Jt Comm J Qual Patient Saf. 2023 Jan;49(1):26-33. doi: 10.1016/j.jcjq.2022.10.002. Epub 2022 Oct 22.
To improve patient safety and pain management, the Centers for Disease Control and Prevention (CDC) released the Guideline for Prescribing Opioids for Chronic Pain (CDC Guideline). Recognizing that issuing a guideline alone is insufficient for transforming practice, CDC supported an Opioid Quality Improvement (QI) Collaborative, consisting of 10 health care systems that represented more than 120 practices across the United States. The research team identified factors related to implementation success using domains described by the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) implementation science framework.
Data from interviews, notes from check-in calls, and documents provided by systems were used. The researchers collected data throughout the project through interviews, meeting notes, and documents.
The iPARIHS framework was used to identify factors that affected implementation related to the context, innovation (implementing recommendations from the CDC Guideline), recipient (clinicians), and facilitation (QI team). Contextual characteristics were at the clinic, health system, and broader external context, including staffing and leadership support, previous QI experience, and state laws. Characteristics of the innovation were its adaptability and challenges operationalizing the measures. Recipient characteristics included belief in the importance of the innovation but challenges engaging in the initiative. Finally, facilitation characteristics driving differential outcomes included staffing and available time of the QI team, the ability to make changes, and experience with QI.
As health care systems continue to implement the CDC Guideline, these insights can advance successful implementation efforts by describing common implementation challenges and identifying strategies to prepare for and overcome them.
为了提高患者安全和疼痛管理水平，疾病预防控制中心（CDC）发布了《慢性疼痛阿片类药物处方指南》（CDC 指南）。认识到仅仅发布指南不足以改变实践，CDC 支持了一个阿片类药物质量改进（QI）合作组织，由 10 个医疗保健系统组成，代表了美国 120 多家以上的实践。研究团队使用综合促进健康服务研究实施（iPARIHS）实施科学框架中描述的领域，确定了与实施成功相关的因素。
使用来自访谈、签到电话记录和系统提供的文件的数据。研究人员通过访谈、会议记录和文件在整个项目中收集数据。
iPARIHS 框架用于确定与背景、创新（实施 CDC 指南中的建议）、接受者（临床医生）和促进（QI 团队）相关的实施因素。背景特征包括诊所、医疗系统和更广泛的外部背景，包括人员配备和领导层的支持、以前的 QI 经验和州法律。创新的特征包括其适应性和实施措施的操作性挑战。接受者的特征包括对创新的重要性的信念，但在参与倡议方面存在挑战。最后，推动差异化结果的促进因素包括 QI 团队的人员配备和可用时间、进行变革的能力以及 QI 经验。
随着医疗保健系统继续实施 CDC 指南，这些见解可以通过描述常见的实施挑战并确定准备和克服这些挑战的策略来推进成功的实施工作。
