Department of Health Administration and Policy, Affiliate Faculty, Center for Evidence-Based Behavioral Health, Department of Psychology, George Mason University, 4400 University Drive MS IJ3, Fairfax, VA, 22030, USA.
Department of Sociology and Anthropology, College of Humanities and Social Sciences, George Mason University, 4400 University Drive, 3G5, Fairfax, VA, 22030, USA.
BMC Prim Care. 2023 Nov 17;24(1):242. doi: 10.1186/s12875-023-02200-8.
The EvidenceNOW: Advancing Heart Health in Primary Care was designed to assist primary care practices in the US in implementing evidence-based practices in cardiovascular care and building capacity for quality improvement. EvidenceNOW, NCT03054090, was registered with ClinicalTrials.gov on 15/02/2017. The goals of this study were to gain a comprehensive understanding of perspectives from research participants and research team members on the value of implementation strategies and factors that influenced the EvidenceNOW initiative in Virginia.
In 2018, we conducted 25 focus groups with clinicians and staff at participating practices, including 80 physicians, advanced practice clinicians, practice managers and other practice staff. We also conducted face-to-face and telephone interviews with 22 research team members, including lead investigators, practice facilitators, physician expert consultants, and evaluators. We used the integrated-Promoting Action on Research Implementation in the Health Services (i-PARIHS) framework in our qualitative data analysis and organization of themes.
Implementation strategies valued by both practice representatives and research team members included the kick-off event, on-site practice facilitation, and interaction with physician expert consultants. Remote practice facilitation and web-based tools were used less frequently. Contextual factors that influence quality improvement efforts include leadership support, access to resources, previous quality improvement experience, and practice ownership type (independent compared to health system owned). Many clinicians and staff were overwhelmed by day-to-day activities and experience initiative fatigue, which hindered their ability to fully participate in the EvidenceNOW initiative.
This study provides details on how the practice environment plays an essential role in the implementation of evidence-based practices in primary care. Future efforts to improve quality in primary care practices should consider the context and environment of individual practices, with targeted implementation strategies to meet the needs of independent and health system owned practices. Future efforts to improve quality in primary care practices require strategies to address initiative fatigue among clinicians and practice staff. External support for building capacity for quality improvement could help primary care practices implement and sustain evidence-based practices and improve quality of care.
This project was registered with ClinicalTrials.gov on 15/02/2017 and the identifier is NCT03054090.
旨在帮助美国初级保健实践实施心血管护理循证实践并建立质量改进能力的 EvidenceNOW：推进初级保健中的心脏健康。EvidenceNOW，NCT03054090，于 2017 年 2 月 15 日在 ClinicalTrials.gov 注册。本研究的目的是全面了解研究参与者和研究团队成员对实施策略的价值以及影响弗吉尼亚州 EvidenceNOW 计划的因素的看法。
2018 年，我们对参与实践的临床医生和工作人员进行了 25 次焦点小组讨论，其中包括 80 名医生、高级实践临床医生、实践经理和其他实践工作人员。我们还对 22 名研究团队成员进行了面对面和电话访谈，其中包括首席研究员、实践促进者、医师专家顾问和评估员。我们在定性数据分析和主题组织中使用了综合促进卫生服务研究实施行动（i-PARIHS）框架。
实践代表和研究团队成员都重视的实施策略包括启动活动、现场实践促进以及与医师专家顾问的互动。远程实践促进和基于网络的工具使用较少。影响质量改进努力的背景因素包括领导力支持、资源获取、以前的质量改进经验以及实践所有权类型（独立与卫生系统拥有）。许多临床医生和工作人员被日常活动压得喘不过气来，并且经历了计划疲劳，这阻碍了他们充分参与 EvidenceNOW 计划的能力。
本研究详细介绍了实践环境如何在初级保健中实施基于证据的实践中发挥重要作用。未来提高初级保健实践质量的努力应考虑到个别实践的背景和环境，并采取有针对性的实施策略，以满足独立实践和卫生系统拥有实践的需求。未来提高初级保健实践质量的努力需要解决临床医生和实践工作人员的计划疲劳问题。为提高质量改进能力提供外部支持可以帮助初级保健实践实施和维持基于证据的实践并改善护理质量。
该项目于 2017 年 2 月 15 日在 ClinicalTrials.gov 注册，标识符为 NCT03054090。
