*RAND Corporation, Santa Monica, CA †IMPAQ International, Washington, DC ‡IMPAQ International, Columbia, MD §Geffen School of Medicine, University of California, Los Angeles, CA.
Med Care. 2014 Feb;52(2 Suppl 1):S17-24. doi: 10.1097/MLR.0000000000000044.
In 2009, the US Department of Health and Human Services (HHS) launched the Action Plan to Prevent Healthcare-associated Infections (HAIs). The Action Plan adopted national targets for reduction of specific infections, making HHS accountable for change across the healthcare system over which federal agencies have limited control.
This article examines the unique infrastructure developed through the Action Plan to support adoption of HAI prevention practices.
Interviews of federal (n=32) and other stakeholders (n=38), reviews of agency documents and journal articles (n=260), and observations of interagency meetings (n=17) and multistakeholder conferences (n=17) over a 3-year evaluation period.
We extract key progress and challenges in the development of national HAI prevention infrastructure--1 of the 4 system functions in our evaluation framework encompassing regulation, payment systems, safety culture, and dissemination and technical assistance. We then identify system properties--for example, coordination and alignment, accountability and incentives, etc.--that enabled or hindered progress within each key development.
The Action Plan has developed a model of interagency coordination (including a dedicated "home" and culture of cooperation) at the federal level and infrastructure for stimulating change through the wider healthcare system (including transparency and financial incentives, support of state and regional HAI prevention capacity, changes in safety culture, and mechanisms for stakeholder engagement). Significant challenges to infrastructure development included many related to the same areas of progress.
The Action Plan has built a foundation of infrastructure to expand prevention of HAIs and presents useful lessons for other large-scale improvement initiatives.
2009 年，美国卫生与公众服务部（HHS）启动了《预防医疗保健相关感染行动计划》。该行动计划采用了减少特定感染的国家目标，使 HHS 对整个医疗体系的变革负责，而联邦机构对该体系的控制有限。
本文探讨了《行动计划》为支持采用 HAI 预防措施而开发的独特基础设施。
对联邦（n=32）和其他利益攸关方（n=38）进行访谈，对机构文件和期刊文章（n=260）进行审查，并对跨机构会议（n=17）和多利益攸关方会议（n=17）进行观察，评估期为 3 年。
我们提取了在国家 HAI 预防基础设施发展方面的关键进展和挑战——这是我们评估框架中 4 个系统功能之一，涵盖监管、支付系统、安全文化以及传播和技术援助。然后，我们确定了系统属性——例如协调和一致性、问责制和激励措施等——这些属性在每个关键发展中促进或阻碍了进展。
《行动计划》在联邦一级建立了机构间协调的模式（包括一个专门的“家园”和合作文化），并为通过更广泛的医疗体系激发变革建立了基础设施（包括透明度和财务激励措施、支持州和地区 HAI 预防能力、安全文化的变化以及利益相关者参与的机制）。基础设施发展面临的重大挑战包括许多与同一领域的进展相关的挑战。
《行动计划》为扩大预防医疗保健相关感染奠定了基础，并为其他大规模改进计划提供了有用的经验教训。
