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Effects of an Implementation Intervention to Promote Use of Patient-Reported Outcome Measures on Clinicians'
Allen W Heinemann1, Kristian P Nitsch, Linda Ehrlich-Jones
1Mr. Heinemann: professor, Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, and Director Shirley Ryan AbilityLab, Center for Rehabilitation Outcomes Research, Chicago, Illinois. Mr. Nitsch: postdoctoral fellow, Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland. Ms. Ehrlich-Jones: Research associate professor, Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, and assistant director, Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois. Ms. Malamut: project coordinator, Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois. Mr. Semik: data analyst, Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois. Ms. Srdanovic: Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine. Dr. Kocherginsky: Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Ms. Hobbs: therapy manager, Spinal Cord Innovation Center, Shirley Ryan Ability Lab, Chicago, Illinois.
Introduction:
Patient-reported outcome measures (PROMs) are administered rarely during rehabilitation hospitalizations because clinicians are unfamiliar with their use and the technology to integrate PROMs into electronic medical records is nascent. This study evaluated an implementation intervention that targeted teams' perceptions of evidence-based practice (EBP), implementation leadership, and team functioning that might facilitate PROM use.
Methods:
We compared clinicians' perceptions on three inpatient rehabilitation units, with sequential implementation across units. Clinicians completed the EBP Attitudes Scale, Implementation Leadership Scale, and the Team Functioning Survey before, shortly after, and 1 month after training.
Results:
Forty-seven clinicians participated, including nurses (27.7%), occupational (21.3%) and physical therapists (21.3%), and two physicians. They worked on spinal cord injury (46.8%), neurologic (40.4%), or pediatric (12.8%) units. EBP Attitude Scale scores improved from preintervention to postintervention and remained above baseline levels at follow-up. The interaction between time and unit was statistically significant for the Divergence subscale such that Pediatric Unit scores increased from preintervention to postintervention and follow-up, while on the spinal cord injury, unit scores increased from preintervention to postintervention, and on the Neurologic Unit scores declined from preintervention to postintervention and follow-up. The EBP Attitudes Requirements score increased at postintervention and follow-up. The Implementation Leadership Scale Proactive score and team functioning survey scores decreased slightly.
Discussion:
Implementing PROMs had varied effects on EBP attitudes and perceptions of leadership and team functioning. Perceptions across units were distinctive on the Evidence-Based Practice Attitudes Scale Divergence subscale. Introduction of PROMs should consider clinician attitudes regarding EBP as well as implementation leadership and team functioning.