Abstract
Background and Purpose Our nation's suboptimal health care quality and unsustainable costs can be linked to the failure to implement evidence-based interventions. Implementation is the bridge between the decision to adopt a strategy and its sustained use in practice. The purpose of this case report is threefold: (1) to outline the historical implementation of an evidence-based quality improvement project, (2) to describe the program's future direction using a systems perspective to identify implementation barriers, and (3) to provide implications for the profession as it works toward closing the evidence-to-practice gap.
Case Description The University of Pittsburgh Medical Center (UPMC) Centers for Rehab Services is a large, multicenter physical therapy organization. In 2005, they implemented a Low Back Initiative utilizing evidence-based protocols to guide clinical decision making.
Outcomes The initial implementation strategy used a multifaceted approach. Formative evaluations were used repeatedly to identify barriers to implementation. Barriers may exist outside the organization, they can be created internally, they may result from personnel, or they may be a direct function of the research evidence. Since the program launch, 3 distinct improvement cycles have been utilized to address identified implementation barriers.
Discussion Implementation is an iterative process requiring evaluation, measurement, and refinement. During this period, behavior change is actualized as clinicians become increasingly proficient and committed to their use of new evidence. Successfully incorporating evidence into routine practice requires a systems perspective to account for the complexity of the clinical setting. The value the profession provides can be enhanced by improving the implementation of evidence-based strategies. Achieving this outcome will require a concerted effort in all areas of the profession. New skills will be needed by leaders, researchers, managers, and clinicians.
Footnotes
All authors provided concept/idea/project design. Dr Stevans, Dr Bise, Dr McGee, Ms Miller, and Dr Delitto provided writing. Dr Stevans, Dr McGee, and Ms Miller provided data collection and analysis. Dr Stevans, Ms Miller, Dr Rockar, and Dr Delitto provided project management. Dr Rockar provided patients. Dr Rockar and Dr Delitto provided facilities/equipment, institutional liaisons, and administrative support. Dr McGee, Ms Miller, Dr Rockar, and Dr Delitto provided consultation (including review of manuscript before submission).
The authors would like to acknowledge the late Michael Culyba, MD, Vice President of Medical Affairs, UPMC Health Plan, who shared the vision and was instrumental in launching the Low Back Quality Improvement Initiative (LBQI). They also would like to acknowledge Nuket Curran, Director of Quality and Risk Management, UPMC Centers for Rehab Services, for her ongoing oversight and tireless efforts to continuously improve the LBQI.
- Received November 12, 2013.
- Accepted January 2, 2015.
- © 2015 American Physical Therapy Association
Issue highlights
- Article
- Abstract
- Setting
- Low Back Quality Improvement (LBQI) Initiative
- Initial Implementation—A Multifaceted Evidence-Based Strategy
- Evaluation of the Initial LBQI Implementation
- Improvement Cycle 1
- Improvement Cycle 2
- Improvement Cycle 3—Moving to a Systems View
- Bundled Payments
- Implications for the Physical Therapy Profession
- Appendix 1.
- Appendix 2.
- Footnotes
- References
- Figures & Data
- Info & Metrics