University of Texas Health Science Center School of Public Health, Department of Health Promotion and Behavioral Science, Brownsville Regional Campus, Brownsville, TX, United States.
Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States.
Front Public Health. 2022 Nov 24;10:928148. doi: 10.3389/fpubh.2022.928148. eCollection 2022.
Despite the availability of multilevel evidence-based interventions for blood pressure management, poor hypertension control is common among community health center patient populations across the state of Texas and the United States. is a national initiative from the American Heart Association and the American Medical Association to assist healthcare organizations and care teams in improving blood pressure control rates using evidence-based approaches and recognition of organizations who have successfully integrated the program in their practice. Using the Implementation Mapping approach, we identified determinants of adoption and use and developed implementation strategies to improve program uptake and implementation in Community Health Centers in Texas.
We used Implementation Mapping (IM) to identify barriers and facilitators influencing the adoption and implementation of the program and develop strategies to increase program adoption and use. We recruited four clinics across four counties in Texas and assessed barriers and facilitators at the organizational level, including electronic health records and data use. We used this data to inform clinic-specific implementation strategies based on the organization capacity and priorities feedback. We developed an implementation plan and timeline designed to improve the implementation and maintenance of .
As part of the needs and capacity assessment, we collected data through interviews with CHC staff, examining gaps in needs and services (e.g., what do clinics need to implement ?), and assets to leverage. We worked with Community Health Centers to a) identify individuals who would be involved in the adoption, implementation, and maintenance of , b) describe adoption and implementation actions, and c) identify barriers and facilitators influencing adoption and implementation. Together with partners from Community Health Center, we used the IM approach to identify and develop program goals, identify methods and strategies to address barriers, and create an implementation plan. Our strategies included monthly or biweekly meetings to provide technical support, reviewing program goals and timeline to ensure program implementation, progress toward reaching goals, and address quality improvement needs at each clinic site. We developed a implementation protocol for each clinic based on the needs and capacity assessment, identification of technology use and capacity, and gap analysis. We reviewed program strategies and self-measured blood pressure protocols tailored to the clinic patient population. We developed a collaborative plan, reviewed funding and capacity for implementation, and provided continuous quality improvement guidance. Ongoing process and impact evaluations using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework are underway.
This paper provides an example of using Implementation Mapping to develop strategies to increase the adoption and implementation of evidence-based cardiovascular risk reduction interventions in Community Health Centers. The use of implementation strategies can increase the use of in Community Health Centers and improve hypertension control.
尽管有针对血压管理的多层次循证干预措施，但德克萨斯州和美国的社区卫生中心患者群体的高血压控制仍然很差。 是美国心脏协会和美国医学协会的一项全国性倡议，旨在通过循证方法帮助医疗保健组织和护理团队提高血压控制率，并认可成功将该项目纳入其实践的组织。我们使用实施映射方法，确定了 采用和使用的决定因素，并制定了实施策略，以提高德克萨斯州社区卫生中心的项目采用率和实施率。
我们使用实施映射（IM）来确定影响该计划采用和实施的障碍和促进因素，并制定策略以提高该计划的采用和使用。我们在德克萨斯州的四个县招募了四个诊所，并评估了组织层面的障碍和促进因素，包括电子健康记录和数据使用。我们根据组织能力和优先级反馈，使用这些数据为每个诊所制定具体的实施策略。我们制定了实施计划和时间表，旨在改善 的实施和维护。
作为需求和能力评估的一部分，我们通过采访社区卫生中心工作人员收集数据，检查需求和服务差距（例如，诊所需要实施 ？），并利用资产。我们与社区卫生中心合作：a）确定将参与该计划的采用、实施和维护的个人，b）描述采用和实施的行动，以及 c）确定影响采用和实施的障碍和促进因素。我们与社区卫生中心的合作伙伴一起，使用 IM 方法来确定和制定项目目标，确定解决障碍的方法和策略，并创建实施计划。我们的策略包括每月或每两周举行一次会议以提供技术支持，审查项目目标和时间表以确保项目的实施、实现目标的进展以及解决每个诊所现场的质量改进需求。我们根据需求和能力评估、技术使用和能力的确定以及差距分析，为每个诊所制定了 实施协议。我们审查了 针对诊所患者人群量身定制的计划策略和自我测量血压方案。我们制定了合作计划，审查了实施的资金和能力，并提供了持续的质量改进指导。正在使用 Reach、Effectiveness、Adoption、Implementation 和 Maintenance（RE-AIM）框架进行持续的过程和影响评估。
本文提供了一个使用实施映射来制定策略以增加社区卫生中心采用和实施循证心血管风险降低干预措施的示例。使用实施策略可以增加社区卫生中心对 的使用，并改善高血压控制。
