Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, 200 Hawkins Dr., Iowa City, IA, 52242, USA.
Department of Internal Medicine, University of Iowa, 200 Hawkins Dr., Iowa City, IA, 52242, USA.
Implement Sci. 2022 Jan 4;17(1):1. doi: 10.1186/s13012-021-01157-5.
An application-oriented implementation framework designed for clinicians and based on the Diffusion of Innovations theory included 81 implementation strategies with suggested timing for use within four implementation phases. The purpose of this research was to evaluate and strengthen the framework for clinician use and propose its usefulness in implementation research.
A multi-step, iterative approach guided framework revisions. Individuals requesting the use of the framework over the previous 7 years were sent an electronic questionnaire. Evaluation captured framework usability, generalizability, accuracy, and implementation phases for each strategy. Next, nurse leaders who use the framework pile sorted strategies for cultural domain analysis. Last, a panel of five EBP/implementation experts used these data and built consensus to strengthen the framework.
Participants (n = 127/1578; 8% response) were predominately nurses (94%), highly educated (94% Master's or higher), and from across healthcare (52% hospital/system, 31% academia, and 7% community) in the USA (84%). Most (96%) reported at least some experience using the framework and 88% would use the framework again. A 4-point scale (1 = not/disagree to 4 = very/agree) was used. The framework was deemed useful (92%, rating 3-4), easy to use (72%), intuitive (67%), generalizable (100%), flexible and adaptive (100%), with accurate phases (96%), and accurate targets (100%). Participants (n = 51) identified implementation strategy timing within four phases (Cochran's Q); 54 of 81 strategies (66.7%, p < 0.05) were significantly linked to a specific phase; of these, 30 (55.6%) matched the original framework. Next, nurse leaders (n = 23) completed a pile sorting activity. Anthropac software was used to analyze the data and visualize it as a domain map and hierarchical clusters with 10 domains. Lastly, experts used these data and implementation science to refine and specify each of the 75 strategies, identifying phase, domain, actors, and function. Strategy usability, timing, and groupings were used to refine the framework.
The Iowa Implementation for Sustainability Framework offers a typology to guide implementation for evidence-based healthcare. This study specifies 75 implementation strategies within four phases and 10 domains and begins to validate the framework. Standard use of strategy names is foundational to compare and understand when implementation strategies are effective, in what dose, for which topics, by whom, and in what context.
本研究旨在评估和加强面向临床医生的应用导向实施框架，并提出其在实施研究中的有用性。该框架基于创新扩散理论，包含 81 项实施策略，并为每个策略在四个实施阶段中的使用建议了时间。
采用多步骤迭代方法指导框架修订。在过去 7 年中请求使用该框架的个人被发送了一份电子问卷。评估包括框架的可用性、可推广性、准确性以及每个策略的实施阶段。接下来，使用该框架的护理领导者对策略进行了文化域分析的堆积分类。最后，由五名 EBP/实施专家使用这些数据并达成共识，以加强框架。
参与者（n = 127/1578；8%的应答率）主要是护士（94%），教育程度较高（94%拥有硕士或更高学位），来自美国各地的医疗保健机构（52%医院/系统，31%学术机构，7%社区）。大多数人（96%）报告至少有一些使用框架的经验，88%的人会再次使用框架。使用 1-4 分制（1=不/不同意到 4=非常/同意）进行评估。框架被认为是有用的（92%，评分 3-4）、易于使用（72%）、直观（67%）、可推广的（100%）、灵活和适应性强（100%），阶段（96%）和目标（100%）准确。参与者（n = 51）确定了四个阶段内实施策略的时间（Cochran's Q）；81 项策略中的 54 项（66.7%，p < 0.05）与特定阶段显著相关；其中 30 项（55.6%）与原始框架相匹配。接下来，护理领导者（n = 23）完成了堆积分类活动。Anthropac 软件用于分析数据，并将其可视化作为一个域图和层次聚类，其中包含 10 个域。最后，专家使用这些数据和实施科学来细化和指定每个 75 项策略，确定阶段、域、行为者和功能。策略的可用性、时间安排和分组用于改进框架。
爱荷华州实施可持续性框架为基于证据的医疗保健提供了一种类型学指导实施。本研究在四个阶段和十个领域内确定了 75 项实施策略，并开始验证该框架。策略名称的标准化使用是比较和理解实施策略何时有效、剂量多少、针对哪些主题、由谁实施以及在何种背景下有效的基础。
