Barratt Helen, Turner Simon, Hutchings Andrew, Pizzo Elena, Hudson Emma, Briggs Tim, Hurd Rob, Day Jamie, Yates Rachel, Gikas Panagiotis, Morris Stephen, Fulop Naomi J, Raine Rosalind
Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
BMC Health Serv Res. 2017 Jan 23;17(1):71. doi: 10.1186/s12913-017-2012-y.
Orthopaedic procedures, such as total hip replacement and total knee replacement, are among the commonest surgical procedures in England. The Getting it Right First Time project (GIRFT) aims to deliver improvements in quality and reductions in the cost of NHS orthopaedic care across the country. We will examine whether the planned changes have delivered improvements in the quality of care and patient outcomes. We will also study the processes involved in developing and implementing changes to care, and professional and organisational factors influencing these processes. In doing so, we will identify lessons to guide future improvement work in other services.
METHODS/DESIGN: We will evaluate the implementation of the GIRFT programme, and its impact on outcomes and cost, using a mixed methods design. Qualitative methods will be used to understand the programme theory underlying the approach and study the effect of the intervention on practice, using a case study approach. This will include an analysis of the central GIRFT programme and local provider responses. Data will be collected via semi-structured interviews, non-participant observation, and documentary analysis. Quantitative methods will be used to examine 'what works and at what cost?' We will also conduct focus groups with patients and members of the public to explore their perceptions of the GIRFT programme. The research will draw on theories of adoption, diffusion, and sustainability of innovation; its characteristics; and contextual factors at provider-level that influence implementation.
We will identify generalisable lessons to inform the organisation and delivery of future improvement programmes, to optimise their implementation and impact, both within the UK and internationally. Potential challenges involved in conducting the evaluation include the phased implementation of the intervention in different provider organisations; the inclusion of both retrospective and prospective components; and the effects of ongoing organisational turbulence in the English NHS. However, these issues reflect the realities of service change and its evaluation.
诸如全髋关节置换和全膝关节置换等骨科手术，是英格兰最常见的外科手术之一。“一次做对”项目（GIRFT）旨在提高全国国民保健制度（NHS）骨科护理的质量并降低成本。我们将研究计划中的变革是否带来了护理质量和患者预后的改善。我们还将研究护理变革的制定和实施过程，以及影响这些过程的专业和组织因素。通过这样做，我们将总结经验教训，以指导其他服务未来的改进工作。
方法/设计：我们将采用混合方法设计来评估GIRFT计划的实施情况及其对结果和成本的影响。定性方法将用于理解该方法背后的项目理论，并采用案例研究方法研究干预措施对实践的影响。这将包括对核心GIRFT计划和当地提供者反应的分析。数据将通过半结构化访谈、非参与观察和文献分析收集。定量方法将用于研究“什么有效以及成本是多少？”我们还将与患者和公众进行焦点小组讨论，以探讨他们对GIRFT计划的看法。该研究将借鉴创新的采用、传播和可持续性理论；其特征；以及提供者层面影响实施的背景因素。
我们将总结可推广的经验教训，为未来改进计划的组织和实施提供参考，以优化其在英国和国际范围内的实施及影响。进行评估所涉及的潜在挑战包括在不同提供者组织中分阶段实施干预措施；纳入回顾性和前瞻性成分；以及英国NHS持续的组织动荡带来的影响。然而，这些问题反映了服务变革及其评估的现实情况。
