From Health Partners Institute, Minneapolis, MN (LIS); Virginia Commonwealth University, Richmond, VA (AKu, AKr); Kaiser Permanente Washington Health Research Institute, Seattle, WA (MLP); School of Global Public Health, New York University (NYU), New York, NY (DRS); University of Colorado, Aurora, CO (WPD, DF); Feinberg School of Medicine, Northwestern University, Chicago, IL (TLW, AKh); NYU Langone Health, New York NY, (AMN, CB); Oregon Health Sciences University, Portland, OR (LRF, DJC, LG); University of North Carolina at Chapel Hill, Chapel Hill, NC (SC); School of Public Health, UTHealth, Dallas, TX (BAB); Lehigh Valley Health Center, Easton, PA (WM); University of Oklahoma, Oklahoma City, OK (DD, ZN).
J Am Board Fam Med. 2021 Jan-Feb;34(1):32-39. doi: 10.3122/jabfm.2021.01.200225.
There is no commonly accepted comprehensive framework for describing the practical specifics of external support for practice change. Our goal was to develop such a taxonomy that could be used by both external groups or researchers and health care leaders.
The leaders of 8 grants from Agency for Research and Quality for the EvidenceNOW study of improving cardiovascular preventive services in over 1500 primary care practices nationwide worked collaboratively over 18 months to develop descriptions of key domains that might comprehensively characterize any external support intervention. Combining literature reviews with our practical experiences in this initiative and past work, we aimed to define these domains and recommend measures for them.
The taxonomy includes 1 domain to specify the conceptual model(s) on which an intervention is built and another to specify the types of support strategies used. Another 5 domains provide specifics about the dose/mode of that support, the types of change process and care process changes that are encouraged, and the degree to which the strategies are prescriptive and standardized. A model was created to illustrate how the domains fit together and how they would respond to practice needs and reactions.
This taxonomy and its use in more consistently documenting and characterizing external support interventions should facilitate communication and synergies between 3 areas (quality improvement, practice change research, and implementation science) that have historically tended to work independently. The taxonomy was designed to be as useful for practices or health systems managing change as it is for research.
目前还没有被广泛认可的综合框架来描述实践变革外部支持的具体内容。我们的目标是开发这样一种分类法，供外部团体或研究人员以及医疗保健领导者使用。
参与国家卫生保健研究与质量机构的 EvidenceNOW 研究的 8 个资助项目的领导者们合作了 18 个月，共同开发了可能全面描述任何外部支持干预措施的关键领域描述。我们结合文献综述和我们在这一倡议及过去工作中的实践经验，旨在定义这些领域并为其推荐测量方法。
该分类法包括一个指定干预措施所依据的概念模型的领域，另一个指定所使用的支持策略类型的领域。另外 5 个领域提供了关于支持的剂量/模式、鼓励的变革过程和护理过程变化类型以及策略的规范性和标准化程度的具体信息。创建了一个模型来说明这些领域是如何相互配合的，以及它们将如何响应实践需求和反应。
该分类法及其在更一致地记录和描述外部支持干预措施方面的应用，应该能够促进质量改进、实践变革研究和实施科学这三个领域（这三个领域在历史上往往各自为政）之间的沟通和协同作用。该分类法旨在为管理变革的实践或卫生系统提供与为研究提供同样的帮助。
