Shade Lindsay, Reeves Kelly, Rees Jennifer, Hendrickson Lori, Halladay Jacqueline, Dolor Rowena J, Bray Paul, Tapp Hazel
1Atrium Health, Department of Family Medicine Research, 2001 Vail Avenue, Suite 400B Mercy Medical Plaza, Charlotte, NC 28207 USA.
2University of North Carolina at Chapel Hill, 160 N. Medical Drive, CB 7064, Chapel Hill, NC 27599 USA.
BMC Nurs. 2020 May 18;19:40. doi: 10.1186/s12912-020-00414-0. eCollection 2020.
Practice facilitation is a method of introducing and sustaining organizational change. It involves the use of skilled healthcare professionals called practice facilitators (PFs) to help address the challenges associated with implementing evidence-based guidelines and complex interventions into practice. PFs provide a framework for translating research into practice by building relationships, improving communication, fostering change, and sharing resources. Nurses are well positioned to serve as PFs for the implementation of complex interventions, however, there is little evidence currently available to describe nurses in this role. Additionally, the best strategies to implement complex interventions into practices are still not fully understood. Combining practice facilitation with the train-the-trainer model has the potential to spread knowledge and skills. Shared decision making (SDM), which involves patients and providers jointly engaging in decisions around treatment options, has been shown to improve outcomes for patients with asthma. The goal of this manuscript is to describe and evaluate the practice facilitation process from the ADAPT-NC Study which successfully utilized research nurses to implement a complex asthma SDM toolkit intervention into primary care practices.
As part of a larger study, 10 primary care practices were recruited for a facilitator-led dissemination intervention involving a 12-week rollout of an asthma SDM toolkit (trial registration: 1.28.2014, #NCT02047929). An experienced lead PF trained research nurses as PFs from each of the 4 participating practice-based research networks (PBRNs) in a train-the-trainer model utilizing a one-day training event and subsequent remote meetings. Evaluation of PF engagement was measured through process improvement surveys.
Overall, the asthma SDM intervention was successfully implemented within the 4 PBRNs. All 10 facilitator-led practices remained engaged with their PFs, with 8 out of the 10 practices able to incorporate and sustain SDM visits or clinics. Responses from the surveys for process improvement yielded improved PF communication and team dynamics over time.
This study demonstrated effective use of research nurses as practice facilitators during the dissemination of an asthma SDM intervention into primary care practices, adding to the knowledge of best practices by describing a model of large-scale implementation of a complex intervention through practice facilitation with nurses.
"Comparing Traditional and Participatory Dissemination of a Shared Decision Making Intervention" was retrospectively registered at https://clinicaltrials.gov/ on January 28th, 2014 (NCT02047929).
实践促进是一种引入并维持组织变革的方法。它涉及利用被称为实践促进者（PFs）的专业医疗保健人员，以帮助应对在实践中实施循证指南和复杂干预措施所面临的挑战。实践促进者通过建立关系、改善沟通、推动变革和共享资源，提供了一个将研究转化为实践的框架。护士非常适合担任实施复杂干预措施的实践促进者，然而，目前几乎没有证据描述护士在这一角色中的情况。此外，将复杂干预措施应用于实践的最佳策略仍未被完全理解。将实践促进与培训培训师模式相结合有可能传播知识和技能。共同决策（SDM），即患者和提供者共同参与围绕治疗方案的决策，已被证明能改善哮喘患者的治疗效果。本手稿的目的是描述和评估ADAPT-NC研究中的实践促进过程，该研究成功利用研究护士在初级保健实践中实施了一个复杂的哮喘共同决策工具包干预措施。
作为一项更大规模研究的一部分，招募了10个初级保健机构参与一项由促进者主导的传播干预，其中包括为期12周推出哮喘共同决策工具包（试验注册：2014年1月28日，#NCT02047929）。一位经验丰富的首席实践促进者采用培训培训师模式，通过为期一天的培训活动和随后的远程会议，将研究护士培训为来自4个参与的基于实践的研究网络（PBRNs）中的实践促进者。通过过程改进调查来衡量实践促进者的参与度评估。
总体而言，哮喘共同决策干预措施在4个基于实践的研究网络中成功实施。所有10个由促进者主导的机构都与他们的实践促进者保持合作，其中10个机构中有8个能够纳入并维持共同决策就诊或诊所。过程改进调查的反馈显示，随着时间的推移，实践促进者的沟通和团队动态得到了改善。
本研究表明，在将哮喘共同决策干预措施传播到初级保健实践的过程中，有效地利用了研究护士作为实践促进者，通过描述一种通过与护士进行实践促进来大规模实施复杂干预措施的模式，增加了对最佳实践的认识。
“比较共同决策干预措施的传统传播和参与式传播”于2014年1月28日在https://clinicaltrials.gov/进行了回顾性注册（NCT02047929）。
