PDF(Pubmed)
Abstract：
UNASSIGNED: Implementing evidence-based practices (EBPs) within service systems is critical to population-level health improvements - but also challenging, especially for complex behavioral health interventions in low-resource settings. \"Mis-implementation\" refers to poor outcomes from an EBP implementation effort; mis-implementation outcomes are an important, but largely untapped, source of information about how to improve knowledge exchange.
UNASSIGNED: We present mis-implementation cases from three pragmatic trials of behavioral health EBPs in U.S. Federally Qualified Health Centers (FQHCs).
UNASSIGNED: We adapted the Consolidated Framework for Implementation Research and its Outcomes Addendum into a framework for mis-implementation and used it to structure the case summaries with information about the EBP and trial, mis-implementation outcomes, and associated determinants (barriers and facilitators). We compared the three cases to identify shared and unique mis-implementation factors.
UNASSIGNED: Across cases, there was limited adoption and fidelity to the interventions, which led to eventual discontinuation. Barriers contributing to mis-implementation included intervention complexity, low buy-in from overburdened providers, lack of alignment between providers and leadership, and COVID-19-related stressors. Mis-implementation occurred earlier in cases that experienced both patient- and provider-level barriers, and that were conducted during the COVID-19 pandemic.
UNASSIGNED: Multi-level determinants contributed to EBP mis-implementation in FQHCs, limiting the ability of these health systems to benefit from knowledge exchange. To minimize mis-implementation, knowledge exchange strategies should be designed around common, core barriers but also flexible enough to address a variety of site-specific contextual factors and should be tailored to relevant audiences such as providers, patients, and/or leadership.
UNASSIGNED: We present mis-implementation cases from three pragmatic trials of behavioral health EBPs in U.S. Federally Qualified Health Centers (FQHCs).
UNASSIGNED: We adapted the Consolidated Framework for Implementation Research and its Outcomes Addendum into a framework for mis-implementation and used it to structure the case summaries with information about the EBP and trial, mis-implementation outcomes, and associated determinants (barriers and facilitators). We compared the three cases to identify shared and unique mis-implementation factors.
UNASSIGNED: Across cases, there was limited adoption and fidelity to the interventions, which led to eventual discontinuation. Barriers contributing to mis-implementation included intervention complexity, low buy-in from overburdened providers, lack of alignment between providers and leadership, and COVID-19-related stressors. Mis-implementation occurred earlier in cases that experienced both patient- and provider-level barriers, and that were conducted during the COVID-19 pandemic.
UNASSIGNED: Multi-level determinants contributed to EBP mis-implementation in FQHCs, limiting the ability of these health systems to benefit from knowledge exchange. To minimize mis-implementation, knowledge exchange strategies should be designed around common, core barriers but also flexible enough to address a variety of site-specific contextual factors and should be tailored to relevant audiences such as providers, patients, and/or leadership.
摘要：
■在服务系统中实施循证实践（EBP）对于改善人口水平的健康至关重要-但也具有挑战性，特别是在低资源环境中的复杂行为健康干预措施。“错误实施”是指EBP实施工作的不良结果；错误实施结果是重要的，但大部分尚未开发，关于如何提高知识交流的信息来源。
■我们介绍了在美国联邦合格健康中心（FQHC）进行的三项行为健康EBP的实用试验中的错误实施案例。
■我们将实施研究综合框架及其结果附录调整为一个错误实施的框架，并使用它来构建案例摘要，其中包含有关EBP和审判的信息，错误执行结果，和相关的决定因素(障碍和促进者)。我们比较了这三种情况，以确定共享和唯一的错误实施因素。
■跨案例，干预措施的采纳和忠诚度有限，这导致了最终的中断。导致错误实施的障碍包括干预复杂性，来自负担过重的提供商的低买入，提供者和领导层之间缺乏一致性，和COVID-19相关的压力源。在经历了患者和提供者级别障碍的情况下，错误的实施发生在早期，这是在COVID-19大流行期间进行的。
■多级决定因素导致了FQHC中EBP的错误实施，限制这些卫生系统从知识交流中受益的能力。为了最大限度地减少错误实施，知识交流策略应该围绕共同的，核心障碍，但也有足够的灵活性，以解决各种特定网站的环境因素，并应针对相关受众，如提供商，病人,和/或领导。
■我们介绍了在美国联邦合格健康中心（FQHC）进行的三项行为健康EBP的实用试验中的错误实施案例。
■我们将实施研究综合框架及其结果附录调整为一个错误实施的框架，并使用它来构建案例摘要，其中包含有关EBP和审判的信息，错误执行结果，和相关的决定因素(障碍和促进者)。我们比较了这三种情况，以确定共享和唯一的错误实施因素。
■跨案例，干预措施的采纳和忠诚度有限，这导致了最终的中断。导致错误实施的障碍包括干预复杂性，来自负担过重的提供商的低买入，提供者和领导层之间缺乏一致性，和COVID-19相关的压力源。在经历了患者和提供者级别障碍的情况下，错误的实施发生在早期，这是在COVID-19大流行期间进行的。
■多级决定因素导致了FQHC中EBP的错误实施，限制这些卫生系统从知识交流中受益的能力。为了最大限度地减少错误实施，知识交流策略应该围绕共同的，核心障碍，但也有足够的灵活性，以解决各种特定网站的环境因素，并应针对相关受众，如提供商，病人,和/或领导。
