社区医院高效临床路径实施的障碍与促进因素

Barriers and Facilitators of High-Efficiency Clinical Pathway Implementation in Community Hospitals.

作者信息

Outram Simon M, Rooholamini Sahar N, Desai Mansi, Edwards Yeelen, Ja Clairissa, Morton Kayce, Vaughan Jordan H, Shaw Judith S, Gonzales Ralph, Kaiser Sunitha V

机构信息

Department of Pediatrics, University of California, San Francisco, California.

Department of Pediatrics, University of Washington, Seattle, Washington.

出版信息

Hosp Pediatr. 2023 Oct 1;13(10):931-939. doi: 10.1542/hpeds.2023-007173.

DOI:10.1542/hpeds.2023-007173

PMID:37697946

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10520265/

Abstract

BACKGROUND

An intervention that involved simultaneously implementing clinical pathways for multiple conditions was tested at a tertiary children's hospital and it improved care quality. We are conducting a randomized trial to evaluate this multicondition pathway intervention in community hospitals. Our objectives in this qualitative study were to prospectively (1) identify implementation barriers and (2) map barriers to facilitators using an established implementation science framework.

METHODS

We recruited participants via site leaders from hospitals enrolled in the trial. We designed an interview guide using the Consolidated Framework for Implementation Research and conducted individual interviews. Analysis was done using constant comparative methods. Anticipated barriers were mapped to facilitators using the Capability, Opportunity, Motivation, Behavior Framework.

RESULTS

Participants from 12 hospitals across the United States were interviewed (n = 21). Major themes regarding the multicondition pathway intervention included clinician perceptions, potential benefits, anticipated barriers/challenges, potential facilitators, and necessary resources. We mapped barriers to additional facilitators using the Capability, Opportunity, Motivation, Behavior framework. To address limited time/bandwidth of clinicians, we will provide Maintenance of Certification credits. To address new staff and trainee turnover, we will provide easily accessible educational videos/resources. To address difficulties in changing practice across other hospital units, we will encourage emergency department engagement. To address parental concerns with deimplementation, we will provide guidance on parent counseling.

CONCLUSIONS

We identified several potential barriers and facilitators for implementation of a multicondition clinical pathway intervention in community hospitals. We also illustrate a prospective process for identifying implementation facilitators.

摘要

背景

在一家三级儿童医院对一项涉及同时为多种病症实施临床路径的干预措施进行了测试，结果显示该措施改善了护理质量。我们正在开展一项随机试验，以评估社区医院中这种多病症路径干预措施的效果。本定性研究的目的是前瞻性地：（1）识别实施障碍；（2）使用既定的实施科学框架将障碍映射到促进因素。

方法

我们通过参与试验的医院的现场负责人招募参与者。我们使用实施研究综合框架设计了一份访谈指南，并进行了个人访谈。分析采用持续比较法。使用能力、机会、动机、行为框架将预期障碍映射到促进因素。

结果

对来自美国12家医院的参与者进行了访谈（n = 21）。关于多病症路径干预措施的主要主题包括临床医生的看法、潜在益处、预期障碍/挑战、潜在促进因素和所需资源。我们使用能力、机会、动机、行为框架将障碍映射到其他促进因素。为解决临床医生时间/带宽有限的问题，我们将提供继续医学教育学分。为解决新员工和实习生流动的问题，我们将提供易于获取的教育视频/资源。为解决在其他医院科室改变实践的困难，我们将鼓励急诊科参与。为解决家长对取消实施的担忧，我们将提供家长咨询指导。