Goetz Goldberg Debora, Haghighat Sahar, Kavalloor Sneha, Nichols Len M
From the George Mason University, Department of Health Administration and Policy, Peterson Family Hall, MS IJ3, 4400 University Drive, Fairfax, VA 22030 (DGG, SK); George Mason University, Department of Sociology Fairfax, VA 22030 (SH); George Mason University, Center for Health Policy Research and Ethics Fairfax, VA 22030 (LMN).
J Am Board Fam Med. 2019 Sep-Oct;32(5):705-714. doi: 10.3122/jabfm.2019.05.190084.
The Heart of Virginia Health care (HVH) was a regional cooperative under the EvidenceNOW initiative to assist primary care practices in implementing evidence-based cardiovascular care and building capacity for quality improvement. The HVH implementation team included individuals from multiple universities, quality improvement organizations, and consulting firms. The goal of this study was to understand HVH team member viewpoints on the challenges, strengths, and lessons learned in each phase of the project.
Qualitative methods were used to facilitate reflection on the implementation and dissemination of the EvidenceNOW initiative in Virginia. In-depth interviews were conducted at the end of the project with 22 HVH team members. A nonparticipant, multidisciplinary research team completed thematic analysis of interview transcripts.
Positive attributes of the HVH initiative included diverse team member skills and areas of expertise, a well-received kick-off event, and a comprehensive set of practice improvement resources. Major challenges included recruiting primary care practices, varying types and capabilities of electronic health records, and working with practices at different transformation stages, with different objectives for participating and involvement in other government initiatives.
Study findings provide insights for future dissemination research and implementation of evidence-based practices in primary care. Challenges experienced in project development can result in a domino effect that could change the project timeline, type of practices recruited for study participation, resource allocation, and planned activities for quality improvement. Effectiveness of external quality improvement support may depend on practice engagement, preexisting organizational structures and processes, availability of resources, and length and continuity of practice facilitation.
弗吉尼亚医疗保健核心项目（HVH）是“即刻证据”倡议下的一个区域合作项目，旨在协助基层医疗实践实施循证心血管护理并提升质量改进能力。HVH实施团队包括来自多所大学、质量改进组织和咨询公司的人员。本研究的目的是了解HVH团队成员对项目各阶段所面临的挑战、优势及经验教训的看法。
采用定性方法促进对“即刻证据”倡议在弗吉尼亚的实施与推广进行反思。在项目结束时，对22名HVH团队成员进行了深入访谈。一个非参与性的多学科研究团队对访谈记录进行了主题分析。
HVH倡议的积极属性包括团队成员技能和专业领域多样、启动活动反响良好以及一套全面的实践改进资源。主要挑战包括招募基层医疗实践机构、电子健康记录的类型和功能各异，以及与处于不同转型阶段、参与和涉及其他政府倡议的目标不同的实践机构合作。
研究结果为未来基层医疗中循证实践的传播研究和实施提供了见解。项目开发中遇到的挑战可能会产生多米诺效应，从而改变项目时间表、招募参与研究的实践机构类型、资源分配以及质量改进的计划活动。外部质量改进支持的有效性可能取决于实践参与度、现有的组织结构和流程、资源可用性以及实践促进的时长和连续性。
