Ford James H, Abramson Betsy, Wise Meg, Dattalo Melissa, Mahoney Jane E
Center for Health Systems Research and Analysis, College of Engineering, University of Wisconsin-Madison, Madison, Wisconsin (Dr Ford); Wisconsin Institute for Healthy Aging, Madison, Wisconsin (Drs Abramson and Mahoney); Sonderegger Research Center, School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin (Dr Wise); Division of Geriatrics and Gerontology, University of Wisconsin, Madison, Wisconsin; Advanced Fellowship in Women's Health, William S. Middleton Memorial VA Hospital, Madison, Wisconsin (Dr Dattalo); and Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (Dr Mahoney).
J Public Health Manag Pract. 2017 Sep/Oct;23(5):e17-e24. doi: 10.1097/PHH.0000000000000503.
To evaluate the effectiveness of a quality improvement intervention to increase delivery of 2 evidence-based health promotion workshops, Stepping On and Chronic Disease Self-Management Program (CDSMP), in rural communities.
A cluster-randomized wait-list control group design.
Rural Wisconsin counties with trained workshop leaders but no workshops in the prior year were eligible to participate.
Sixteen counties were randomized to receive the NIATx intervention or wait-list control. The 1-year intervention consisted of training and coaching county aging unit staff to apply NIATx methods to increase and sustain the number of Stepping On or CDSMP workshops in their community.
Mann-Whitney tests examined effect on workshops held, participants, and workshop completers. The paired Wilcoxon signed rank test explored change in participants' health behaviors and health care utilization.
Counties receiving the NIATx intervention significantly increased the number of workshops per county per year as compared with baseline (1.5 vs 0.19, P < .001) and sustained improvements during the year following the intervention. Stepping On participants, during the 6 months postintervention, had reduced falls risk behaviors (P < .001), 0.43 fewer falls (P < .01), and 0.028 fewer medical record-verified emergency department visits for falls-related injuries (P < .05) compared with the 6 months before the intervention. CDSMP participants had reduced social isolation (P = .018) and improved physician communication skills (P = .005).
Our study demonstrates that coaching rural service organizations in use of the quality improvement process, NIATx, may increase implementation reach of evidence-based health promotion/disease prevention programs. Initiative findings indicate that this approach may be a new and potentially important strategy to increase reach of health promotion programs for older adults in community settings.
A quality improvement approach effectively increases and sustains delivery of evidence-based health promotion/workshops for older adults in rural communities. Counties or states struggling to engage older adults in evidence-based health promotion workshops could integrate quality improvement into policies and practices to increase workshop availability. Once engaged, older adults experience improved health behaviors from both programs and reduced falls and emergency department utilization from Stepping On.
评估一项质量改进干预措施在农村社区提高两个循证健康促进工作坊（“步步稳”和慢性病自我管理项目，即CDSMP）举办率的有效性。
整群随机等待列表对照组设计。
威斯康星州的农村县，这些县有经过培训的工作坊负责人，但上一年未举办工作坊，符合参与条件。
16个县被随机分为接受NIATx干预组或等待列表对照组。为期1年的干预包括培训和指导县老龄单位工作人员应用NIATx方法，以增加并维持其社区内“步步稳”或CDSMP工作坊的数量。
采用曼-惠特尼检验来考察对举办的工作坊、参与者及工作坊完成者的影响。采用配对威尔科克森符号秩检验来探究参与者健康行为和医疗保健利用情况的变化。
与基线相比，接受NIATx干预的县每年每个县的工作坊数量显著增加（1.5个对0.19个，P <.001），且在干预后的一年中持续保持改善。与干预前6个月相比，“步步稳”项目的参与者在干预后6个月内，跌倒风险行为减少（P <.001），跌倒次数减少0.43次（P <.01），因跌倒相关损伤经病历核实的急诊科就诊次数减少0.028次（P <.05）。CDSMP项目的参与者社交孤立感减轻（P = .018），与医生沟通的技能得到改善（P = .005）。
我们的研究表明，指导农村服务组织运用质量改进流程NIATx，可能会提高循证健康促进/疾病预防项目的实施范围。初步研究结果表明，这种方法可能是在社区环境中扩大针对老年人的健康促进项目覆盖范围的一种新的且可能重要的策略。
一种质量改进方法能有效增加并维持农村社区为老年人提供的循证健康促进工作坊。难以让老年人参与循证健康促进工作坊的县或州，可以将质量改进纳入政策和实践中，以增加工作坊的可及性。一旦参与其中，老年人会从这两个项目中获得健康行为的改善，并且“步步稳”项目能减少跌倒和急诊科就诊次数。
