Department of Veterans Affairs, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA; University of Colorado, Aurora, CO, USA.
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Geriatr Nurs. 2022 Mar-Apr;44:282-287. doi: 10.1016/j.gerinurse.2022.02.006. Epub 2022 Feb 24.
Randomized controlled trials are considered the most rigorous research design in efficacy and effectiveness research; however, such trials present numerous challenges that limit their applicability in real-world settings. As a consequence, pragmatic trials are increasingly viewed as a research design that overcomes some of these barriers with the potential to produce data that are more reproducible. Although pragmatic methodology in long-term care is receiving increasing attention as an approach to improve successful dissemination and implementation, pragmatic trials present complexities of their own. To address these complexities and related issues, experts with experience conducting pragmatic trials, developing nursing home policy, participating in advocacy efforts, and providing clinical care in long-term care settings participated in a virtual consensus conference funded by the National Institute on Aging in Spring 2021. Participants recommended 4 cross-cutting principles key to dissemination and implementation of pragmatic trial interventions: (1) engage stakeholders, (2) ensure diversity and inclusion, (3) assess organizational strain and readiness, and (4) learn from adaptations. Specifically related to implementation, participants provided 2 recommendations: (1) integrate interventions into existing workflows and (2) maintain agility and responsiveness. Finally, participants had 3 recommendations specific to dissemination: (1) package the message for the audience, (2) engage diverse audiences, and (3) apply dissemination and diffusion tools. Participants emphasized that implementation processes must be grounded in the perspectives of the people who will ultimately be responsible for implementing the intervention once it is proven to be effective. In addition, messaging must speak to long-term care staff and all others who have a stake in its outcomes. Although our understanding of dissemination and implementation strategies remains underdeveloped, this article is designed to guide long-term care researchers and community providers who are increasingly aware of the need for pragmatism in disseminating and implementing evidence-based care interventions.
随机对照试验被认为是在疗效和有效性研究中最严格的研究设计；然而，这种试验提出了许多挑战，限制了其在实际环境中的适用性。因此，实用主义试验越来越被视为一种研究设计，它克服了一些这些障碍，有可能产生更具可重复性的数据。尽管长期护理中的实用主义方法作为一种提高成功传播和实施的方法越来越受到关注，但实用主义试验本身也存在复杂性。为了解决这些复杂性和相关问题，具有进行实用主义试验、制定养老院政策、参与宣传工作和在长期护理环境中提供临床护理经验的专家参加了由国家老龄化研究所资助的 2021 年春季虚拟共识会议。与会者建议了 4 个贯穿始终的原则，这些原则对传播和实施实用试验干预措施至关重要：（1）让利益相关者参与，（2）确保多样性和包容性，（3）评估组织压力和准备情况，以及（4）从适应中学习。特别是与实施相关，与会者提出了 2 项建议：（1）将干预措施融入现有工作流程，（2）保持灵活性和响应能力。最后，与会者提出了 3 项专门针对传播的建议：（1）为受众打包信息，（2）吸引不同的受众，以及（3）应用传播和扩散工具。与会者强调，实施过程必须立足于那些最终将负责实施干预措施的人的观点，一旦证明干预措施有效。此外，信息必须针对长期护理人员和所有其他对其结果有利益关系的人。尽管我们对传播和实施策略的理解仍不发达，但本文旨在指导长期护理研究人员和社区提供者，他们越来越意识到在传播和实施循证护理干预措施方面需要实用主义。
