Ke Peng1,2, Hueiming Liu2, Jing Zhang3,4, Minghui Yang5, Yishu Liu2,4, Maoyi Tian2,4, Hongling Chu6, Xinbao Wu7, Rebecca Ivers1,2,4. 1. School of Public Health, The University of Sydney, Sydney, Australia. 2. The George Institute for Global Health, UNSW Sydney, Sydney, Australia. 3. School of Public Health and Community Medicine, UNSW, Sydney, Australia. 4. The George Institute for Global Health at Peking University Health Science Center, Beijing, China. 5. Department of Orthopaedic and Traumatology, Beijing Jishuitan Hospital, Beijing, China. 6. Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China. 7. Department of Orthopaedic and Traumatology, Beijing Jishuitan Hospital, Beijing, China. wuxinbao@jsthospital.org.
Abstract
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.
This qualitative study identified the barriers to the implementation of a multidisciplinary co-management program for older hip fracturepatients 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.
Entities:
Keywords:
Clinical pathway; Hip fracture, ageing; Multidisciplinary management; Normalization process theory
Authors: Paul James Mitchell; Seng Bin Ang; Leilani Basa Mercado-Asis; Reynaldo Rey-Matias; Wen-Shiang Chen; Leon Flicker; Edward Leung; David Choon; Sankara Kumar Chandrasekaran; Jacqueline Clare Therese Close; Hannah Seymour; Cyrus Cooper; Philippe Halbout; Robert Daniel Blank; Yanling Zhao; Jae-Young Lim; Irewin Tabu; Maoyi Tian; Aasis Unnanuntana; Ronald Man Yeung Wong; Noriaki Yamamoto; Ding-Cheng Chan; Joon Kiong Lee Journal: Arch Osteoporos Date: 2022-08-20 Impact factor: 2.879