Gold Rachel, Bunce Arwen E, Cohen Deborah J, Hollombe Celine, Nelson Christine A, Proctor Enola K, Pope Jill A, DeVoe Jennifer E
Kaiser Permanente Center for Health Research, Portland, Ore; OCHIN, Inc, Portland, Ore.
Kaiser Permanente Center for Health Research, Portland, Ore.
Mayo Clin Proc. 2016 Aug;91(8):1074-83. doi: 10.1016/j.mayocp.2016.03.014. Epub 2016 Apr 23.
The objective of this study was to empirically demonstrate the use of a new framework for describing the strategies used to implement quality improvement interventions and provide an example that others may follow. Implementation strategies are the specific approaches, methods, structures, and resources used to introduce and encourage uptake of a given intervention's components. Such strategies have not been regularly reported in descriptions of interventions' effectiveness, or in assessments of how proven interventions are implemented in new settings. This lack of reporting may hinder efforts to successfully translate effective interventions into "real-world" practice. A recently published framework was designed to standardize reporting on implementation strategies in the implementation science literature. We applied this framework to describe the strategies used to implement a single intervention in its original commercial care setting, and when implemented in community health centers from September 2010 through May 2015. Per this framework, the target (clinic staff) and outcome (prescribing rates) remained the same across settings; the actor, action, temporality, and dose were adapted to fit local context. The framework proved helpful in articulating which of the implementation strategies were kept constant and which were tailored to fit diverse settings, and simplified our reporting of their effects. Researchers should consider consistently reporting this information, which could be crucial to the success or failure of implementing proven interventions effectively across diverse care settings.
clinicaltrials.gov Identifier: NCT02299791.
本研究的目的是通过实证证明一种用于描述实施质量改进干预措施所采用策略的新框架,并提供一个可供他人效仿的示例。实施策略是指用于引入并鼓励采用特定干预措施组成部分的具体方法、手段、结构和资源。在干预措施效果的描述中,或者在评估已证实的干预措施如何在新环境中实施时,此类策略并未得到定期报告。这种报告的缺失可能会阻碍将有效干预措施成功转化为“实际”实践的努力。最近发布的一个框架旨在规范实施科学文献中关于实施策略的报告。我们应用此框架来描述在其原始商业护理环境中以及在2010年9月至2015年5月期间在社区卫生中心实施单一干预措施时所采用的策略。根据该框架,不同环境下的目标(诊所工作人员)和结果(处方率)保持不变;行动者、行动、时间性和剂量则根据当地情况进行调整。该框架有助于阐明哪些实施策略保持不变,哪些策略进行了调整以适应不同环境,并简化了我们对其效果的报告。研究人员应考虑始终报告这些信息,这对于在不同护理环境中有效实施已证实的干预措施的成败可能至关重要。
clinicaltrials.gov标识符:NCT02299791。