Helfrich Christian D, Savitz Lucy A, Swiger Kathleen D, Weiner Bryan J
Health Services Research and Development Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington 98101, USA.
Am J Prev Med. 2007 Jul;33(1 Suppl):S50-8; quiz S59-65. doi: 10.1016/j.amepre.2007.04.002.
Innovations adopted by healthcare organizations are often externally mandated. However, few studies examine how mandated innovations progress from adoption to sustained effective use. This study uses Rogers's model of organizational innovation to explore community health centers' (CHCs') mandated adoption and implementation of disease registries in the federal Health Disparities Collaborative (HDC).
Case studies were conducted on six CHCs in North Carolina participating in the HDC on type 2 diabetes mellitus. Data were collected from semistructured interviews with key staff, and from site-level and individual-level surveys.
Although disease registry adoption and implementation were mandated, CHCs exercised prerogative in the timing of registry adoption and the functions emphasized. Executive and medical director involvement, often directly on the HDC teams, was the single most salient influence on adoption and implementation. Staff members' personal experience with diabetes also provided context and gave registries added significance. Participants lauded HDC's technique of small-scale, rapid-cycle change, but valued even more shared problem solving and peer learning among HDC teams. However, lack of cross-training, inadequate resources, and staff turnover posed serious threats to sustainability of the registries.
The present study illustrates the usefulness of Rogers's model for studying mandated innovation and highlights several key factors, including direct, personal involvement of organizational leadership, and shared problem solving and peer learning facilitated by the HDC. However, these six CHCs elected to participate early in the HDC, and may not be typical of North Carolina's remaining CHCs. Furthermore, most face important long-term challenges that threaten routinization.
医疗保健机构采用的创新举措通常是由外部强制要求的。然而，很少有研究探讨强制要求的创新如何从采用阶段发展到持续有效使用阶段。本研究运用罗杰斯的组织创新模型，来探究社区卫生中心（CHC）在联邦健康差异协作项目（HDC）中被强制要求采用和实施疾病登记系统的情况。
对北卡罗来纳州参与HDC中2型糖尿病项目的6家CHC进行了案例研究。数据收集自与关键工作人员的半结构化访谈，以及机构层面和个人层面的调查。
尽管疾病登记系统的采用和实施是被强制要求的，但CHC在采用登记系统的时间和所强调的功能方面拥有自主权。行政人员和医疗主任的参与，通常是直接参与HDC团队，是对采用和实施影响最为显著的单一因素。工作人员个人的糖尿病经历也提供了背景信息，并使登记系统更具意义。参与者称赞HDC的小规模、快速循环变革技术，但更重视HDC团队之间的共同问题解决和同行学习。然而，缺乏交叉培训、资源不足和人员流动对登记系统的可持续性构成了严重威胁。
本研究说明了罗杰斯模型在研究强制要求的创新方面的有用性，并突出了几个关键因素，包括组织领导层的直接亲身参与，以及HDC所推动的共同问题解决和同行学习。然而，这6家CHC选择在早期就参与HDC，可能并不代表北卡罗来纳州其他CHC的情况。此外，大多数CHC面临着威胁常规化的重要长期挑战。
