Tonkikh Orly, Young Heather M, Bell Janice F, Famula Jessica, Whitney Robin, Mongoven Jennifer, Kelly Kathleen
Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel.
Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA, United States.
JMIR Aging. 2024 Dec 10;7:e63355. doi: 10.2196/63355.
In 2022, the US Department of Health and Human Services released the first National Strategy to Support Family Caregivers, identifying actions for both government and the private sector. One of the major goals is to expand data, research, and evidence-based practices to support family caregivers. While IT tools are widely deployed in health care settings, they are rarely available at scale in community agencies. In 2019, the state of California recognized the importance of a statewide database and a platform to serve caregivers remotely by enhancing existing service supports and investing in a web-based platform, CareNav. Implementation commenced in early 2020 across all 11 California Caregiver Resource Centers.
This paper describes the implementation strategies and outcomes of the statewide implementation of CareNav, a web-based platform to support family caregivers.
The Consolidated Framework for Implementation Research (CFIR), including a recent addendum, guided this mixed methods evaluation. Two major approaches were used to evaluate the implementation process: in-depth qualitative interviews with key informants (n=82) and surveys of staff members (n=112) and caregivers (n=2229). We analyzed the interview transcripts using qualitative descriptive methods; subsequently, we identified subthemes and relationships among the ideas, mapping the findings to the CFIR addendum. For the surveys, we used descriptive statistics.
We present our findings about implementation strategies, implementation outcomes (ie, adoption, fidelity, and sustainment), and the impact on population health (organizational effectiveness and equity, as well as caregiver satisfaction, health, and well-being). The platform was fully adopted within 18 months, and the system is advancing toward sustainment through statewide collaboration. The deployment has augmented organizational effectiveness and quality, enhanced equity, and improved caregiver health and well-being.
This study provides a use case for technological implementation across a multisite system with diverse community-based agencies. Future research can expand the understanding of the barriers and facilitators to achieving relevant outcomes and population impact.
2022年，美国卫生与公众服务部发布了首份支持家庭护理人员的国家战略，确定了政府和私营部门的行动。主要目标之一是扩展数据、研究和循证实践，以支持家庭护理人员。虽然信息技术工具在医疗保健环境中广泛部署，但在社区机构中很少大规模提供。2019年，加利福尼亚州认识到全州数据库和一个通过加强现有服务支持并投资基于网络的平台CareNav来远程服务护理人员的平台的重要性。2020年初在加利福尼亚州所有11个护理人员资源中心开始实施。
本文描述了支持家庭护理人员的基于网络的平台CareNav在全州实施的实施策略和成果。
实施研究综合框架（CFIR），包括最近的一个附录，指导了这项混合方法评估。使用了两种主要方法来评估实施过程：对关键信息提供者进行深入定性访谈（n = 82）以及对工作人员（n = 112）和护理人员（n = 2229）进行调查。我们使用定性描述方法分析访谈记录；随后，我们确定了子主题和想法之间的关系，将结果映射到CFIR附录。对于调查，我们使用描述性统计。
我们展示了关于实施策略、实施成果（即采用、保真度和可持续性）以及对人群健康的影响（组织有效性和公平性，以及护理人员满意度、健康和幸福感）的研究结果。该平台在18个月内被全面采用，并且该系统正在通过全州范围的合作朝着可持续性发展。此次部署提高了组织有效性和质量，增强了公平性，并改善了护理人员的健康和幸福感。
本研究为跨多个具有不同社区机构的系统进行技术实施提供了一个应用案例。未来的研究可以扩展对实现相关成果和人群影响的障碍及促进因素的理解。
