Williams Nathaniel J, Becker-Haimes Emily M, Schriger Simone H, Beidas Rinad S
School of Social Work, Boise State University, 1910 University Drive, Boise, ID, 83625, USA.
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
Implement Sci Commun. 2022 Jun 11;3(1):64. doi: 10.1186/s43058-022-00309-y.
Theory and empirical research suggest organizational climate for evidence-based practice (EBP) implementation may be an important and malleable target to improve clinician use of EBPs in healthcare; however, this work has been criticized for overreliance on self-report measures of implementation outcomes and cross-sectional designs. This study combines data from two studies spanning 7 years to test the hypothesis that higher levels of organizational EBP implementation climate prospectively predicts improved clinician adherence to an EBP, cognitive behavioral therapy (CBT), as rated by expert observers.
Biennial assessments of EBP implementation climate collected in 10 community mental health agencies in Philadelphia as part of a systemwide evaluation (time 1) were linked to subsequent observer ratings of clinician adherence to CBT in clinical encounters with 108 youth (time 2). Experts rated clinician adherence to CBT using the Therapy Process Observation Coding System which generated two primary outcomes (a) maximum CBT adherence per session (i.e., highest rated CBT intervention per session; depth of delivery) and (b) average CBT adherence per session (i.e., mean rating across all CBT interventions used; depth and breadth of delivery).
On average, time 2 clinician adherence observations occurred 19.8 months (SD = 10.15) after time 1 organizational climate assessments. Adjusting for organization, clinician, and client covariates, a one standard deviation increase in organizational EBP implementation climate at time 1 predicted a 0.63-point increase in clinicians' maximum CBT adherence per session at time 2 (p = 0.000), representing a large effect size (d = 0.93; 95% CI = 0.63-1.24) when comparing organizations in the upper (k = 3) versus lower tertiles (k = 3) of EBP implementation climate. Higher levels of time 1 organizational EBP implementation climate also predicted higher time 2 average CBT adherence per session (b = 0.23, p < 0.001, d = 0.72). Length of time between assessments of climate and adherence did not moderate these relationships.
Organizational EBP implementation climate is a promising predictor of clinicians' subsequent observed adherence to CBT. Implementation strategies that target this antecedent may improve the delivery of EBPs in healthcare settings.
理论和实证研究表明，基于证据的实践（EBP）实施的组织氛围可能是提高临床医生在医疗保健中使用EBP的一个重要且可塑造的目标；然而，这项工作因过度依赖实施结果的自我报告测量和横断面设计而受到批评。本研究结合了两项跨度7年的研究数据，以检验以下假设：组织EBP实施氛围水平越高，前瞻性地预测临床医生对一种EBP（认知行为疗法，CBT）的依从性会提高，这是由专家观察者评定的。
作为全系统评估（时间1）的一部分，在费城的10个社区心理健康机构中每两年进行一次EBP实施氛围评估，并与随后专家对108名青少年临床诊疗中临床医生对CBT依从性的评定（时间2）相关联。专家使用治疗过程观察编码系统对临床医生对CBT的依从性进行评定，该系统产生两个主要结果：（a）每次诊疗的最大CBT依从性（即每次诊疗中评定最高的CBT干预；实施深度）和（b）每次诊疗的平均CBT依从性（即所有使用的CBT干预的平均评定；实施深度和广度）。
平均而言，时间2的临床医生依从性观察是在时间1的组织氛围评估后19.8个月（标准差=10.15）进行的。在对组织、临床医生和患者协变量进行调整后，时间1的组织EBP实施氛围每增加一个标准差，预测时间2临床医生每次诊疗的最大CBT依从性会增加0.63分（p=0.000），在比较EBP实施氛围处于上三分位数（k=3）与下三分位数（k=3）的组织时，这代表着较大的效应量（d=0.93；95%置信区间=0.63-1.24）。时间1的组织EBP实施氛围水平越高，也预测时间2每次诊疗的平均CBT依从性越高（b=0.23，p<0.001，d=0.72）。氛围评估和依从性评估之间的时间长度并未调节这些关系。
组织EBP实施氛围是临床医生随后观察到的对CBT依从性的一个有前景的预测指标。针对这一前提因素的实施策略可能会改善医疗环境中EBP的提供。
