tailieunhanh - Tailoring an intervention to the context and system redesign related to the intervention: A case study of implementing shared medical appointments for diabetes

Tailoring an intervention to the context and system redesign related to the intervention: A case study of implementing shared medical appointments for diabetes Susan R Kirsh*1,2, Renée H Lawrence1 and David C Aron1,2 Address: 1Center for Quality Improvement Research, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA and 2School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA Email: Susan R Kirsh* - ; Renée H Lawrence - ; David C Aron - * Corresponding author. | Implementation Science BioMed Central Research article Tailoring an intervention to the context and system redesign related to the intervention A case study of implementing shared medical appointments for diabetes Susan R Kirsh 1 2 Renée H Lawrence1 and David C Aron1 2 Open Access Address 1Center for Quality Improvement Research Louis Stokes Cleveland Veterans Affairs Medical Center Cleveland Ohio USA and 2School of Medicine Case Western Reserve University Cleveland Ohio USA Email Susan R Kirsh - Renée H Lawrence - David C Aron - Corresponding author Published 4 June 2008 Received 26 September 2007 Implementation Science 2008 3 34 doi 1748-5908-3-34 Accepted 4 June 2008 This article is available from http content 3 1 34 2008 Kirsh et al licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License http licenses by which permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited. Abstract Background Incorporating shared medical appointments SMAs or group visits into clinical practice to improve care and increase efficiency has become a popular intervention but the processes to implement and sustain them have not been well described. The purpose of this study was to describe the process of implementation of SMAs in the local context of a primary care clinic over time. Methods The setting was a primary care clinic of an urban academic medical center of the Veterans Health Administration. We performed an in-depth case analysis utilizing both an innovations framework and a nested systems framework approach. This analysis helped organize and summarize implementation and sustainability issues specifically the pre-SMA local context the processes of

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