Health Services Research Unit, University of Aberdeen, 3rd floor, HSB, Foresterhill, Aberdeen AB25 2ZD, UK.
Implement Sci. 2012 Aug 16;7:76. doi: 10.1186/1748-5908-7-76.
Access and equity in children's therapy services may be improved by directing clinicians' use of resources toward specific goals that are important to patients. A practice-change intervention (titled 'Good Goals') was designed to achieve this. This study investigated uptake, adoption, and possible effects of that intervention in children's occupational therapy services.
Mixed methods case studies (n = 3 services, including 46 therapists and 558 children) were conducted. The intervention was delivered over 25 weeks through face-to-face training, team workbooks, and 'tools for change'. Data were collected before, during, and after the intervention on a range of factors using interviews, a focus group, case note analysis, routine data, document analysis, and researchers' observations.
Factors related to uptake and adoptions were: mode of intervention delivery, competing demands on therapists' time, and leadership by service manager. Service managers and therapists reported that the intervention: helped therapists establish a shared rationale for clinical decisions; increased clarity in service provision; and improved interactions with families and schools. During the study period, therapists' behaviours changed: identifying goals, odds ratio 2.4 (95% CI 1.5 to 3.8); agreeing goals, 3.5 (2.4 to 5.1); evaluating progress, 2.0 (1.1 to 3.5). Children's LoT decreased by two months [95% CI -8 to +4 months] across the services. Cost per therapist trained ranged from £1,003 to £1,277, depending upon service size and therapists' salary bands.
Good Goals is a promising quality improvement intervention that can be delivered and adopted in practice and may have benefits. Further research is required to evaluate its: (i) impact on patient outcomes, effectiveness, cost-effectiveness, and (ii) transferability to other clinical contexts.
通过将临床医生的资源使用导向对患者重要的具体目标，可以改善儿童治疗服务的可及性和公平性。一项名为“Good Goals”的实践改变干预措施旨在实现这一目标。本研究调查了该干预措施在儿童职业治疗服务中的采用情况、采用情况和可能的效果。
采用混合方法案例研究（n=3 个服务，包括 46 名治疗师和 558 名儿童）。该干预措施通过面对面培训、团队工作手册和“变革工具”在 25 周内实施。在干预之前、期间和之后，使用访谈、焦点小组、案例记录分析、常规数据、文献分析和研究人员观察，收集了一系列因素的数据。
与采用相关的因素包括：干预措施的实施模式、治疗师时间的竞争需求以及服务经理的领导。服务经理和治疗师报告说，该干预措施：帮助治疗师为临床决策建立共同的基本原理；提高服务提供的清晰度；并改善与家庭和学校的互动。在研究期间，治疗师的行为发生了变化：确定目标，比值比 2.4（95%置信区间 1.5 至 3.8）；达成目标，3.5（2.4 至 5.1）；评估进展，2.0（1.1 至 3.5）。在整个服务中，儿童的 LoT 减少了两个月[95%置信区间-8 至+4 个月]。每位受训治疗师的成本范围为 1003 英镑至 1277 英镑，具体取决于服务规模和治疗师的薪级。
Good Goals 是一种有前途的质量改进干预措施，可在实践中实施和采用，并且可能具有益处。需要进一步研究来评估其对患者结果的影响、有效性、成本效益，以及（ii）在其他临床环境中的可转移性。
