法。方法我们在中国六个城市进行了具有全国代表性的调查。共有165名关键信息受访者，包括90家医院胸痛中心（cpc）的主任和协调员，参加了半结构化访谈。访谈被逐字转录，翻译成英文，并在NVivo 12.0中进行分析。我们使用了实施研究综合框架（CFIR）来指导准则和主题。结果NCPCP实施的障碍主要来自于9个CFIR结构。障碍包括干预的复杂性（复杂性），要求的灵活性低（适应性），对ACS患者胸痛的认识不足（患者需求和资源），相对较低的政府支持（外部政策和激励），急诊科和其他相关部门的人员流动性（结构特征），相关部门的阻力（网络和通信），CPC协调员的任务繁重（兼容性），缺乏常规方案协调会业务的可用资源（可用资源），以及对干预措施实施的忠诚和可持续性（执行）。干预实施的推动因素包括变革的内在动机（干预来源）、干预的证据强度和质量、相对较低的成本（成本）、个人对干预的认识和信念、来自其他医院的压力（同伴压力）、干预的激励和奖励、医院领导的参与（领导参与、参与）。结论简化干预措施以适应医务人员的日常任务，优化院前急救系统与政府支持下的院内治疗系统之间的运作机制，提高胸痛患者的急救意识，对NCPCP的实施至关重要。澄清和解决这些障碍是在中国和世界各地发展中国家设计可持续的急性心血管疾病QI项目的关键。试验注册本研究已在中国临床试验注册中心（ChiCTR 2100043319）注册，注册日期为2021年2月10日。
BackgroundIschemic heart disease causes a high disease burden globally and numerous challenges in treatment, particularly in developing countries such as China. The National Chest Pain Centers Program (NCPCP) was launched in China as the first nationwide, hospital-based, comprehensive, continuous quality improvement (QI) program to improve early diagnosis and standardized treatment of acute coronary syndromes (ACS) and improve patients’ clinical outcomes. With implementation and scaling up of the NCPCP, we investigated barriers and enablers in the NCPCP implementation process and provided examples and ideas for overcoming such barriers.MethodsWe conducted a nationally representative survey in six cities in China. A total of 165 key informant interviewees, including directors and coordinators of chest pain centers (CPCs) in 90 hospitals, participated in semi-structured interviews. The interviews were transcribed verbatim, translated into English, and analyzed in NVivo 12.0. We used the Consolidated Framework for Implementation Research (CFIR) to guide the codes and themes.ResultsBarriers to NCPCP implementation mainly arose from nine CFIR constructs. Barriers included the complexity of the intervention (complexity), low flexibility of requirements (adaptability), a lack of recognition of chest pain in patients with ACS (patient needs and resources), relatively low government support (external policies and incentives), staff mobility in the emergency department and other related departments (structural characteristics), resistance from related departments (networks and communications), overwhelming tasks for CPC coordinators (compatibility), lack of available resources for regular CPC operations (available resources), and fidelity to and sustainability of intervention implementation (executing). Enablers of intervention implementation were inner motivation for change (intervention sources), evidence strength and quality of intervention, relatively low cost (cost), individual knowledge and beliefs regarding the intervention, pressure from other hospitals (peer pressure), incentives and rewards of the intervention, and involvement of hospital leaders (leadership engagement, engaging).ConclusionSimplifying the intervention to adapt routine tasks for medical staff and optimizing operational mechanisms between the prehospital emergency system and in-hospital treatment system with government support, as well as enhancing emergency awareness among patients with chest pain are critically important to NCPCP implementation. Clarifying and addressing these barriers is key to designing a sustainable QI program for acute cardiovascular diseases in China and similar contexts across developing countries worldwide.Trial registrationThis study was registered in the Chinese Clinical Trial Registry (ChiCTR 2100043319), registered 10 February 2021.
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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：
Berwanger, Otavio;Guimaraes, Helio P.;Lopes, Renato D.
通讯作者：
Lopes, Renato D.
DOI：
10.1108/01443570410552108
发表时间：
2004-01-01
影响因子：
9.9
作者：
Burnes, B
通讯作者：
Burnes, B
影响因子：
2.2
作者：
Fan, RP
通讯作者：
Fan, RP
影响因子：
5.4
作者：
Fan, Fangfang;Li, Yuxi;Ou, Zhihong
通讯作者：
Ou, Zhihong