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开发和验证一个预测 IHCS 实施成功的模型:实施准备度模型。

Developing and validating a model to predict the success of an IHCS implementation: the Readiness for Implementation Model.

机构信息

Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19012, USA.

出版信息

J Am Med Inform Assoc. 2010 Nov-Dec;17(6):707-13. doi: 10.1136/jamia.2010.005546.

Abstract

OBJECTIVE

To develop and validate the Readiness for Implementation Model (RIM). This model predicts a healthcare organization's potential for success in implementing an interactive health communication system (IHCS). The model consists of seven weighted factors, with each factor containing five to seven elements.

DESIGN

Two decision-analytic approaches, self-explicated and conjoint analysis, were used to measure the weights of the RIM with a sample of 410 experts. The RIM model with weights was then validated in a prospective study of 25 IHCS implementation cases.

MEASUREMENTS

Orthogonal main effects design was used to develop 700 conjoint-analysis profiles, which varied on seven factors. Each of the 410 experts rated the importance and desirability of the factors and their levels, as well as a set of 10 different profiles. For the prospective 25-case validation, three time-repeated measures of the RIM scores were collected for comparison with the implementation outcomes.

RESULTS

Two of the seven factors, 'organizational motivation' and 'meeting user needs,' were found to be most important in predicting implementation readiness. No statistically significant difference was found in the predictive validity of the two approaches (self-explicated and conjoint analysis). The RIM was a better predictor for the 1-year implementation outcome than the half-year outcome.

LIMITATIONS

The expert sample, the order of the survey tasks, the additive model, and basing the RIM cut-off score on experience are possible limitations of the study.

CONCLUSION

The RIM needs to be empirically evaluated in institutions adopting IHCS and sustaining the system in the long term.

摘要

目的

开发和验证实施准备度模型(RIM)。该模型预测医疗保健组织在实施交互式健康通信系统(IHCS)方面的成功潜力。该模型由七个加权因素组成,每个因素包含五个至七个要素。

设计

使用两种决策分析方法,自我解释和联合分析,对 410 名专家进行样本测量,以确定 RIM 的权重。然后,在对 25 个 IHCS 实施案例的前瞻性研究中验证了带有权重的 RIM 模型。

测量

采用正交主效应设计开发了 700 个联合分析配置文件,这些配置文件在七个因素上有所不同。410 名专家中的每位专家都对因素及其水平的重要性和可取性进行了评分,以及一组 10 个不同的配置文件。对于前瞻性的 25 个案例验证,共收集了三个重复测量的 RIM 得分,以与实施结果进行比较。

结果

在预测实施准备度方面,七个因素中的两个因素,“组织动机”和“满足用户需求”,被认为是最重要的。两种方法(自我解释和联合分析)的预测有效性没有统计学上的显著差异。RIM 对 1 年的实施结果的预测能力优于半年的结果。

局限性

专家样本、调查任务的顺序、加性模型以及基于经验的 RIM 截止分数是该研究的可能局限性。

结论

RIM 需要在采用 IHCS 并长期维持系统的机构中进行实证评估。

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