PDF(Pubmed)
Abstract：
Practical and feasible methods for matching implementation strategies to diagnosed barriers of evidence-based interventions in real-world contexts are lacking. This evaluation compared actual implementation strategies applied with those recommended by an expert opinion-based tool to improve guideline-concordant cirrhosis care in a Veterans Health Administration national learning collaborative effort.
This convergent parallel mixed-methods study aimed to (1) identify pre-implementation Consolidated Framework for Implementation Research (CFIR) barriers to cirrhosis care through focus groups with frontline providers, (2) generate 20 recommended strategies using focus group identified barriers entered into the CFIR-Expert Recommendations for Implementing Change (ERIC) Implementation Strategy Matching Tool, (3) survey providers over two consecutive years on the actual use of 73 ERIC strategies and determine strategy effectiveness, (4) compare actual versus recommended strategy use, and (5) compare actual versus expected barriers by reverse applying the CFIR-ERIC Matching Tool.
Eighteen semi-structured focus groups were conducted with 197 providers representing 95 VA sites to identify barriers to quality improvement, including cirrhosis care complexity, clarity of national goals, and local leadership support. The CFIR-ERIC Matching Tool recommended strategies such as assessing for readiness and needs, promoting adaptability, building local groups, preparing champions, and working with opinion leaders and early adopters. Subsequent strategy surveys found that sites used the top 20 \"recommended\" strategies no more frequently than other strategies. However, 14 (70%) of the top recommended strategies were significantly positively associated with cirrhosis care compared to 48% of actual strategies. Reverse CFIR-ERIC matching found that the strategies most used in the first year corresponded to the following barriers: opinion leaders, access to knowledge and information, and resources. The strategies most frequently employed in the second year addressed barriers such as champions, cosmopolitanism, readiness for implementation, relative priority, and patient needs and resources. Strategies used in both years were those that addressed adaptability, trialability, and compatibility.
This study is among the first to empirically evaluate the relationship between CFIR-ERIC Matching Tool recommended strategies and actual strategy selection and effectiveness in the real world. We found closer connections between recommended strategies and strategy effectiveness compared to strategy frequency, suggesting validity of barrier identification, and application of the expert-informed tool.
This convergent parallel mixed-methods study aimed to (1) identify pre-implementation Consolidated Framework for Implementation Research (CFIR) barriers to cirrhosis care through focus groups with frontline providers, (2) generate 20 recommended strategies using focus group identified barriers entered into the CFIR-Expert Recommendations for Implementing Change (ERIC) Implementation Strategy Matching Tool, (3) survey providers over two consecutive years on the actual use of 73 ERIC strategies and determine strategy effectiveness, (4) compare actual versus recommended strategy use, and (5) compare actual versus expected barriers by reverse applying the CFIR-ERIC Matching Tool.
Eighteen semi-structured focus groups were conducted with 197 providers representing 95 VA sites to identify barriers to quality improvement, including cirrhosis care complexity, clarity of national goals, and local leadership support. The CFIR-ERIC Matching Tool recommended strategies such as assessing for readiness and needs, promoting adaptability, building local groups, preparing champions, and working with opinion leaders and early adopters. Subsequent strategy surveys found that sites used the top 20 \"recommended\" strategies no more frequently than other strategies. However, 14 (70%) of the top recommended strategies were significantly positively associated with cirrhosis care compared to 48% of actual strategies. Reverse CFIR-ERIC matching found that the strategies most used in the first year corresponded to the following barriers: opinion leaders, access to knowledge and information, and resources. The strategies most frequently employed in the second year addressed barriers such as champions, cosmopolitanism, readiness for implementation, relative priority, and patient needs and resources. Strategies used in both years were those that addressed adaptability, trialability, and compatibility.
This study is among the first to empirically evaluate the relationship between CFIR-ERIC Matching Tool recommended strategies and actual strategy selection and effectiveness in the real world. We found closer connections between recommended strategies and strategy effectiveness compared to strategy frequency, suggesting validity of barrier identification, and application of the expert-informed tool.
