Data from: Testing a systematic approach to identify and prioritise barriers to successful implementation of a complex healthcare intervention

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Background

Multiple barriers may inhibit the adoption of clinical interventions and impede successful implementation. Use of standardised methods to prioritise barriers to target when selecting implementation interventions is an understudied area of implementation research. The aim of this study was to describe a method to identify and prioritise barriers to the implementation of clinical practice elements which were used to inform the development of the T3 trial implementation intervention (Triage, Treatment [thrombolysis administration; monitoring and management of temperature, blood glucose levels, and swallowing difficulties] and Transfer of stroke patients from Emergency Departments [ED]).

Methods

A survey was developed based on a literature review and data from a complementary trial to identify the commonly reported barriers for the nine T3 clinical care elements. This was administered via a web-based questionnaire to a purposive sample of Australian multidisciplinary clinicians and managers in acute stroke care. The questionnaire addressed barriers to each of the nine T3 trial clinical care elements. Participants produced two ranked lists: on their perception of: firstly, how influential each barrier was in preventing clinicians from performing the clinical care element (influence attribute); and secondly how difficult the barrier was to overcome (difficulty attribute). The rankings for both influence and difficulty were combined to classify the barriers according to three categories (‘least desirable’, desirable’ or ‘most desirable’ to target) to assist interpretation.

Results

All invited participants completed the survey; (n = 17; 35% medical, 35% nursing, 18% speech pathology, 12% bed managers). The barriers classified as most desirable to target and overcome were a ‘lack of protocols for the management of fever’ and ‘not enough blood glucose monitoring machines’.

Conclusions

A structured decision-support procedure has been illustrated and successfully applied to identify and prioritise barriers to target within an implementation intervention. This approach may prove to be a useful in other studies and as an adjunct to undertaking barrier assessments within individual sites when planning implementation interventions.

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背景
临床干预的推广应用可能面临多重阻碍，且会影响其成功落地的进程。采用标准化方法优先确定需重点攻克的障碍，以便选择适配的实施干预策略，这一领域在实施研究中尚未得到充分探索。本研究旨在阐述一种用于识别并排序临床实践要素落地障碍的方法，该方法可为T3试验（T3 trial）实施干预策略的开发提供参考依据——T3试验即针对卒中患者的分诊、治疗[包括溶栓给药；体温、血糖水平及吞咽困难的监测与管理]以及从急诊科（Emergency Departments）转诊卒中患者的干预措施。

方法
本研究通过文献综述与一项互补性试验的数据，开发了一套调查问卷，用于识别T3试验9项临床护理要素常见的落地障碍。该网络问卷面向澳大利亚急性卒中护理领域的多学科临床医师与管理人员开展目的性抽样调查。问卷针对9项T3试验临床护理要素分别设置障碍相关问题。参与者需完成两份排序清单：其一为各障碍对临床医师执行对应护理要素的阻碍影响力评分（影响力属性）；其二为各障碍的克服难度评分（难易度属性）。将影响力与难易度的评分结果结合，可将障碍划分为三类："最应优先解决"、"可考虑解决"与"暂不优先解决"，以辅助结果解读。

结果
所有受邀参与者均完成了调查问卷，有效样本量n=17，其中内科医师占35%、护理人员占35%、言语治疗师占18%、病房管理人员占12%。被划分为最应优先解决与克服的障碍为"缺乏发热管理相关规程"以及"血糖监测设备不足"。

结论
本研究阐述并成功应用了一套结构化决策支持流程，用于识别并排序实施干预过程中需优先解决的障碍。该方法或可在其他同类研究中发挥作用，亦可作为单个医疗站点在规划实施干预策略时开展障碍评估的辅助工具。