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To explore variation in organizational and provider context and readiness for strategy training implementation to inform the design of a trial in partnership with a national rehabilitation corporation.
Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted a two-phase cross-sectional descriptive study. Phase I examined variation in facility, provider, and patient characteristics among 139 inpatient rehabilitation facilities. We selected 30 facilities, oversampling those treating a higher proportion of patients from racial and ethnic minorities, to participate in phase II. In phase II, Directors of Therapy Operations (DTOs) and six providers (i.e., occupational, physical, and speech therapy) from each facility were recruited to complete surveys and focus groups to examine readiness for strategy training implementation. Using the findings and the CFIR-Expert Recommendations for Implementing Change Matching Tool, we identified a core set of implementation strategies to be examined in a future hybrid I effectiveness-implementation pragmatic trial.
Inpatient rehabilitation facilities in the United States and Puerto Rico.
Phase I: 139 facilities; Phase II: 30 DTOs, 180 providers.
Main Outcome Measures
Organizational Readiness for Change Assessment, Inner Setting Questionnaire.
The 139 facilities varied based on region, size, and patient socioeconomic status indicators (phase I). Twenty-nine of 30 consented DTOs and 152 of 173 consented providers completed all research activities (phase II). Providers identified variations in readiness for change, leader behaviors and resources, implementation climate, and perceived barriers and facilitators to implementing strategy training. Data informed a core set of implementation strategies to address barriers.
Although facilities operate under the same national corporate infrastructure, context related to readiness for implementation appears to vary.
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