基于医院的干预措施：对实施过程中员工报告的障碍和促进因素的系统评价。
Hospital-based interventions: a systematic review of staff-reported barriers and facilitators to implementation processes.
机构信息
Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia.
Sydney Catalyst Translational Cancer Research Centre, NHMRC Clinical Trials Centre, The University of Sydney, Chris O'Brien Lifehouse, Level 6, 119-143 Missenden Rd, Sydney, NSW, 2050, Australia.
出版信息
Implement Sci. 2018 Feb 23;13(1):36. doi: 10.1186/s13012-018-0726-9.
BACKGROUND
Translation of evidence-based interventions into hospital systems can provide immediate and substantial benefits to patient care and outcomes, but successful implementation is often not achieved. Existing literature describes a range of barriers and facilitators to the implementation process. This systematic review identifies and explores relationships between these barriers and facilitators to highlight key domains that need to be addressed by researchers and clinicians seeking to implement hospital-based, patient-focused interventions.
METHODS
We searched MEDLINE, PsychInfo, Embase, Web of Science, and CINAHL using search terms focused specifically on barriers and facilitators to the implementation of patient-focused interventions in hospital settings. To be eligible, papers needed to have collected formal data (qualitative or quantitative) that specifically assessed the implementation process, as experienced by the staff involved.
RESULTS
Of 4239 papers initially retrieved, 43 papers met inclusion criteria. Staff-identified barriers and facilitators to implementation were grouped into three main domains: system, staff, and intervention. Bi-directional associations were evident between these domains, with the strongest links evident between staff and intervention.
CONCLUSIONS
Researchers and health professionals engaged in designing patient-focused interventions need to consider barriers and facilitators across all three identified domains to increase the likelihood of implementation success. The interrelationships between domains are also crucial, as resources in one area can be leveraged to address barriers in others. These findings emphasize the importance of careful intervention design and pre-implementation planning in response to the specific system and staff context in order to increase likelihood of effective and sustainable implementation.
TRIAL REGISTRATION
This review was registered on the PROSPERO database: CRD42017057554 in February 2017.
背景
将循证干预措施转化为医院系统可以为患者护理和结果提供即时和实质性的益处，但通常无法实现成功实施。现有文献描述了实施过程中的一系列障碍和促进因素。本系统评价确定并探讨了这些障碍和促进因素之间的关系，以突出研究人员和临床医生在试图实施以医院为基础、以患者为中心的干预措施时需要解决的关键领域。
方法
我们使用专门针对医院环境中以患者为中心的干预措施实施的障碍和促进因素的搜索词，在 MEDLINE、PsychInfo、Embase、Web of Science 和 CINAHL 中进行了搜索。为了符合条件，论文需要收集专门评估相关人员实施过程的经验的正式数据（定性或定量）。
结果
最初检索到的 4239 篇论文中，有 43 篇符合纳入标准。工作人员确定的实施障碍和促进因素分为三个主要领域：系统、员工和干预措施。这些领域之间存在双向关联，其中员工和干预措施之间的关联最强。
结论
参与设计以患者为中心的干预措施的研究人员和卫生专业人员需要考虑所有三个确定的领域的障碍和促进因素，以增加实施成功的可能性。各领域之间的相互关系也至关重要，因为一个领域的资源可以用于解决其他领域的障碍。这些发现强调了精心设计干预措施和预先实施计划的重要性，以应对特定的系统和员工背景，以提高有效和可持续实施的可能性。
试验注册
本综述于 2017 年 2 月在 PROSPERO 数据库中注册：CRD42017057554。
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