Branch-Elliman Westyn, van den Berg Polly, Dong Sara W, Kapoor Andrew K, Merchant Elisabeth A, Schechter-Perkins Elissa M
Veterans' Affairs (VA) Boston Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts.
Section of Infectious Diseases, Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts.
Antimicrob Steward Healthc Epidemiol. 2022 Jan 12;2(1):e4. doi: 10.1017/ash.2021.249. eCollection 2022.
OBJECTIVE: We developed an implementation plan to integrate diagnostic testing for coronavirus disease 2019 (COVID-19) into a public school system. Implementation barriers were identified and strategies were mapped to overcome them. DESIGN: A COVID-19 diagnostic testing program leveraging a public-private partnership was developed for a public school system. SETTING: A suburban school district and a local hospital during the 2020-2021 academic year. METHODS: Using Consolidated Framework for Implementation Research (CFIR) constructs and evidenced-based implementation strategies, the program was designed as a "closed system" and was adapted based on stakeholder feedback. Implementation barriers and facilitators were identified and mapped to CFIR constructs to provide insights into factors influencing program adoption. RESULTS: Preimplementation stages of engagement, feasibility, and readiness planning were completed. The program did not progress to implementation due to multiple factors, including changes in school leadership (inner setting and process-level constructs), improved access to outside testing, and lack of an existing paradigm for in-school testing (external constructs). Limited support from key stakeholders and opinion leaders was also a barrier (process-level construct). CONCLUSIONS: Although this locally initiated program did not progress beyond the preimplementation stage, the processes developed and barriers identified may be useful to inform planning efforts in other testing programs within public school systems. Future programs may consider incorporating multiplex diagnostic testing for influenza in addition to COVID-19. With relaxation of infection control measures, the prevalence of other respiratory viruses will increase. Actionable results will be needed to inform decisions about closures and quarantines.
目的:我们制定了一项实施计划,将2019冠状病毒病(COVID-19)诊断检测纳入公立学校系统。识别了实施障碍,并制定了克服这些障碍的策略。 设计:为一个公立学校系统开发了一项利用公私合作伙伴关系的COVID-19诊断检测计划。 背景:2020 - 2021学年的一个郊区学区和一家当地医院。 方法:使用实施研究综合框架(CFIR)构建要素和循证实施策略,该计划被设计为一个“封闭系统”,并根据利益相关者的反馈进行调整。识别实施障碍和促进因素,并将其映射到CFIR构建要素,以深入了解影响计划采用的因素。 结果:完成了参与、可行性和准备计划的实施前阶段。由于多种因素,该计划未能推进到实施阶段,这些因素包括学校领导的变动(内部环境和过程层面的构建要素)、外部检测途径的改善以及缺乏校内检测的现有模式(外部构建要素)。关键利益相关者和意见领袖的支持有限也是一个障碍(过程层面的构建要素)。 结论:尽管这个本地启动的计划没有超越实施前阶段,但所制定的流程和识别出的障碍可能有助于为公立学校系统内其他检测计划的规划工作提供参考。未来的计划除了COVID-19检测外,可能还应考虑纳入流感多重诊断检测。随着感染控制措施的放宽,其他呼吸道病毒的流行率将会增加。需要可采取行动的结果来为关于学校关闭和隔离的决策提供依据。
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