Clinician Investigator at the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute and Associate Professor in the Department of Family Medicine at the University of Ottawa in Ontario.
Principal Lead of Rowan Research and Evaluation and Assistant Professor in the Department of Family Medicine at the University of Ottawa.
Can Fam Physician. 2018 Jan;64(1):e23-e32.
To examine the barriers to and facilitators of practice facilitation experienced by participants in the Improving Delivery of Cardiovascular Care (IDOCC) project.
Case studies of practice facilitators' narrative reports.
Eastern Ontario.
Primary care practices that participated in the IDOCC project.
Cases were identified by calculating sum scores in order to determine practices' performance relative to their peers. Two case exemplars were selected that scored within ± 1 SD of the total mean score, and a qualitative analysis of practice facilitators' narrative reports was conducted using a 5-factor implementation framework to identify barriers and facilitators. Narratives were divided into 3 phases: planning, implementation, and sustainability.
Barriers and facilitators fluctuated over the intervention's 3 phases. Site A reported more barriers (n = 47) than facilitators (n = 38), while site B reported a roughly equal number of barriers (n = 144) and facilitators (n = 136). In both sites, the most common barriers involved organizational and provider factors and the most common facilitators were associated with innovation and structural factors.
Both practices encountered various barriers and facilitators throughout the IDOCC's 3 phases. The case studies reveal the complex interactions of these factors over time, and provide insight into the implementation of practice facilitation programs.
考察改善心血管护理服务（IDOCC）项目参与者在实践促进方面所面临的障碍和促进因素。
实践促进者叙述报告的案例研究。
安大略省东部。
参与 IDOCC 项目的初级保健实践。
通过计算总分来确定案例，以确定实践相对于同行的表现。选择了两个得分在总平均值的±1SD 范围内的案例示例，并使用 5 因素实施框架对实践促进者的叙述报告进行定性分析，以确定障碍和促进因素。叙述被分为 3 个阶段：规划、实施和可持续性。
障碍和促进因素在干预的 3 个阶段中波动。A 站点报告的障碍（n=47）多于促进因素（n=38），而 B 站点报告的障碍（n=144）和促进因素（n=136）大致相当。在两个站点中，最常见的障碍涉及组织和提供者因素，最常见的促进因素与创新和结构因素有关。
在 IDOCC 的 3 个阶段中，两个实践都遇到了各种障碍和促进因素。这些案例研究揭示了这些因素随时间的复杂相互作用，并深入了解了实践促进计划的实施。
