Indiana University.
University of North Carolina at Chapel Hill.
Behav Ther. 2018 Jul;49(4):525-537. doi: 10.1016/j.beth.2017.11.012. Epub 2017 Dec 12.
Implementation experts suggest tailoring strategies to the intended context may enhance outcomes. However, it remains unclear which strategies are best suited to address specific barriers to implementation, in part because few measurement methods exist that adhere to recommendations for reporting. In the context of a dynamic cluster randomized trial comparing a standardized to tailored approach to implementing measurement-based care (MBC), this study aimed to (a) describe a method for tracking implementation strategies, (b) demonstrate the method by tracking strategies generated by teams tasked with implementing MBC at their clinics in the tailored condition, and (c) conduct preliminary examinations of the relation between strategy use and implementation outcomes (i.e., self-reported fidelity to MBC). The method consisted of a coding form based on Proctor, Powell, and McMillen (2013) implementation strategy reporting guidelines and Powell et al.'s (2012) taxonomy to facilitate specification of the strategies. A trained research specialist coded digitally recorded implementation team meetings. The method allowed for the following characterization of strategy use. Each site generated 39 unique strategies across an average of six meetings in five months. There was little variability in the use of types of implementation strategies across sites with the following order of prevalence: quality management (50.00%), restructuring (16.53%), communication (15.68%), education (8.90%), planning (7.20%), and financing (1.69%). We identified a new category of strategies not captured by the existing taxonomy, labeled "communication." There was no evidence that number of implementation strategies enacted was statistically significantly associated with changes in self-reported fidelity to MBC-however, financing strategies were associated with increased fidelity. This method has the capacity to yield rich data that will inform investigations into tailored implementation approaches.
实施专家建议根据预期情境调整策略，以提高实施效果。然而，尚不清楚哪种策略最适合解决实施的具体障碍，部分原因是很少有符合报告建议的测量方法。在一项比较标准化方法和个体化方法实施基于测量的护理（MBC）的动态群组随机试验中，本研究旨在：（a）描述一种跟踪实施策略的方法；（b）通过跟踪在个体化条件下负责在其诊所实施 MBC 的团队生成的策略来展示该方法；（c）初步检验策略使用与实施结果之间的关系（即，自我报告的 MBC 保真度）。该方法包括一个基于 Proctor、Powell 和 McMillen（2013）实施策略报告指南以及 Powell 等人（2012）分类法的编码表，以方便策略的具体说明。经过培训的研究专家对数字记录的实施团队会议进行编码。该方法允许对策略使用进行以下描述。每个站点在五个月的六次会议中生成了 39 种独特的策略。各站点之间实施策略类型的使用差异很小，以下是其出现频率的顺序：质量管理（50.00%）、结构重组（16.53%）、沟通（15.68%）、教育（8.90%）、规划（7.20%）和融资（1.69%）。我们发现了一种新的策略类别，未被现有分类法所涵盖，标记为“沟通”。实施策略的数量与自我报告的 MBC 保真度的变化没有统计学上的显著关联，但是融资策略与保真度的提高有关。该方法具有产生丰富数据的能力，这些数据将为个体化实施方法的研究提供信息。
