背景:实施科学框架建议多层次合作伙伴的参与(在患者,提供者,和系统级别),以适应和增加对循证实践(EBPs)的吸收。然而,几乎没有指导来确保系统级的适应能反映提供医疗服务的提供者和接受EBP的患者/护理人员的声音.
方法:我们提出了一种新的方法,以实施研究综合框架(CFIR)为基础,这将多层次合作伙伴的参与锚定到交付和接收EBPs的个人的声音中。使用CFIR域:干预自适应,涉及的个人,内部/外部设置,和过程,我们通过哮喘链接的案例说明了我们的4步方法,学校监督的哮喘管理干预。在步骤1中,我们采访了参与干预的“个人”(提供者/护理人员/哮喘链接患者),以确定实施障碍。在步骤2中,我们在“内部和外部设置”中选择了可以帮助解决这些障碍的系统级合作伙伴。在第3步中,我们向这些系统级合作伙伴展示了障碍,并进行了半结构化访谈,以引出他们推荐的解决方案(流程)。采访是录音的,转录,和开放编码。使用理论抽样模型和演绎推理来确定实施障碍的解决方案。在步骤4中,我们利用多级输入来适应哮喘链路干预。
结果:确定的障碍包括无法获得两种供家庭和学校使用的吸入器,家庭不一致地将吸入器送到学校,和挑战,当学校没有护士。与学校/诊所领导进行的访谈,药剂师,付款人,立法者,和政策制定者(n=22)提出了解决方案,以解决提供者和患者/护理人员识别的障碍,包括(1)建立医疗补助特定的药房政策,以允许分配两个吸入器,(2)利用药房-学校递送服务,确保药物到达学校,(3)确定候补(非护士)官员来监督药物管理。参与多层次合作伙伴的迭代过程有助于创建适应性哮喘链接干预措施,为有效实施做好准备。
结论:这种新颖的方法,在CFIR中接地,确保需要多层次合作伙伴参与的系统级变更反映交付和接收EBP的个人的声音。此方法演示了CFIR域的动态相互作用,以推进实施科学领域。
BACKGROUND: Implementation science frameworks advise the engagement of multi-level partners (at the patient, provider, and systems level) to adapt and increase the uptake of evidence-based practices (EBPs). However, there is little guidance to ensure that systems-level adaptations reflect the voices of providers who deliver and patients/caregivers who receive EBPs.
METHODS: We present a novel methodology, grounded in the Consolidated Framework for Implementation Research (CFIR), which anchors the engagement of multi-level partners to the voices of individuals who deliver and receive EBPs. Using the CFIR domains: intervention adaptation, individuals involved, inner/outer setting, and process, we illustrate our 4-step methodology through a
case example of Asthma Link, a school-supervised asthma management intervention. In step 1, we interviewed \"individuals involved\" in the intervention (providers/caregivers/patients of Asthma Link) to identify implementation barriers. In step 2, we selected systems-level partners in the \"inner and outer setting\" that could assist with addressing these barriers. In step 3, we presented the barriers to these systems-level partners and conducted semi-structured interviews to elicit their recommended solutions (process). Interviews were audio-recorded, transcribed, and open-coded. A theoretical sampling model and deductive reasoning were used to identify solutions to implementation barriers. In step 4, we utilized multi-level input to adapt the Asthma Link intervention.
RESULTS: Identified barriers included inability to obtain two inhalers for home and school use, inconsistent delivery of the inhaler to school by families, and challenges when schools did not have a nurse. Interviews conducted with school/clinic leaders, pharmacists, payors, legislators, and policymakers (n=22) elicited solutions to address provider and patient/caregiver-identified barriers, including (1) establishing a Medicaid-specific pharmacy policy to allow dispensation of two inhalers, (2) utilizing pharmacy-school delivery services to ensure medication reaches schools, and (3) identifying alternate (non-nurse) officials to supervise medication administration. The iterative process of engaging multi-level partners helped to create an adapted Asthma Link intervention, primed for effective implementation.
CONCLUSIONS: This novel methodology, grounded in the CFIR, ensures that systems-level changes that require the engagement of multi-level partners reflect the voices of individuals who deliver and receive EBPs. This methodology demonstrates the dynamic interplay of CFIR domains to advance the field of implementation science.