将卫生服务研究实施促进行动框架应用于农村小医院的团队策略与工具（TeamSTEPPS）实施中。
Promoting Action on Research Implementation in Health Services framework applied to TeamSTEPPS implementation in small rural hospitals.
作者信息
Ward Marcia M, Baloh Jure, Zhu Xi, Stewart Greg L
机构信息
Marcia M. Ward, PhD, is Professor, College of Public Health, University of Iowa. E-mail:
出版信息
Health Care Manage Rev. 2017 Jan/Mar;42(1):2-13. doi: 10.1097/HMR.0000000000000086.
BACKGROUND
A particularly useful model for examining implementation of quality improvement interventions in health care settings is the PARIHS (Promoting Action on Research Implementation in Health Services) framework developed by Kitson and colleagues. The PARIHS framework proposes three elements (evidence, context, and facilitation) that are related to successful implementation.
PURPOSES
An evidence-based program focused on quality enhancement in health care, termed TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), has been widely promoted by the Agency for Healthcare Research and Quality, but research is needed to better understand its implementation. We apply the PARIHS framework in studying TeamSTEPPS implementation to identify elements that are most closely related to successful implementation.
METHODOLOGY/APPROACH: Quarterly interviews were conducted over a 9-month period in 13 small rural hospitals that implemented TeamSTEPPS. Interview quotes that were related to each of the PARIHS elements were identified using directed content analysis. Transcripts were also scored quantitatively, and bivariate regression analysis was employed to explore relationships between PARIHS elements and successful implementation related to planning activities.
FINDINGS
The current findings provide support for the PARIHS framework and identified two of the three PARIHS elements (context and facilitation) as important contributors to successful implementation.
PRACTICE IMPLICATIONS
This study applies the PARIHS framework to TeamSTEPPS, a widely used quality initiative focused on improving health care quality and patient safety. By focusing on small rural hospitals that undertook this quality improvement activity of their own accord, our findings represent effectiveness research in an understudied segment of the health care delivery system. By identifying context and facilitation as the most important contributors to successful implementation, these analyses provide a focus for efficient and effective sustainment of TeamSTEPPS efforts.
背景
用于检验医疗保健环境中质量改进干预措施实施情况的一个特别有用的模型是基特森及其同事开发的PARIHS（促进卫生服务研究实施行动）框架。PARIHS框架提出了与成功实施相关的三个要素（证据、背景和促进因素）。
目的
一项以提高医疗保健质量为重点的循证项目，即团队策略与工具提升绩效和患者安全（TeamSTEPPS），已得到医疗保健研究与质量局的广泛推广，但需要开展研究以更好地了解其实施情况。我们应用PARIHS框架来研究TeamSTEPPS的实施，以确定与成功实施最密切相关的要素。
方法/途径：在13家实施了TeamSTEPPS的农村小医院进行了为期9个月的季度访谈。使用定向内容分析法确定与PARIHS各要素相关的访谈引述。还对访谈记录进行了定量评分，并采用双变量回归分析来探讨PARIHS要素与与规划活动相关的成功实施之间的关系。
研究结果
当前的研究结果为PARIHS框架提供了支持，并确定了PARIHS三个要素中的两个（背景和促进因素）是成功实施的重要促成因素。
实践意义
本研究将PARIHS框架应用于TeamSTEPPS，这是一项广泛使用的旨在提高医疗保健质量和患者安全的质量倡议。通过关注自行开展这项质量改进活动的农村小医院，我们的研究结果代表了对医疗保健提供系统中一个研究不足的部分的有效性研究。通过确定背景和促进因素是成功实施的最重要促成因素，这些分析为高效有效地维持TeamSTEPPS的努力提供了重点。
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