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首页> 外文期刊>International Journal of Integrated Care >Developing an active implementation model for a chronic disease management program
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Developing an active implementation model for a chronic disease management program

机译：为慢性病管理计划开发积极的实施模型

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Background: Introduction and diffusion of new disease management programs in healthcare is usually slow, but active theory-driven implementation seems to outperform other implementation strategies. However, we have only scarce evidence on the feasibility and real effect of such strategies in complex primary care settings where municipalities, general practitioners and hospitals should work together. The Central Denmark Region recently implemented a disease management program for chronic obstructive pulmonary disease (COPD) which presented an opportunity to test an active implementation model against the usual implementation model. The aim of the present paper is to describe the development of an active implementation model using the Medical Research Council’s model for complex interventions and the Chronic Care Model. Methods: We used the Medical Research Council’s five-stage model for developing complex interventions to design an implementation model for a disease management program for COPD. First, literature on implementing change in general practice was scrutinised and empirical knowledge was assessed for suitability. In phase I, the intervention was developed; and in phases II and III, it was tested in a block- and cluster-randomised study. In phase IV, we evaluated the feasibility for others to use our active implementation model. Results: The Chronic Care Model was identified as a model for designing efficient implementation elements. These elements were combined into a multifaceted intervention, and a timeline for the trial in a randomised study was decided upon in accordance with the five stages in the Medical Research Council’s model; this was captured in a PaTPlot, which allowed us to focus on the structure and the timing of the intervention. The implementation strategies identified as efficient were use of the Breakthrough Series, academic detailing, provision of patient material and meetings between providers. The active implementation model was tested in a randomised trial (results reported elsewhere). Conclusion: The combination of the theoretical model for complex interventions and the Chronic Care Model and the chosen specific implementation strategies proved feasible for a practice-based active implementation model for a chronic-disease-management-program for COPD. Using the Medical Research Council’s model added transparency to the design phase which further facilitated the process of implementing the program. Trial registration: http://www.clinicaltrials.gov/ (NCT01228708).
机译：背景：在医疗保健领域中，新疾病管理计划的引入和传播通常很慢，但积极的理论驱动实施似乎胜过其他实施策略。但是，我们仅有很少的证据表明这种策略在市政，全科医生和医院应该共同努力的复杂初级保健环境中的可行性和实际效果。丹麦中部地区最近实施了针对慢性阻塞性肺疾病（COPD）的疾病管理计划，这为对照常规实施模式测试主动实施模式提供了机会。本文的目的是描述使用医学研究理事会针对复杂干预措施的模型和长期护理模型开发的主动实施模型。方法：我们使用了医学研究理事会的五阶段模型来开发复杂的干预措施，从而为COPD的疾病管理计划设计了实施模型。首先，对有关在一般实践中实施变更的文献进行审查，并评估经验知识的适用性。在第一阶段，制定了干预措施。在第二阶段和第三阶段，在一项区块和集群随机研究中对其进行了测试。在第四阶段，我们评估了其他人使用我们的主动实施模型的可行性。结果：慢性护理模型被确定为设计有效实施要素的模型。这些要素被组合成一个多方面的干预措施，并根据医学研究理事会模型的五个阶段确定了一项随机研究的试验时间表;这是在PaTPlot中捕获的，这使我们可以专注于干预的结构和时机。被确定为有效的实施策略是使用突破系列，学术细节，提供患者材料以及提供者之间的会议。主动执行模型在随机试验中进行了测试（结果在其他地方报告）。结论：将复杂干预的理论模型与慢性护理模型以及所选的具体实施策略相结合，证明对于慢性阻塞性肺病慢性疾病管理计划的基于实践的主动实施模型是可行的。使用医学研究理事会的模型为设计阶段增加了透明度，从而进一步促进了该计划的实施过程。试用注册：http：//www.clinicaltrials.gov/（NCT01228708）。

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