School of Public Health, The University of Sydney, Sydney, Australia.
The George Institute for Global Health, UNSW Sydney, Sydney, Australia.
Arch Osteoporos. 2020 Jun 19;15(1):92. doi: 10.1007/s11657-020-00760-1.
This qualitative study identified the barriers to the implementation of a multidisciplinary co-management program for older hip fracture patients and provided evidence for future intervention improvement and scale-up.
Multidisciplinary co-management has been recommended as an effective intervention for hip fracture management in older people. This study is a process evaluation of a multidisciplinary co-management program in an orthopaedic hospital in Beijing, China, to better understand the barriers to implementation.
Data collection involved semi-structured interviews with key implementers of the co-management intervention (surgeon, geriatrician, physician, nurse, physiotherapist and anaesthetist) and observations of patients' journey to map the care processes were conducted in Beijing Jishuitan Hospital. Data were transcribed, qualitatively coded and analysed using normalization process theory to understand the intervention process from four constructs: coherence, cognitive participation, collective action and reflexive monitoring.
Ten stakeholder interviews were conducted. Despite multidisciplinary co-management intervention was meaningful and valued by participants, barriers to its implementation were identified. These included unmatched investment and benefit (cognitive participation), challenges of facing increased workload (collective action), deficient training and supervision system (collective action), limited accommodating capacity of hospital (collective action) and difficulties in accessing information about the effect of the intervention (reflexive monitoring).
Multiple barriers to the effective implementation of the multidisciplinary co-management program in China were identified. The process evaluation highlights key aspects in less willingness to fully invest in the program, inappropriate workload allocation and lack of training and supervision which need to be addressed before scaling up.
本定性研究旨在确定实施多学科协作管理方案以治疗老年髋部骨折患者的障碍，并为未来的干预措施改进和推广提供依据。
多学科协作管理已被推荐为治疗老年人髋部骨折的有效干预措施。本研究对中国北京一家骨科医院的多学科协作管理方案进行了过程评估，以更好地了解实施过程中的障碍。
在北京积水潭医院，通过对协作管理干预措施的主要实施者（外科医生、老年病医生、内科医生、护士、物理治疗师和麻醉师）进行半结构化访谈，并观察患者的就诊过程，以绘制护理流程，收集数据。将数据转录、定性编码，并使用规范化进程理论进行分析，从四个方面理解干预过程：一致性、认知参与、集体行动和反思性监测。
共进行了 10 次利益相关者访谈。尽管多学科协作管理干预措施对参与者具有意义和价值，但仍存在实施障碍。这些障碍包括投资和收益不匹配（认知参与）、面临工作量增加的挑战（集体行动）、培训和监督系统不足（集体行动）、医院容纳能力有限（集体行动）以及难以获取干预效果的信息（反思性监测）。
在中国，多学科协作管理方案的有效实施存在多种障碍。该过程评估突出了在充分投资意愿不足、工作量分配不当以及缺乏培训和监督等方面存在的关键问题，在推广之前需要加以解决。
