Sarkies Mitchell N, Francis-Auton Emilie, Long Janet C, Partington Andrew, Pomare Chiara, Nguyen Hoa Mi, Wu Wendy, Westbrook Johanna, Day Richard O, Levesque Jean-Frederic, Mitchell Rebecca, Rapport Frances, Cutler Henry, Tran Yvonne, Clay-Williams Robyn, Watson Diane E, Arnolda Gaston, Hibbert Peter D, Lystad Reidar, Mumford Virginia, Leipnik George, Sutherland Kim, Hardwick Rebecca, Braithwaite Jeffrey
Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia.
BMJ Open. 2020 Dec 22;10(12):e044049. doi: 10.1136/bmjopen-2020-044049.
Value-based healthcare delivery models have emerged to address the unprecedented pressure on long-term health system performance and sustainability and to respond to the changing needs and expectations of patients. Implementing and scaling the benefits from these care delivery models to achieve large-system transformation are challenging and require consideration of complexity and context. Realist studies enable researchers to explore factors beyond 'what works' towards more nuanced understanding of 'what tends to work for whom under which circumstances'. This research proposes a realist study of the implementation approach for seven large-system, value-based healthcare initiatives in New South Wales, Australia, to elucidate how different implementation strategies and processes stimulate the uptake, adoption, fidelity and adherence of initiatives to achieve sustainable impacts across a variety of contexts.
This exploratory, sequential, mixed methods realist study followed RAMESES II (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) reporting standards for realist studies. Stage 1 will formulate initial programme theories from review of existing literature, analysis of programme documents and qualitative interviews with programme designers, implementation support staff and evaluators. Stage 2 envisages testing and refining these hypothesised programme theories through qualitative interviews with local hospital network staff running initiatives, and analyses of quantitative data from the programme evaluation, hospital administrative systems and an implementation outcome survey. Stage 3 proposes to produce generalisable middle-range theories by synthesising data from context-mechanism-outcome configurations across initiatives. Qualitative data will be analysed retroductively and quantitative data will be analysed to identify relationships between the implementation strategies and processes, and implementation and programme outcomes. Mixed methods triangulation will be performed.
Ethical approval has been granted by Macquarie University (Project ID 23816) and Hunter New England (Project ID 2020/ETH02186) Human Research Ethics Committees. The findings will be published in peer-reviewed journals. Results will be fed back to partner organisations and roundtable discussions with other health jurisdictions will be held, to share learnings.
基于价值的医疗服务提供模式已应运而生，以应对长期卫生系统绩效和可持续性方面前所未有的压力，并回应患者不断变化的需求和期望。实施这些医疗服务提供模式并扩大其益处以实现大规模系统转型具有挑战性，需要考虑复杂性和具体情况。现实主义研究使研究人员能够探索“什么有效”之外的因素，以便更细致入微地理解“在何种情况下对谁有效”。本研究提议对澳大利亚新南威尔士州的七项大型系统、基于价值的医疗保健倡议的实施方法进行现实主义研究，以阐明不同的实施策略和流程如何促进倡议的采用、采纳、保真度和坚持度，从而在各种情况下实现可持续影响。
这项探索性、序贯性、混合方法现实主义研究遵循了现实主义研究的RAMESES II（现实主义与元叙事证据综合：不断发展的标准）报告标准。第一阶段将通过对现有文献的回顾、项目文件分析以及对项目设计者、实施支持人员和评估人员的定性访谈，制定初步的项目理论。第二阶段设想通过对实施倡议的当地医院网络工作人员进行定性访谈，以及对项目评估、医院行政系统和实施结果调查的定量数据分析，来测试和完善这些假设的项目理论。第三阶段提议通过综合各倡议的背景 - 机制 - 结果配置数据来生成可推广的中程理论。定性数据将进行回溯分析，定量数据将进行分析以确定实施策略和流程与实施及项目结果之间的关系。将进行混合方法三角验证。
麦考瑞大学（项目编号23816）和亨特新英格兰（项目编号2020/ETH02186）人类研究伦理委员会已批准伦理审查。研究结果将发表在同行评审期刊上。结果将反馈给合作组织，并将与其他卫生管辖区举行圆桌讨论，以分享经验教训。
