使用实施研究逻辑模型来研究在熟练护理设施中高强度抗性康复的实施:一种混合方法的多站点案例研究
Lauren A Hinrichs-Kinney1,2, Danielle Derlein3, Mattie E Pontiff3,4
1Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. lauren.hinrichs-kinney@cuanschutz.edu.
Implementation science communications
|May 21, 2025
概括
在熟练护理设施 (SNFs) 中实施高强度抵抗康复 (HIR) 需要解决临床医生的观点和现场基础设施. 冠军和患者参与是成功采用基于证据的康复以改善身体功能的关键.
科学领域:
- 老年学是一门学科.
- 康复科学 康复科学 康复科学
- 实施科学 实施科学
背景情况:
- 基于证据的康复,如高强度抵抗 (HIR),对于改善身体功能和减少熟练护理设施 (SNFs) 的不良事件至关重要.
- 在复杂的SNF环境中实施HIR的最佳策略仍未得到充分探索.
- 本研究利用实施研究逻辑模型 (IRLM) 调查影响HIR在SNF实施的因素.
研究的目的:
- 追溯检查在SNF中实施高强度抗性康复 (HIR) 的情况.
- 确定可以增强未来HIR采用的上下文因素和实施途径.
- 为改善老年人身体功能结果的策略提供信息.
主要方法:
- 进行了一项融合的,混合方法的,涉及8个SNF的多地点案例研究.
- 使用高强度阻力康复 (HIR) 的情况是使用提供者报告维持量表 (PRESS) 进行测量.
- 使用实用稳健实施和可持续性模型 (PRISM) 通过调查问卷和采访评估了上下文因素,并进行了描述性和主题分析.
主要成果:
- 所有站点至少实现了中度的HIR实施,更高的实施站点能够适应不同患者的干预.
- 高级和低级实施站点之间的关键区别包括临床医生的观点,站点基础设施和领导人的满意度.
- 成功实施与拥有一个冠军,强大的患者参与,以及解决实践惯性和感知复杂性的策略有关.
结论:
- 采用基于证据的康复,如HIR,对于提高老年人的身体功能至关重要.
- 实施策略应侧重于基础设施,领导力支持,沟通,解决实践惯性,以及临床医生的复杂性和患者兼容性观点.
- 识别冠军和指导患者参与对于成功实施HIR至关重要.
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