Exploring the Implementation of Multiple Telementoring ECHO Programs From an Institutional and Organizational Perspective: Qualitative Study
Notice bibliographique
Résumé
Background: Project Extension for Community Healthcare Outcomes (ECHO) is an innovative model to increase capacity to treat patients in their community. Despite a growing body of evidence supporting its effectiveness, little is known about the implementation processes of multiple ECHO programs within an institution from the perspective of executives and institutional leaders. Objective: The study objective was to explore from an institutional and organizational standpoint the systemic characteristics that influence the implementation of Project ECHO programs, their growth within an ecosystem, and their sustainability. Methods: Focus groups and individual interviews were carried out with executives and leaders from an institution that implemented 3 Project ECHO programs, and verbatim were analyzed based on organizational readiness and implementation tools for Project ECHO. Results: This study highlighted the rarely reported perspectives of executives and institutional partners, shedding light on the organizational components that are essential to the deployment and sustainability of Project ECHO. Results reflect the intricate balance between institutional resources and its broader mission within a provincial, public health care system. In terms of acceptability, the fit between the projects and the institution's values of innovation, contribution to the broader community, and improving patient trajectory was central from the organizational leaders' standpoint. The structure of the projects and their rapid growth within the institution confirmed the adequacy with the institution. The projects benefited from temporary funds initially, and the lack of performance indicators that were easily measurable and the lack of recognition for invested time from clinicians were barriers to moving toward sustainability. Organizational characteristics, including a decentralized management structure and ministerial support for innovative educational practices, increased the perceived feasibility of implementing and maintaining these programs. Conclusions: This qualitative study of institution leaders and directors highlighted the challenges and facilitators to the deployment of an innovative continuous education model aimed at building capacity in the community for the management of various health conditions. Despite limitations, such as temporary initial funding, challenges in collecting performance indicators, most valued, and rigidity of the projects' structure, results also show many characteristics (innovative model, alignment with the institution's mission, and simplicity of its deployment) that helped move these projects toward sustainability within the institution. Results offer learning experiences that will be relevant to other settings evolving within a similar public health care system, wanting to implement this model.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,018 | 0,019 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,006 | 0,007 |
| Communication savante | 0,003 | 0,004 |
| Science ouverte | 0,002 | 0,004 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».