Sabus Carla, Spake Ellen
Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS.
Rockhurst University, Kansas City, MO, USA.
J Healthc Leadersh. 2016 Dec 1;8:107-120. doi: 10.2147/JHL.S115772. eCollection 2016.
New ideas, methods, and technologies spread through cultures through typical patterns described by diffusion of innovation (DOI) theory. Professional cultures, including the physical therapy profession, have distinctive features and traditions that determine the adoption of practice innovation. The Consolidated Framework for Implementation Research (CFIR) proposes a framework of innovation implementation specific to health care services. While the CFIR has been applied to medical and nursing practice, it has not been extended to rehabilitation professions. The purpose of this qualitative study was to verify the CFIR factors in outpatient physical therapy practice.
Through a nomination process of area rehabilitation managers and area directors of clinical education, 2 exemplar, outpatient, privately owned physical therapy clinics were identified as innovation practices. A total of 18 physical therapists (PTs), including 3 owners and a manager, participated in the study.
The 2 clinics served as case studies within a qualitative approach of directed content analysis. Data were collected through observation, spontaneous, unstructured questioning, workflow analysis, structured focus group sessions, and artifact analysis including clinical documents. Focus group data were transcribed. All the data were analyzed and coded among 4 investigators.
Through data analysis and alignment with literature in DOI theory in health care practice, the factors that determine innovation adoption were verified. The phenomena of implementation in PT practice are largely consistent with models of implementation in health care service. Within the outpatient practices studied, patient-centered care and collaborative learning were foundational elements to diffusion of an innovation.
Innovation in outpatient physical therapy practice can be understood as a social process situated within the culture of the physical therapy professional that follows predictable patterns that strongly align with DOI theory and the CFIR.
新思想、方法和技术通过创新扩散（DOI）理论所描述的典型模式在文化中传播。包括物理治疗专业在内的专业文化具有独特的特征和传统，这些特征和传统决定了实践创新的采用。实施研究综合框架（CFIR）提出了一个针对医疗保健服务的创新实施框架。虽然CFIR已应用于医学和护理实践，但尚未扩展到康复专业。本定性研究的目的是验证门诊物理治疗实践中的CFIR因素。
通过地区康复经理和临床教育地区主任的提名过程，确定了2家典型的门诊私人物理治疗诊所作为创新实践案例。共有18名物理治疗师（PT）参与了研究，其中包括3名诊所所有者和1名经理。
这2家诊所作为案例研究，采用定向内容分析的定性方法。通过观察、自发的非结构化提问、工作流程分析、结构化焦点小组会议以及包括临床文件在内的人工制品分析来收集数据。焦点小组数据进行了转录。所有数据由4名研究人员进行分析和编码。
通过数据分析并与医疗保健实践中DOI理论的文献进行比对，确定了决定创新采用的因素。物理治疗实践中的实施现象在很大程度上与医疗保健服务的实施模式一致。在所研究的门诊实践中，以患者为中心的护理和协作学习是创新扩散的基础要素。
门诊物理治疗实践中的创新可被理解为物理治疗专业文化中的一个社会过程，遵循与DOI理论和CFIR高度一致的可预测模式。
