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.
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。