Skeat J, Perry A
Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia.
Int J Lang Commun Disord. 2008 Mar-Apr;43(2):110-25. doi: 10.1080/13682820701449984.
Outcome measurement is important to clinical practice--yet outcome many speech and language therapists find it difficult to apply measures in practice, and not all clinicians and services have been able to implement and/ or use outcome measurement successfully. To date there has been little research to explain why implementation is often unsuccessful, and to provide clinicians and managers with direction as to the likely barriers and facilitators which should be considered.
To develop a theoretical framework to explain the implementation and use of outcome measurement in clinical practice by speech and language therapists.
METHODS & PROCEDURES: A qualitative, inductive theory-building approach, using grounded theory methodology, was applied. This included theoretical sampling, constant comparison, memo writing, and theoretical integration. Participants were 16 Australian managers and clinicians who were using, or who had used, outcome measures.
OUTCOMES & RESULTS: The resulting theoretical framework explains two interactive stages that occur when speech pathologists attempt to use outcome measurements in practice. First, clinicians must 'try on' outcome measurement in their own context, examining the way it fits with existing areas, such as their normal practices and priorities, and the wider group and organizational context. Having identified where outcome measurement does not 'fit', clinicians attempt to 'align' outcome measurement with the context (or vice versa), in order to create a better fit between the two. Strategies of 'tailoring' outcome measurement (e.g. using only parts of a measure) or 'accommodating' outcome measurement (e.g. changing routines to allow time for outcome measurement ratings) are possible, but are dependent on clinicians having a true picture of outcome measurement, the role and need for the data, and the existing context. Clinicians must also have control over the areas that need to change in order for outcome measurement and the context to 'align'. Where outcome measurement and the context can be aligned, outcome measures are more easily used.
The theory provides a framework for considering the use of outcome measurement in clinical practice. Implications for implementing outcome measurement in clinical practice are discussed, including the need to clarify the role and need for the data; the requirement that clinicians understand how outcome measurement fits with context outside of their own personal purview; and the need for managers to support change to areas that are outside of the control of clinicians.
结果测量对临床实践很重要——然而，许多言语和语言治疗师发现难以在实践中应用测量方法，而且并非所有临床医生和服务机构都能成功实施和/或使用结果测量。迄今为止，几乎没有研究来解释为何实施往往不成功，也没有为临床医生和管理人员提供有关应考虑的可能障碍和促进因素的指导。
构建一个理论框架，以解释言语和语言治疗师在临床实践中实施和使用结果测量的情况。
采用定性的、归纳式的理论构建方法，运用扎根理论方法。这包括理论抽样、持续比较、撰写备忘录和理论整合。参与者是16位正在使用或曾经使用过结果测量的澳大利亚管理人员和临床医生。
所得出的理论框架解释了言语病理学家在实践中尝试使用结果测量时出现的两个相互作用阶段。首先，临床医生必须在自身环境中“试用”结果测量，审视其与现有领域（如他们的常规做法和优先事项）以及更广泛的团队和组织环境的契合方式。在确定结果测量何处“不契合”后，临床医生试图使结果测量与环境“对齐”（反之亦然），以便在两者之间实现更好的契合。“调整”结果测量（例如仅使用测量的部分内容）或“适应”结果测量（例如改变常规以留出时间进行结果测量评级）的策略是可行的，但这取决于临床医生对结果测量、数据的作用和需求以及现有环境有真实的了解。临床医生还必须对需要改变的领域有控制权，以便结果测量与环境“对齐”。当结果测量与环境能够对齐时，结果测量就更容易被使用。
该理论为考虑在临床实践中使用结果测量提供了一个框架。讨论了在临床实践中实施结果测量的意义，包括需要阐明数据的作用和需求；临床医生需要了解结果测量如何与他们个人职责范围之外的环境相契合；以及管理人员需要支持对临床医生无法控制的领域进行变革。
