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首页> 外文期刊>Implementation Science >Exploring scale-up, spread, and sustainability: an instrumental case study tracing an innovation to enhance dysphagia care
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Exploring scale-up, spread, and sustainability: an instrumental case study tracing an innovation to enhance dysphagia care

机译：探索扩大规模，传播和可持续性：追踪创新以增强吞咽困难护理的工具案例研究

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Background Adoption, adaptation, scale-up, spread, and sustainability are ill-defined, undertheorised, and little-researched implementation science concepts. An instrumental case study will track the adoption and adaptation, or not, of a locally developed innovation about dysphagia as a patient safety issue. The case study will examine a conceptual framework with a continuum of spread comprising hierarchical control or ‘making it happen’, participatory adaptation or ‘help it happen’, and facilitated evolution or ‘let it happen’. Methods This case study is a prospective, longitudinal design using mixed methods. The fifteen-month (October 2012 to December 2013) instrumental case study is set in large, healthcare organisation in England. The innovation refers to introducing a nationally recognised, inter-disciplinary dysphagia competency framework to guide workforce development about fundamental aspects of care. Adoption and adaptation will be examined at an organisational level and along two, contrasting care pathways: stroke and fractured neck of femur. A number of educational interventions will be deployed, including training a cadre of trainers to cascade the essentials of dysphagia management and developing a Dysphagia Toolkit as a learning resource. Mixed methods will be used to investigate scale-up, spread, and sustainability in acute and community settings. A purposive sample of senior managers and clinical leaders will be interviewed to identify path dependency or the context specific particularities of implementation. A pre- and post-evaluation, using mealtime observations and a survey, will investigate the learning effect on staff adherence to patient specific dysphagia recommendations and attitudes towards dysphagia, respectively. Official documents and an ethnographic field journal allow critical junctures, temporal aspects and confounding factors to be explored. Discussion Researching spread and sustainability presents methodological and practical challenges. These include fidelity, adaptation latitude, time, and organisational changes. An instrumental case study will allow these confounding factors to be tracked over time and in place. The case study is underpinned by, and will test a conceptual framework about spread, to explore theoretical generalizability.
机译：背景技术采纳，适应，扩大规模，传播和可持续性是定义不清，理论不足和研究很少的实施科学概念。一个工具性的案例研究将追踪吞咽困难作为患者安全问题的本地开发创新的采用与否。该案例研究将研究具有连续性的概念框架，包括层次控制或“实现”，参与式适应或“帮助实现”，以及促进发展或“实现”。方法本案例研究是使用混合方法的前瞻性纵向设计。为期15个月（2012年10月至2013年12月）的案例研究在英格兰的大型医疗机构中进行。创新是指引入全国公认的跨学科吞咽困难能力框架，以指导劳动力发展有关护理基本方面的知识。收养和适应将在组织层面和两种相对的护理途径中进行检查：中风和股骨颈骨折。将会部署许多教育干预措施，包括培训一批干部培训师，以级联吞咽困难的基本知识，并开发吞咽困难工具包作为学习资源。混合方法将用于调查急性和社区环境中的规模扩大，传播和可持续性。将采访有目的的高级管理人员和临床负责人样本，以识别路径依赖或具体实施背景的特殊性。评估前和评估后，使用进餐时间观察和调查，将分别研究员工对患者特定吞咽困难建议的依从性和吞咽态度的学习效果。官方文件和民族志期刊允许探讨关键的关头，时间方面和混杂因素。讨论研究传播和可持续性提出了方法和实践方面的挑战。这些包括保真度，适应范围，时间和组织变化。一个工具性的案例研究将使这些混杂因素能够随着时间的推移而被追踪到位。该案例研究的基础是，并将测试有关传播的概念框架，以探索理论的普遍性。

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