Department of Health Sciences, The University of York, York YO10 5DD, England.
Implement Sci. 2013 May 29;8:56. doi: 10.1186/1748-5908-8-56.
In an era of scarce and competing priorities for implementation, choosing what to implement is a key decision point for many behavioural change projects. The values and attitudes of the professionals and managers involved inevitably impact the priority attached to decision options. Reliably capturing such values is challenging.
This paper presents an approach for capturing and incorporating professional values into the prioritization of healthcare innovations being considered for adoption. Conjoint Analysis (CA) was used in a single UK Primary Care Trust to measure the priorities of healthcare professionals working with women with postnatal depression. Rating-based CA data was gathered using a questionnaire and then mapped onto 12 interventions being considered as a means of improving the management of postnatal depression.
The 'impact on patient care' and the 'quality of supporting evidence' associated with the potential innovations were the most influential in shaping priorities. Professionals were least influenced by whether an innovation was an existing national or local priority, or whether current practice in the Trust was meeting minimum standards. Ranking the 12 innovations by the preferences of potential adopters revealed 'guided self help' was the top priority for implementation and 'screening questions for post natal depression' the least. When other factors were considered (such as the presence of routine data or planned implementation activity elsewhere in the Trust), the project team chose to combine the eight related treatments and implement these as a single innovation referred to as 'psychological therapies'.
Using Conjoint Analysis to prioritise potential innovation implementation options is a feasible means of capturing the utility of stakeholders and thus increasing the chances of an innovation being adopted. There are some practical barriers to overcome such as increasing response rates to conjoint surveys before routine and unevaluated use of this technique should be considered.
在资源稀缺且需优先考虑实施事项的时代，选择实施哪些内容是许多行为改变项目的关键决策点。相关专业人员和管理人员的价值观和态度不可避免地会影响决策选项的优先级。可靠地捕捉这些价值观具有挑战性。
本文提出了一种方法，用于捕获和将专业价值观纳入正在考虑采用的医疗创新的优先级排序中。联合分析（CA）在英国的一个初级保健信托基金中用于衡量与产后抑郁症女性合作的医疗保健专业人员的优先级。使用问卷收集基于评分的 CA 数据，然后将其映射到 12 种正在考虑用于改善产后抑郁症管理的干预措施上。
与潜在创新相关的“对患者护理的影响”和“支持证据的质量”是影响优先级的最重要因素。专业人员受创新是否是国家或地方现有优先事项，或者信托基金当前实践是否符合最低标准的影响最小。根据潜在采用者的偏好对 12 种创新进行排名，发现“指导自助”是实施的首要优先级，而“产后抑郁症筛查问题”的优先级最低。当考虑其他因素（例如常规数据的存在或信托基金中其他地方的计划实施活动）时，项目团队选择将这 8 种相关治疗方法结合起来，并将其作为一种名为“心理治疗”的单一创新实施。
使用联合分析对潜在创新实施选项进行优先级排序是捕获利益相关者效用的可行方法，从而增加创新被采用的机会。在考虑常规和未经评估使用这种技术之前，需要克服一些实际障碍，例如增加联合调查的回复率。
