TitleApplying normalization process theory and process mapping to understand implementation of a co-management program for older hip fracture patients in China: a qualitative study
AuthorsPeng, Ke
Liu, Hueiming
Zhang, Jing
Yang, Minghui
Liu, Yishu
Tian, Maoyi
Chu, Hongling
Wu, Xinbao
Ivers, Rebecca
AffiliationUniv Sydney, Sch Publ Hlth, Sydney, NSW, Australia
UNSW Sydney, George Inst Global Hlth, Sydney, NSW, Australia
UNSW, Sch Publ Hlth & Community Med, Sydney, NSW, Australia
Peking Univ, Hlth Sci Ctr, George Inst Global Hlth, Beijing, Peoples R China
Beijing Jishuitan Hosp, Dept Orthopaed & Traumatol, Beijing, Peoples R China
Peking Univ, Res Ctr Clin Epidemiol, Hosp 3, Beijing, Peoples R China
Issue Date19-Jun-2020
Abstract.Summary. This qualitative study identified the barriers to the implementation of a multidisciplinary co-management program for older hip fracture patients and provided evidence for future intervention improvement and scale-up. Introduction Multidisciplinary co-management has been recommended as an effective intervention for hip fracture management in older people. This study is a process evaluation of a multidisciplinary co-management program in an orthopaedic hospital in Beijing, China, to better understand the barriers to implementation. Methods Data collection involved semi-structured interviews with key implementers of the co-management intervention (surgeon, geriatrician, physician, nurse, physiotherapist and anaesthetist) and observations of patients' journey to map the care processes were conducted in Beijing Jishuitan Hospital. Data were transcribed, qualitatively coded and analysed using normalization process theory to understand the intervention process from four constructs: coherence, cognitive participation, collective action and reflexive monitoring. Results Ten stakeholder interviews were conducted. Despite multidisciplinary co-management intervention was meaningful and valued by participants, barriers to its implementation were identified. These included unmatched investment and benefit (cognitive participation), challenges of facing increased workload (collective action), deficient training and supervision system (collective action), limited accommodating capacity of hospital (collective action) and difficulties in accessing information about the effect of the intervention (reflexive monitoring). Conclusions Multiple barriers to the effective implementation of the multidisciplinary co-management program in China were identified. The process evaluation highlights key aspects in less willingness to fully invest in the program, inappropriate workload allocation and lack of training and supervision which need to be addressed before scaling up.
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