National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, North Carolina 27705, USA.
Am J Prev Med. 2011 Nov;41(5):457-64. doi: 10.1016/j.amepre.2011.06.047.
Obesity is a substantial problem in the Veterans Health Administration (VHA). VHA developed and disseminated the MOVE! Weight Management Program for Veterans to its medical facilities but implementation of the program has been variable.
The objective was to explore variation in MOVE! program implementation to identify facility structure, policies, and processes associated with larger patient weight-loss outcomes.
Qualitative comparative analysis (QCA) was used to identify facility conditions or combinations of conditions associated with larger 6-month patient weight-loss outcomes. QCA is a method that allows for systematic cross-case comparison to better understand causal complexity. Eleven sites with larger outcomes and 11 sites with smaller outcomes were identified and data were collected with site interviews, facility-completed program summary forms, and medical record abstraction in 2009 and 2010. Conditions were selected based on theory and experience implementing MOVE! and were calibrated using QCA methods. Configuration patterns were examined to identify necessary conditions (i.e., always present when outcome present, but alone do not guarantee outcome) and sufficient conditions (i.e., presence guarantees outcome) at sites with larger and smaller outcomes. A thematic analysis of site interview data supplemented QCA findings.
No two sites shared the same condition pattern. Necessary conditions included the use of a standard curriculum and group care-delivery format, and they were present at all sites with larger outcomes but at only six sites with smaller outcomes. At the 17 sites with both necessary conditions, four combinations of conditions were identified that accounted for all sites with larger outcomes. These included high program complexity combined with high staff involvement; group care-delivery format combined with low accountability to facility leadership; an active physician champion combined with low accountability to facility leadership; and the use of quality-improvement strategies combined with not using a waiting list.
The use of a standard curriculum delivered with a group care-delivery format is an essential feature of successful VHA facility MOVE! Weight Management Programs, but alone does not guarantee success. Program development and policy will be used to ensure dissemination of the best practices identified in this evaluation.
肥胖是退伍军人健康管理局（VHA）的一个重大问题。VHA 为其医疗设施开发并传播了“MOVE！退伍军人体重管理计划”，但该计划的实施情况各不相同。
本研究旨在探讨“MOVE！”计划实施的差异，以确定与更大患者体重减轻结果相关的设施结构、政策和流程。
使用定性比较分析（QCA）来确定与更大 6 个月患者体重减轻结果相关的设施条件或条件组合。QCA 是一种允许系统地进行跨案例比较以更好地理解因果复杂性的方法。2009 年和 2010 年，确定了具有更大结果的 11 个站点和具有更小结果的 11 个站点，并通过站点访谈、设施完成的计划摘要表格和医疗记录摘要收集数据。根据实施“MOVE！”的理论和经验选择条件，并使用 QCA 方法进行校准。检查配置模式以确定在具有更大和更小结果的站点中存在的必要条件（即，结果存在时总是存在，但单独存在并不能保证结果）和充分条件（即，存在保证结果）。站点访谈数据的主题分析补充了 QCA 结果。
没有两个站点具有相同的条件模式。必要条件包括使用标准课程和小组护理交付格式，并且在所有具有更大结果的站点中都存在，但在只有六个具有更小结果的站点中存在。在具有必要条件的 17 个站点中，确定了四种条件组合，这些组合涵盖了所有具有更大结果的站点。这些组合包括高计划复杂性与高员工参与度相结合；小组护理交付格式与向设施领导层问责制较低相结合；积极的医生拥护者与向设施领导层问责制较低相结合；以及使用质量改进策略与不使用等待名单相结合。
使用小组护理交付格式提供的标准课程是 VHA 设施“MOVE！体重管理计划”成功的关键特征，但单独使用并不能保证成功。将制定计划和政策，以确保传播本评估中确定的最佳实践。
