Center for Healthcare Transformation, Avalere Health , Washington, DC, USA.
Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA.
J Gerontol Soc Work. 2020 Nov-Dec;63(8):822-836. doi: 10.1080/01634372.2020.1817828. Epub 2020 Nov 9.
As the number of Veterans enrolled in the Veterans Health Administration (VHA) and at risk for needing Long Term Services and Supports increases, VHA is shifting from institutional to Home and Community Based Services, such as the Veteran-Directed Care (VDC) program. VDC is a multi-sector program implemented as a collaboration between individual VHA medical centers (VAMCs) and Aging and Disability Network Agencies (ADNAs), entities that sit outside the VHA. Factors that affect establishment of effective multi-sector programs such as VDC are poorly understood, limiting ability to effectively deliver and scale programs. We conducted a qualitative study to describe factors affecting the interorganizational implementation context of VDC. Using constructs from the Consolidated Framework for Implementation Research (CFIR), we interviewed VDC coordinators from seven different VAMC-ADNA partnerships that initiated the VDC program between 2017 and 2018. We identified eight CFIR determinants which manifested similarly for the VAMCs and ADNAs: evidence strength and quality, relative advantage, adaptability, tension for change, access to knowledge and information, self-efficacy; engaging, and champions. We identified three CFIR determinants that varied dramatically across VAMCs and ADNAs: available resources, implementation climate, and relative priority. Our results suggest that interorganizational context plays a critical and dynamic role within multi-sector collaborations.
随着在退伍军人健康管理局（VHA）登记的退伍军人数量增加，并且有长期服务和支持需求的风险增加，VHA 正在从机构服务向家庭和社区为基础的服务转变，例如退伍军人直接护理（VDC）计划。VDC 是一个多部门计划，由 VHA 各个医疗中心（VAMC）和老龄化和残疾网络机构（ADNA）合作实施，这些机构位于 VHA 之外。影响像 VDC 这样的有效多部门计划建立的因素了解甚少，限制了有效交付和扩大计划的能力。我们进行了一项定性研究，以描述影响 VDC 跨组织实施背景的因素。我们使用实施研究综合框架（CFIR）的结构，采访了 2017 年至 2018 年期间启动 VDC 计划的七个不同 VAMC-ADNA 伙伴关系的 VDC 协调员。我们确定了对 VAMC 和 ADNA 表现相似的八项 CFIR 决定因素：证据强度和质量、相对优势、适应性、变革的紧张局势、获取知识和信息、自我效能；参与和拥护者。我们确定了三个在 VAMC 和 ADNA 之间差异巨大的 CFIR 决定因素：可用资源、实施氛围和相对优先级。我们的研究结果表明，跨组织背景在多部门合作中起着关键和动态的作用。
