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Contextual Factors Influencing Implementation of Evidence-Based Care for Children Hospitalized With Asthma
Flory L Nkoy1, Victoria L Wilkins2, Bernhard A Fassl2
1Department of Pediatrics University of Utah, Salt Lake City, Utah; flory.nkoy@hsc.utah.edu.
Insights
Successful asthma care process model implementation in hospitals depends on leadership support, resources, and provider engagement. Understanding these factors can guide future evidence-based practice adoption for chronic diseases.
Area of Science:
- Healthcare Management
- Implementation Science
- Pediatric Asthma Care
Background:
- Translating research into routine clinical practice is a significant challenge.
- Previous work demonstrated successful implementation of an asthma evidence-based care process model (EB-CPM) in multiple hospitals, achieving high provider adherence and improved outcomes.
Purpose of the Study:
- To explore the contextual factors perceived by healthcare providers (HCPs) that facilitate the successful implementation of an asthma EB-CPM.
Main Methods:
- A survey using structured and open-ended questions was administered to 260 HCPs (physicians, nurses, respiratory therapists).
- Quantitative analysis identified significant facilitators (correlation coefficient ≥0.5; P ≤ .05), complemented by qualitative analysis for additional insights.
Main Results:
- Facilitators included inner setting factors (leadership, resources, communication, culture, experience), intervention characteristics (relevance), individual factors (agreement, knowledge), and implementation process elements (participation, teamwork, feedback).
- Appropriate preparation, education, and training were identified as additional key facilitators.
Conclusions:
- Multiple factors are associated with successful EB-CPM implementation in hospitals.
- These findings can guide the implementation and dissemination of evidence-based interventions for pediatric asthma and other chronic diseases.
Background And Objectives:
The translation of research findings into routine care remains slow and challenging. We previously reported successful implementation of an asthma evidence-based care process model (EB-CPM) at 8 (1 tertiary care and 7 community) hospitals, leading to a high health care provider (HCP) adherence with the EB-CPM and improved outcomes. In this study, we explore contextual factors perceived by HCPs to facilitate successful EB-CPM implementation.
Methods:
Structured and open-ended questions were used to survey HCPs (n = 260) including physicians, nurses, and respiratory therapists, about contextual factors perceived to facilitate EB-CPM implementation. Quantitative analysis was used to identify significant factors (correlation coefficient ≥0.5; P ≤ .05) and qualitative analysis to assess additional facilitators.
Results:
Factors perceived by HCPs to facilitate EB-CPM implementation were related to (1) inner setting (leadership support, adequate resources, communication and/or collaboration, culture, and previous experience with guideline implementation), (2) intervention characteristics (relevant and applicable to the HCP's practice), (3) individuals (HCPs) targeted (agreement with the EB-CPM and knowledge of supporting evidence), and (4) implementation process (participation of HCPs in implementation activities, teamwork, implementation team with a mix of expertise and professional's input, and data feedback). Additional facilitators included (1) having appropriate preparation and (2) providing education and training.
Conclusions:
Multiple factors were associated with successful EB-CPM implementation and may be used by others as a guide to facilitate implementation and dissemination of evidence-based interventions for pediatric asthma and other chronic diseases in the hospital setting.
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