Boehmer Kasey R, Thota Anjali, Organick Paige, Havens Kathryn, Shah Nilay D
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.
Kern Institute, Medical College of Wisconsin, Milwaukee, WI.
Mayo Clin Proc Innov Qual Outcomes. 2020 Feb 17;4(2):190-202. doi: 10.1016/j.mayocpiqo.2019.11.002. eCollection 2020 Apr.
To qualitatively evaluate the implementation of Capacity Coaching, an intervention to address the work patients must undertake to manage their conditions, implemented as a quality improvement pilot in 1 of 2 implementing US Department of Veterans Affairs medical centers.
Two Veterans Affairs medical centers in the Midwest sought to implement Capacity Coaching as a quality improvement pilot in their Patient-Aligned Care Teams for 6 months (April 1, 2017, through October 31, 2017). Following the pilot, we conducted a focused ethnographic evaluation (on-site data collection, January 2-4, 2018), including interviews, a focus group, and observations with staff at one site to assess the implementation of capacity coaching. Data were analyzed inductively and findings were cross-referenced with implementation theory.
We found that implementation was feasible and achieved changes that were aligned with reducing patient work and increasing capacity. We found that the key facilitators for the implementation of this program were in participants making sense of the intervention (coherence) and working collectively to enact the program (collective action). The main challenges for the program were in planning the work of implementation and enrolling a diverse coalition of staff to expand referrals to the program (cognitive participation) and in evaluating the impact of the program on outcomes that upper leadership was interested in (reflexive monitoring).
Implementation of Capacity Coaching is feasible in clinical practice and may be a promising intervention for the care of chronic conditions. Further research should focus on testing capacity coaching using these lessons learned.
对能力辅导的实施情况进行定性评估。能力辅导是一项旨在解决患者为管理自身病情而必须开展的工作的干预措施，作为质量改进试点在美国退伍军人事务部的两家医疗中心之一实施。
美国中西部的两家退伍军人事务医疗中心试图在其患者导向型护理团队中开展能力辅导，作为为期6个月（2017年4月1日至2017年10月31日）的质量改进试点。试点结束后，我们进行了一次重点人种志评估（2018年1月2日至4日进行现场数据收集），包括访谈、焦点小组讨论以及对其中一家医疗中心的工作人员进行观察，以评估能力辅导的实施情况。对数据进行归纳分析，并将研究结果与实施理论进行交叉参照。
我们发现该实施是可行的，并且实现了与减少患者工作量和提高能力相一致的改变。我们发现该项目实施的关键促进因素在于参与者理解干预措施（连贯性）并共同努力实施该项目（集体行动）。该项目的主要挑战在于规划实施工作、招募不同的工作人员联盟以扩大对该项目的转诊（认知参与），以及评估该项目对高层领导感兴趣的结果的影响（反思性监测）。
能力辅导在临床实践中是可行的，可能是一种治疗慢性病的有前景的干预措施。进一步的研究应集中于利用这些经验教训对能力辅导进行测试。
