Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Ave., Toronto, ON, M5G 1V7, Canada.
Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
BMC Health Serv Res. 2024 Oct 23;24(1):1276. doi: 10.1186/s12913-024-11734-1.
The transition from pediatric to adult care is a vulnerable time for young people living with type 1 diabetes (T1D). Bridging the Gap (BTG) is an audit-and-feedback (AF) intervention aimed at improving both transitions-in-care processes and diabetes management in the year following transition. As part of BTG, we conducted a qualitative process evaluation to understand: (a) what was implemented and how; and (b) the contextual factors (micro-, meso- and macro-) that affected implementation, outcomes and study processes.
Using qualitative descriptive methodology, interviews were conducted with 13 healthcare professionals (HCPs) delivering diabetes care to transitioning youth. Participants were asked about their experiences of BTG study processes and feedback tools, the quality improvement (QI) initiatives implemented at their site, and potential spread and scale. Interviews also explored the impacts of COVID-19 on transition care and study processes and results.
Five key themes were identified. Participants' reflections on the BTG study design indicated they appreciated its flexible, site-specific approach to QI, which they saw as crucial to the success of their initiatives. Engagement with feedback reports and other study resources provided comparative, site-specific data. Participants described the challenges posed by the COVID-19 pandemic and its impacts on patients, care provision and study implementation. Their site-specific QI initiatives resulted in changes to their transition practices. Finally, participants commented on how BTG and its processes fostered a community of practice (CoP) between sites, resulting in new opportunities to collaborate and share experiences.
BTG resulted in a CoP among practitioners delivering transition care to youth with T1D, which could be scaled up to promote a learning health system in pediatric diabetes care. Qualitative process evaluation is a useful tool for understanding how contextual factors affect the implementation and outcomes of complex QI interventions.
从儿科过渡到成人护理是患有 1 型糖尿病（T1D）的年轻人的脆弱时期。弥合差距（BTG）是一项审核和反馈（AF）干预措施，旨在改善护理过渡过程和过渡后一年的糖尿病管理。作为 BTG 的一部分，我们进行了定性过程评估，以了解：（a）实施了什么以及如何实施；（b）影响实施、结果和研究过程的微观、中观和宏观环境因素。
使用定性描述性方法，对 13 名提供过渡期间青年糖尿病护理的医疗保健专业人员（HCP）进行了访谈。参与者被问及他们对 BTG 研究过程和反馈工具的经验、他们所在地点实施的质量改进（QI）举措，以及潜在的推广和扩展。访谈还探讨了 COVID-19 对过渡护理和研究过程和结果的影响。
确定了五个关键主题。参与者对 BTG 研究设计的反思表明，他们赞赏其 QI 的灵活、特定于地点的方法，他们认为这对他们举措的成功至关重要。参与反馈报告和其他研究资源提供了具有可比性的、特定于地点的数据。参与者描述了 COVID-19 大流行带来的挑战及其对患者、护理提供和研究实施的影响。他们的特定于地点的 QI 举措导致他们的过渡实践发生了变化。最后，参与者评论了 BTG 及其流程如何在提供过渡护理的从业者之间建立实践社区（CoP），从而为合作和分享经验创造了新的机会。
BTG 在为 T1D 青年提供过渡护理的从业者中建立了一个实践社区，可以扩大规模，促进儿科糖尿病护理中的学习型卫生系统。定性过程评估是了解环境因素如何影响复杂 QI 干预实施和结果的有用工具。
