*RAND Corporation, Santa Monica, CA †IMPAQ International, Columbia, MD ‡Geffen School of Medicine, University of California, Los Angeles, CA.
Med Care. 2014 Feb;52(2 Suppl 1):S83-90. doi: 10.1097/MLR.0000000000000032.
Strengthening capacity across the healthcare system for improvement is critical to ensuring that past efforts and investments establish a foundation for sustaining progress in patient safety.
The objective of this analysis was to identify key system capacity issues for sustainability from evaluation of the Action Plan to prevent healthcare-associated infections, a major national initiative launched by the US Department of Health and Human Services in 2009.
The analysis involves the review and synthesis of results across the components of a 3-year evaluation of the Action Plan, as described in the evaluation framework and detailed in separate analyses elsewhere in this special issue. Data collection methods included interviews with government and private stakeholders, document and literature reviews, and observations of meetings and conferences at multiple time points.
Key developments in healthcare-associated infection prevention system capacity were extracted on the basis of "major activities" identified through multiple methods and organized into the level of progress based on perspectives of multiple stakeholders. Activities within each level were then examined and compared according to our evaluation's framework of 4 system functions and 5 system properties.
Key system capacity and sustainability issues for the Action Plan to be addressed centered on coordination and alignment (among participating agencies, with other federal initiatives, and across levels of healthcare), infrastructure for data and accountability (including more efficient technologies and unintended consequences), cultural embedding of prevention practices, and uncertainty and variability in resources.
Sustainability depends on improvements across system functions and properties and how they reinforce each other. Change is more robust if different system elements support and incentivize behavior in similar directions.
加强医疗体系的能力对于确保过去的努力和投资为患者安全的持续进展奠定基础至关重要。
本分析的目的是从评估预防医疗保健相关感染行动计划（美国卫生与公众服务部于 2009 年发起的一项重大国家倡议）中确定可持续性的关键系统能力问题。
该分析涉及对行动计划三年评估的各个组成部分的结果进行审查和综合，如评估框架所述，并在本特刊的其他地方的单独分析中详细说明。数据收集方法包括对政府和私营利益相关者的访谈、文件和文献综述以及在多个时间点对会议和会议的观察。
根据通过多种方法确定的“主要活动”，提取医疗保健相关感染预防系统能力的主要发展情况，并根据多方利益相关者的观点将其组织到进展水平。然后根据我们评估的 4 个系统功能和 5 个系统属性框架检查和比较每个级别内的活动。
行动计划的关键系统能力和可持续性问题集中在协调和一致性（参与机构之间、与其他联邦倡议之间以及医疗保健各个层面之间）、数据和问责制基础设施（包括更高效的技术和意外后果）、预防实践的文化嵌入以及资源的不确定性和可变性。
可持续性取决于系统功能和特性的改进以及它们如何相互加强。如果不同的系统要素以相似的方向支持和激励行为，那么变革就更加稳健。
