Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, HSB-334, London, ON, N6A 2K5, Canada.
Department of Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond St, HSB-334, London, ON, N6A 2K5, Canada.
BMC Health Serv Res. 2022 Mar 30;22(1):420. doi: 10.1186/s12913-022-07785-x.
In Canada, there is widespread agreement about the need for integrated models of team-based care. However, there is less agreement on how to support the scale-up and spread of successful models, and there is limited empirical evidence to support this process in chronic disease management. We studied the supporting and mitigating factors required to successfully implement and scale-up an integrated model of team-based care in primary care.
We conducted a collective case study using multiple methods of data collection including interviews, document analysis, living documents, and a focus group. Our study explored a team-based model of care for chronic obstructive pulmonary disease (COPD) known as Best Care COPD (BCC) that has been implemented in primary care settings across Southwestern Ontario. BCC is a quality improvement initiative that was developed to enhance the quality of care for patients with COPD. Participants included healthcare providers involved in the delivery of the BCC program.
We identified several mechanisms influencing the scale-up and spread of BCC and categorized them as Foundational (e.g., evidence-based program, readiness to implement, peer-led implementation team), Transformative (adaptive process, empowerment and collaboration, embedded evaluation), and Enabling Mechanisms (provider training, administrative support, role clarity, patient outcomes). Based on these results, we developed a framework to inform the progressive implementation of integrated, team-based care for chronic disease management. Our framework builds off our empirical work and is framed by local contextual factors.
This study explores the implementation and spread of integrated team-based care in a primary care setting. Despite the study's focus on COPD, we believe the findings can be applied in other chronic disease contexts. We provide a framework to support the progressive implementation of integrated team-based care for chronic disease management.
在加拿大，人们普遍认为需要建立基于团队的综合护理模式。然而，对于如何支持成功模式的扩大和推广，以及如何为慢性病管理提供支持这一过程，还没有达成共识，也缺乏实证证据。我们研究了在基层医疗中成功实施和扩大基于团队的综合护理模式所需的支持和缓解因素。
我们采用了多种数据收集方法，包括访谈、文献分析、实时文件和焦点小组，进行了一项集体案例研究。我们的研究探讨了一种在安大略省西南部基层医疗环境中实施的基于团队的慢性阻塞性肺疾病（COPD）护理模式，称为最佳 COPD 护理（BCC）。BCC 是一项质量改进计划，旨在提高 COPD 患者的护理质量。参与者包括参与 BCC 项目实施的医疗保健提供者。
我们确定了影响 BCC 扩大和推广的几个机制，并将其归类为基础机制（如基于证据的项目、实施准备、同行领导的实施团队）、转型机制（适应性过程、赋权和协作、嵌入式评估）和使能机制（提供者培训、行政支持、角色明确、患者结果）。基于这些结果，我们开发了一个框架，为慢性病管理的综合、基于团队的护理渐进式实施提供信息。我们的框架基于我们的实证工作，并受到当地背景因素的影响。
本研究探讨了在基层医疗环境中实施和推广综合基于团队的护理。尽管本研究的重点是 COPD，但我们认为这些发现可以应用于其他慢性病环境。我们提供了一个框架，以支持慢性病管理的综合基于团队的护理的渐进式实施。
