VISN 4 Center for the Evaluation of Patient Aligned Care Teams (CEPACT), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
Corporal Michael J. Crescenz VA Medical Center, VA Center for Health Equity Research and Promotion (CHERP), Philadelphia, PA, USA.
J Gen Intern Med. 2020 Nov;35(Suppl 2):808-814. doi: 10.1007/s11606-020-06099-0. Epub 2020 Oct 26.
Patient engagement is a key tenet of patient-centered care and is associated with many positive health outcomes. To improve resources for patient engagement, we created a web-based, interactive patient engagement toolkit to improve patient engagement in primary care across the Veterans Health Administration (VHA).
To use the knowledge translation (KT) framework to evaluate the dissemination and implementation of a patient engagement toolkit at facilities across one region in the VHA.
Using a mixed-methods approach, this process evaluation involved phone monitoring via semi-structured interviews and group meetings, during which we explored barriers and facilitators to KT. Outcomes were assessed using a structured rubric and existing patient satisfaction measures.
We enlisted implementers at 40 VHA facilities primarily serving Pennsylvania, New Jersey, and Delaware to implement patient engagement practices at their sites. Sites were randomly assigned into a high or low coaching group to assess whether external support influenced implementation.
Sites with high rubric scores employed and possessed several elements across the KT trajectory from identification of the problem to sustainment of knowledge use. Key factors for successful implementation and dissemination included implementer engagement, organizational support, and strong collaborators. The most frequently cited barriers included short staffing, time availability, lack of buy-in, and issues with leadership. Successful implementers experienced just as many barriers, but leveraged facilitators to overcome obstacles. While sites that received more coaching did not have different outcomes, they were more likely to revisit the toolkit and indicated that they felt more accountable to local personnel.
Because leveraging available resources is a key component of successful implementation, future toolkits should highlight the type of facilitators necessary for successful implementation of toolkit content in healthcare settings. The ability to tailor interventions to local context is critical for overcoming barriers faced in most healthcare settings.
患者参与是以患者为中心的护理的关键原则，与许多积极的健康结果相关。为了改善患者参与的资源，我们创建了一个基于网络的互动患者参与工具包，以改善退伍军人健康管理局（VHA）内的初级保健中的患者参与度。
使用知识转化（KT）框架评估 VHA 一个区域内的各个设施中患者参与工具包的传播和实施情况。
使用混合方法，该过程评估包括通过半结构化访谈和小组会议进行电话监测，在此期间，我们探讨了 KT 的障碍和促进因素。使用结构化评分表和现有的患者满意度措施评估结果。
我们招募了 40 个主要为宾夕法尼亚州、新泽西州和特拉华州提供服务的 VHA 设施的实施者，要求他们在各自的场所实施患者参与实践。根据是否接受外部支持来评估实施情况，将站点随机分配到高或低辅导组中。
在 KT 轨迹中，从确定问题到维持知识使用，评分较高的站点都采用并具备了几个要素。成功实施和传播的关键因素包括实施者的参与、组织支持和强大的合作者。实施中最常遇到的障碍包括人手不足、时间可用性、缺乏认可以及领导层的问题。成功的实施者也遇到了同样多的障碍，但利用促进因素克服了障碍。虽然接受更多辅导的站点没有产生不同的结果，但他们更有可能重新访问工具包，并表示他们对当地人员更有责任感。
由于利用现有资源是成功实施的关键组成部分，因此未来的工具包应突出显示在医疗保健环境中成功实施工具包内容所需的促进因素类型。根据当地情况调整干预措施的能力对于克服大多数医疗保健环境中面临的障碍至关重要。
