Implementation Core

项目总结 实施核心的主要作用是：1)协调核心职能和流程；2)优化 并集成临床决策支持；以及3)支持培训和干预保真度 干预措施。实施核心负责人Grudzen(MPI)和核心总监将负责监督 协调、适应和保真度监测与项目负责人(Chodosh、Brody、Shah)的投入，以及 实施科学家(Mittman)、定性方法学家(Dickson和Arbaje)。他们将监督 与首席信息学家(MANN)合作优化临床决策支持。这些调味品 合作者得到丰富的研究基础设施和具有以下专业知识的人员的支持 在患有严重疾病的老年人中，在多种环境中实施复杂的健康干预措施。 纽约大学格罗斯曼医学院，纽约大学罗里·迈尔斯护理学院，威斯康星大学麦迪逊分校， 纪念斯隆·凯特林和MPI团队在协调核心职能方面拥有丰富的专业知识 复杂的干预措施，在不同的环境中实现跨多地点务实试验的高保真，并定制 跨不同的电子健康记录(EHR)平台的可用的临床决策支持工具。为了确保 根据不同环境中的当地背景因素，实施核心指导委员会将参与 生活体验小组和生活实践小组预先指定表格中允许的改编，包括 投放方式、涉及的提供者、所需材料或工具、剂量和频率/强度。此外 监督核心的所有方面，执行核心领导格鲁岑，核心主任将领导 监督和持续改进执行情况的战略。他们将首先进行需求评估，并 评估每个站点的准备情况，以制定量身定制的实施蓝图。这将包括详细的标准 描述实施战略以及计划内和计划外调整将如何进行的操作程序 随着时间的推移进行管理、测量/记录和报告。他们将与行政部门协调 核心，监督每一次干预的保真度，以确保所有核心职能在三人小组期间执行 相遇。实现高保真的方法将包括在多个地点进行试点测试；确定护士， 每个急诊室的医生和社会工作冠军；建立点对点学习网络；以及使用 评估和迭代工具，直到达到保真度目标。在试点测试期间对变化进行周期性的小规模测试将 确定最佳实施策略。首席信息学家将指导用于优化 临床决策支持，并确保内部和外部之间的文档和沟通 护理团队的成员既顺从又无缝。数据管理员将与站点合作，以建立 他们的EHR构建和提取方法。信息学分析师将确保数据提取正常运行， 提供用于实时保真度监测的数据，并将数据打包并发送到统计分析核心，以便 可进一步为实时和以后的结果分析服务的分析。

PROJECT SUMMARY The primary roles of the Implementation Core are to: 1) harmonize core functions and processes; 2) optimize and integrate clinical decision support; and 3) enable training and intervention fidelity across the three interventions. The Implementation Core Lead, Grudzen (mPI), and the Core Director will oversee harmonization, adaptation, and fidelity monitoring with input from the project leads (Chodosh, Brody, Shah), an implementation scientist (Mittman), qualitative methodologists (Dickson and Arbaje). They will oversee optimization of clinical decision support in collaboration with a lead informatician (Mann). These seasoned collaborators are supported by a rich research infrastructure and personnel with expertise in the implementation of complex health interventions across multiple settings in older adults with serious illness. NYU Grossman School of Medicine, NYU Rory Meyers College of Nursing, University of Wisconsin-Madison, Memorial Sloan Kettering, and the mPI team have substantial expertise in harmonizing core functions of complex interventions, enabling high fidelity across multi-site pragmatic trials in diverse settings, and tailoring usable clinical decision support tools across variable electronic health record (EHR) platforms. To ensure tailoring to local contextual factors across settings, the Implementation Core Steering Committee will engage the Lived Experience Panel and Lived Practice Panel to pre-specify allowable adaptations in form, including the mode of delivery, providers involved, materials or tools needed, dose, and frequency/intensity. Besides overseeing all aspects of the core, the Implementation Core Lead Grudzen and the Core Director will lead strategy to monitor and continually improve implementation. They will first conduct a needs assessment and assess readiness at each site to develop a tailored implementation blueprint. This will include detailed standard operating procedures that describe implementation strategies and how planned and unplanned adaptations will be managed, measured/documented, and reported over time. They will, in coordination with the Administrative Core, oversee the fidelity of each intervention to ensure all core functions are performed during the triadic encounters. Approaches to achieve high fidelity will include pilot testing at multiple sites; identifying nurse, physician, and social work champions at each ED; establishing peer-to-peer learning networks; and using evaluative and iterative tools until fidelity targets are met. Cyclical small tests of change during pilot testing will identify optimal implementation strategies. The lead informatician will direct the processes used to optimize the clinical decision support and ensure that documentation and communication between internal and external members of the care team are both compliant and seamless. A data manager will work with sites to establish their EHR builds and extraction methods. An informatics analyst will ensure data extractions function properly, present data for real-time fidelity monitoring, and package and send data to the Statistical Analysis Core for analyses that may further serve real-time and later outcome analyses.