Anderson Amanda Joy, Noyes Katia, Hewner Sharon
School of Nursing, State University of New York at Buffalo, Buffalo, NY, United States.
Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, State University of New York at Buffalo, Buffalo, NY, United States.
Front Health Serv. 2023 Sep 8;3:1124054. doi: 10.3389/frhs.2023.1124054. eCollection 2023.
Patients with medical and social complexity require care administered through cross-sector collaboration (CSC). Due to organizational complexity, biomedical emphasis, and exacerbated needs of patient populations, interventions requiring CSC prove challenging to implement and study. This report discusses challenges and provides strategies for implementation of CSC through a collaborative, cross-sector, interagency, multidisciplinary team model.
A collaborative, cross-sector, interagency, multidisciplinary team was formed called the Buffalo City Mission Recuperative Care Collaborative (RCU Collaborative), in Buffalo, NY, to provide care transition support for people experiencing homelessness at acute care hospital discharge through a medical respite program. Utilizing the Expert Recommendations for Implementing Change (ERIC) framework and feedback from cross-sector collaborative team, implementation strategies were drawn from three validated ERIC implementation strategy clusters: 1) Develop stakeholder relationships; 2) Use evaluative and iterative strategies; 3) Change infrastructure.
Stakeholders identified the following factors as the main barriers: organizational culture clash, disparate visions, and workforce challenges related to COVID-19. Identified facilitators were clear group composition, clinical academic partnerships, and strategic linkages to acute care hospitals.
A CSC interagency multidisciplinary team can facilitate complex care delivery for high-risk populations, such as medical respite care. Implementation planning is critically important when crossing agency boundaries for new multidisciplinary program development. Insights from this project can help to identify and minimize barriers and optimize utilization of facilitators, such as academic partners. Future research will address external organizational influences and emphasize CSC as central to interventions, not simply a domain to consider during implementation.
患有复杂医疗和社会问题的患者需要通过跨部门协作（CSC）来提供护理。由于组织复杂性、生物医学重点以及患者群体需求的加剧，需要跨部门协作的干预措施在实施和研究方面具有挑战性。本报告讨论了相关挑战，并提供了通过协作、跨部门、跨机构、多学科团队模式实施跨部门协作的策略。
在纽约州布法罗市成立了一个协作、跨部门、跨机构、多学科团队，称为布法罗市使命康复护理协作组织（RCU协作组织），通过医疗暂托计划为急性护理医院出院时无家可归的人提供护理过渡支持。利用实施变革的专家建议（ERIC）框架以及跨部门协作团队的反馈，从三个经过验证的ERIC实施策略集群中得出实施策略：1）发展利益相关者关系；2）使用评估和迭代策略；3）改变基础设施。
利益相关者确定以下因素为主要障碍：组织文化冲突、不同的愿景以及与COVID-19相关的劳动力挑战。确定的促进因素包括明确的团队组成、临床学术伙伴关系以及与急性护理医院的战略联系。
跨部门协作的跨机构多学科团队可以促进为高风险人群提供复杂护理，例如医疗暂托护理。在跨机构界限开展新的多学科项目开发时，实施规划至关重要。该项目的见解有助于识别和最小化障碍，并优化促进因素（如学术伙伴）的利用。未来的研究将探讨外部组织影响，并强调跨部门协作是干预措施的核心，而不仅仅是实施过程中需要考虑的一个领域。
