Evaluating broad-scale system change using the Consolidated Framework for Implementation Research: challenges and strategies to overcome them.
Evaluating broad-scale system change using the Consolidated Framework for Implementation Research: challenges and strategies to overcome them.
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DOI：
10.1186/s13104-018-3650-9
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发表时间：
2018-08-04
影响因子：
1.8
通讯作者：
LaVela SL
中科院分区：
文献类型：
--
作者：
Hill JN;Locatelli SM;Bokhour BG;Fix GM;Solomon J;Mueller N;LaVela SL
本文的目的是通过讨论规划大规模变革评估时要解决的挑战以及评估团队为应对这些挑战而开发的解决方案，展示 CFIR 框架在评估大规模变革方面的实用性。对退伍军人事务部 (VA) 内以患者为中心的护理和文化转型 (PCC&CT) 实施情况的评估将用作示范性示例。以患者为中心的护理 (PCC) 是一种考虑患者情况和目标的个性化医疗保健。退伍军人事务部 (VA) 正在努力在其整个医疗保健系统中实施 PCC，其中包括多种干预措施，其单一长期目标是文化转型，但人们对影响其实施的因素知之甚少。本文讨论了使用 CFIR 定性评估影响文化转型实施的因素所出现的问题。 CFIR 在此大规模评估中的应用揭示了建议用于评估大规模变革实施情况的三种策略：(1) 需要对 CFIR 结构进行调整定义（特别是由于大规模变革的新应用），(2) 使用主题编码的混合演绎-归纳方法来捕获 CFIR 未涵盖的新兴主题，以及 (3) 将其用于快速分析和综合，以便将结果快速交付给运营合作伙伴。本文是最早描述使用 CFIR 来指导大规模转型评估（而不是离散干预措施）的论文之一。本文描述的流程和策略提供了详细的示例和结构化方法，可供其他评估大规模评估实施情况的人员使用和扩展。尽管CFIR是本次评估选择的框架，但本文描述的策略包括：使用改编的定义、使用混合演绎-归纳方法以及快速分析和综合的方法可以与其他框架一起转移和测试。
The objective of this paper is to demonstrate the utility of the CFIR framework for evaluating broad-scale change by discussing the challenges to be addressed when planning the assessment of broad-scale change and the solutions developed by the evaluation team to address those challenges. The evaluation of implementation of Patient-centered Care and Cultural Transformation (PCC&CT) within the Department of Veterans Affairs (VA) will be used as a demonstrative example. Patient-Centered Care (PCC) is personalized health care that considers a patient’s circumstances and goals. The Department of Veterans Affairs (VA) is working towards implementing PCC throughout its healthcare system, comprised of multiple interventions with a singular long-term goal of cultural transformation, however little is known about the factors influencing its implementation. This paper discusses the issues that arose using CFIR to qualitatively assess the factors influencing implementation of cultural transformation. Application of CFIR to this broad-scale evaluation revealed three strategies recommended for use in evaluating implementation of broad-scale change: (1) the need for adapted definitions for CFIR constructs (especially due to new application to broad-scale change), (2) the use of a mixed deductive-inductive approach with thematic coding to capture emergent themes not encompassed by CFIR, and (3) its use for expedited analysis and synthesis for rapid delivery of findings to operational partners. This paper is among the first to describe use of CFIR to guide the evaluation of a broad-scale transformation, as opposed to discrete interventions. The processes and strategies described in this paper provide a detailed example and structured approach that can be utilized and expanded upon by others evaluating implementation of broad-scale evaluations. Although CFIR was the framework selected for this evaluation, the strategies described in this paper including: use of adapted definitions, use of mixed deductive-inductive approach, and the approach for expedited analysis and synthesis can be transferred and tested with other frameworks.