全球综合护理实施的对比案例研究：寻求行动。
Comparative case studies in integrated care implementation from across the globe: a quest for action.
机构信息
Department of Psychiatry, University of California San Diego, La Jolla, USA.
Child and Adolescent Services Research Center, San Diego, USA.
出版信息
BMC Health Serv Res. 2019 Nov 27;19(1):899. doi: 10.1186/s12913-019-4661-5.
BACKGROUND
Integrated care is the coordination of general and behavioral health and is a highly promising and practical approach to improving healthcare delivery and patient outcomes. While there is growing interest and investment in integrated care implementation internationally, there are no formal guidelines for integrated care implementation applicable to diverse healthcare systems. Furthermore, there is a complex interplay of factors at multiple levels of influence that are necessary for successful implementation of integrated care in health systems.
METHODS
Guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework (Aarons et al., 2011), a multiple case study design was used to address two research objectives: 1) To highlight current integrated care implementation efforts through seven international case studies that target a range of healthcare systems, patient populations and implementation strategies and outcomes, and 2) To synthesize the shared and unique challenges and successes across studies using the EPIS framework.
RESULTS
The seven reported case studies represent integrated care implementation efforts from five countries and continents (United States, United Kingdom, Vietnam, Israel, and Nigeria), target a range of clinical populations and care settings, and span all phases of the EPIS framework. Qualitative synthesis of these case studies illuminated common outer context, inner context, bridging and innovation factors that were key drivers of implementation.
CONCLUSIONS
We propose an agenda that outlines priority goals and related strategies to advance integrated care implementation research. These goals relate to: 1) the role of funding at multiple levels of implementation, 2) meaningful collaboration with stakeholders across phases of implementation and 3) clear communication to stakeholders about integrated care implementation.
TRIAL REGISTRATION
Not applicable.
背景
综合医疗保健是一般医疗和行为健康的协调，是改善医疗保健服务提供和患者结果的一种极具前景和实用性的方法。虽然国际上对综合医疗保健的实施越来越感兴趣和投资，但没有适用于不同医疗保健系统的综合医疗保健实施的正式指南。此外，在卫生系统中成功实施综合医疗保健需要在多个层面上有一系列复杂的相互作用的因素。
方法
受探索、准备、实施、维持（EPIS）框架（Aarons 等人，2011 年）的指导，采用多案例研究设计来解决两个研究目标：1）通过七个国际案例研究突出当前的综合医疗保健实施工作，这些案例研究针对各种医疗保健系统、患者群体和实施策略和结果；2）使用 EPIS 框架综合研究中的共同和独特的挑战和成功。
结果
报告的七个案例研究代表了来自五个国家和大陆（美国、英国、越南、以色列和尼日利亚）的综合医疗保健实施工作，针对各种临床人群和护理环境，涵盖了 EPIS 框架的所有阶段。对这些案例研究的定性综合分析揭示了实施的共同外部环境、内部环境、桥梁和创新因素，这些因素是实施的关键驱动因素。
结论
我们提出了一个议程，概述了推进综合医疗保健实施研究的优先目标和相关战略。这些目标涉及：1）实施多个层面的资金作用，2）在实施的各个阶段与利益相关者进行有意义的合作，3）向利益相关者清楚地传达综合医疗保健实施情况。
试验注册
不适用。
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