Lee Rebekka M, Ramanadhan Shoba, Kruse Gina R, Deutsch Charles
Clinical and Translational Science Center, Harvard Medical School, Boston, MA, United States.
Prevention Research Center, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
Front Public Health. 2018 Jun 5;6:150. doi: 10.3389/fpubh.2018.00150. eCollection 2018.
Strong partnerships are critical to integrate evidence-based prevention interventions within clinical and community-based settings, offering multilevel and sustainable solutions to complex health issues. As part of Massachusetts' 2012 health reform, The Prevention and Wellness Trust Fund (PWTF) funded nine local partnerships throughout the state to address hypertension, pediatric asthma, falls among older adults, and tobacco use. The initiative was designed to improve health outcomes through prevention and disease management strategies and reduce healthcare costs. Describe the mixed-methods study design for investigating PWTF implementation. The Consolidated Framework for Implementation Research guided the development of this evaluation. First, the study team conducted semi-structured qualitative interviews with leaders from each of nine partnerships to document partnership development and function, intervention adaptation and delivery, and the influence of contextual factors on implementation. The interview findings were used to develop a quantitative survey to assess the implementation experiences of 172 staff from clinical and community-based settings and a social network analysis to assess changes in the relationships among 72 PWTF partner organizations. The quantitative survey data on ratings of perceived implementation success were used to purposively select 24 staff for interviews to explore the most successful experiences of implementing evidence-based interventions for each of the four conditions. This mixed-methods approach for evaluation of implementation of evidence-based prevention interventions by PWTF partnerships can help decision-makers set future priorities for implementing and assessing clinical-community partnerships focused on prevention.
强大的伙伴关系对于将循证预防干预措施整合到临床和社区环境中至关重要，可为复杂的健康问题提供多层次且可持续的解决方案。作为马萨诸塞州2012年医疗改革的一部分，预防与健康信托基金（PWTF）资助了全州范围内的九个地方伙伴关系项目，以解决高血压、儿童哮喘、老年人跌倒和烟草使用等问题。该倡议旨在通过预防和疾病管理策略改善健康结果并降低医疗成本。描述用于调查PWTF实施情况的混合方法研究设计。实施研究综合框架指导了本次评估的开展。首先，研究团队对九个伙伴关系项目中的每个项目的负责人进行了半结构化定性访谈，以记录伙伴关系的发展与功能、干预措施的调整与实施，以及背景因素对实施的影响。访谈结果被用于制定一项定量调查，以评估来自临床和社区环境的172名工作人员的实施经验，并开展一项社会网络分析，以评估72个PWTF伙伴组织之间关系的变化。关于感知到的实施成功程度评级的定量调查数据被用于有目的地挑选24名工作人员进行访谈，以探讨针对四种情况中的每一种实施循证干预措施的最成功经验。这种用于评估PWTF伙伴关系实施循证预防干预措施的混合方法，有助于决策者为实施和评估以预防为重点的临床-社区伙伴关系设定未来的优先事项。
