Highfield Linda, Ferguson Gayla M, Holcomb Jennifer
Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, United States.
Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, United States.
Front Health Serv. 2022 Nov 2;2:926657. doi: 10.3389/frhs.2022.926657. eCollection 2022.
A multitude of HRSN interventions are undergoing testing in the U.S., with the CMS Accountable Health Communities (AHC) Model as the largest. HRSN interventions typically include screening for social needs, referral to community resources, and patient navigation to ensure needs are met. There is currently a paucity of evidence on implementation of HRSN interventions. The Consolidated Framework for Implementation Research (CFIR) is a determinant framework widely used to plan and assess implementation. To the authors knowledge, there are no published studies assessing CFIR constructs for HRSN intervention implementation in the U.S. In the Assessment step of the Strengthening Peer AHC Navigation (SPAN) model, a between-site qualitative assessment methodology was used to examine implementation within and between AHC bridge organizations (BOs) within six ERIC implementation strategies identified by the authors based on AHC Model requirements.
Our aim was to identify and present between-site barriers and facilitators to AHC Model implementation strategies.
A multi-site qualitative analysis methodology was used. CFIR determinants were linked to six Expert Recommendations for Implementing Change (ERIC) strategies: staff training, identify and prepare champions, facilitation, community resource engagement (alignment through advisory boards and working groups), data systems, and quality monitoring and assurance. Interviews were analyzed using thematic content analysis in NVivo 12 (QSR International).
Five health-related bridge organizations participating in the AHC Model.
Fifty-eight interviews were completed with 34 staff and 24 patients or patient proxies. Facilitators were identified across five of the six ERIC strategies. Barriers were identified across all six. While organizations found the AHC Model compatible and facilitators to implementation included previous experience, meeting patient needs and resources, and leadership engagement and support, a number of barriers presented challenges to implementation. Issues with adequate staff training, staff skills to resolve HRSN, including patient communication and boundary spanning, setting staff goals, beneficiary caseloads and measurement of progress, data infrastructure (including EHR), available resources to implement and differences in perceptions between clinical delivery site (CDS), and CSP of how to measure and resolve HRSN.
The conduct of a pre-implementation readiness assessment benefited from identifying CFIR determinants linked to various ERIC implementation strategies.
美国正在对众多基于健康相关社会需求（HRSN）的干预措施进行测试，其中以医疗保险和医疗补助服务中心（CMS）的责任医疗社区（AHC）模式规模最大。HRSN干预措施通常包括社会需求筛查、转介至社区资源以及患者导航，以确保需求得到满足。目前，关于HRSN干预措施实施的证据匮乏。实施研究整合框架（CFIR）是一个广泛用于规划和评估实施情况的决定性框架。据作者所知，在美国尚无已发表的研究评估CFIR构建在HRSN干预措施实施中的应用。在强化同伴AHC导航（SPAN）模式的评估步骤中，采用了跨站点定性评估方法，以研究在作者根据AHC模式要求确定的六种实施研究与实施协作（ERIC）策略范围内，AHC桥梁组织（BO）内部以及之间的实施情况。
我们的目标是识别并呈现AHC模式实施策略在不同站点间的障碍和促进因素。
采用多站点定性分析方法。CFIR决定因素与六种实施变革的专家建议（ERIC）策略相关联：员工培训、识别并培养支持者、促进、社区资源参与（通过咨询委员会和工作组实现协调一致）、数据系统以及质量监测与保证。使用NVivo 12（QSR国际公司）中的主题内容分析法对访谈进行分析。
五个参与AHC模式的健康相关桥梁组织。
共完成了58次访谈，访谈对象包括34名工作人员以及24名患者或患者代理人。在六种ERIC策略中的五种策略中识别出了促进因素。在所有六种策略中均识别出了障碍。虽然各组织认为AHC模式具有兼容性，实施的促进因素包括以往经验、满足患者需求和资源以及领导层的参与和支持，但仍有一些障碍给实施带来了挑战。这些障碍包括员工培训是否充分的问题、员工解决HRSN问题的技能，包括与患者沟通和跨越界限的能力、设定员工目标、受益人的工作量以及进展衡量、数据基础设施（包括电子健康记录）、实施所需的可用资源，以及临床服务站点（CDS）和社区服务点（CSP）在如何衡量和解决HRSN问题上的认知差异。
进行实施前准备评估得益于识别与各种ERIC实施策略相关联的CFIR决定因素。
