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sustaining a new model of acute stroke care: a mixed-method process evaluation of the melbourne mobile stroke unit
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نویسنده
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bagot kathleen l. ,purvis tara ,hancock shaun ,zhao henry ,coote skye ,easton damien ,campbell bruce cv ,davis stephen m. ,donnan geoff a. ,foster shane ,langenberg francesca ,smith karen ,stephenson michael ,bernard stephen ,mcgowan sharon ,yan bernard ,mitchell peter ,middleton sandy ,cadilhac dominique a.
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منبع
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international journal of health policy and management - 2023 - دوره : 12 - شماره : Issue 1 - صفحه:1 -13
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چکیده
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Background internationally, mobile stroke unit (msu) ambulances have changed pre-hospital acute stroke care delivery. msu clinical and cost-effectiveness studies are emerging, but little is known about important factors for achieving sustainability of this innovative model of care.methods mixed-methods study from the melbourne msu (operational since november 2017) process evaluation. participant purposive sampling included clinical, operational and executive/management representatives from ambulance victoria (av) (emergency medical service provider), the msu clinical team, and receiving hospitals. sustainability was defined as ongoing msu operations, including msu workforce and future model considerations. theoretically-based on-line survey with unified theory of acceptance and use of technology (utaut), self determination theory (sdt, intrinsic motivation), and open-text questions targeting barriers and benefits was administered (june-september 2019). individual/group interviews were conducted, eliciting improvement suggestions and requirements for ongoing use. descriptive and regression analyses (quantitative data) and directed content and thematic analysis (open text and interview data) were conducted.results there were 135 surveys completed. identifying that the msu was beneficial to daily work (β = 0.61), not experiencing pressure/tension about working on the msu (β = 0.17) and thinking they did well working within the team model (β = 0.17) were significantly associated with wanting to continue working within the msu model [r2 = 0.76; f(15, 60) = 12.76, p < .001]. experiences varied between those on the msu team and those working with the msu. advantages were identified for patients (better, faster care) and clinicians (interdisciplinary learning). disadvantages included challenges integrating into established systems, and establishing working relationships. themes identified from 35 interviews were msu team composition, msu vehicle design and layout, personnel recruitment and rostering, communication improvements between organisations, telemedicine options, msu operations and dispatch specificity.conclusion important factors affecting the sustainability of the msu model of stroke care emerged. a cohesive team approach, with identifiable benefits and good communication between participating organisations is important for clinical and operational sustainability.
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کلیدواژه
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stroke ,ambulances ,evaluation studies ,program sustainability
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آدرس
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university of melbourne, florey institute neuroscience and mental health, australia. monash university, school of clinical sciences at monash health, department of medicine, australia, monash university, school of clinical sciences at monash health, department of medicine, australia, university of melbourne, florey institute neuroscience and mental health, australia, royal melbourne hospital, melbourne brain centre, department of neurology, australia. university of melbourne, faculty of medicine, department of medicine, australia. ambulance victoria, australia, royal melbourne hospital, melbourne brain centre, department of neurology, australia. university of melbourne, faculty of medicine, department of medicine, australia, royal melbourne hospital, melbourne brain centre, department of neurology, australia. university of melbourne, faculty of medicine, department of medicine, australia, royal melbourne hospital, melbourne brain centre, department of neurology, australia. university of melbourne, faculty of medicine, department of medicine, australia. ambulance victoria, australia. stroke foundation, australia, royal melbourne hospital, melbourne brain centre, department of neurology, australia. university of melbourne, faculty of medicine, department of medicine, australia, university of melbourne, florey institute neuroscience and mental health, australia. royal melbourne hospital, melbourne brain centre, department of neurology, australia. university of melbourne, faculty of medicine, melbourne brain centre, department of medicine, australia, ambulance victoria, australia, royal melbourne hospital, melbourne brain centre, department of neurology, australia. ambulance victoria, australia, ambulance victoria, australia. monash university, department of epidemiology and preventive medicine, australia. university of western australia, australia, ambulance victoria, australia. monash university, department of epidemiology and preventive medicine, australia, ambulance victoria, australia. monash university, department of epidemiology and preventive medicine, australia, stroke foundation, australia, royal melbourne hospital, melbourne brain centre, department of neurology, australia, university of melbourne, faculty of medicine, department of medicine, australia, st vincent’s hospital melbourne, australia. australian catholic university, nursing research institute, australia, university of melbourne, florey institute neuroscience and mental health, australia. monash university, school of clinical sciences at monash health, department of medicine, australia
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پست الکترونیکی
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dominique.cadilhac@monash.edu
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Authors
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