Implementation and outcome evaluations of a multi-site improvement program in cancer genetics.

Autor: Bednar EM; Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.; Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Harper B; Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.; Impact Evaluation Core, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Walsh MT Jr; Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.; Impact Evaluation Core, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Rechis R; Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.; Impact Evaluation Core, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Bilbao M; Department of Gynecologic Oncology, MD Anderson Cancer Center at Cooper University Health Care, Camden, New Jersey, USA., Carr RL; Cancer Genetics Program, Banner MD Anderson Cancer Center, Gilbert, Arizona, USA., Eppolito AL; Cancer Genetics Program, Piedmont Oncology at Piedmont Healthcare, Atlanta, Georgia, USA., Goedde T; Cancer Genetics Program, Community Health Network, Indianapolis, Indiana, USA., Levin B; William G. Rohrer Cancer Genetics Program, MD Anderson Cancer Center at Cooper University Health Care, Camden, New Jersey, USA., Mattie K; William G. Rohrer Cancer Genetics Program, MD Anderson Cancer Center at Cooper University Health Care, Camden, New Jersey, USA., Morman NA; Genetic Counseling Program, OhioHealth, Columbus, Ohio, USA., Rath K; Department of Gynecologic Oncology, OhioHealth, Columbus, Ohio, USA., Russ P; Genetic Counseling Program, OhioHealth, Columbus, Ohio, USA.; Department of Surgical Oncology, OhioHealth Cancer Care, Columbus, Ohio, USA., Siettmann JM; Cancer Genetics Program, Banner MD Anderson Cancer Center, Gilbert, Arizona, USA., Warshal D; Department of Gynecologic Oncology, MD Anderson Cancer Center at Cooper University Health Care, Camden, New Jersey, USA., Wise E; Genetic Counseling Program, OhioHealth, Columbus, Ohio, USA., Yobbi C; Cancer Genetics Program, Community Health Network, Indianapolis, Indiana, USA., Lu KH; Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Jazyk: angličtina
Zdroj: Journal of genetic counseling [J Genet Couns] 2023 Feb; Vol. 32 (1), pp. 182-196. Date of Electronic Publication: 2022 Sep 19.
DOI: 10.1002/jgc4.1633
Abstrakt: Program evaluation can identify the successes and challenges of implementing clinical programs, which can inform future dissemination efforts. A cancer genetics improvement program, disseminated from the Lead Team's institution to five health systems (Participating Sites), was genetic counselor led, using virtual implementation facilitation to support Participating Sites' performance of quality improvement (QI) activities over several years. Program implementation and outcome evaluations were performed and included evaluation of program delivery and initial effects of the program on Participating Sites. A logic model guided evaluation of program implementation (inputs, activities, outputs, delivery/fidelity, and coverage/reach) and initial outcomes (short-term and intermediate outcomes). Data were collected from program documents and an Evaluation Survey of Participating Site team members (21 respondents), compared against the Lead Team's expectations of participation, and analyzed using descriptive statistics. All program inputs, outputs, and activities were available and delivered as expected across the five Participating Sites. The most frequently used activities and inputs were facilitation-associated meetings and meeting resources, which were rated as useful/helpful by the majority of respondents. Nearly all respondents noted improvement in short-term outcomes following participation: 82.4% reported increased awareness of clinical processes, 94.1% increased knowledge of QI methods, 100% reported increased perceived importance of QI, 94.1% increased perceived feasibility of QI, and 76.5% reported increased problem-solving skills and self-efficacy to use QI at their site. Intermediate outcomes (identifying barriers, developing interventions, improved teamwork, and capacity) were achieved following program participation as indicated by the results of the program document review and Evaluation Survey responses. Implementation challenges at Participating Sites included staffing constraints, difficulties obtaining buy-in and participation, and developing interventions over time. The multi-site improvement program was delivered and implemented with high levels of fidelity and resulted in improved short and intermediate outcomes. Future research will evaluate long-term, patient-level outcomes associated with site-specific QI interventions.
(© 2022 National Society of Genetic Counselors.)
Databáze: MEDLINE
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