Faculty of Health Sciences at Western University, 1151 Richmond St., London, Ontario N6A 3K7, Canada.
Faculty of Health Sciences at Western University, 1151 Richmond St., London, Ontario N6A 3K7, Canada; Department of Family Medicine and the Schulich Interfaculty Program in Public Health at the Schulich School of Medicine and Dentistry, 1151 Richmond St., London, Ontario N6A 3K7, Canada.
Eval Program Plann. 2024 Feb;102:102384. doi: 10.1016/j.evalprogplan.2023.102384. Epub 2023 Oct 30.
Chronic Obstructive Pulmonary Disease (COPD) is a primary cause of adult hospitalizations and imposes substantial burdens on patients and healthcare systems. Initiatives that support providers and patients in addressing needs at each stage of this illness are needed. The INSPIRED COPD Outreach Program™ was introduced in 2010 in Halifax, Nova Scotia, Canada to improve care for those with advanced COPD. The huge success of the program led to its expansion to various contexts and geographic locations through a pan-Canadian quality improvement collaborative (QIC). Our study explored early elements of program planning and practice with an aim to understand factors that influence program sustainability. We evaluated the implementation process of 19 teams across Canada; post-collaborative team reports, focus groups, interviews and self-ratings of progress were collected from all teams. Analysis of data revealed three phases important to fostering sustainability (facilitating implementation, keeping the momentum, and securing sustainability) and each phase had unique supporting themes. Not surprisingly, teams that planned for sustainability early in the implementation process were more likely to successfully achieve program sustainability. However, teams also benefited more broadly from sustainability planning; this included being better able to plan for program spread as well as skill retention and knowledge transfer. This was also seen for quality improvement skills introduced early in the program that were more likely to be maintained and used through other contexts when sustainability planning was present. This study highlights that a QIC can be effective in not only influencing program sustainability but also beyond program implementation through improving knowledge and skill acquisition.
慢性阻塞性肺疾病（COPD）是导致成人住院的主要原因，给患者和医疗体系带来了巨大负担。需要采取措施来支持医疗服务提供者和患者，以满足该疾病各阶段的需求。INSPIRED COPD 外展计划™于 2010 年在加拿大新斯科舍省哈利法克斯推出，旨在改善晚期 COPD 患者的护理。该计划取得了巨大成功，通过全加质量改进合作组织（QIC）在不同背景和地理位置上进行了扩展。我们的研究探讨了计划规划和实践的早期要素，旨在了解影响计划可持续性的因素。我们评估了加拿大 19 个团队的实施过程；从所有团队收集了协作后的团队报告、焦点小组、访谈和自我评估进度。数据分析揭示了促进可持续性的三个重要阶段（促进实施、保持动力和确保可持续性），每个阶段都有独特的支持主题。毫不奇怪，在实施过程中早期规划可持续性的团队更有可能成功实现计划的可持续性。然而，团队也从可持续性规划中获得了更广泛的收益；这包括更有能力规划项目的扩展以及技能保留和知识转移。这也适用于在计划实施早期引入的质量改进技能，当存在可持续性规划时，这些技能更有可能在其他环境中得到保留和使用。本研究强调，QIC 不仅可以通过提高知识和技能的获取来影响计划的可持续性，而且可以在计划实施之外产生影响。
