实施基于证据的实践,以改善高风险患者的初级保健:VA高风险退伍军人 (RIVET) 类型III有效性实施试验的研究协议
Elvira E Jimenez1,2, Ann-Marie Rosland3,4, Susan E Stockdale5,6
1Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA. elvira.jimenez@va.gov.
Implementation science communications
|July 15, 2024
概括
本研究比较了两个实施策略,个人指导和协作学习,以改善基于证据的高风险退伍军人护理. 它旨在确定最有效的方法,以提高初级保健机构患者的治疗结果.
科学领域:
- 实施科学 实施科学
- 医疗保健服务研究 医疗服务研究
- 主要护理是指初级护理.
背景情况:
- 高风险退伍军人在医疗保健获取和协调方面面临挑战,导致健康状况不佳.
- 尽管初级保健团队管理了大多数高风险退伍军人,但基于证据的实践 (EBP) 的采用率很低.
- 需要有效的策略来实施EBP来满足复杂的患者需求.
研究的目的:
- 将两个基于证据的质量改进 (EBQI) 策略进行比较:个人指导 (EBQI-IC) 和协作学习 (EBQI-LC).
- 评估EBQI-IC与EBQI-LC在实施两个不同的EBP方面的有效性:综合评估和护理规划 (CACP) 和药物坚持评估 (MAA).
- 确定最佳的实施策略,以改善对具有复杂需求的高风险退伍军人的护理和结果.
主要方法:
- 一个混合方法的3型混合有效性-实施试验,使用并发阶段设计.
- 16个站点随机分配到EBQI-IC或EBQI-LC来实施选择的EBP,站点冠军为18个月提供便利.
- 使用实用,稳健实施和可持续性模型 (PRISM) 框架进行评估,评估范围,有效性,采用,实施,成本,维护和传播. 主要的结果是达到.
主要成果:
- 该研究旨在比较两个实施策略的有效性.
- 它将评估EBP在初级保健中的采用,实施和可持续性.
- 衡量的主要结果将是接受EBP的符合条件的高风险患者的百分比.
结论:
- 该研究将确定在各种背景下对高风险退伍军人最有效的实施策略.
- 它将提供对影响EBP实施的障碍,促进者和适应因素的见解.
- 这些发现将指导初级保健诊所选择策略,以改善对有复杂医疗需求的患者的护理.
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