Johnson Emily E, Simpson Annie N, Harvey Jillian B, Simpson Kit N
College of Nursing, Medical University of South Carolina, Room 414, 99 Jonathan Lucas Street, Charleston, SC, 29425, USA.
Department of Health Leadership and Management, Medical University of South Carolina, 151 Rutledge Avenue, Charleston, SC, 29425, USA.
Implement Sci. 2016 Feb 20;11:21. doi: 10.1186/s13012-016-0382-x.
Many beneficial health care interventions are either not put into practice or fail to diffuse over time due to complex contextual factors that affect implementation and diffusion. Bariatric surgery is an example of an effective intervention that recently experienced a plateau and decrease in rates, with minimal documented justification for this trend. While there are conceptual models that provide frameworks of general innovation implementation and diffusion, few studies have tested these models with data to measure the relative effects of factors that affect diffusion of specific health care interventions.
A literature review identified factors associated with implementation and diffusion of health care innovations. These factors were utilized to construct a conceptual model of diffusion to explain changes in bariatric surgery over time. Six data sources were used to construct measures of the study population and factors in the model that may affect diffusion of surgery. The population included obese and morbidly obese patients from 2002 to 2012 who had bariatric surgery in 15 states. Multivariable models were used to identify environmental, population, and medical practice factors that facilitated or impeded diffusion of bariatric surgery over time.
It was found that while bariatric surgery rates increased over time, the speed of growth in surgeries, or diffusion, slowed. Higher cumulative number of surgeries and higher proportion of the state population in age group 50-59 slowed surgery growth, but presence of Medicare centers of excellence increased the speed of surgery diffusion. Over time, the factors affecting the diffusion of bariatric surgery fluctuated, indicating that diffusion is affected by temporal and cumulative effects.
The primary driver of diffusion of bariatric surgery was the extent of centers of excellence presence in a state. Higher cumulative surgery rates and higher proportions of older populations in a state slowed diffusion. Surprisingly, measures of the presence of champions were not significant, perhaps because these are difficult to measure in the aggregate. Our results generally support the conceptual model of diffusion developed from the literature, which may be useful for examining other innovations, as well as for designing interventions to support rapid diffusion of innovations to improve health outcomes and quality of care.
由于影响实施和推广的复杂背景因素，许多有益的医疗保健干预措施要么未得到实施，要么随着时间的推移未能广泛传播。减肥手术就是一个有效的干预措施的例子，该手术最近经历了增长率的平稳期和下降，而对此趋势的记录在案的理由却很少。虽然有一些概念模型提供了一般创新实施和推广的框架，但很少有研究用数据来测试这些模型，以衡量影响特定医疗保健干预措施推广的因素的相对影响。
一项文献综述确定了与医疗保健创新的实施和推广相关的因素。这些因素被用来构建一个推广的概念模型，以解释减肥手术随时间的变化。六个数据源被用来构建研究人群的测量指标以及模型中可能影响手术推广的因素。研究人群包括2002年至2012年在15个州接受减肥手术的肥胖和病态肥胖患者。多变量模型被用来识别随着时间的推移促进或阻碍减肥手术推广的环境、人群和医疗实践因素。
研究发现，虽然减肥手术率随时间增加，但手术增长速度或推广速度放缓。手术累计数量较高以及50 - 59岁年龄组在该州人口中所占比例较高会减缓手术增长，但存在医疗保险卓越中心会提高手术推广速度。随着时间的推移，影响减肥手术推广的因素波动不定，表明推广受到时间和累积效应的影响。
减肥手术推广的主要驱动因素是一个州内卓越中心的存在程度。一个州内较高的累计手术率和较高比例的老年人口会减缓推广速度。令人惊讶的是，倡导者存在程度的测量指标并不显著，也许是因为这些指标难以整体衡量。我们的结果总体上支持从文献中发展而来的推广概念模型，该模型可能有助于研究其他创新，以及设计干预措施以支持创新的快速推广，从而改善健康结果和医疗质量。
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