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Promoting Evidence-Based Practice: The Influence of Novel Structural Change to Accelerate Translational Rehabilitation

Published:March 14, 2023DOI:https://doi.org/10.1016/j.apmr.2023.02.014
Promoting Evidence-Based Practice: The Influence of Novel Structural Change to Accelerate Translational Rehabilitation
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      ABSTRACT

      Objective

      To evaluate changes in clinicians’ use of evidence-based practice, openness toward evidence-based practice, and their acceptance of organizational changes after a rehabilitation hospital transitioned to a new facility designed to accelerate clinician-researcher collaborations.

      Design

      Three repeated surveys of clinicians before, 7-9 months and 2.5 years after transition to the new facility.

      Setting

      Inpatient rehabilitation hospital.

      Participants

      Physicians, nurses, therapists, and other healthcare professionals (410, 442, and 448 respondents at time 1, 2, and 3 respectively).

      Interventions

      Implementation of physical (architecture, design) and team-focused (champions, leaders, incentives) changes in a new model of care to promote clinician-researcher collaborations.

      Main outcome measures

      Adapted versions of the Evidence-Based Practice Questionnaire (EBPQ), the Evidence-Based Practice Attitudes Scale (EBPAS), and the Organizational Change Recipients’ Beliefs Scale (OCRBS) were used. Open-ended survey questions were analyzed through exploratory content analysis.

      Results

      Response rates at Times 1, 2, and 3 were 67% (n=410), 69% (n=422), and 71% (n=448), respectively. After accounting for familiarity with the model of care, there was greater reported use of evidence-based practice at Time 3 compared to Time 2 (adjusted meant2=3.51, standard error (SE)=0.05; adj. meant3=3.64, SE=0.05; p=0.043). Attitudes toward evidence-based practices were similar over time. Acceptance of the new model of care was lower at Time 2 compared to Time 1, but rebounded at Time 3 (adjusted meant1=3.44, SE=0.04; adj. meant2=3.19, SE=0.04; p<.0001; adj. meant3=3.51, SE=0.04; p<.0001). Analysis of open-ended responses suggested that clinicians’ optimism for the model of care was greater over time, but continued quality improvement should focus on cultivating communication between clinicians and researchers.

      Conclusions

      Accelerating clinician-researcher collaborations in a rehabilitation setting requires sustained effort for successful implementation beyond novel physical changes. Organizations must be responsive to clinicians’ changing concerns to adapt and sustain a collaborative translational medicine model and allow sufficient time, probably years, for such transitions to occur.

      Key words

      List of abbreviations:

      EBP (Evidence-based practice), SRAlab (Shirley Ryan AbilityLab), EBPQ (Evidence-Based Practice Questionnaire), EBPAS (Evidence-Based Practice Attitudes Scale), OCRBS (Organizational Change Recipients’ Beliefs Scale), ANOVA (Analysis of variance), SAS (Statistical Analysis System), Phys (Physicians), AH (Allied health)
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      Article info

      Publication history

      Accepted: February 15, 2023
      Received in revised form: January 16, 2023
      Received: May 9, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Acknowledgement of any presentation of this material:

      Preliminary analyses of the first year's data were presented in a symposium at the American Congress of Rehabilitation Medicine in October 2017, with the final data published to validate the measurements at time 1 was published in BMC Health Services Research by Smith et al, 2020 (DOI: 10.1186/s12913-020-05118-4).

      Preliminary analyses of the three-year results were presented at the APTA's Center on Health Services Research and Training Summer Institute as a virtual meeting platform presentation (May 21, 2020), as a virtual poster presentation at Academy Health conference (June 2020), in a virtual symposium at American Congress of Rehabilitation Medicine (September 2020), and at an in-person symposium at American Congress of Rehabilitation Medicine (November 2022).

      Acknowledgement of financial support: Research reported in this publication was supported, in part, for MR by the National Institute on Disability, Independent Living, and Rehabilitation Research Advances in Rehabilitation Research and Training Grant (H133P130013); the Agency for Healthcare Research and Quality (F32 HS025077), the National Institutes of Health's National Institute on Aging (P30AG059988), and for RL by Research Career Scientist Award (Number IK6 RX003351 from the United States Department of Veterans Affairs Rehabilitation R&D (Rehab RD) Service. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the organizations.

      In Memoriam: The authors are indebted to the vision and leadership of Dr. Joanne Smith who oversaw the transition of the Rehabilitation Institute of Chicago to the Shirley Ryan AbilityLab.

      Conflicts of interest: The authors declare salary from the organization (see affiliations) studied in the article. AH is a former board member of the American Congress of Rehabilitation Medicine. PH reports travel support from the University of Illinois at Chicago. RL reports travel support by the target organization, as well as being a Scientific Advisory Board member of SpineX, Inc, and a Scientific Advisor of the KITE Research Institute of UHN, Toronto ON, Canada, and has received in kind donations by Celgene, Inc and Allergan, with no other relevant conflicts of interest.

      Identification

      DOI: https://doi.org/10.1016/j.apmr.2023.02.014

      Copyright

      © 2023 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine

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