The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill; School of Social Work, University of North Carolina at Chapel Hill; Gillings School of Global Public Health, University of North Carolina at Chapel Hill.
The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill; School of Social Work, University of North Carolina at Chapel Hill.
Geriatr Nurs. 2020 Nov-Dec;41(6):878-884. doi: 10.1016/j.gerinurse.2020.06.002. Epub 2020 Jun 24.
There are countless efficacious interventions that improve outcomes when conducted in controlled situations. Many fewer are effective when implemented in real-world situations, largely because they are not implemented with fidelity. Still fewer are sustained over time, for reasons including lack of institutional support and fit with existing values, among others. It is especially important to examine fidelity and sustainability when efficacious interventions are being implemented, because these interventions are the ones that hold the most promise. This project examined the fidelity and sustainability of Mouth Care Without a Battle (MCWB), an evidence-based program conducted in a two-year cluster randomized trial in 14 nursing homes. Results that triangulated two sources of data indicated that fidelity decreased after the first year; they provide guidance to promote fidelity and sustainability of this and other new care practices in nursing homes, including ongoing education, coaching, evaluation, feedback, and sufficient resources.
在受控环境中实施时，有无数有效的干预措施可以改善结果。而在实际情况下实施时，效果要差得多，这主要是因为它们的实施不够忠实。能够持续一段时间的就更少了，原因包括缺乏制度支持以及与现有价值观的契合度等。当实施有效的干预措施时，特别有必要检查其忠实度和可持续性，因为这些干预措施最有希望取得成功。本项目研究了在 14 家养老院进行的为期两年的集群随机试验中实施的基于证据的口腔护理项目（MCWB）的忠实度和可持续性。对两种数据来源进行三角剖分的结果表明，忠实度在第一年之后下降；这些结果为促进养老院中这种新护理实践以及其他新护理实践的忠实度和可持续性提供了指导，包括持续的教育、指导、评估、反馈和充足的资源。
