PDF(Pubmed)
Abstract：
Reducing the burden of neonatal sepsis requires timely identification and initiation of suitable antibiotic treatment in primary health care (PHC) settings. Countries are encouraged to adopt simplified antibiotic regimens at the PHC level for treating sick young infants (SYI) with signs of possible serious bacterial infection (PSBI). As countries implement PSBI guidelines, more lessons on effective implementation strategies and outcome measurements are needed. We document pragmatic approaches used to design, measure and report implementation strategies and outcomes while adopting PSBI guidelines in Kenya.
We designed implementation research using longitudinal mixed methods embedded in a continuous regular systematic learning and adoption of evidence in the PHC context. We synthesized formative data to co-create with stakeholders, implementation strategies to incorporate PSBI guidelines into routine service delivery for SYIs. This was followed by quarterly monitoring for learning and feedback on the effect of implementation strategies, documented lessons learned and tracked implementation outcomes. We collected endline data to measure the overall effect on service level outcomes.
Our findings show that characterizing implementation strategies and linking them with implementation outcomes, helps illustrate the pathway between the implementation process and outcomes. Although we have demonstrated that it is feasible to implement PSBI in PHC, effective investment in continuous capacity strengthening of providers through blended approaches, efficient use of available human resources, and improving the efficiency of service areas for managing SYIs optimizes timely identification and management of SYI. Sustained provision of commodities for management of SYI facilitates increased uptake of services. Strengthening facility-community linkages supports adherence to scheduled visits. Enhancing the caregiver\'s preparedness during postnatal contacts in the community or facility will facilitate the effective completion of treatment.
Careful design, and definition of terms related to the measurement of implementation outcomes and strategies enable ease of interpretation of findings. Using the taxonomy of implementation outcomes help frame the measurement process and provides empirical evidence in a structured way to demonstrate causal relationships between implementation strategies and outcomes. Using this approach, we have illustrated that the implementation of simplified antibiotic regimens for treating SYIs with PSBI in PHC settings is feasible in Kenya.
We designed implementation research using longitudinal mixed methods embedded in a continuous regular systematic learning and adoption of evidence in the PHC context. We synthesized formative data to co-create with stakeholders, implementation strategies to incorporate PSBI guidelines into routine service delivery for SYIs. This was followed by quarterly monitoring for learning and feedback on the effect of implementation strategies, documented lessons learned and tracked implementation outcomes. We collected endline data to measure the overall effect on service level outcomes.
Our findings show that characterizing implementation strategies and linking them with implementation outcomes, helps illustrate the pathway between the implementation process and outcomes. Although we have demonstrated that it is feasible to implement PSBI in PHC, effective investment in continuous capacity strengthening of providers through blended approaches, efficient use of available human resources, and improving the efficiency of service areas for managing SYIs optimizes timely identification and management of SYI. Sustained provision of commodities for management of SYI facilitates increased uptake of services. Strengthening facility-community linkages supports adherence to scheduled visits. Enhancing the caregiver\'s preparedness during postnatal contacts in the community or facility will facilitate the effective completion of treatment.
Careful design, and definition of terms related to the measurement of implementation outcomes and strategies enable ease of interpretation of findings. Using the taxonomy of implementation outcomes help frame the measurement process and provides empirical evidence in a structured way to demonstrate causal relationships between implementation strategies and outcomes. Using this approach, we have illustrated that the implementation of simplified antibiotic regimens for treating SYIs with PSBI in PHC settings is feasible in Kenya.
摘要：
背景：降低新生儿败血症的负担需要在初级卫生保健（PHC）环境中及时识别和启动合适的抗生素治疗。鼓励各国采用PHC水平的简化抗生素治疗方案，以治疗可能有严重细菌感染（PSBI）迹象的患病幼儿（SYI）。随着国家实施PSBI指南，需要更多关于有效实施战略和成果衡量的经验教训。我们记录了用于设计的务实方法，在肯尼亚采用PSBI指南的同时，衡量和报告实施战略和成果。
方法：我们使用嵌入在PHC背景下的连续常规系统学习和采用证据中的纵向混合方法设计了实施研究。我们综合了形成性数据，与利益相关者共同创造，实施策略，将PSBI指南纳入SYI的常规服务交付中。随后是对执行战略效果的学习和反馈进行季度监测，记录经验教训并跟踪实施结果。我们收集了端线数据来衡量对服务水平结果的总体影响。
结果：我们的研究结果表明，表征实施策略并将其与实施结果联系起来，有助于说明实施过程和结果之间的路径。虽然我们已经证明在PHC中实现PSBI是可行的，通过混合方法对提供商持续能力加强的有效投资，有效利用现有人力资源，提高SYI管理服务区域的效率，优化SYI的及时识别和管理。为SYI的管理持续提供商品有助于增加服务的吸收。加强设施与社区的联系有助于遵守预定的访问。在社区或设施的产后接触期间加强护理人员的准备将有助于有效完成治疗。
结论：精心设计，以及与实施成果和战略的衡量有关的术语的定义，使解释调查结果变得容易。使用实施结果的分类法有助于构建测量过程，并以结构化的方式提供经验证据，以证明实施策略与结果之间的因果关系。使用这种方法，我们已经证明,在肯尼亚,在PHC患者中实施简化的抗生素治疗方案是可行的.
方法：我们使用嵌入在PHC背景下的连续常规系统学习和采用证据中的纵向混合方法设计了实施研究。我们综合了形成性数据，与利益相关者共同创造，实施策略，将PSBI指南纳入SYI的常规服务交付中。随后是对执行战略效果的学习和反馈进行季度监测，记录经验教训并跟踪实施结果。我们收集了端线数据来衡量对服务水平结果的总体影响。
结果：我们的研究结果表明，表征实施策略并将其与实施结果联系起来，有助于说明实施过程和结果之间的路径。虽然我们已经证明在PHC中实现PSBI是可行的，通过混合方法对提供商持续能力加强的有效投资，有效利用现有人力资源，提高SYI管理服务区域的效率，优化SYI的及时识别和管理。为SYI的管理持续提供商品有助于增加服务的吸收。加强设施与社区的联系有助于遵守预定的访问。在社区或设施的产后接触期间加强护理人员的准备将有助于有效完成治疗。
结论：精心设计，以及与实施成果和战略的衡量有关的术语的定义，使解释调查结果变得容易。使用实施结果的分类法有助于构建测量过程，并以结构化的方式提供经验证据，以证明实施策略与结果之间的因果关系。使用这种方法，我们已经证明,在肯尼亚,在PHC患者中实施简化的抗生素治疗方案是可行的.
