Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
Obstet Gynecol. 2017 Jan;129(1):3-9. doi: 10.1097/AOG.0000000000001798.
To understand the most important steps required to implement immediate postpartum long-acting reversible contraception (LARC) programs in different Georgia hospitals and the barriers to implementing such a program.
This was a qualitative study. We interviewed 32 key personnel from 10 Georgia hospitals working to establish immediate postpartum LARC programs. Data were analyzed using directed qualitative content analysis principles. We used the Stages of Implementation to organize participant-identified key steps for immediate postpartum LARC into an implementation guide. We compared this guide to hospitals' implementation experiences.
At the completion of the study, LARC was available for immediate postpartum placement at 7 of 10 study hospitals. Participants identified common themes for the implementation experience: team member identification and ongoing communication, payer preparedness challenges, interdependent department-specific tasks, and piloting with continuing improvements. Participants expressed a need for anticipatory guidance throughout the process. Key first steps to immediate postpartum LARC program implementation were identifying project champions, creating an implementation team that included all relevant departments, obtaining financial reassurance, and ensuring hospital administration awareness of the project. Potential barriers included lack of knowledge about immediate postpartum LARC, financial concerns, and competing clinical and administrative priorities. Hospitals that were successful at implementing immediate postpartum LARC programs did so by prioritizing clear communication and multidisciplinary teamwork. Although the implementation guide reflects a comprehensive assessment of the steps to implementing immediate postpartum LARC programs, not all hospitals required every step to succeed.
Hospital teams report that implementing immediate postpartum LARC programs involves multiple departments and a number of important steps to consider. A stage-based approach to implementation, and a standardized guide detailing these steps, may provide the necessary structure for the complex process of implementing immediate postpartum LARC programs in the hospital setting.
了解在佐治亚州不同医院实施即刻产后长效可逆避孕（LARC）项目所需的最重要步骤，以及实施此类项目的障碍。
这是一项定性研究。我们采访了 10 家佐治亚州医院的 32 名关键人员，他们正在努力建立即刻产后 LARC 项目。使用定向定性内容分析原则对数据进行分析。我们使用实施阶段将参与者确定的即刻产后 LARC 的关键步骤组织到一个实施指南中。我们将该指南与医院的实施经验进行了比较。
在研究完成时，10 家研究医院中有 7 家可提供即刻产后放置 LARC。参与者确定了实施经验的共同主题：团队成员的识别和持续沟通、支付方准备挑战、相互依存的部门特定任务以及持续改进的试点。参与者表示在整个过程中需要进行预期指导。即刻产后 LARC 项目实施的关键第一步是确定项目负责人，创建一个包括所有相关部门的实施团队，获得财务保证，并确保医院管理层了解该项目。潜在的障碍包括对即刻产后 LARC 的知识不足、财务问题以及竞争的临床和行政重点。成功实施即刻产后 LARC 项目的医院通过优先考虑明确的沟通和多学科团队合作来实现这一目标。尽管实施指南反映了对实施即刻产后 LARC 项目的步骤的全面评估，但并非所有医院都需要采取所有步骤才能成功。
医院团队报告称，实施即刻产后 LARC 项目涉及多个部门和许多需要考虑的重要步骤。分阶段实施方法和详细说明这些步骤的标准化指南可能为医院环境中实施即刻产后 LARC 项目的复杂过程提供必要的结构。
