Promoting Evidence-Based Practice: The Influence of Novel Structural Change to Accelerate Translational Rehabilitation |
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| Affiliation: | 1. Shirley Ryan AbilityLab, Chicago, IL;2. Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL;3. Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL;4. Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City, UT;5. Occupational Therapy Department, Rush University, Chicago, IL;6. Northwestern University, Kellogg School of Management, Chicago, IL;7. Hines V.A. Medical Center, Hines, IL;1. Shirley Ryan AbilityLab, Chicago, IL;2. Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL;3. Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL;4. Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City, UT;5. Occupational Therapy Department, Rush University, Chicago, IL;6. Northwestern University, Kellogg School of Management, Chicago, IL;7. Hines V.A. Medical Center, Hines, IL;1. Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK;2. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK;1. Michigan State University College of Human Medicine, East Lansing, MI;2. Department of Neurology, Case Western Reserve University, University Hospital Cleveland Medical Center, Cleveland, OH;3. Wayne State University School of Medicine, Detroit, MI;4. Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI;5. Department of Neurosurgery, Semmes Murphey Clinic, Memphis, TN;6. University of Tennessee Health Sciences Center, Memphis, TN;1. Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia;2. Allied Health Professorial Unit, Sydney Local Health District, Sydney, Australia;3. Charles Perkins Centre, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia;4. Ingham Institute for Applied Medical Research, Sydney, Australia;5. Allied Health Professorial Unit, South Western Sydney Local Health District, Sydney, Australia;1. Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain;2. Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain;3. Fundació Institut d''Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain;1. Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Associação Mineira de Reabilitação, Belo Horizonte, Brazil;2. Graduate Program in Analysis and Modeling of Environmental Systems, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil;3. Department of Occupational Therapy, College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, MA;4. Department of Statistics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil;5. Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil;6. Department of Occupational Therapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil;1. University of Rome “La Sapienza”, S. Andrea Hospital, via di Grottarossa Roma, Italy;2. University of Rome “La Sapienza”, Policlinico Umberto I, Roma, Italy;3. Ospedale Privato Accreditato “Sol Et Salus” Spa Rimini, Torre Pedrera, Italy;4. Policlinico Tor Vergata, Roma, Italy;5. National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Roma, Italy |
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| Abstract: | ObjectiveTo evaluate changes in clinicians’ use of evidence-based practice (EBP), openness toward EBP, and their acceptance of organizational changes after a rehabilitation hospital transitioned to a new facility designed to accelerate clinician-researcher collaborations.DesignThree repeated surveys of clinicians before, 7-9 months, and 2.5 years after transition to the new facility.SettingInpatient rehabilitation hospital.ParticipantsPhysicians, nurses, therapists, and other health care professionals (n=410, 442, and 448 respondents at Times 1, 2, and 3, respectively).InterventionsImplementation of physical (architecture, design) and team-focused (champions, leaders, incentives) changes in a new model of care to promote clinician-researcher collaborations.Main Outcome MeasuresAdapted versions of the Evidence-Based Practice Questionnaire (EBPQ), the Evidence-Based Practice Attitudes Scale (EBPAS), and the Organizational Change Recipients’ Beliefs Scale (OCRBS) were used. Open-ended survey questions were analyzed through exploratory content analysis.ResultsResponse rates at Times 1, 2, and 3 were 67% (n=410), 69% (n=422), and 71% (n=448), respectively. After accounting for familiarity with the model of care, there was greater reported use of EBP at Time 3 compared with Time 2 (adjusted meant2=3.51, standard error (SE)=0.05; adj. meant3=3.64, SE=0.05; P=.043). Attitudes toward EBPs were similar over time. Acceptance of the new model of care was lower at Time 2 compared with Time 1, but rebounded at Time 3 (adjusted meant1=3.44, SE=0.04; adj. meant2=3.19, SE=0.04; P<.0001; adj. meant3=3.51, SE=0.04; P<.0001). Analysis of open-ended responses suggested that clinicians’ optimism for the model of care was greater over time, but continued quality improvement should focus on cultivating communication between clinicians and researchers.ConclusionsAccelerating clinician-researcher collaborations in a rehabilitation setting requires sustained effort for successful implementation beyond novel physical changes. Organizations must be responsive to clinicians’ changing concerns to adapt and sustain a collaborative translational medicine model and allow sufficient time, probably years, for such transitions to occur. |
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| Keywords: | Hospital Hehabilitation Implementation science Interdisciplinary health team Interdisciplinary communication Learning health system Physical medicine and rehabilitation Rehabilitation centers Rehabilitation research |
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