Pratt-Chapman Mandi L, Silber Rachel, Tang Jeffrey, Le Phuong Thao D
GW Cancer Center, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA.
Graduate School of Arts and Sciences, New York University, New York, USA.
Implement Sci Commun. 2021 Dec 20;2(1):141. doi: 10.1186/s43058-021-00248-0.
Patient navigation (PN) is an evidence-based practice that involves assessing and addressing individual barriers to care for patients. While PN has shown effectiveness in numerous studies, designing successful, sustainable PN programs has remained challenging for many healthcare organizations. The purpose of the present study was to examine implementation factors for successful PN programs to optimize the sustainability of PN services across cancer care settings in the USA.
Data were collected via semi-structured interviews with PN stakeholders (n=17) from diverse cancer care settings. Thematic content analysis was conducted by deductively coding major themes based on constructs from the Exploration-Preparation-Implementation-Sustainability framework and by inductively coding emergent themes.
Facilitators in the outer context included payer guidelines, accreditation requirements, community partnerships, and demonstrated need and demand for services. Inner context factors such as alignment with organizational and leadership priorities, appropriate staff support and workloads, and relative advantage were important to program success. Innovation characteristics such as the presence of innovation champions, clear role and scope of practice, clear protocols, strong communication channels, and innovation fit were facilitators of program success. Community-Academic partnerships and funding stability also emerged as facilitators for program sustainability.
Our qualitative analysis from a diverse sample of PN stakeholders and programs across the USA supports intentional use of implementation theory to design PN programs to optimize implementation success.
患者导航（PN）是一种循证实践，涉及评估和解决患者就医过程中的个体障碍。虽然PN在众多研究中已显示出有效性，但对许多医疗保健组织而言，设计成功且可持续的PN项目仍具有挑战性。本研究的目的是探讨成功的PN项目的实施因素，以优化美国癌症护理环境中PN服务的可持续性。
通过对来自不同癌症护理环境的PN利益相关者（n = 17）进行半结构化访谈收集数据。采用主题内容分析法，根据探索 - 准备 - 实施 - 可持续性框架中的构建对主要主题进行演绎编码，并对新出现的主题进行归纳编码。
外部环境中的促进因素包括支付方指南、认证要求、社区伙伴关系以及对服务的明确需求。内部环境因素，如与组织和领导优先事项的一致性、适当的人员支持和工作量以及相对优势，对项目成功很重要。创新特征，如创新倡导者的存在、明确的角色和实践范围、明确的协议、强大的沟通渠道以及创新契合度，是项目成功的促进因素。社区 - 学术伙伴关系和资金稳定性也成为项目可持续性的促进因素。
我们对美国各地PN利益相关者和项目的不同样本进行的定性分析支持有意运用实施理论来设计PN项目，以优化实施成功率。
