在基于社区的综合初级卫生保健模型中使用信息通信技术：从 iCOACH 案例研究中学习。
Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies.
机构信息
Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 1 Bridgepoint Drive, Toronto, M4M 2B5, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Toronto, Ontario, M5T 3M6, Canada.
出版信息
Implement Sci. 2018 Jun 26;13(1):87. doi: 10.1186/s13012-018-0780-3.
BACKGROUND
Information communication technology (ICT) is a critical enabler of integrated models of community-based primary health care; however, little is known about how existing technologies have been used to support new models of integrated care. To address this gap, we draw on data from an international study of integrated models, exploring how ICT is used to support activities of integrated care and the organizational and environmental barriers and enablers to its adoption.
METHODS
We take an embedded comparative multiple-case study approach using data from a study of implementation of nine models of integrated community-based primary health care, the Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH) study. Six cases from Canada, three each in Ontario and Quebec, and three in New Zealand, were studied. As part of the case studies, interviews were conducted with managers and front-line health care providers from February 2015 to March 2017. A qualitative descriptive approach was used to code data from 137 interviews and generate word tables to guide analysis.
RESULTS
Despite different models and contexts, we found strikingly similar accounts of the types of activities supported through ICT systems in each of the cases. ICT systems were used most frequently to support activities like care coordination by inter-professional teams through information sharing. However, providers were limited in their ability to efficiently share patient data due to data access issues across organizational and professional boundaries and due to system functionality limitations, such as a lack of interoperability.
CONCLUSIONS
Even in innovative models of care, managers and providers in our cases mainly use technology to enable traditional ways of working. Technology limitations prevent more innovative uses of technology that could support disruption necessary to improve care delivery. We argue the barriers to more innovative use of technology are linked to three factors: (1) information access barriers, (2) limited functionality of available technology, and (3) organizational and provider inertia.
背景
信息通信技术（ICT）是社区为基础的初级卫生保健综合模式的关键推动因素；然而，对于现有的技术如何用于支持新的综合护理模式，我们知之甚少。为了弥补这一空白，我们利用一项综合模式国际研究的数据，探讨了 ICT 如何用于支持综合护理活动，以及采用 ICT 所面临的组织和环境障碍与促进因素。
方法
我们采用嵌入式比较多案例研究方法，利用 9 种综合社区初级卫生保健模式实施情况研究（实施综合照顾有复杂健康需求的老年人研究，iCOACH）的数据。对来自加拿大的 6 个案例进行了研究，安大略省和魁北克省各 3 个，新西兰 3 个。作为案例研究的一部分，从 2015 年 2 月到 2017 年 3 月，对管理人员和一线医疗保健提供者进行了访谈。采用定性描述方法对来自 137 次访谈的资料进行编码，并生成词表以指导分析。
结果
尽管模型和背景不同，但我们发现，在每个案例中，ICT 系统支持的活动类型的描述惊人地相似。ICT 系统最常被用于支持跨专业团队的信息共享等护理协调活动。然而，由于组织和专业边界的数据访问问题以及系统功能限制，如缺乏互操作性，提供者在有效共享患者数据方面受到限制。
结论
即使在创新性的护理模式中，我们案例中的管理人员和提供者主要将技术用于支持传统的工作方式。技术限制阻碍了更具创新性的技术应用，而这些应用可能有助于改善护理服务的中断。我们认为，更具创新性地使用技术的障碍与三个因素有关：（1）信息访问障碍；（2）现有技术的功能有限；（3）组织和提供者的惰性。
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