Center for Aging Research, Indiana University, Indianapolis, Indiana.
Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana.
J Am Geriatr Soc. 2018 Apr;66 Suppl 1(Suppl 1):S28-S35. doi: 10.1111/jgs.15320.
The workforce available to care for older adults has not kept pace with the need. In response to workforce limitations and the growing complexity of healthcare, scientists have tested new models of care that redesign clinical practice. This article describes why new models of care in aging, dementia, and mental health diffuse inadequately into the healthcare systems and communities where they might benefit older adults. We review a general framework for the diffusion of innovations and highlight the importance of other features of innovations that deter or facilitate diffusion. Although scientists often focus on generating evidence-based innovations, end-users apply their own criteria to determine an innovation's value. In 1962, Rogers suggested six features of an innovation that facilitate or deter diffusion suggested: relative advantage, compatibility with the existing environment, ease or difficulty of implementation, trial-ability or ability to "test drive", adaptability, and observed effectiveness. We describe examples of models of care in aging, dementia and mental health that enjoy a modicum of diffusion into practice and place the features of these models in the context of deterrents and facilitators for diffusion. Developers of models of care in aging, dementia, and mental health typically fail to incorporate the complexities of health systems, the barriers to diffusion, and the role of emotion into design considerations of new models. We describe agile implementation as a strategy to facilitate the speed and scale of diffusion in the setting of complex adaptive systems, social networks, and dynamic macroenvironments.
照顾老年人的劳动力供应跟不上需求。为了应对劳动力的局限性和医疗保健日益复杂的情况，科学家们已经测试了重新设计临床实践的新护理模式。本文描述了为什么新的老龄化、痴呆症和精神健康护理模式不能充分渗透到可能使老年人受益的医疗保健系统和社区中。我们回顾了创新扩散的一般框架，并强调了创新的其他特征对扩散的阻碍或促进作用的重要性。尽管科学家们通常专注于生成基于证据的创新，但最终用户会根据自己的标准来确定创新的价值。1962 年，罗杰斯提出了促进或阻碍创新扩散的六项创新特征：相对优势、与现有环境的兼容性、实施的难易程度、试验性或“试驾”能力、适应性和观察到的有效性。我们描述了在老龄化、痴呆症和精神健康领域中具有一定扩散程度的护理模式的例子，并将这些模式的特征置于扩散的障碍和促进因素的背景下。老龄化、痴呆症和精神健康护理模式的开发者通常未能将医疗保健系统的复杂性、扩散的障碍以及情感在新模型设计中的作用纳入考虑。我们将敏捷实施描述为一种在复杂自适应系统、社交网络和动态宏观环境中促进扩散速度和规模的策略。
