Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, USA.
VA Office of Patient Care Services, Primary Care Analytics Team, Iowa City VA Health Care System, Iowa City, Iowa, USA.
Health Serv Res. 2021 Oct;56 Suppl 1(Suppl 1):1057-1068. doi: 10.1111/1475-6773.13859. Epub 2021 Aug 27.
To identify factors affecting implementation of Geriatric Patient-Aligned Care Teams (GeriPACTs), a patient-centered medical home model for older adults with complex care needs including multiple chronic conditions (MCC), designed to provide them with comprehensive, managed, and coordinated primary care.
Qualitative data were collected from key informants at eight Veterans Health Administration Medical Centers geographically spread across the United States.
Guided by the Consolidated Framework for Implementation Research (CFIR), we collected prospective primary data through semi-structured interviews with GeriPACT team members (e.g., physicians, nurses, social workers, pharmacists), leaders (e.g., executive leaders, middle managers), and other staff referring to the program.
We conducted in-person, semi-structured interviews with 134 key informants. Interviews were recorded with permission and professionally transcribed. Transcripts were coded in Nvivo 11. We used directed content analysis to identify key factors affecting GeriPACT implementation across sites.
Five key factors affected GeriPACT implementation-five CFIR constructs within two CFIR domains. Within the intervention characteristics domain, two constructs emerged, namely, (1) the structure of the GeriPACT model and (2) design, quality, and packaging. Within the inner setting domain, we identified three constructs, namely, (1) available resources (e.g., staffing and space, and infrastructure and information technology), (2) leadership support and engagement, and (3) networks and communications including teamwork, communication, and coordination.
Older veterans with MCC have complex primary care needs requiring high levels of care management and coordination. Knowing what key factors affect GeriPACT implementation is critical. Study findings also contribute to the growing implementation science literature on applying CFIR to evaluate factors that affect program implementation, especially to aging research. Further studies on MCC-focused specialty primary care will help facilitate patient-centered care provision for older adults' complex health needs while also leveraging synergistic work across factors affecting implementation.
确定影响老年患者护理团队实施的因素，老年患者护理团队是一种以患者为中心的医疗模式，适用于有复杂护理需求的老年人，包括多种慢性疾病（MCC），旨在为他们提供全面、管理和协调的初级保健。
定性数据来自美国各地八个退伍军人健康管理医疗中心的关键信息提供者。
根据实施研究综合框架（CFIR），我们通过与 GeriPACT 团队成员（例如医生、护士、社会工作者、药剂师）、领导（例如执行领导、中层管理人员）和其他参与该项目的人员进行半结构化访谈，前瞻性地收集初级数据。
我们对 134 名关键信息提供者进行了面对面的半结构化访谈。在获得许可和专业转录的情况下记录访谈。使用 Nvivo 11 对转录本进行编码。我们使用定向内容分析来确定影响跨站点 GeriPACT 实施的关键因素。
有五个关键因素影响了 GeriPACT 的实施——CFIR 两个领域中的五个 CFIR 结构。在干预特征领域中，出现了两个结构，即（1）GeriPACT 模型的结构和（2）设计、质量和包装。在内部环境领域中，我们确定了三个结构，即（1）可用资源（例如人员配备和空间、基础设施和信息技术）、（2）领导力支持和参与以及（3）网络和沟通，包括团队合作、沟通和协调。
患有 MCC 的老年退伍军人有复杂的初级保健需求，需要高水平的护理管理和协调。了解影响 GeriPACT 实施的关键因素至关重要。研究结果还为应用 CFIR 评估影响项目实施的因素的不断发展的实施科学文献做出了贡献，特别是对老龄化研究。进一步研究以 MCC 为重点的专科初级保健将有助于为老年人的复杂健康需求提供以患者为中心的护理，同时利用影响实施的因素之间的协同作用。
