Warren Connor M, Ashcraft Laura Ellen, Peeples Amanda, Piazza Kirstin Manges, Goodman Octavia, Gitlin Laura N, Long Judith A, Burke Robert E, Werner Rachel M, Brown Rebecca T
Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
Inquiry. 2025 Jan-Dec;62:469580251322364. doi: 10.1177/00469580251322364. Epub 2025 Mar 12.
The Tailored Activity Program (TAP), an intervention for people living with dementia (PLWD) and their caregivers, has been shown to reduce behavioral symptoms for PLWD and caregiver burden. While TAP is proven as an evidence-based practice (EBP), it has yet to be implemented at scale. The Department of Veterans Affairs (VA) has prioritized the Age-Friendly Health System (AFHS) initiative, providing an opportunity to test implementation of TAP in a complex healthcare system. We conducted semi-structured pre-implementation interviews with leaders and clinicians at 6 VA Medical Centers (VAMCs) to engage key implementation partners and understand their unique implementation contexts. We utilized team-based rapid qualitative analysis to identify themes related to implementation determinants. We interviewed 65 unique informants in 58 interviews (5 VAMC leaders, 36 department leaders, and 17 frontline clinical staff). Informants identified 4 key factors critical to consider prior to implementing TAP: (1) alignment with organizational priorities; (2) perceived value and fit with existing clinical workflows; (3) competition with existing organizational and clinical priorities; and (4) considerations about the effect of caregiver burden on participation. We identified key factors to consider for successful implementation of a multicomponent intervention for PLWD and their caregivers within a complex healthcare system. As the AFHS initiative expands, there is a growing need for EBPs focused on the care of PLWD and their caregivers. These factors can guide clinicians, leaders, and implementation scientists in planning for implementation and sustainment of EBPs to bolster AFHS initiatives.Trial RegistrationRegistered 05 May 2021, at ISRCTN #60,657,985.Reporting GuidelinesThe COnsolidated criteria for REporting Qualitative research (COREQ) checklist was used to ensure proper standards for reporting qualitative studies (see attached).
量身定制活动计划（TAP）是一项针对痴呆症患者（PLWD）及其护理人员的干预措施，已被证明可以减轻痴呆症患者的行为症状和护理人员的负担。虽然TAP已被证明是一种循证实践（EBP），但尚未大规模实施。退伍军人事务部（VA）已将老年友好型医疗系统（AFHS）倡议列为优先事项，这为在复杂的医疗系统中测试TAP的实施提供了机会。我们对6家VA医疗中心（VAMC）的领导人和临床医生进行了实施前的半结构化访谈，以吸引关键的实施伙伴并了解他们独特的实施背景。我们利用基于团队的快速定性分析来确定与实施决定因素相关的主题。我们在58次访谈中采访了65名独特的受访者（5名VAMC领导人、36名部门领导人和17名一线临床工作人员）。受访者确定了在实施TAP之前需要考虑的4个关键因素：（1）与组织优先事项保持一致；（2）感知价值以及与现有临床工作流程的契合度；（3）与现有组织和临床优先事项的竞争；（4）对护理人员负担对参与度影响的考量。我们确定了在复杂医疗系统中成功实施针对痴呆症患者及其护理人员的多组分干预措施时需要考虑的关键因素。随着AFHS倡议的扩大，对专注于痴呆症患者及其护理人员护理的循证实践的需求日益增长。这些因素可以指导临床医生、领导人和实施科学家规划循证实践的实施和维持，以加强AFHS倡议。试验注册于2021年5月5日在ISRCTN #60,657,985进行。报告指南使用了定性研究报告统一标准（COREQ）清单，以确保定性研究报告的适当标准（见附件）。
