BACKGROUND Evaluation of health technology programmes should be theoretically informed, interdisciplinary, and generate in-depth explanations. The NASSS (non-adoption, abandonment, scale-up, spread, sustainability) framework was developed to study unfolding technology programmes in real time-and in particular to identify and manage their emergent uncertainties and interdependencies. In this paper, we offer a worked example of how NASSS can also inform ex post (i.e. retrospective) evaluation. METHODS We studied the TORPEDO (Treatment of Cardiovascular Risk in Primary Care using Electronic Decision Support) research programme, a multi-faceted computerised quality improvement intervention for cardiovascular disease prevention in Australian general practice. The technology (HealthTracker) had shown promise in a cluster randomised controlled trial (RCT), but its uptake and sustainability in a real-world implementation phase was patchy. To explain this variation, we used NASSS to undertake secondary analysis of the multi-modal TORPEDO dataset (results and process evaluation of the RCT, survey responses, in-depth professional interviews, videotaped consultations) as well as a sample of new, in-depth narrative interviews with TORPEDO researchers. RESULTS Ex post analysis revealed multiple areas of complexity whose influence and interdependencies helped explain the wide variation in uptake and sustained use of the HealthTracker technology: the nature of cardiovascular risk in different populations, the material properties and functionality of the technology, how value (financial and non-financial) was distributed across stakeholders in the system, clinicians' experiences and concerns, organisational preconditions and challenges, extra-organisational influences (e.g. policy incentives), and how interactions between all these influences unfolded over time. CONCLUSION The NASSS framework can be applied retrospectively to generate a rich, contextualised narrative of technology-supported change efforts and the numerous interacting influences that help explain its successes, failures, and unexpected events. A NASSS-informed ex post analysis can supplement earlier, contemporaneous evaluations to uncover factors that were not apparent or predictable at the time but dynamic and emergent.

中文翻译：

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用于技术支持的医疗保健变革的事后理论化的 NASSS 框架：鱼雷计划的工作示例。

背景 卫生技术项目的评估应该具有理论依据、跨学科并产生深入的解释。NASSS（不采用、放弃、扩大、传播、可持续性）框架的开发是为了实时研究正在展开的技术项目，特别是识别和管理其出现的不确定性和相互依赖性。在本文中，我们提供了一个可行的示例，说明 NASSS 如何为事后（即回顾性）评估提供信息。方法 我们研究了 TORPEDO（使用电子决策支持在初级保健中治疗心血管风险）研究计划，这是澳大利亚全科医学中针对心血管疾病预防的多方面计算机化质量改进干预措施。该技术 (HealthTracker) 在一项整群随机对照试验 (RCT) 中显示出了良好的前景，但其在现实世界实施阶段的采用和可持续性却参差不齐。为了解释这种变化，我们使用 NASSS 对多模式 TORPEDO 数据集进行了二次分析（RCT 的结果和过程评估、调查回复、深入的专业访谈、录像咨询）以及新的、深入的样本对鱼雷研究人员的深度叙述采访。结果 事后分析揭示了多个复杂领域，其影响和相互依赖性有助于解释 HealthTracker 技术的采用和持续使用的巨大差异：不同人群心血管风险的性质、技术的材料特性和功能、价值（财务）系统中的利益相关者、临床医生的经验和关注点、组织先决条件和挑战、组织外影响（例如政策激励）以及所有这些影响之间的相互作用如何随着时间的推移而展开。结论 NASSS 框架可以回顾性地应用，以生成技术支持的变革努力的丰富的、情境化的叙述，以及有助于解释其成功、失败和意外事件的众多相互作用的影响。NASSS 知情的事后分析可以补充早期的同期评估，以发现当时不明显或不可预测的动态和突发因素。