Faculty of Nursing, University of Windsor, Windsor, Canada.
Department of Family Medicine, McMaster University, Hamilton, Canada.
Health Promot Int. 2020 Feb 1;35(1):160-170. doi: 10.1093/heapro/day123.
Designing and implementing population-based systems of care that address the social determinants of health, take action on multiple levels, and are guided by evidence-based principles is a pressing priority, and an international challenge. Aging persons are a priority demographic whose health needs span physical, psychosocial and existential care domains, increase in the last year of life, are often poorly coordinated and therefore remain unmet. Compassionate communities (CCs) are an example of a public health approach that fully addresses the holistic healthcare needs of those who are aging and nearing end of life. The sharing of resources, tools, and innovations among implementers of CCs is occurring globally. Although this can increase impact, it also generates complexity that can complicate robust evaluation. When initiating population health level projects, it is important to clearly define and organize concepts and processes that are proposed to influence the health outcomes. The Health Impact Change Model (HICM) was developed to unpack the complexities associated with the implementation and evaluation of a Canadian CC intervention. The HICM offers utility for citizens, leaders and decision-makers who are engaged in the implementation of population health level strategies or other social approaches to care, such as compassionate cities and age or dementia-friendly communities. The HICM's concepts can be adapted to address a community's healthcare context, needs, and goals for change. We share examples of how the model's major concepts have been applied in the development, evaluation and spread of a complex CC approach.
设计和实施基于人群的护理系统，以解决健康的社会决定因素，在多个层面采取行动，并以循证原则为指导，这是当务之急，也是一个国际挑战。老年人是一个优先考虑的人群，他们的健康需求跨越身体、心理社会和存在关怀领域，在生命的最后一年增加，往往协调不佳，因此仍然得不到满足。富有同情心的社区（CCs）是一种公共卫生方法的例子，它充分满足了那些正在衰老和接近生命尽头的人的整体医疗保健需求。CCs 的实施者之间正在全球范围内共享资源、工具和创新。虽然这可以提高影响力，但也会产生复杂性，从而使稳健的评估变得复杂。在启动人口健康水平项目时，重要的是要清楚地定义和组织拟影响健康结果的概念和流程。健康影响变化模型（HICM）是为了解开与加拿大 CC 干预措施的实施和评估相关的复杂性而开发的。HICM 为参与实施人口健康水平战略或其他社会关怀方法（如富有同情心的城市和年龄或痴呆症友好社区）的公民、领导人和决策者提供了实用工具。HICM 的概念可以适应解决社区的医疗保健背景、需求和变革目标。我们分享了如何将模型的主要概念应用于复杂 CC 方法的开发、评估和传播的示例。
