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ImplementingMeaningfulProjectstoEnhanceEBPinyourClinic

WendyRomney,PT,DPT,PhD,NCSJenniMoore,PT,DHS,NCSJulieTilson,PT,DPT,MSSusanPerry,PT,DPTJudithEDeutsch,PT,PhD,FAPTAHallieZeleznik,PT,DPT,NCS

Objectives

• Explorequalityimprovement(QI)andknowledgetranslation(KT)practiceandresearchinphysicaltherapy• Describestrategiestoplan,implementandevaluateQI/KTprojects• DevelopQI/KTactionplans

Overview

• DefineandreviewthehistoryofQIandKTresearch(10minutes)• ReviewstrategiestoimplementQIandKTprojects(10minutes)• Projectdevelopmentandfeedbackbypresenters(1hour)• Highlightkeypointsfromprojectandnewdirections(20minutes)• QuestionsandAnswers

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QualityImprovement

Quality

“Adirectcorrelationbetweenthelevelofimprovedhealthservicesandthedesiredhealthoutcomesofindividualsandpopulations”(IOM)

• Linkedtoservicedeliveryandunderlyingsystemsofcare

• Tochangeperformance(i.e.:improvequality),thehealthcareorganizationssystemsofcareneedtochange

QualityofCareGap(McGlynn,2003)

Evidence-BasedBestPracticeRecommendationsvs.

ActualCareDelivered

54.9%ofthetimetherecommendedcarewasdelivered

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4KeyPrinciplesofQI

SystemsandProcesses

• Needtounderstandunderlyingprocesses

PatientFocused

• Careshouldmeettheneedsandexpectationsofthepatient

• Accessible,evidence-based,safe,coordinateandappropriate

TeamOriented

• Processesinhealthcarearecomplex

• Teampullsintheknowledge,skills,experienceandperspectivesfromdifferentindividuals

DataFocused

•Whatwethink ishappeningvs.whatisreally happening

• Establishbaselines,monitorforchanges,compareperformanceacrosssites/sytstems

https://www.hrsa.gov/sites/default/files/quality/toolbox/508pdfs/qualityimprovement.pdf

TheModelforImprovement&PlanDoStudyAct

Whatarewetryingtoaccomplish?

Howwillweknowthatachangeisanimprovement?

Whatchangescanwemakethatwillresultinimprovement?

Plan•Organizeateam•Examinecurrentprocesses

•Identifysolutions•Developtheimprovementtheory

Do•Testthetheoryforimprovement

Study•Usethedatatostudytheresults

•Wereyousuccessfulinthechangeanddidoutcomesimprove>

Act•Standardizetheimprovementordetermineanewtheory

•Establishfutureplans

AssociatesinProcessImprovement

QualityImprovementLiteratureinRehabilitation• AdherencetoprotocolsandreducedcostsforpatientswithLBP(Stevens,

2015)

• PromoteacultureofmobilityinanICUsetting(Harris,2014)

• Useofregistryforoutcomemeasurereporting(Meerhoff,2017)

• OpportunityforQIresearch/publicationgrowthinourfield(Jesus,2018)

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KnowledgeTranslation

KnowledgeTranslation

“Adynamicanditerativeprocessthatincludessynthesis,dissemination,exchangeandethically-soundapplicationofknowledgetoimprove…

health,providemoreeffectivehealthservicesandproductsandstrengthenthehealthcaresystem”

CanadianInstituteofHealthResearch,2005

• KTInterventions• Strategiestopromoteawarenessandimplementationofnewknowledge

www.KTClearninghouse.ca

https://tw itter.com/drluanamarques

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QIandKT

ApplyBestEvidence

Systematic

ReduceUnwarrantedVariation

ImprovePatientOutcomes

ReduceHealthcareCosts

KnowledgeTranslation

DetailedBarrierAssessment

InterventionMapping

AssessmentofOutcomes

KnowledgeTranslationInterventions

• TheoreticallyInformed(Eccles,2005;Field,2014;Hudon,2014;Kitson,2008;Sudsawad,2007)

• Locallytailored(Duncan&Murray,2012)

• Active(Grimshaw,2012;Jones,2014;Menon,2009)

• Multi-modal(Grimshaw,2012;Jones,2014;Menon,2009)

(Graham,2006)

Knowledge-to-ActionFramework:

(Graham,2006)

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BarrierAssessment(DuncanandMurray2012)

• Patients• Characteristics

(Salbach 2011,Pattison2015)

• PhysicalTherapists/HealthcareProviders• Knowledge,EducationandPerceivedvalue

• Organization• Support

• PracticeConsiderations• Time• Culture• Setting

• ExternalEnvironment

InterventionMapping(EPOC)

• Education• Auditandfeedback(Colquhoun,2017)• Adherencegoal

• Localopinionleaders(Russell2010,Perry2014,Schreiber2015,Romney2018,Moore2018)• Knowledgebrokers,facilitators,champions

• Groupconsensusandengagement(Leehman,2014)

• OrganizationalSupport(CFIR)(Damschroder,etal2009)

• EnvironmentalChange(Michie,2008)

• Reminders(Michie,2008)

EffectivenessofKTInterventions(Grimshaw,2012)

0%

2%

4%

6%

8%

10%

12%

14%

PrintedEducationalMaterial

EducationalMeetings

EducationalOutreach

LocalOpinionLeaders

AuditandFeedback

MedianAbsoluteImprovement

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Outcomes(Straus,2013)

• Mixedmethods• Quantitative:survey,chartaudit,casevignettes• Qualitative:focusgroupandindividualinterviews

• Physicaltherapists• Patient• Organization

KTInterventionsinPhysicalTherapy

• GeneralEBP• (Christensen2017;Lizarondo 2012;Moore2018;Schreiber2009;Tilson2014)

• ImplementationofCPG (LBP,Stroke,NeckPain)• (Bekkering,2005;Bernhardsson,2014;Maas,2015;Rebbeck,2016;Salbach 2017;W illems2016)

• Useofstandardizedassessments• (Colquhoun2017;Kall 2016;Meerhoff 2017)

• Specificinterventions:• Fallprevention(Brown,2005)

• Stroke(Connell2016;Levac 2016;Nanninga 2015;Perry,2014)

• Parkinson’sdisease(Leavy,2017)

ProjectDevelopmentProjectideasanddiscussion

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ProjectIdeas

• ImplementationofClinicalPracticeGuidelines• Stroke• LowBackPain• NeckPain• FallPrevention• EarlyMobilityintheICU• OutcomeMeasure

ContactInformation

WendyRomney romneyw@sacredheart.edu

Jenni Moore jmoore@knowledgetranslaiton.org

JulieTilson Tilson@pt.usc.edu

SusanPerry perry@chatham.edu

JudyDeutsch Deutsch@shp.rutgers.edu

HallieZeleznik zeleznikh@upmc.edu

Implementing Meaningful Projects to Enhance EBP in your Clinic -- Worksheet

What is the goal of your project, i.e., what kind of behavior change would you like to see (best determined by local consensus with buy-in at multiple levels)? What are the anticipated barriers to this behavior change? Why hasn’t this change already occurred? (e.g., patient characteristics, provider knowledge/education/perceived value, organizational support, practice considerations such as time, culture, setting, external environment, other?) Develop an intervention plan that considers anticipated barriers. Include a timeline. How will you monitor behavior change? How will you evaluate the impact of this behavior change? What is your plan for sustainability?

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