Implementation of Evidence-based Practice Within a Physician-led Quality Improvement Collaborative: A Multimethod Analysis of Facilitators and Barriers to Implementation.

quality improvement collaborative;implementation science;barriers and facilitators of implementation;collective opinion leader;Public Health;Social Sciences (General);Business and Economics;Health Sciences;Social Sciences;Health Services Organization and Policy

Sexton, Donald WilliamMiller, David C ;

University of Michigan

关键词: quality improvement collaborative;    implementation science;    barriers and facilitators of implementation;    collective opinion leader;    Public Health;    Social Sciences (General);    Business and Economics;    Health Sciences;    Social Sciences;    Health Services Organization and Policy;   

Others  :  https://deepblue.lib.umich.edu/bitstream/handle/2027.42/116751/dwsexton_1.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

In this dissertation, I have reported on a multimethod study of the barriers and facilitators to implementation of imaging appropriateness criteria, an evidence-based practice to improve the use of imaging for prostate cancer patients, within the Michigan Urological Surgery Improvement Collaborative (MUSIC).I conducted seven months of field research throughout MUSIC to study the history and organization of the collaborative. I conducted field site visits and interviews with key members of the urology practices. I performed a comparative case study assessment of this qualitative data to explain the barriers and facilitators of the implementation efforts within the urology practices.I also developed and deployed an instrument to assess and explain the specific factors affecting the behavioral intentions of the urologists in the collaborative. Through this extensive assessment, I have shown how the collaborative can organize in a purposefully way to positively shape the behaviors of the members. These strategies included: 1) Professional interplay to build trust and professional relationships; 2) positive reinforcement to strengthen beliefs about legitimacy; and 3) inclusiveness to shape attitudes about the grassroots efforts. I suggested these strategies helped influence the collaborative members’ to adopt and use the innovation. Therefore, the collaborative assumed the role as the ;;collective opinion leader.” I have shown that beliefs related to professional identity, along with patient or resource constraints, can be barriers to implementation. Additionally, knowing the criteria and its evidence, as well as having strong beliefs about the consequences, are the strongest predictors of an urologist’s intention to follow the imaging appropriateness criteria. Furthermore, strong social influences from the practice and positive attitudes towards the collaborative will facilitate implementation efforts and possibly reduce barriers from the environment.