학술논문
The Systems Analysis and Improvement Approach: specifying core components of an implementation strategy to optimize care cascades in public health.
Document Type
Academic Journal
Author
Gimbel S; Department of Child, Family, and Population Health Nursing, University of Washington, Magnuson Health Science Bldg, Seattle, WA, USA. sgimbel@uw.edu.; Department of Global Health, University of Washington, Seattle, WA, USA. sgimbel@uw.edu.; Ásbjörnsdóttir K; Department of Global Health, University of Washington, Seattle, WA, USA.; Center for Public Health Sciences, University of Iceland, Reykjavík, Iceland.; Department of Epidemiology, University of Washington, Seattle, WA, USA.; Banek K; Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA.; Borges M; Department of Child, Family, and Population Health Nursing, University of Washington, Magnuson Health Science Bldg, Seattle, WA, USA.; Department of Global Health, University of Washington, Seattle, WA, USA.; Crocker J; Department of Global Health, University of Washington, Seattle, WA, USA.; Coutinho J; Comité para a Saúde de Moçambique, Beira, Mozambique.; Cumbe V; Ministry of Health, Provincial Health Department, Sofala, Mozambique.; Dinis A; Department of Global Health, University of Washington, Seattle, WA, USA.; Ministry of Health, National Department of Public Health, Maputo, Mozambique.; Eastment M; Department of Medicine, University of Washington, Seattle, WA, USA.; Gaitho D; Network of AIDS Researchers of East and Southern Africa, Nairobi, Kenya.; Lambdin BH; Department of Global Health, University of Washington, Seattle, WA, USA.; RTI International, Berkeley, CA, USA.; Pope S; Department of Child, Family, and Population Health Nursing, University of Washington, Magnuson Health Science Bldg, Seattle, WA, USA.; Department of Global Health, University of Washington, Seattle, WA, USA.; Uetela O; Department of Global Health, University of Washington, Seattle, WA, USA.; Hazim C; Department of Global Health, University of Washington, Seattle, WA, USA.; McClelland RS; Department of Global Health, University of Washington, Seattle, WA, USA.; Department of Epidemiology, University of Washington, Seattle, WA, USA.; Department of Medicine, University of Washington, Seattle, WA, USA.; Mocumbi AO; Department of Global Health, University of Washington, Seattle, WA, USA.; Instituto Nacional de Saúde de Maputo, Maputo, Mozambique.; Universidade Eduardo Mondlane, Maputo, Mozambique.; Muanido A; Comité para a Saúde de Moçambique, Beira, Mozambique.; Nduati R; University of Nairobi, Nairobi, Kenya.; Njuguna IN; Department of Global Health, University of Washington, Seattle, WA, USA.; Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.; Wagenaar BH; Department of Global Health, University of Washington, Seattle, WA, USA.; Department of Epidemiology, University of Washington, Seattle, WA, USA.; Wagner A; Department of Global Health, University of Washington, Seattle, WA, USA.; Wanje G; Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.; Sherr K; Department of Global Health, University of Washington, Seattle, WA, USA.; Department of Epidemiology, University of Washington, Seattle, WA, USA.
Source
Publisher: BioMed Central Country of Publication: England NLM ID: 101764360 Publication Model: Electronic Cited Medium: Internet ISSN: 2662-2211 (Electronic) Linking ISSN: 26622211 NLM ISO Abbreviation: Implement Sci Commun Subsets: PubMed not MEDLINE
Subject
Language
English
Abstract
Background: Healthcare systems in low-resource settings need simple, low-cost interventions to improve services and address gaps in care. Though routine data provide opportunities to guide these efforts, frontline providers are rarely engaged in analyzing them for facility-level decision making. The Systems Analysis and Improvement Approach (SAIA) is an evidence-based, multi-component implementation strategy that engages providers in use of facility-level data to promote systems-level thinking and quality improvement (QI) efforts within multi-step care cascades. SAIA was originally developed to address HIV care in resource-limited settings but has since been adapted to a variety of clinical care systems including cervical cancer screening, mental health treatment, and hypertension management, among others; and across a variety of settings in sub-Saharan Africa and the USA. We aimed to extend the growing body of SAIA research by defining the core elements of SAIA using established specification approaches and thus improve reproducibility, guide future adaptations, and lay the groundwork to define its mechanisms of action.
Methods: Specification of the SAIA strategy was undertaken over 12 months by an expert panel of SAIA-researchers, implementing agents and stakeholders using a three-round, modified nominal group technique approach to match core SAIA components to the Expert Recommendations for Implementing Change (ERIC) list of distinct implementation strategies. Core implementation strategies were then specified according to Proctor's recommendations for specifying and reporting, followed by synthesis of data on related implementation outcomes linked to the SAIA strategy across projects.
Results: Based on this review and clarification of the operational definitions of the components of the SAIA, the four components of SAIA were mapped to 13 ERIC strategies. SAIA strategy meetings encompassed external facilitation, organization of provider implementation meetings, and provision of ongoing consultation. Cascade analysis mapped to three ERIC strategies: facilitating relay of clinical data to providers, use of audit and feedback of routine data with healthcare teams, and modeling and simulation of change. Process mapping matched to local needs assessment, local consensus discussions and assessment of readiness and identification of barriers and facilitators. Finally, continuous quality improvement encompassed tailoring strategies, developing a formal implementation blueprint, cyclical tests of change, and purposefully re-examining the implementation process.
Conclusions: Specifying the components of SAIA provides improved conceptual clarity to enhance reproducibility for other researchers and practitioners interested in applying the SAIA across novel settings.
(© 2023. The Author(s).)
Methods: Specification of the SAIA strategy was undertaken over 12 months by an expert panel of SAIA-researchers, implementing agents and stakeholders using a three-round, modified nominal group technique approach to match core SAIA components to the Expert Recommendations for Implementing Change (ERIC) list of distinct implementation strategies. Core implementation strategies were then specified according to Proctor's recommendations for specifying and reporting, followed by synthesis of data on related implementation outcomes linked to the SAIA strategy across projects.
Results: Based on this review and clarification of the operational definitions of the components of the SAIA, the four components of SAIA were mapped to 13 ERIC strategies. SAIA strategy meetings encompassed external facilitation, organization of provider implementation meetings, and provision of ongoing consultation. Cascade analysis mapped to three ERIC strategies: facilitating relay of clinical data to providers, use of audit and feedback of routine data with healthcare teams, and modeling and simulation of change. Process mapping matched to local needs assessment, local consensus discussions and assessment of readiness and identification of barriers and facilitators. Finally, continuous quality improvement encompassed tailoring strategies, developing a formal implementation blueprint, cyclical tests of change, and purposefully re-examining the implementation process.
Conclusions: Specifying the components of SAIA provides improved conceptual clarity to enhance reproducibility for other researchers and practitioners interested in applying the SAIA across novel settings.
(© 2023. The Author(s).)