Health Systems Unit, Centre for Chronic Disease Control, New Delhi, India.
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
Glob Heart. 2019 Jun;14(2):165-172. doi: 10.1016/j.gheart.2019.06.002.
Appropriate strategies and key stakeholder engagement are the keys to successful implementation of new health care interventions.
The study sought to articulate the key strategies used for scaling up a research-based intervention, mPower Heart electronic Clinical Decision Support System (e-CDSS), for state-wide implementation at health facilities in Tripura.
Multiple strategies were used for statewide implementation of mPower Heart e-CDSS at noncommunicable diseases clinics across the government health facilities in Tripura: formation of a technical coordination-cum-support unit, change management, enabling environment, adapting the intervention with user focus, and strengthening the Health Information System.
The effective delivery of a new health system intervention requires engagement at multiple levels including political leadership, health administrators, and health professionals, which can be achieved by forming a technical coordination-cum-support unit. It is important to specify the role and responsibilities of existing manpower and provide a structured training program. Enabling environment at health facilities (providing essential equipment, space and time, etc.) is also crucial. Successful implementation also requires that patients, health care providers, the health system, and leadership recognize the immediate and long-term benefits of the new intervention and have a buy-in in the intervention. With constant encouragement and nudge from administrative authorities and by using multiple strategies, 40 government health facilities adopted the mPower Heart e-CDSS. From its launch in May 2017 until November 20, 2018, a total of 100,810 eligible individuals were screened and enrolled, with 35,884 treated for hypertension, 9,698 for diabetes, and 5,527 for both hypertension and diabetes.
Multiple strategies, based on implementation principles, are required for successful scaling up of research-based interventions.
适当的策略和关键利益相关者的参与是成功实施新医疗干预措施的关键。
本研究旨在阐明在特里普拉邦的卫生设施中扩大基于研究的干预措施 mPower Heart 电子临床决策支持系统（e-CDSS）的关键策略，以实现全州范围的实施。
在特里普拉邦的政府卫生设施中的非传染性疾病诊所中，采用了多种策略来全州范围内实施 mPower Heart e-CDSS：成立技术协调和支持单位、进行变革管理、创造有利环境、关注用户来调整干预措施以及加强卫生信息系统。
有效提供新的卫生系统干预措施需要在多个层面上进行利益相关者的参与，包括政治领导层、卫生行政人员和卫生专业人员，这可以通过成立技术协调和支持单位来实现。明确现有人力的角色和责任并提供结构化的培训计划很重要。卫生设施的有利环境（提供必要的设备、空间和时间等）也至关重要。成功实施还需要患者、医疗保健提供者、卫生系统和领导层认识到新干预措施的当前和长期利益，并对干预措施有认同感。通过行政当局的不断鼓励和推动，并采用多种策略，有 40 家政府卫生机构采用了 mPower Heart e-CDSS。自 2017 年 5 月推出以来，截至 2018 年 11 月 20 日，共有 100810 名符合条件的个体接受了筛查和登记，其中 35884 人被诊断为高血压、9698 人被诊断为糖尿病、5527 人同时患有高血压和糖尿病。
基于实施原则的多种策略是成功扩大基于研究的干预措施的必要条件。
