基于社区的初级卫生保健中循证创新的可扩展性评估：一项横断面研究。
Assessment of scalability of evidence-based innovations in community-based primary health care: a cross-sectional study.
作者信息
Ben Charif Ali, Hassani Kasra, Wong Sabrina T, Zomahoun Hervé Tchala Vignon, Fortin Martin, Freitas Adriana, Katz Alan, Kendall Claire E, Liddy Clare, Nicholson Kathryn, Petrovic Bojana, Ploeg Jenny, Légaré France
机构信息
Centre de recherche sur les soins et les services de première ligne (Ben Charif, Zomahoun, Freitas, Légaré); Health and Social Services Systems, Knowledge Translation and Implementation component (Ben Charif, Zomahoun, Légaré), Quebec Strategy for Patient-Oriented Research (SPOR) Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation (Ben Charif, Freitas, Légaré); Department of Family Medicine and Emergency Medicine (Ben Charif, Légaré), Université Laval, Québec, Que.; School of Nursing (Hassani, Wong) and Centre for Health Services and Policy Research (Hassani, Wong), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Diabetes Action Canada (Freitas, Légaré), Université Laval, Québec, Que.; Departments of Community Health Sciences (Katz) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Élisabeth Bruyère Research Institute (Kendall, Liddy), C.T. Lamont Primary Health Care Research Group; Department of Family Medicine (Kendall, Liddy) and Ottawa Hospital Research Institute (Kendall), University of Ottawa, Ottawa, Ont.; Li Ka Shing Knowledge Institute (Kendall), St. Michael's Hospital, Toronto, Ont.; Department of Epidemiology and Biostatistics (Nicholson), Western University, London, Ont.; Department of Family and Community Medicine (Petrovic) and Dalla Lana School of Public Health (Petrovic), University of Toronto, Toronto, Ont.; School of Nursing (Ploeg), Faculty of Health Sciences, and Diabetes Action Canada (Ploeg), McMaster University, Hamilton, Ont.
出版信息
CMAJ Open. 2018 Nov 2;6(4):E520-E527. doi: 10.9778/cmajo.20180143. Print 2018 Oct-Dec.
BACKGROUND
In 2013, the Canadian Institutes of Health Research funded 12 community-based primary health care research teams to develop evidence-based innovations. We aimed to explore the scalability of these innovations.
METHODS
In this cross-sectional study, we invited the 12 teams to rate their evidence-based innovations for scalability. Based on a systematic review, we developed a self-administered questionnaire with 16 scalability assessment criteria grouped into 5 dimensions (theory, impact, coverage, setting and cost). Teams completed a questionnaire for each of their innovations. We analyzed the data using simple frequency counts and hierarchical cluster analysis. We calculated the mean number and standard deviation (SD) of innovations that met criteria within each dimension that included more than 1 criterion. The analysis unit was the innovation.
RESULTS
The 11 responding teams evaluated 33 evidence-based innovations (median 3, range 1-8 per team). The innovations focused on access to care and chronic disease prevention and management, and varied from health interventions to methodological innovations. Most of the innovations were health interventions ( = 21), followed by analytical methods ( = 4), conceptual frameworks ( = 4), measures ( = 3) and strategies to build research capacity ( = 1). Most (29) met criteria in the theory dimension, followed by impact (mean 22.3 [SD 5.6] innovations per dimension), setting (mean 21.7 [SD 8.5]), cost (mean 17.5 [SD 2.1]) and coverage (mean 14.0 [SD 4.1]). On average, the innovations met 10 of the 16 criteria. Adoption was the least assessed criterion ( = 9). Most (20) of the innovations were highly ranked for scalability.
INTERPRETATION
Scalability varied among innovations, which suggests that readiness for scale up was suboptimal for some innovations. Coverage remained largely unaddressed; further investigation of this critical dimension is necessary.
背景
2013年，加拿大卫生研究院资助了12个基于社区的初级卫生保健研究团队，以开展基于证据的创新。我们旨在探讨这些创新的可扩展性。
方法
在这项横断面研究中，我们邀请这12个团队对其基于证据的创新的可扩展性进行评分。基于系统评价，我们编制了一份自填式问卷，其中包含16项可扩展性评估标准，分为5个维度（理论、影响、覆盖范围、环境和成本）。团队为其每项创新填写一份问卷。我们使用简单频数计数和分层聚类分析对数据进行分析。我们计算了每个包含多项标准的维度内符合标准的创新的平均数和标准差（SD）。分析单位为创新。
结果
11个回应团队评估了33项基于证据的创新（中位数为3项，每个团队范围为1 - 8项）。这些创新聚焦于医疗服务可及性以及慢性病预防与管理，涵盖从健康干预到方法学创新等多个方面。大多数创新为健康干预（n = 21），其次是分析方法（n = 4）、概念框架（n = 4）、测量方法（n = 3）和研究能力建设策略（n = 1）。大多数（29项）在理论维度符合标准，其次是影响（每个维度平均22.3项[标准差5.6]创新）、环境（平均21.7项[标准差8.5]）、成本（平均17.5项[标准差2.1]）和覆盖范围（平均14.0项[标准差4.1]）。平均而言，这些创新符合16项标准中的10项。采用情况是评估最少的标准（n = 9）。大多数（20项）创新在可扩展性方面排名较高。
解读
创新之间的可扩展性各不相同，这表明对于某些创新而言，扩大规模的准备情况并不理想。覆盖范围在很大程度上仍未得到解决；有必要对这一关键维度进行进一步研究。
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