Department of Public Health Sciences, Medical University of South Carolina (MUSC), 135 Cannon Street, Charleston, SC 29425, USA.
BMC Health Serv Res. 2013 Jan 29;13:33. doi: 10.1186/1472-6963-13-33.
Telemedicine technology can improve care to patients in rural and medically underserved communities yet adoption has been slow. The objective of this study was to study organizational readiness to participate in an academic-community hospital partnership including clinician education and telemedicine outreach focused on sepsis and trauma care in underserved, rural hospitals.
This is a multi-method, observational case study. Participants included staff from 4 participating rural South Carolina hospitals. Using a readiness-for-change model, we evaluated 5 general domains and the related factors or topics of organizational context via key informant interviews (n=23) with hospital leadership and staff, compared these to data from hospital staff surveys (n=86) and triangulated data with investigators' observational reports. Survey items were grouped into 4 categories (based on content and fit with conceptual model) and scored, allowing regression analyses for inferential comparisons to assess factors related to receptivity toward the telemedicine innovation.
General agreement existed on the need for the intervention and feasibility of implementation. Previous experience with a telemedicine program appeared pivotal to enthusiasm. Perception of need, task demands and resource need explained nearly 50% of variation in receptivity. Little correlation emerged with hospital or ED leadership culture and support. However qualitative data and investigator observations about communication and differing support among disciplines and between staff and leadership could be important to actual implementation.
A mixed methods approach proved useful in assessing organizational readiness for change in small organizations. Further research on variable operational definitions, potential influential factors, appropriate and feasible methods and valid instruments for such research are needed.
远程医疗技术可以改善农村和医疗资源匮乏社区患者的护理，但采用速度缓慢。本研究的目的是研究参与学术-社区医院伙伴关系的组织准备情况，包括对服务不足的农村医院的脓毒症和创伤护理进行临床医生教育和远程医疗外展。
这是一项多方法、观察性案例研究。参与者包括来自南卡罗来纳州 4 家参与农村医院的工作人员。我们使用变革准备模型，通过对医院领导和工作人员进行关键信息采访（n=23）评估了 5 个一般领域以及组织背景的相关因素或主题，将这些与来自医院工作人员调查（n=86）的数据进行了比较，并将数据与调查人员的观察报告进行了三角剖分。调查项目分为 4 类（基于内容和与概念模型的契合度）并进行评分，允许进行回归分析以进行推断性比较，从而评估与接受远程医疗创新相关的因素。
普遍认为需要干预和实施的可行性。以前使用远程医疗计划的经验对热情至关重要。对需求的感知、任务需求和资源需求解释了接受程度变化的近 50%。与医院或 ED 领导文化和支持的相关性很小。然而，关于沟通以及不同学科之间和员工与领导之间的不同支持的定性数据和调查人员观察可能对实际实施很重要。
混合方法方法证明在评估小型组织的变革准备情况方面非常有用。需要进一步研究变量操作定义、潜在影响因素、此类研究的适当和可行方法以及有效工具。
