Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA.
Physical Therapy, Hearing and Balance Center, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA.
BMC Health Serv Res. 2022 Dec 1;22(1):1462. doi: 10.1186/s12913-022-08796-4.
When a new guideline is published there is a need to understand how its recommendations can best be implemented in real-world practice. Yet, guidelines are often published with little to no roadmap for organizations to follow to promote adherence to their recommendations. The purpose of this study was to evaluate the impact of using a common process model to implement a single clinical practice guideline across multiple physical therapy clinical settings.
Five organizationally distinct sites with physical therapy services for patients with peripheral vestibular hypofunction participated. The Knowledge to Action model served as the foundation for implementation of a newly published guideline. Site leaders conducted preliminary gap surveys and face-to-face meetings to guide physical therapist stakeholders' identification of target-behaviors for improved guideline adherence. A 6-month multimodal implementation intervention included local opinion leaders, audit and feedback, fatigue-resistant reminders, and communities of practice. Therapist adherence to target-behaviors for the 6 months before and after the intervention was the primary outcome for behavior change.
Therapist participants at all sites indicated readiness for change and commitment to the project. Four sites with more experienced therapists selected similar target behaviors while the fifth, with more inexperienced therapists, identified different goals. Adherence to target behaviors was mixed. Among four sites with similar target behaviors, three had multiple areas of statistically significantly improved adherence and one site had limited improvement. Success was most common with behaviors related to documentation and offering patients low technology resources to support home exercise. A fifth site showed a trend toward improved therapist self-efficacy and therapist behavior change in one provider location.
The Knowledge to Action model provided a common process model for sites with diverse structures and needs to implement a guideline in practice. Multimodal, active interventions, with a focus on auditing adherence to therapist-selected target behaviors, feedback in collaborative monthly meetings, fatigue-resistant reminders, and developing communities of practice was associated with long-term improvement in adherence. Local rather than external opinion leaders, therapist availability for community building meetings, and rate of provider turnover likely impacted success in this model.
This study does not report the results of a health care intervention on human participants.
当发布新指南时，需要了解如何将其建议在实际实践中最好地实施。然而，指南通常发布时，几乎没有为组织提供遵循的路线图，以促进对其建议的遵守。本研究的目的是评估使用通用流程模型在多个物理治疗临床环境中实施单一临床实践指南的影响。
五个具有周围性前庭功能低下患者物理治疗服务的组织上不同的地点参与了研究。知识转化模型为实施新发布的指南提供了基础。现场负责人进行了初步差距调查和面对面会议，以指导物理治疗师利益相关者确定改善指南依从性的目标行为。为期 6 个月的多模式实施干预措施包括当地意见领袖、审核和反馈、抗疲劳提醒以及实践社区。干预前后 6 个月治疗师对目标行为的依从性是行为改变的主要结果。
所有地点的治疗师参与者都表示愿意改变并承诺参与该项目。四个有更多经验的治疗师的地点选择了相似的目标行为，而第五个有更多经验不足的治疗师的地点则确定了不同的目标。对目标行为的依从性参差不齐。在具有相似目标行为的四个地点中，有三个在多个领域的依从性有统计学意义的提高，而一个地点的改善有限。成功最常见于与文档记录相关的行为和为患者提供支持家庭锻炼的低技术资源。第五个地点在一个提供者地点显示出治疗师自我效能和治疗师行为改变的趋势。
知识转化模型为具有不同结构和实施实践指南需求的地点提供了通用流程模型。多模式、积极的干预措施，重点是审核治疗师选择的目标行为的依从性、在协作的每月会议上进行反馈、抗疲劳提醒以及发展实践社区，与长期改善依从性相关。当地而不是外部意见领袖、治疗师参加社区建设会议的可用性以及提供者周转率可能影响了该模型的成功。
本研究未报告对人类参与者进行的医疗干预的结果。
