基层医疗机构实施糖尿病共享门诊的组织准备度与影响因素研究  

Organizational Readiness for Change and Factors Influencing the Implementation of Shared Medical Appointment for Diabetes in Primary Healthcare Institutions

作　　者：杨薇 蔡毅媛[1,2] 陈佳佳 卯润 令狐浪 吕森森 徐东 YANG Wei;CAI Yiyuan;CHEN Jiajia;MAO Run;LINGHU Lang;LYU Sensen;XU Dong(Acacia Lab for Primary Healthcare,Department of Epidemiology and Health Statistics,School of Publie Health,Ministry of Education,Guizhou Medical University,Guiyang 561113,China;The key Laboratory of Environmental Pollution Monitoring and Disease Control,Ministry of Education,Guizhou Medical University,Guiyang 561113,China;Acacia Lab for lmplementation Science,Department of Health Management,School of Health Management,Southern Medical University,Guangzhou 510515,China;Southern Medical University Institute for Global Health(SIGHT),Dermatology Hospital of Southemm Medical University,Guangzhou 510091,China;Center for World Health Organization Studies,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]贵州医科大学公共卫生与健康学院流行病与卫生统计学系Acacia基层医疗卫生实验室,贵阳561113 [2]贵州医科大学公共卫生与健康学院环境污染与疾病监控教育部重点实验室,贵阳561113 [3]南方医科大学卫生管理学院卫生管理学系Acacia实施科学实验室,广州510515 [4]南方医科大学皮肤病医院全球健康研究院,广州510091 [5]南方医科大学世界卫生组织研究中心,广州510515

出　　处：《协和医学杂志》2025年第2期479-491,共13页Medical Journal of Peking Union Medical College Hospital

基　　金：国家自然科学基金(72164005)。

摘　　要：目的实施性研究的成功执行受机构准备程度的影响。本研究旨在探索基层医疗机构实施“糖尿病共享门诊优化的实施性研究”项目(简称“SMART项目”)的组织变革准备度(organizational readiness for change,ORC)和影响因素,进而为提高ORC,促进项目有效实施提供参考依据。方法通过定性访谈和定量调查,采集实施SMART项目的12家机构的ORC水平及影响因素。通过机构实施循证实践的准备程度评估量表定量采集ORC水平;对变革执行者进行定性访谈,收集影响因素存在状态,利用主题分析法从访谈结果中提取影响因素条目,编制影响因素作用程度问卷,并采用该问卷收集变革执行者对影响因素作用程度的评估。采用模糊集定性比较分析(fuzzy-set qualitative comparative analysis,fsQCA)方法确定影响因素对ORC的影响和良好ORC实施路径。结果共12家SMART项目试点机构的70名变革执行者参与访谈和问卷调查,受访者包括机构管理者、临床医生和健康管理人员。ORC得分中位数为105.20(101.23,107.33)。fsQCA结果显示,了解具体任务和责任、具备关键人物、做好项目前期准备、制定评估与反馈是达到高水平ORC的路径。反之,缺少关键人物与前期准备两个核心条件,或其只发挥边缘作用时,将导致机构ORC水平较低。结论实施变革前,变革执行者对变革的思想认同和认知参与程度是影响ORC的关键因素。关键人物的引领可有效促进变革准备度的提升,为后续提高实施保真度和成功率奠定基础。Objective The success of implementation research is closely tied to the institutions pre⁃im⁃plementation readiness.This study aims to explore the organizational readiness for change(ORC)and its influ⁃encing factors on primary healthcare settings in the implementation of the“Shared Medical Appointment for Dia⁃betes(SMART)in China:design of an optimization trial”and to enhance ORC and provide insights to support the effective implementation of the program.Methods Qualitative interviews and quantitative surveys were conducted to evaluate the ORC level and its influencing factors in 12 institutions implementing the SMART pro⁃gram.The Scale for Assessing the Institution's Readiness to Implement Evidence⁃Based Practices was utilized to measure ORC levels.Qualitative interviews were conducted among change implementers to gather information re⁃garding the status of influencing factors.Thematic analysis was applied to extract factors from the interview data,and an assessment questionnaire was developed to measure the perceived impact of these factors.A fuzzy⁃set qualitative comparative analysis(fsQCA)method was employed to identify the influencing factors of ORC and pathways leading to high⁃level ORC.Results Seventy implementers from 12 institutions,encompassing admin⁃istrators,clinicians,and health managers,participated in the interviews and surveys.The median and inter⁃quartile of the ORC scores were 105.20(101.23,107.33).The fsQCA indicated that a clear understanding of specific tasks and responsibilities,the active engagement of key participants,sufficient preliminary preparation,and the use of audits and feedback mechanisms were critical pathways to a high⁃level ORC.Conversely,institu⁃tions lacking key participants,preliminary preparation,or marginal influence demonstrated a low⁃level ORC.Conclusions Before implementing innovation,Coherence and Cognitive Participation were identified as critical factors in influencing ORC.Strong leadership from key participants played pivotal role in e

关 键 词：实施性研究 医防融合 糖尿病共享门诊 组织变革准备度 定性比较分析 

分 类 号：R181.3[医药卫生—流行病学] R-3[医药卫生—公共卫生与预防医学] R587.1