Center for Health System Sciences, Atrium Health, 1300 Scott Ave, Charlotte, NC, 28203, USA.
Department of Internal Medicine, Medical Center Boulevard, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA.
BMC Health Serv Res. 2024 Aug 28;24(1):996. doi: 10.1186/s12913-024-11344-x.
Sepsis survivors experience high morbidity and mortality. Though recommended best practices have been established to address the transition and early post hospital needs and promote recovery for sepsis survivors, few patients receive recommended post-sepsis care. Our team developed the Sepsis Transition and Recovery (STAR) program, a multicomponent transition intervention that leverages virtually-connected nurses to coordinate the application of evidence-based recommendations for post-sepsis care with additional clinical support from hospitalist and primary care physicians. In this paper, we present findings from a qualitative pre-implementation study, guided by the Consolidated Framework for Implementation Research (CFIR), of factors to inform successful STAR implementation at a large learning health system prior to effectiveness testing as part of a Type I Hybrid trial.
We conducted semi-structured qualitative interviews (n = 16) with 8 administrative leaders and 8 clinicians. Interviews were transcribed and analyzed in ATLAS.ti using a combination deductive/inductive strategy based on CFIR domains and constructs and the Constant Comparison Method.
Six facilitators and five implementation barriers were identified spanning all five CFIR domains (Intervention Characteristics, Outer Setting, Inner Setting, Characteristics of Individuals and Process). Facilitators of STAR included alignment with health system goals, fostering stakeholder engagement, sharing STAR outcomes data, good communication between STAR navigators and patient care teams/PCPs, clinician promotion of STAR with patients, and good rapport and effective communication between STAR navigators and patients, caregivers, and family members. Barriers of STAR included competing demands for staff time and resources, insufficient communication and education of STAR's value and effectiveness, underlying informational and technology gaps among patients, lack of patient access to community resources, and patient distrust of the program and/or health care.
CFIR proved to be a robust framework for examining facilitators and barriers for pre-implementation planning of post-sepsis care programs within diverse hospital and community settings in a large LHS. Conducting a structured pre-implementation evaluation helps researchers design with implementation in mind prior to effectiveness studies and should be considered a key component of Type I hybrid trials when feasible.
Clinicaltrials.gov, NCT04495946 . Registered August 3, 2020.
脓毒症幸存者的发病率和死亡率较高。尽管已经制定了推荐的最佳实践来解决脓毒症幸存者的过渡和早期出院后需求，并促进其康复，但很少有患者接受推荐的脓毒症后护理。我们的团队开发了 Sepsis Transition and Recovery（STAR）计划，这是一种多组分过渡干预措施，利用虚拟连接的护士协调实施针对脓毒症后护理的循证建议，并由医院医生和初级保健医生提供额外的临床支持。在本文中，我们根据实施研究整合框架（CFIR）介绍了一项定性预实施研究的结果，该研究旨在在有效性测试之前为大型学习健康系统中的 STAR 实施提供信息，作为 I 型混合试验的一部分。
我们对 8 名行政领导和 8 名临床医生进行了半结构式定性访谈（n=16）。访谈内容使用 ATLAS.ti 进行转录和分析，采用基于 CFIR 域和结构以及常数比较法的演绎/归纳策略。
确定了六个促进因素和五个实施障碍，涵盖了所有五个 CFIR 域（干预特性、外部环境、内部环境、个体特征和过程）。STAR 的促进因素包括与卫生系统目标保持一致、促进利益相关者参与、共享 STAR 结果数据、STAR 导航员与患者护理团队/PCP 之间良好的沟通、临床医生向患者推荐 STAR，以及 STAR 导航员与患者、照顾者和家庭成员之间的良好关系和有效沟通。STAR 的障碍包括员工时间和资源的竞争需求、对 STAR 的价值和有效性的沟通和教育不足、患者之间存在信息和技术差距、患者缺乏获得社区资源的机会以及患者对该计划和/或医疗保健的不信任。
CFIR 被证明是一个强大的框架，可用于在大型 LHS 中检查多样化医院和社区环境中脓毒症后护理计划的实施前促进因素和障碍。在进行有效性研究之前进行结构化的预实施评估有助于研究人员在设计时考虑到实施，当可行时，应将其视为 I 型混合试验的关键组成部分。
Clinicaltrials.gov，NCT04495946。于 2020 年 8 月 3 日注册。