摘要：
背景：缺乏将实施策略与现实环境中基于证据的干预措施的诊断障碍相匹配的实用可行方法。该评估将实际实施策略与基于专家意见的工具推荐的实施策略进行了比较，以改善退伍军人健康管理局国家学习协作努力中的指南一致肝硬化护理。
方法：这项融合并行混合方法研究旨在（1）通过与一线提供者的焦点小组，确定实施前合并实施研究框架（CFIR）对肝硬化护理的障碍，(2)使用进入CFIR-ExpertRecommendationsforImplementingchange(ERIC)ImplementationStrategyMatchingTool的焦点小组识别的障碍，生成20个推荐策略，(3)调查提供者连续两年对73个ERIC策略的实际使用情况,并确定策略的有效性,(4)比较实际和推荐策略的使用，和（5）通过反向应用CFIR-ERIC匹配工具比较实际与预期的障碍。
结果：与代表95个VA站点的197个提供商进行了18个半结构化焦点小组，以确定质量改进的障碍，包括肝硬化护理的复杂性，明确国家目标，地方领导支持。CFIR-ERIC匹配工具推荐的策略，例如评估准备情况和需求，促进适应性，建立当地团体，准备冠军,与意见领袖和早期采用者合作。随后的策略调查发现，网站使用前20个“推荐”策略的频率并不比其他策略高。然而,与实际策略的48％相比，14（70％）的顶级推荐策略与肝硬化护理显着正相关。反向CFIR-ERIC匹配发现，第一年最常用的策略对应于以下障碍：意见领袖，获取知识和信息，和资源。第二年最常用的策略解决了诸如冠军之类的障碍，世界主义,准备实施，相对优先权,病人的需求和资源。这两年使用的策略都是解决适应性问题的策略，可试验性,和兼容性。
结论：这项研究是首次对CFIR-ERIC匹配工具推荐策略与现实世界中实际策略选择和有效性之间的关系进行实证评估的研究。与策略频率相比，我们发现推荐策略与策略有效性之间存在更紧密的联系，表明障碍识别的有效性，和专家知情工具的应用。
方法：这项融合并行混合方法研究旨在（1）通过与一线提供者的焦点小组，确定实施前合并实施研究框架（CFIR）对肝硬化护理的障碍，(2)使用进入CFIR-ExpertRecommendationsforImplementingchange(ERIC)ImplementationStrategyMatchingTool的焦点小组识别的障碍，生成20个推荐策略，(3)调查提供者连续两年对73个ERIC策略的实际使用情况,并确定策略的有效性,(4)比较实际和推荐策略的使用，和（5）通过反向应用CFIR-ERIC匹配工具比较实际与预期的障碍。
结果：与代表95个VA站点的197个提供商进行了18个半结构化焦点小组，以确定质量改进的障碍，包括肝硬化护理的复杂性，明确国家目标，地方领导支持。CFIR-ERIC匹配工具推荐的策略，例如评估准备情况和需求，促进适应性，建立当地团体，准备冠军,与意见领袖和早期采用者合作。随后的策略调查发现，网站使用前20个“推荐”策略的频率并不比其他策略高。然而,与实际策略的48％相比，14（70％）的顶级推荐策略与肝硬化护理显着正相关。反向CFIR-ERIC匹配发现，第一年最常用的策略对应于以下障碍：意见领袖，获取知识和信息，和资源。第二年最常用的策略解决了诸如冠军之类的障碍，世界主义,准备实施，相对优先权,病人的需求和资源。这两年使用的策略都是解决适应性问题的策略，可试验性,和兼容性。
结论：这项研究是首次对CFIR-ERIC匹配工具推荐策略与现实世界中实际策略选择和有效性之间的关系进行实证评估的研究。与策略频率相比，我们发现推荐策略与策略有效性之间存在更紧密的联系，表明障碍识别的有效性，和专家知情工具的应用。
