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首页> 外文期刊>BMC Psychiatry >Community stakeholder preferences for evidence-based practice implementation strategies in behavioral health: a best-worst scaling choice experiment
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Community stakeholder preferences for evidence-based practice implementation strategies in behavioral health: a best-worst scaling choice experiment

机译：社区利益相关者对行为健康的基于证据的实践实施策略的偏好：最糟糕的缩放选择实验

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Community behavioral health clinicians, supervisors, and administrators play an essential role in implementing new psychosocial evidence-based practices (EBP) for patients receiving psychiatric care; however, little is known about these stakeholders’ values and preferences for implementation strategies that support EBP use, nor how best to elicit, quantify, or segment their preferences. This study sought to quantify these stakeholders’ preferences for implementation strategies and to identify segments of stakeholders with distinct preferences using a rigorous choice experiment method called best-worst scaling. A total of 240 clinicians, 74 clinical supervisors, and 29 administrators employed within clinics delivering publicly-funded behavioral health services in a large metropolitan behavioral health system participated in a best-worst scaling choice experiment. Participants evaluated 14 implementation strategies developed through extensive elicitation and pilot work within the target system. Preference weights were generated for each strategy using hierarchical Bayesian estimation. Latent class analysis identified segments of stakeholders with unique preference profiles. On average, stakeholders preferred two strategies significantly more than all others—compensation for use of EBP per session and compensation for preparation time to use the EBP (P??.05); two strategies were preferred significantly less than all others—performance feedback via email and performance feedback via leaderboard (P??.05). However, latent class analysis identified four distinct segments of stakeholders with unique preferences: Segment 1 (n?=?121, 35%) strongly preferred financial incentives over all other approaches and included more administrators; Segment 2 (n?=?80, 23%) preferred technology-based strategies and was younger, on average; Segment 3 (n?=?52, 15%) preferred an improved waiting room to enhance client readiness, strongly disliked any type of clinical consultation, and had the lowest participation in local EBP training initiatives; Segment 4 (n?=?90, 26%) strongly preferred clinical consultation strategies and included more clinicians in substance use clinics. The presence of four heterogeneous subpopulations within this large group of clinicians, supervisors, and administrators suggests optimal implementation may be achieved through targeted strategies derived via elicitation of stakeholder preferences. Best-worst scaling is a feasible and rigorous method for eliciting stakeholders’ implementation preferences and identifying subpopulations with unique preferences in behavioral health settings.
机译：社区行为健康临床医生，监事和管理员在实施接受精神科护理的患者的新的心理社会循证实践（EBP）方面发挥着重要作用;但是，对于这些利益相关者的价值观和偏好，对支持EBP使用的实施策略的价值和偏好几乎是知之甚少，也没有如何最好地引出，量化或分段他们的偏好。本研究试图量化这些利益相关者的实施策略的偏好，并使用称为最佳缩放的严谨性选择实验方法识别利益攸关方的细分。共有240名临床医生，74名临床监督员和29名临床管理员，在大都市行为卫生系统中提供公开资助的行为卫生服务，参加了最糟糕的缩放选择实验。参与者通过目标系统内通过广泛的挑选和试点工作进行了评估了14项实施策略。使用分层贝叶斯估计为每个策略生成偏好权重。潜在类分析确定了具有独特偏好概况的利益相关者的细分。平均而言，利益相关者优先考虑两种策略，比所有其他策略 - 补偿每次会议使用EBP和准备时间使用EBP的补偿（P？＆ 05）;通过电子邮件和绩效反馈通过排行榜（P？＆ 05），两种策略优先于所有其他策略 - 通过电子邮件和性能反馈的表现反馈明显少于绩效反馈。但是，潜在的阶级分析确定了具有独特偏好的利益相关者的四个不同部分：段1（n？= 121,35％）强烈优先于所有其他方法的财务激励，并包括更多管理员;段2（n？=？80,23％）优选的基于技术的策略，平均是年轻的;段3（n？= 52,15％）首选改进的候诊室，以提高客户准备，强烈不喜欢任何类型的临床咨询，并获得了当地EBP培训计划的最低参与;细分4（N？= 90,26％）强烈优选的临床咨询策略，包括更多临床医生在物质使用诊所。这一大群临床医生，监事和管理人员中存在四个异质群体的存在表明，通过通过利益相关者偏好的挑战来实现最佳实施。最糟糕的缩放是一种可行且严谨的方法，可引出利益相关者的实施偏好，并在行为健康环境中识别具有独特偏好的子项目。

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