PDF(Pubmed)
Abstract：
Food insecurity (FI), the limited access to healthy food to live an active and healthy life, is a social determinant of health linked to poor dietary health and difficulty with disease management in the United States (U.S.). Healthcare experts support the adoption of validated screening tools within primary care practice to identify and connect FI patients to healthy and affordable food resources. Yet, a lack of standard practices limits uptake. The purpose of this study was to understand program processes and outcomes of primary care focused FI screening initiatives that may guide wide-scale program implementation.
This was an embedded multiple case study of two primary care-focused initiatives implemented in two diverse health systems in Chicago and Suburban Cook County that routinely screened patients for FI and referred them to onsite food assistance programs. The Consolidated Framework for Implementation Research and an iterative process were used to collect/analyze qualitative data through semi-structured interviews with N = 19 healthcare staff. Intended program activities, outcomes, actors, implementation barriers/facilitators and overarching implementation themes were identified as a part of a cross-case analysis.
Programs outcomes included: the number of patients screened, identified as FI and that participated in the onsite food assistance program. Study participants reported limited internal resources as implementation barriers for program activities. The implementation climate that leveraged the strength of community collaborations and aligned internal, implementation climate were critical facilitators that contributed to the flexibility of program activities that were tailored to fill gaps in resources and meet patient and clinician needs.
Highly adaptable programs and the healthcare context enhanced implementation feasibility across settings. These characteristics can support program uptake in other settings, but should be used with caution to preserve program fidelity. A foundational model for the development and testing of standard clinical practice was the product of this study.
This was an embedded multiple case study of two primary care-focused initiatives implemented in two diverse health systems in Chicago and Suburban Cook County that routinely screened patients for FI and referred them to onsite food assistance programs. The Consolidated Framework for Implementation Research and an iterative process were used to collect/analyze qualitative data through semi-structured interviews with N = 19 healthcare staff. Intended program activities, outcomes, actors, implementation barriers/facilitators and overarching implementation themes were identified as a part of a cross-case analysis.
Programs outcomes included: the number of patients screened, identified as FI and that participated in the onsite food assistance program. Study participants reported limited internal resources as implementation barriers for program activities. The implementation climate that leveraged the strength of community collaborations and aligned internal, implementation climate were critical facilitators that contributed to the flexibility of program activities that were tailored to fill gaps in resources and meet patient and clinician needs.
Highly adaptable programs and the healthcare context enhanced implementation feasibility across settings. These characteristics can support program uptake in other settings, but should be used with caution to preserve program fidelity. A foundational model for the development and testing of standard clinical practice was the product of this study.
摘要：
粮食不安全(FI)，获得健康食品的机会有限，过上积极健康的生活，是健康的社会决定因素，与不良的饮食健康和疾病管理困难有关。医疗保健专家支持在初级保健实践中采用经过验证的筛查工具，以识别FI患者并将其与健康和负担得起的食物资源联系起来。然而，缺乏标准做法限制了吸收。这项研究的目的是了解以初级保健为重点的FI筛查计划的计划过程和结果，这些计划可以指导大规模计划的实施。
这是一项嵌入的多案例研究，涉及在芝加哥和郊区库克县两个不同的卫生系统中实施的两个以初级保健为重点的计划，这些计划常规筛查患者的FI并将其转介给现场食品援助计划。实施研究的综合框架和迭代过程用于通过对N=19名医护人员的半结构化访谈来收集/分析定性数据。计划活动，结果，演员,实施障碍/促进者和总体实施主题被确定为跨案例分析的一部分。
项目结果包括：筛查的患者数量，被确定为FI，并参与了现场食品援助计划。研究参与者报告说，内部资源有限是计划活动的实施障碍。利用社区合作的力量和内部协调的实施氛围，实施氛围是关键的促进因素,有助于项目活动的灵活性,这些活动旨在填补资源缺口并满足患者和临床医生的需求.
高度适应性计划和医疗保健环境增强了跨环境的实施可行性。这些特性可以支持其他设置中的程序摄取，但应谨慎使用，以保持程序保真度。开发和测试标准临床实践的基础模型是本研究的产物。
这是一项嵌入的多案例研究，涉及在芝加哥和郊区库克县两个不同的卫生系统中实施的两个以初级保健为重点的计划，这些计划常规筛查患者的FI并将其转介给现场食品援助计划。实施研究的综合框架和迭代过程用于通过对N=19名医护人员的半结构化访谈来收集/分析定性数据。计划活动，结果，演员,实施障碍/促进者和总体实施主题被确定为跨案例分析的一部分。
项目结果包括：筛查的患者数量，被确定为FI，并参与了现场食品援助计划。研究参与者报告说，内部资源有限是计划活动的实施障碍。利用社区合作的力量和内部协调的实施氛围，实施氛围是关键的促进因素,有助于项目活动的灵活性,这些活动旨在填补资源缺口并满足患者和临床医生的需求.
高度适应性计划和医疗保健环境增强了跨环境的实施可行性。这些特性可以支持其他设置中的程序摄取，但应谨慎使用，以保持程序保真度。开发和测试标准临床实践的基础模型是本研究的产物。
