Masters Claire, Carandang Rogie Royce, Lewis Jessica B, Hagaman Ashley, Metrick Rebecca, Ickovics Jeannette R, Cunningham Shayna D
Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, 06510, USA.
Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, 06030, USA.
Implement Sci Commun. 2024 Mar 4;5(1):20. doi: 10.1186/s43058-024-00556-1.
Group prenatal care enhances quality of care, improves outcomes, and lowers costs. However, this healthcare innovation is not widely available. Using a case-study approach, our objectives were to (1) examine organizational characteristics that support implementation of Expect With Me group prenatal care and (2) identify key factors influencing adoption and sustainability.
We studied five clinical sites implementing group prenatal care, collecting qualitative data including focus group discussions with clinicians (n = 4 focus groups, 41 clinicians), key informant interviews (n = 9), and administrative data. We utilized a comparative qualitative case-study approach to characterize clinical sites and explain organizational traits that fostered implementation success. We characterized adopting and non-adopting (unable to sustain group prenatal care) sites in terms of fit for five criteria specified in the Framework for Transformational Change: (1) impetus to transform, (2) leadership commitment to quality, (3) improvement initiatives that engage staff, (4) alignment to achieve organization-wide goals, and (5) integration.
Two sites were classified as adopters and three as non-adopters based on duration, frequency, and consistency of group prenatal care implementation. Adopters had better fit with the five criteria for transformational change. Adopting organizations were more successful implementing group prenatal care due to alignment between organizational goals and resources, dedicated healthcare providers coordinating group care, space for group prenatal care sessions, and strong commitment from organization leadership.
Adopting sites were more likely to integrate group prenatal care when stakeholders achieved alignment across staff on organizational change goals, leadership buy-in, and committed institutional support and dedicated resources to sustain it.
The Expect With Me intervention's design and hypotheses were preregistered: https://clinicaltrials.gov/study/NCT02169024 . Date: June 19, 2014.
小组产前护理可提高护理质量、改善结局并降低成本。然而，这种医疗创新并未广泛普及。采用案例研究方法，我们的目标是：（1）研究支持“与我同期待”小组产前护理实施的组织特征；（2）确定影响采用和可持续性的关键因素。
我们研究了五个实施小组产前护理的临床地点，收集定性数据，包括与临床医生进行焦点小组讨论（n = 4个焦点小组，41名临床医生）、关键信息人访谈（n = 9）以及行政数据。我们采用比较定性案例研究方法来描述临床地点的特征，并解释促进实施成功的组织特征。我们根据变革性变革框架中规定的五个标准来描述采用和未采用（无法维持小组产前护理）的地点：（1）变革动力；（2）领导层对质量的承诺；（3）使员工参与的改进举措；（4）与全组织目标的一致性；（5）整合。
根据小组产前护理实施的持续时间、频率和一致性，两个地点被归类为采用者，三个为未采用者。采用者更符合变革性变革的五个标准。由于组织目标与资源之间的一致性、协调小组护理的专职医疗服务提供者、小组产前护理课程的场地以及组织领导层的坚定承诺，采用小组产前护理的组织实施得更为成功。
当利益相关者在组织变革目标、领导层支持以及持续实施所需的坚定机构支持和专用资源方面达成一致时，采用小组产前护理的地点更有可能将其整合。
“与我同期待”干预措施的设计和假设已预先注册：https://clinicaltrials.gov/study/NCT02169024 。日期：2014年6月19日。
