Department of Pediatrics, University of Washington, Seattle, Washington.
Department of Social and Behavioral Sciences, University of California, San Francisco, California.
J Hosp Med. 2020 Jan 1;15(1):35-41. doi: 10.12788/jhm.3296. Epub 2019 Sep 18.
Pathways can improve the quality of care and outcomes for children with asthma; however, we know little about how to successfully implement pathways across diverse hospital settings. Prior studies of pathways have focused on determining clinical effectiveness and the majority were conducted in children's hospitals. These approaches have left crucial gaps in our understanding of how to successfully implement pathways in community hospitals, where most of the children with asthma are treated nationally.
The aim of this study was to identify the key determinants of successful pediatric asthma pathway implementation in community hospitals.
We conducted a qualitative study of healthcare providers that served as project leaders in a national collaborative to improve pediatric asthma care. Data were collected by recording semi-structured discussions between project leaders and external facilitators (EF) from December 2017 to April 2018. Using inductive thematic analysis, we identified the themes that describe the key determinants of pathway implementation.
Project leaders (n = 32) from 18 hospitals participated in this study. The key determinants of pathway implementation in community hospitals included (1) building an implementation infrastructure (eg, forming a team of local champions, modifying clinical workflows, delivering education/skills training), (2) engaging and motivating providers (eg, obtaining project buy-in, facilitating multidisciplinary collaboration, handling conflict), (3) addressing organizational and resource limitations (eg, support for electronic medical record integration), and (4) devising implementation solutions with EFs (eg, potential workflow modifications).
Our identification of the key determinants of pathway implementation may help guide pediatric quality improvement efforts in community hospitals. EFs may play an important role in successfully implementing pathways in community settings.
路径可以提高儿童哮喘的护理质量和结果；然而，我们对如何在不同的医院环境中成功实施路径知之甚少。先前关于路径的研究侧重于确定临床效果，而且大多数都是在儿童医院进行的。这些方法在我们理解如何在社区医院成功实施路径方面留下了关键的空白，而全国大多数哮喘儿童都在社区医院接受治疗。
本研究旨在确定在社区医院成功实施儿科哮喘路径的关键决定因素。
我们对医疗保健提供者进行了定性研究，他们在全国范围内改善儿科哮喘护理的合作中担任项目负责人。数据是通过记录项目负责人与外部促进者（EF）之间的半结构化讨论收集的，时间为 2017 年 12 月至 2018 年 4 月。使用归纳主题分析，我们确定了描述路径实施关键决定因素的主题。
来自 18 家医院的 32 名项目负责人参与了这项研究。社区医院路径实施的关键决定因素包括：（1）建立实施基础设施（例如，组建当地拥护者团队，修改临床工作流程，提供教育/技能培训）；（2）吸引和激励提供者（例如，获得项目认可，促进多学科合作，处理冲突）；（3）解决组织和资源限制（例如，支持电子病历集成）；（4）与 EF 一起设计实施解决方案（例如，潜在的工作流程修改）。
我们确定的路径实施关键决定因素可能有助于指导社区医院的儿科质量改进工作。EF 可能在社区环境中成功实施路径方面发挥重要作用。
