Health Research Economics, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
BMJ Open. 2021 Feb 23;11(2):e040749. doi: 10.1136/bmjopen-2020-040749.
To (1) apply the (FAIT) to Lessons from the Best to Better the Rest (LFTB), (2) report on impacts from LFTB and (3) assess the feasibility and outcomes from a retrospective application of FAIT.
Three Indigenous primary healthcare (PHC) centres in the Northern Territory, Australia; project coordinating centre distributed between Townsville, Darwin and Cairns and the broader LFTB learning community across Australia.
LFTB research team and one representative from each PHC centre.
Impact reported as (1) quantitative metrics within domains of benefit using a modified Payback Framework, (2) a cost-consequence analysis given a return on investment was not appropriate and (3) a narrative incorporating qualitative evidence of impact. Data were gathered through in-depth stakeholder interviews and a review of project documentation, outputs and relevant websites.
LFTB contributed to knowledge advancement in Indigenous PHC service delivery; enhanced existing capacity of health centre staff, researchers and health service users; enhanced supportive networks for quality improvement; and used a strengths-based approach highly valued by health centres. LFTB also leveraged between $A1.4 and $A1.6 million for the subsequent Leveraging Effective Ambulatory Practice (LEAP) Project to apply LFTB learnings to resource development and creation of a learning community to empower striving PHC centres.
Retrospective application of FAIT to LFTB, although not ideal, was feasible. Prospective application would have allowed Indigenous community perspectives to be included. Greater appreciation of the full benefit of LFTB including a measure of return on investment will be possible when LEAP is complete. Future assessments of impact need to account for the limitations of fully capturing impact when intermediate/final impacts have not yet been realised and captured.
(1)将最佳实践应用于改进其余实践(LFTB)中的 FAIT,(2)报告 LFTB 的影响,(3)评估 FAIT 的回顾性应用的可行性和结果。
澳大利亚北领地的三个原住民初级保健(PHC)中心;项目协调中心分布在汤斯维尔、达尔文和凯恩斯之间,以及澳大利亚更广泛的 LFTB 学习社区。
LFTB 研究团队和每个 PHC 中心的一名代表。
影响报告为(1)使用修改后的回报框架在受益领域内的定量指标,(2)由于不适合投资回报,因此进行成本效益分析,以及(3)包含影响的定性证据的叙述。数据通过深入的利益相关者访谈和项目文件、产出和相关网站的审查收集。
LFTB 为原住民 PHC 服务提供方面的知识进步做出了贡献;增强了卫生中心工作人员、研究人员和卫生服务用户的现有能力;增强了质量改进的支持网络;并采用了卫生中心高度重视的基于优势的方法。LFTB 还利用了 140 万至 160 万澳元用于后续的利用有效门诊实践(LEAP)项目,将 LFTB 的学习应用于资源开发和创建一个学习社区,以赋予努力的 PHC 中心权力。
尽管 FAIT 对 LFTB 的回顾性应用并不理想,但却是可行的。如果进行前瞻性应用,将能够包括原住民社区的观点。当 LEAP 完成后,将有可能更全面地了解 LFTB 的全部收益,包括投资回报的衡量。未来的影响评估需要考虑到在尚未实现和记录中间/最终影响时,全面捕捉影响的局限性。