Shin Marlena H, Montano Anna-Rae L, Adjognon Omonyêlé L, Harvey Kimberly L L, Solimeo Samantha L, Sullivan Jennifer L
Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.
Center of Innovation in Long-Term Services and Supports, VA Providence Healthcare System, Providence, Rhode Island, USA.
Gerontologist. 2023 Mar 21;63(3):439-450. doi: 10.1093/geront/gnac157.
As the proportion of the U.S. population over 65 and living with complex chronic conditions grows, understanding how to strengthen the implementation of age-sensitive primary care models for older adults, such as the Veterans Health Administration's Geriatric Patient-Aligned Care Teams (GeriPACT), is critical. However, little is known about which implementation strategies can best help to mitigate barriers to adopting these models. We aimed to identify barriers to GeriPACT implementation and strategies to address these barriers using the Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change (CFIR-ERIC) Matching Tool.
We conducted a content analysis of qualitative responses obtained from a web-based survey sent to GeriPACT members. Using a matrix approach, we grouped similar responses into key barrier categories. After mapping barriers to CFIR, we used the Tool to identify recommended strategies.
Across 53 Veterans Health Administration hospitals, 32% of team members (n = 197) responded to our open-ended question about barriers to GeriPACT care. Barriers identified include Available Resources, Networks & Communication, Design Quality & Packaging, Knowledge & Beliefs, Leadership Engagement, and Relative Priority. The Tool recommended 12 Level 1 (e.g., conduct educational meetings) and 24 Level 2 ERIC strategies (e.g., facilitation). Several strategies (e.g., conduct local consensus discussions) cut across multiple barriers.
Strategies identified by the Tool can inform on-going development of the GeriPACT model's effective implementation and sustainment. Incorporating cross-cutting implementation strategies that mitigate multiple barriers at once may further support these next steps.
随着美国65岁以上患有复杂慢性病的人口比例不断增加，了解如何加强针对老年人的年龄敏感型初级保健模式的实施至关重要，例如退伍军人健康管理局的老年患者对齐护理团队（GeriPACT）。然而，对于哪些实施策略能够最有效地帮助减轻采用这些模式的障碍，我们知之甚少。我们旨在使用实施研究综合框架-实施变革的专家建议（CFIR-ERIC）匹配工具，确定GeriPACT实施的障碍以及解决这些障碍的策略。
我们对通过网络调查从GeriPACT成员处获得的定性回复进行了内容分析。我们采用矩阵方法，将相似的回复归为关键障碍类别。在将障碍映射到CFIR后，我们使用该工具确定推荐策略。
在53家退伍军人健康管理局医院中，32%的团队成员（n = 197）回复了我们关于GeriPACT护理障碍的开放式问题。确定的障碍包括可用资源、网络与沟通、设计质量与包装、知识与信念、领导参与度以及相对优先级。该工具推荐了12项一级（例如，召开教育会议）和24项二级ERIC策略（例如，促进）。一些策略（例如，进行当地共识讨论）跨越了多个障碍。
该工具确定的策略可为GeriPACT模式有效实施和维持的持续发展提供信息。纳入能够一次性减轻多个障碍的交叉实施策略可能会进一步支持这些后续步骤。
