Adult and Child Consortium for Health Outcomes Research and Delivery Science (J.S.T., M.D.F., L.A.A., C.K.M., R.E.G., M.A.M., D.D.M.), University of Colorado School of Medicine, Aurora, CO.
Division of Cardiology (L.A.A., C.K.M.), University of Colorado School of Medicine, Aurora, CO.
Circ Cardiovasc Qual Outcomes. 2021 Feb;14(2):e007256. doi: 10.1161/CIRCOUTCOMES.120.007256. Epub 2021 Feb 3.
Background The left ventricular assist device (LVAD) has become a common medical option for patients with end-stage heart failure. Although patients' chances of survival may increase with an LVAD compared with medical therapy, the LVAD poses many risks and requires major lifestyle changes, thus making it a complex medical decision. Our prior work found that a decision aid for LVADs significantly increased decision quality for both patients and caregivers and was successfully implemented at 6 LVAD programs. Methods In follow-up, we are conducting a nationwide dissemination and implementation project, with the goal of implementing the decision aid at as many of the 176 LVAD programs in the United States as possible. Guided by the Theory of Diffusion of Innovations, the project consists of 4 phases: (1) building a network; (2) promoting adoption; (3) supporting implementation; and (4) encouraging maintenance. Developing an LVAD network of contacts occurs by using a national baseline survey of LVAD clinicians, existing professional relationships, and an internet-based strategy. A suite of resources targeted to promote adoption and support implementation of the decision aid into standard LVAD education processes are provided to the network. Evaluation is guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance framework, where clinician and patient surveys and qualitative interviews determine the reach, effectiveness, adoption, implementation, and maintenance achieved. Conclusions This project is a true dissemination study in that it targets the entire population of LVAD programs in the United States and is unique in its use of social marketing principles to promote adoption and implementation. The implementation plan is intended to serve as a test case and model for dissemination and implementation of other evidence-based decision support aids and strategies.
左心室辅助装置（LVAD）已成为心力衰竭终末期患者的常见医疗选择。虽然与药物治疗相比，LVAD 可提高患者的生存率，但 LVAD 存在许多风险，需要患者生活方式发生重大改变，因此这是一个复杂的医疗决策。我们之前的研究发现，LVAD 决策辅助工具可显著提高患者和护理人员的决策质量，并已在 6 个 LVAD 项目中成功实施。
在此基础上，我们正在开展一项全国性的传播和实施项目，目标是在美国的 176 个 LVAD 项目中尽可能多地实施该决策辅助工具。该项目以创新扩散理论为指导，包括 4 个阶段：（1）建立网络；（2）促进采用；（3）支持实施；（4）鼓励维持。通过对 LVAD 临床医生进行全国性基线调查、利用现有专业关系以及基于互联网的策略，来发展 LVAD 联系人网络。为网络提供一整套针对促进采用和支持将决策辅助工具纳入 LVAD 标准教育流程的资源。评估工作遵循 Reach、Effectiveness、Adoption、Implementation、Maintenance 框架进行，通过临床医生和患者调查以及定性访谈确定达到的范围、效果、采用、实施和维持程度。
该项目是一项真正的传播研究，因为它针对美国所有 LVAD 项目，且采用社会营销原则来促进采用和实施，这是其独特之处。实施计划旨在作为传播和实施其他基于证据的决策支持工具和策略的测试案例和模型。
