背景:当新指南发布时,需要了解如何在现实世界的实践中最好地实施其建议。然而,准则的发布通常很少甚至没有路线图,供组织遵循以促进对其建议的遵守。这项研究的目的是评估使用通用过程模型在多种物理治疗临床环境中实施单一临床实践指南的影响。
方法:五个组织上不同的地点为周围前庭功能减退患者提供物理治疗服务。知识到行动模式是实施新发布的指南的基础。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识别目标行为,以提高指南的依从性。为期6个月的多式联运实施干预包括当地意见领袖,审计和反馈,耐疲劳提醒,和实践社区。治疗师在干预前后6个月对目标行为的坚持是行为改变的主要结果。
结果:所有站点的治疗师参与者都表示愿意改变并致力于项目。四个有经验的治疗师选择了相似的目标行为,而第五个,更多缺乏经验的治疗师,确定了不同的目标。对目标行为的坚持是混合的。在四个目标行为相似的网站中,3例患者的多个领域的依从性有统计学显著改善,1例患者的改善有限.成功最常见的是与文档相关的行为,并为患者提供低技术资源来支持家庭锻炼。第五个站点在一个提供者位置显示出改善治疗师自我效能和治疗师行为变化的趋势。
结论:知识到行动模型为具有不同结构和需要在实践中实施指南的站点提供了一个通用的过程模型。多式联运,积极干预,专注于审核对治疗师选择的目标行为的依从性,每月协作会议的反馈,耐疲劳提醒,发展实践社区与坚持的长期改善有关。地方而不是外部舆论领袖,社区建设会议的治疗师可用性,和提供者更替率可能会影响这种模式的成功。
背景:这项研究没有报告对人类参与者进行医疗保健干预的结果。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
BACKGROUND: This study does not report the results of a health care intervention on human participants.