Adoption of Evidence-based Practices:Patterns and Positive Deviants in the National Survey of Physician Organizations

采用循证实践：全国医师组织调查中的模式和积极偏差

• 批准号: 8960845
• 负责人: Isomi Muriel Miake-Lye
• 金额: $ 1.02万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-30 至 2016-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8960845
• 关键词: Adoption; Evidence; based; Practices; Patterns

 DESCRIPTION (provided by applicant): Despite extensive expenditures of money and effort in the healthcare industry, evidence-based practices are often slow to diffuse from the settings in which they were initially developed.1 Differential adoption rates can result in significant disparities in the quality and costs of care provided. In trying to decrease this variation, evidence-based practices as they are originally conceived may not be well equipped to spread to other organizations.10, 11 Since pilot interventions are usually tested in innovative organizations, 11 the lessons learned from initial implementation may not be directly applicable to organizations later in the adoption process, which might behave very differently from those early innovators. Little is known about the factors influencing physician organizations' adoption of evidence-based practices for chronic care conditions, and more specifically how past adoption efforts may affect future adoption choices. Past literature tends to focus on high performers, creating a dearth of information on later adopters.7, 14 this proposed dissertation seeks to address these gaps. This proposed dissertation would use data from the 2012-2013 National Survey of Physician Organizations (NSPO), a survey that collected data describing the organizational characteristics of physician organizations across the United States, including adoption of evidence-based practices with a specific focus on four key chronic illnesses (asthma, congestive heart failure, depression, and diabetes). This proposed dissertation will use an explanatory sequential mixed methods design2 to examine organizational factors influencing physician organizations' adoption of evidence-based practices for chronic care conditions. The proposed research will occur in two sequential phases. In Phase I, quantitative data analyses of the data set will address the first three Aims: 1) explore the adoption patterns of evidence-based practices using scale analysis; 2) Identify organizational characteristics associated with non-adoption using a two-part model; and 3) Identify the characteristics of positive deviants who have adopted practices despite sharing similar characteristics with non-adopters by calculating predicted probabilities of adoption and contrasting the predictions with actual adoption choices. In Phase II, qualitative data analysis of semi- structured interviews at both positive deviant and low adopting physician organizations will address Aim 4: Explore the role of culture, leadership, and organizational priorities in the decision to adopt evidence-based practices. Three key informants from four positive deviants and four low adopter physician organizations will provide data for template analysis. If the milieu of factors influencing adoption patterns are better understood, especially in low adopting practices, better strategies for evidence-based practice uptake can be crafted and disseminated.

 描述（由申请人提供）：尽管在医疗保健行业花费了大量的金钱和精力，但循证实践通常在最初发展的环境中传播缓慢。10、11由于试点干预措施通常在创新组织中进行测试，11从最初实施中吸取的经验教训可能不直接适用于后来采用过程中的组织，这些组织的行为可能与早期创新者大不相同。关于影响医生组织采用循证实践治疗慢性病的因素知之甚少，更具体地说，过去的采用努力如何影响未来的采用选择。过去的文献往往集中在高性能，创建一个缺乏信息的后来采用者。7，14本论文旨在解决这些差距。本论文将使用2012-2013年全国医师组织调查（NSPO）的数据，该调查收集了描述美国各地医师组织组织特征的数据，包括采用循证实践，重点关注四种主要慢性疾病（哮喘，充血性心力衰竭，抑郁症和糖尿病）。本论文将使用一个解释性的顺序混合方法设计2来研究影响医生组织采用循证实践慢性病护理条件的组织因素。拟议的研究将分两个连续阶段进行。在第一阶段，数据集的定量数据分析将解决前三个目标：1）使用量表分析探索循证实践的采用模式; 2）使用两部分模型识别与不采用相关的组织特征;和3）识别积极偏差者的特征，尽管他们与非积极偏差者有相似的特征，采用者通过计算预测的采用概率，并将预测与实际采用选择进行对比。在第二阶段，在积极偏差和低采用医生组织的半结构化访谈的定性数据分析将解决目标4：探索文化，领导和组织优先事项在决定采用循证实践中的作用。来自四个积极的偏差和四个低采纳医生组织的三个关键线人将提供模板分析的数据。如果更好地了解影响采用模式的因素，特别是在低采用的做法，更好的战略，以证据为基础的做法摄取可以制作和传播。