PDF(Pubmed)
Abstract：
BACKGROUND: The international scale and spread of evidence-based perioperative medicine for older people undergoing surgery (POPS) services has not yet been fully realised. Implementation science provides a structured approach to understanding factors that act as barriers and facilitators to the implementation of POPS services. In this study, we aimed to identify factors that influence the implementation of POPS services in the UK.
METHODS: A qualitative case study at three UK health services was undertaken. The health services differed across contextual factors (population, workforce, size) and stages of POPS service implementation maturity. Semi-structured interviews with purposively sampled clinicians (perioperative medical, nursing, allied health, and pharmacy) and managers (n = 56) were conducted. Data were inductively coded, then thematically analysed using the Consolidated Framework for Implementation Research (CFIR).
RESULTS: Fourteen factors across all five CFIR domains were relevant to the implementation of POPS services. Key shared facilitators included stakeholders understanding the rationale of the POPS service, with support from their networks, POPS champions, and POPS clinical leads. We found substantial variation and flexibility in the way that health services responded to these shared facilitators and this was relevant to the implementation of POPS services.
CONCLUSIONS: Health services planning to implement a POPS service should use health service-specific strategies to respond flexibly to local factors that are acting as barriers or facilitators to implementation. To support implementation of a POPS service, we recommend health services prioritise understanding local networks, identifying POPS champions, and ensuring that stakeholders understand the rationale for the POPS service. Our study also provides a structure for future research to understand the factors associated with \'unsuccessful\' implementation of a POPS service, which can inform ongoing efforts to implement evidence-based perioperative models of care for older people.
METHODS: A qualitative case study at three UK health services was undertaken. The health services differed across contextual factors (population, workforce, size) and stages of POPS service implementation maturity. Semi-structured interviews with purposively sampled clinicians (perioperative medical, nursing, allied health, and pharmacy) and managers (n = 56) were conducted. Data were inductively coded, then thematically analysed using the Consolidated Framework for Implementation Research (CFIR).
RESULTS: Fourteen factors across all five CFIR domains were relevant to the implementation of POPS services. Key shared facilitators included stakeholders understanding the rationale of the POPS service, with support from their networks, POPS champions, and POPS clinical leads. We found substantial variation and flexibility in the way that health services responded to these shared facilitators and this was relevant to the implementation of POPS services.
CONCLUSIONS: Health services planning to implement a POPS service should use health service-specific strategies to respond flexibly to local factors that are acting as barriers or facilitators to implementation. To support implementation of a POPS service, we recommend health services prioritise understanding local networks, identifying POPS champions, and ensuring that stakeholders understand the rationale for the POPS service. Our study also provides a structure for future research to understand the factors associated with \'unsuccessful\' implementation of a POPS service, which can inform ongoing efforts to implement evidence-based perioperative models of care for older people.
摘要：
背景：针对接受手术（POPS）服务的老年人的循证围手术期医学的国际规模和传播尚未完全实现。实施科学提供了一种结构化的方法来理解作为实施POPS服务的障碍和促进者的因素。在这项研究中,我们旨在确定影响英国实施POPS服务的因素。
方法：对英国三个卫生服务机构进行了定性案例研究。卫生服务因环境因素而异(人口，劳动力，规模)和POPS服务实施成熟度的阶段。与有目的地抽样的临床医生的半结构化访谈(围手术期医疗，护理,联合健康,和药房）和管理人员（n=56）进行了调查。数据被感应编码，然后使用实施研究综合框架(CFIR)进行主题分析。
结果：在所有五个CFIR领域中，有14个因素与POPS服务的实施有关。主要的共享促进者包括了解POPS服务原理的利益相关者，在他们网络的支持下，POPS冠军,和POPS临床线索。我们发现，卫生服务对这些共享促进者的反应方式存在很大差异和灵活性，这与POPS服务的实施有关。
结论：计划实施POPS服务的卫生服务应使用特定于卫生服务的策略，以灵活应对作为实施障碍或促进因素的当地因素。为了支持POPS服务的实施，我们建议医疗服务优先了解本地网络，识别POPS冠军,并确保利益相关者了解POPS服务的基本原理。我们的研究还为未来的研究提供了一个结构，以了解与POPS服务的“不成功”实施相关的因素，这可以为正在进行的老年人实施循证围手术期护理模式提供信息。
方法：对英国三个卫生服务机构进行了定性案例研究。卫生服务因环境因素而异(人口，劳动力，规模)和POPS服务实施成熟度的阶段。与有目的地抽样的临床医生的半结构化访谈(围手术期医疗，护理,联合健康,和药房）和管理人员（n=56）进行了调查。数据被感应编码，然后使用实施研究综合框架(CFIR)进行主题分析。
结果：在所有五个CFIR领域中，有14个因素与POPS服务的实施有关。主要的共享促进者包括了解POPS服务原理的利益相关者，在他们网络的支持下，POPS冠军,和POPS临床线索。我们发现，卫生服务对这些共享促进者的反应方式存在很大差异和灵活性，这与POPS服务的实施有关。
结论：计划实施POPS服务的卫生服务应使用特定于卫生服务的策略，以灵活应对作为实施障碍或促进因素的当地因素。为了支持POPS服务的实施，我们建议医疗服务优先了解本地网络，识别POPS冠军,并确保利益相关者了解POPS服务的基本原理。我们的研究还为未来的研究提供了一个结构，以了解与POPS服务的“不成功”实施相关的因素，这可以为正在进行的老年人实施循证围手术期护理模式提供信息。
