Keith Rosalind E, Crosson Jesse C, O'Malley Ann S, Cromp DeAnn, Taylor Erin Fries
Mathematica Policy Research, PO Box 2393, Princeton, NJ, 08543, USA.
Mathematica Policy Research, 1100 1st Street, NE, 12th Floor, Washington, DC, 20002, USA.
Implement Sci. 2017 Feb 10;12(1):15. doi: 10.1186/s13012-017-0550-7.
Much research does not address the practical needs of stakeholders responsible for introducing health care delivery interventions into organizations working to achieve better outcomes. In this article, we present an approach to using the Consolidated Framework for Implementation Research (CFIR) to guide systematic research that supports rapid-cycle evaluation of the implementation of health care delivery interventions and produces actionable evaluation findings intended to improve implementation in a timely manner.
To present our approach, we describe a formative cross-case qualitative investigation of 21 primary care practices participating in the Comprehensive Primary Care (CPC) initiative, a multi-payer supported primary care practice transformation intervention led by the Centers for Medicare and Medicaid Services. Qualitative data include observational field notes and semi-structured interviews with primary care practice leadership, clinicians, and administrative and medical support staff. We use intervention-specific codes, and CFIR constructs to reduce and organize the data to support cross-case analysis of patterns of barriers and facilitators relating to different CPC components.
Using the CFIR to guide data collection, coding, analysis, and reporting of findings supported a systematic, comprehensive, and timely understanding of barriers and facilitators to practice transformation. Our approach to using the CFIR produced actionable findings for improving implementation effectiveness during this initiative and for identifying improvements to implementation strategies for future practice transformation efforts.
The CFIR is a useful tool for guiding rapid-cycle evaluation of the implementation of practice transformation initiatives. Using the approach described here, we systematically identified where adjustments and refinements to the intervention could be made in the second year of the 4-year intervention. We think the approach we describe has broad application and encourage others to use the CFIR, along with intervention-specific codes, to guide the efficient and rigorous analysis of rich qualitative data.
NCT02318108.
许多研究并未关注负责将医疗服务干预措施引入致力于实现更好成果的组织的利益相关者的实际需求。在本文中，我们提出一种使用实施研究综合框架（CFIR）来指导系统研究的方法，该研究支持对医疗服务干预措施的实施进行快速循环评估，并产生旨在及时改善实施情况的可操作评估结果。
为了介绍我们的方法，我们描述了一项对参与综合初级保健（CPC）倡议的21个初级保健机构进行的形成性跨案例定性调查，该倡议是由医疗保险和医疗补助服务中心牵头的一项由多方支付支持的初级保健机构转型干预措施。定性数据包括观察性现场记录以及对初级保健机构领导、临床医生、行政和医疗支持人员的半结构化访谈。我们使用特定于干预措施的编码以及CFIR构建要素来减少和组织数据，以支持对与不同CPC组成部分相关的障碍和促进因素模式进行跨案例分析。
使用CFIR来指导数据收集、编码、分析和结果报告，有助于系统、全面且及时地了解实践转型的障碍和促进因素。我们使用CFIR的方法产生了可操作的结果，用于在此倡议期间提高实施效果，并为未来实践转型努力确定实施策略的改进方向。
CFIR是指导实践转型倡议实施的快速循环评估的有用工具。使用此处描述的方法，我们在为期4年的干预措施的第二年系统地确定了可以对干预措施进行哪些调整和完善。我们认为我们所描述的方法具有广泛的适用性，并鼓励其他人使用CFIR以及特定于干预措施的编码，来指导对丰富的定性数据进行高效且严谨的分析。
NCT02318108。
