以医院主导的家庭心脏康复实践方案实施影响因素分析:基于CFIR理论框架  

An analysis of the factors influencing the implementation of a center guided home-based cardiac rehabilitation program:based on the CFIR theoretical framework

作　　者：平亚杰 秦庆祝[1] PING Yajie;QIN Qingzhu(Department of Cardiology,Henan Provincial People’s Hospital,Zhengzhou 463599,China)

机构地区：[1]河南省人民医院心血管内科,河南郑州463599

出　　处：《健康研究》2023年第4期421-427,共7页Health Research

摘　　要：目的探究以医院主导的家庭心脏康复(CHBCR)循证实践方案实施过程中的促进和障碍因素,推动循证实践项目的持续进行。方法以实施性研究综合框架(CFIR)为理论基础,采用个人访谈法收集数据,抽取医院心血管外科实施CHBCR干预方案的利益相关者作为研究对象。结果共识别出22项实施影响因素,CFIR框架中3个领域的10个构成要素为促进因素:干预方案特征包括来源于专家共识、干预方案优势突出、证据强度与质量高、具有可调整性、可试用性;内部因素包括高效的学习氛围、奖励机制、领导支持与鼓励;个体特征包括自我效能感、变革阶段延长;CFIR框架4个领域中12个构成要素为障碍因素:干预方案特征包括CHBCR中心建设和多学科团队实施复杂性、实施成本较大;外部因素包括无相关政策及工作流程标准、不能及时了解患者需求与资源、同行压力;内部因素包括目标与反馈不一致、可用资源不足、可触及的CHBCR的知识信息有限、医护患沟通质量有待加强、组织的结构特征有待加强;个体特征包括个体对团队组织缺乏认同感、患者态度。结论CFIR理论框架可用来识别CHBCR干预实施项目实施初期的影响因素,进而修改或调整干预方案的关键内容,制定更完善的实施策略。Objective To investigate the facilitators and barriers to the implementation of center guided home-based cardiac rehabilitation(CHBCR)evidence-based practice program,with a view to promoting sustained evidence-based practice initiatives.Methods Data was collected through personal interviews,in accordance with the comprehensive framework for implementation research(CFIR),and stakeholders responsible for implementing the CHBCR intervention program within the cardiovascular surgery department of a hospital were selected as research participants.Results The consensus has identified 22 factors that influence implementation,and within the CFIR framework,there are 10 components across three areas that act as promoting factors:intervention program characteristics such as expert consensus,prominent advantages of the program,high evidence strength and quality,adjustability and probability.Internal factors comprise an effective learning environment,a system of rewards,leadership support and encouragement;individual characteristics encompass self-efficacy and sustained progression through the stages of change.The 12 components across the four domains of the CFIR framework represent impediments to success:intervention program features include the complexity and high cost associated with constructing CHBCR centers and implementing multidisciplinary teams.External factors encompass the absence of relevant policies and workflow standards,delayed comprehension of patient needs and resources,as well as peer pressure.Internal factors comprise inconsistent goals and feedback,inadequate available resources,limited knowledge and information regarding accessible CHBCR,a need to strengthen the quality of communication between medical professionals and patients,as well as organizational structure characteristics.The individual characteristics encompass the absence of identification with the team organization and a lack of patience towards patients.Conclusions The CFIR theoretical framework can facilitate the identification of influential

关 键 词：PCI术后 家庭心脏康复 实施性研究综合框架 

分 类 号：R318.11[医药卫生—生物医学工程]