Depla Anne L, Crombag Neeltje M, Franx Arie, Bekker Mireille N
Department of Obstetrics and Gynaecology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, KE.04.123.1, Lundlaan 6, 3584, EA, Utrecht, The Netherlands.
Department of Development and Regeneration, KU Leuven University, Leuven, Belgium.
BMC Health Serv Res. 2021 Feb 2;21(1):113. doi: 10.1186/s12913-021-06121-z.
To improve their quality, healthcare systems are increasingly focused on value delivered to patients. For perinatal care, the International Consortium for Health Outcomes Measurement (ICHOM) proposed a patient-centred outcome set with both clinical and patient-reported measures for pregnancy and childbirth (PCB set). This study aimed to identify factors that affect the implementation of the PCB set at the pre-implementation stage, using the consolidated framework for implementation research (CFIR).
In this qualitative study, we conducted semi-structured interviews amongst a purposive sample of key stakeholders within an obstetric care network (OCN): 1) patients, 2) perinatal care professionals involved in the full cycle of perinatal care, and 3) policy makers, including hospital managers, administrative staff and health care insurers. While the CFIR guided data capture and structuring, thematic analysis revealed overarching themes that best reflected the barriers and facilitators from different stakeholder perspectives. Within these overarching themes, the CFIR constructs were maintained.
Interviews were conducted with 6 patients, 16 professionals and 5 policy makers. Thematic analysis supported by the CFIR framework identified four main themes: the instrument and its implementation process, use in individual patient care, use in quality improvement, and the context of the OCN. Important barriers included professional workload, data reliability, and interprofessional and interorganizational collaboration. Potential facilitators were the PCB set's direct value in individual care, interprofessional feedback and education, and aligning with existing systems. Prominent variations between stakeholder groups included the expected patient burden, the level of use, transparency of outcomes and the degree of integrated care.
This study clarified critical factors that affect successful implementation of the PCB set in perinatal care. Practice recommendations, suggested at multiple levels, can enable structural patient-centred care improvement and may unite stakeholders towards integrated birth care.
为提高医疗保健系统的质量，其越来越关注为患者提供的价值。对于围产期护理，国际健康结果测量协会（ICHOM）提出了一套以患者为中心的结果集，其中包括针对妊娠和分娩的临床及患者报告指标（PCB集）。本研究旨在利用实施研究综合框架（CFIR），确定在实施前阶段影响PCB集实施的因素。
在这项定性研究中，我们对产科护理网络（OCN）中有目的抽取的关键利益相关者样本进行了半结构化访谈：1）患者；2）参与围产期护理全过程的围产期护理专业人员；3）政策制定者，包括医院管理人员、行政人员和医疗保险公司。虽然CFIR指导数据收集和整理，但主题分析揭示了最能反映不同利益相关者观点的障碍和促进因素的总体主题。在这些总体主题中，保留了CFIR的结构。
对6名患者、16名专业人员和5名政策制定者进行了访谈。CFIR框架支持的主题分析确定了四个主要主题：工具及其实施过程、在个体患者护理中的应用、在质量改进中的应用以及OCN的背景。重要障碍包括专业工作量、数据可靠性以及跨专业和跨组织协作。潜在的促进因素是PCB集在个体护理中的直接价值、跨专业反馈和教育以及与现有系统保持一致。利益相关者群体之间的显著差异包括预期的患者负担、使用水平、结果透明度和综合护理程度。
本研究阐明了影响围产期护理中PCB集成功实施的关键因素。在多个层面提出的实践建议可以实现以患者为中心的结构性护理改进，并可能使利益相关者团结起来实现综合分娩护理。
