PDF(Pubmed)
Abstract：
BACKGROUND: Research demonstrates the importance of documenting adaptations to implementation strategies that support integration of evidence-based interventions into practice. While studies have utilized the FRAME-IS [Framework for Reporting Adaptations and Modifications for Implementation Strategies] to collect structured adaptation data, they are limited by a focus on discrete implementation strategies (e.g., training), which do not reflect the complexity of multifaceted strategies like practice facilitation. In this paper, we apply the FRAME-IS to our trial evaluating the effectiveness of PF on implementation fidelity of an evidence-based technology-facilitated team care model for improved hypertension control within a federally qualified health center (FQHC).
METHODS: Three data sources are used to document adaptations: (1) implementation committee meeting minutes, (2) narrative reports completed by practice facilitators, and (3) structured notes captured on root cause analysis and Plan-Do-Study-Act worksheets. Text was extracted from the data sources according to the FRAME-IS modules and inputted into a master matrix for content analysis by two authors; a third author conducted member checking and code validation.
RESULTS: We modified the FRAME-IS to include part 2 of module 2 (what is modified) to add greater detail of the modified strategy, and a numbering system to track adaptations across the modules. This resulted in identification of 27 adaptations, of which 88.9% focused on supporting practices in identifying eligible patients and referring them to the intervention. About half (52.9%) of the adaptations were made to modify the context of the PF strategy to include a group-based format, add community health workers to the strategy, and to shift the implementation target to nurses. The adaptations were often widespread (83.9%), affecting all practices within the FQHC. While most adaptations were reactive (84.6%), they resulted from a systematic process of reviewing data captured by multiple sources. All adaptations included the FQHC in the decision-making process.
CONCLUSIONS: With modifications, we demonstrate the ability to document our adaptation data across the FRAME-IS modules, attesting to its applicability and value for a range of implementation strategies. Based on our experiences, we recommend refinement of tracking systems to support more nimble and practical documentation of iterative, ongoing, and multifaceted adaptations.
BACKGROUND: Clinicaltrials.gov NCT03713515, Registration date: October 19, 2018.
METHODS: Three data sources are used to document adaptations: (1) implementation committee meeting minutes, (2) narrative reports completed by practice facilitators, and (3) structured notes captured on root cause analysis and Plan-Do-Study-Act worksheets. Text was extracted from the data sources according to the FRAME-IS modules and inputted into a master matrix for content analysis by two authors; a third author conducted member checking and code validation.
RESULTS: We modified the FRAME-IS to include part 2 of module 2 (what is modified) to add greater detail of the modified strategy, and a numbering system to track adaptations across the modules. This resulted in identification of 27 adaptations, of which 88.9% focused on supporting practices in identifying eligible patients and referring them to the intervention. About half (52.9%) of the adaptations were made to modify the context of the PF strategy to include a group-based format, add community health workers to the strategy, and to shift the implementation target to nurses. The adaptations were often widespread (83.9%), affecting all practices within the FQHC. While most adaptations were reactive (84.6%), they resulted from a systematic process of reviewing data captured by multiple sources. All adaptations included the FQHC in the decision-making process.
CONCLUSIONS: With modifications, we demonstrate the ability to document our adaptation data across the FRAME-IS modules, attesting to its applicability and value for a range of implementation strategies. Based on our experiences, we recommend refinement of tracking systems to support more nimble and practical documentation of iterative, ongoing, and multifaceted adaptations.
BACKGROUND: Clinicaltrials.gov NCT03713515, Registration date: October 19, 2018.
摘要：
背景：研究证明了记录适应实施策略的重要性，这些策略支持将循证干预措施融入实践。虽然研究利用了FRAME-IS[报告实施战略的适应和修改框架]来收集结构化的适应数据，它们受到对离散实施策略的关注的限制(例如，培训),这并不能反映出实践便利化等多方面策略的复杂性。在本文中,我们将FRAME-IS应用于我们的试验中,评估PF在实施保真度方面的有效性,即在联邦合格的健康中心(FQHC)内采用循证技术促进的团队护理模式改善高血压控制.
方法：三个数据源用于记录改编：（1）实施委员会会议纪要，(2)由实践主持人完成的叙述性报告，和(3)在根本原因分析和计划-做-研究-行动工作表上记录的结构化说明。根据FRAME-IS模块从数据源中提取文本，并将其输入主矩阵，以供两位作者进行内容分析；第三作者进行了成员检查和代码验证。
结果：我们修改了FRAME-IS，使其包括模块2的第2部分（修改的内容），以增加修改后的策略的更多细节，和一个编号系统来跟踪跨模块的适应。这导致了27种改编的鉴定，其中88.9%的人专注于支持识别合格患者并将他们推荐给干预措施。大约一半（52.9％）的改编是为了修改PF策略的上下文，以包括基于组的格式，将社区卫生工作者加入战略，并将实施目标转移到护士身上。适应通常很普遍（83.9％），影响FQHC内的所有做法。虽然大多数适应是反应性的(84.6%)，它们是由系统审查由多个来源捕获的数据的过程产生的。所有改编都将FQHC纳入决策过程。
结论：经过修改，我们展示了跨FRAME-IS模块记录我们的适应数据的能力，证明其对一系列实施策略的适用性和价值。根据我们的经验,我们建议改进跟踪系统，以支持更灵活和实用的迭代文档，正在进行,和多方面的适应。
背景：Clinicaltrials.govNCT03713515，注册日期：2018年10月19日。
方法：三个数据源用于记录改编：（1）实施委员会会议纪要，(2)由实践主持人完成的叙述性报告，和(3)在根本原因分析和计划-做-研究-行动工作表上记录的结构化说明。根据FRAME-IS模块从数据源中提取文本，并将其输入主矩阵，以供两位作者进行内容分析；第三作者进行了成员检查和代码验证。
结果：我们修改了FRAME-IS，使其包括模块2的第2部分（修改的内容），以增加修改后的策略的更多细节，和一个编号系统来跟踪跨模块的适应。这导致了27种改编的鉴定，其中88.9%的人专注于支持识别合格患者并将他们推荐给干预措施。大约一半（52.9％）的改编是为了修改PF策略的上下文，以包括基于组的格式，将社区卫生工作者加入战略，并将实施目标转移到护士身上。适应通常很普遍（83.9％），影响FQHC内的所有做法。虽然大多数适应是反应性的(84.6%)，它们是由系统审查由多个来源捕获的数据的过程产生的。所有改编都将FQHC纳入决策过程。
结论：经过修改，我们展示了跨FRAME-IS模块记录我们的适应数据的能力，证明其对一系列实施策略的适用性和价值。根据我们的经验,我们建议改进跟踪系统，以支持更灵活和实用的迭代文档，正在进行,和多方面的适应。
背景：Clinicaltrials.govNCT03713515，注册日期：2018年10月19日。
