AimTo facilitate the delivery of appropriate care, the aim was to test if a tailored, multifaceted de‐implementation strategy (RENEW) (1) would lead to less low‐value nursing care and (2) was acceptable, implementable, cost effective and scalable in the home‐based nursing care context.DesignA mixed‐methods design.MethodsThe RENEW strategy with components on education, persuasion, enablement, incentives and training was introduced in seven teams from two organisations in the Netherlands. To estimate the effect size, data were collected at baseline (T0) and follow‐up measurement (T1), on the volume of care in both frequency and time in minutes per week and independent samples t‐tests were performed. A qualitative evaluation was conducted to understand feasibility aspects, see how the strategy works and identify influencing factors and used document analyses and semi‐structured interviews. Deductive coding was used to analyse the results.ResultsThe time spent on low‐value nursing care (mean, minutes per week per client) in seven teams for 210 clients in T1 compared to 222 clients in T0 reduced statistically significant. The difference between T0 and T1 equals 17.94%. The frequency of delivered low‐value nursing care (mean per week) reduced but not statistically significant. From the transcripts of eight semi‐structured interviews and documents, a list of 79 influencing factors were identified. Practical implementation tools, workplace coaching and sharing experiences within and between teams were considered as the most contributing elements.ConclusionThe results showed that for the seven home‐healthcare teams in this study, the RENEW strategy (1) leads to a reduction in low‐value care and (2) is—conditional upon minor modifications—acceptable, implementable, cost effective and scalable.Reporting MethodStandards for Reporting Implementation Studies (StaRI) guidelines.Patient or Public ContributionNo Patient or Public Contribution.

中文翻译：

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减少低价值家庭护理的定制实施策略：混合方法可行性研究


目的为了促进提供适当的护理，目的是测试量身定制的、多方面的取消实施策略 （RENEW） （1） 是否会导致低价值护理减少，以及 （2） 在家庭护理环境中是可接受的、可实施的、具有成本效益的和可扩展的。设计混合方法设计.方法荷兰两个组织的 7 个团队引入了 RENEW 策略，包括教育、说服、支持、激励和培训等组成部分。为了估计效应大小，在基线 （T0） 和随访测量 （T1） 收集数据，收集每周护理频率和时间（以分钟为单位）的数据，并进行独立样本 t 检验。进行了定性评估以了解可行性方面，了解策略如何运作并确定影响因素，并使用文档分析和半结构化访谈。采用演绎编码分析结果。结果与 T0 的 222 名客户相比，T1 中 210 名客户的 7 个团队花在低价值护理上的时间（平均值，每个客户每周分钟数）在统计学上显着减少。T0 和 T1 之间的差异等于 17.94%。提供低价值护理的频率（每周平均值）减少，但无统计学意义。从 8 个半结构化访谈和文件的记录中，确定了 79 个影响因素的清单。实用的实施工具、工作场所辅导以及团队内部和团队之间的经验分享被认为是最有贡献的要素。结论结果表明，对于本研究中的七个家庭医疗保健团队，RENEW 策略 （1） 导致低价值护理的减少，并且 （2） 以微小的修改为条件 - 可接受、可实施、具有成本效益和可扩展性。报告方法报告实施研究 （StaRI） 指南的标准。患者或公众捐款没有患者或公众捐款。