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

 描述(由申请人提供)：尽管医疗保健行业花费了大量的金钱和精力，但循证做法在最初发展的环境中传播往往很慢。1不同的采用率可能导致所提供的医疗质量和成本的显著差异。在努力减少这种差异的过程中，最初构思的循证做法可能不能很好地推广到其他组织。10、11由于试点干预措施通常在创新型组织中进行测试，11从初步实施中学到的经验教训可能不会直接适用于后来的采用过程中的组织，这些组织的行为可能与早期的创新者有很大不同。对影响医生组织采用循证做法治疗慢性护理条件的因素知之甚少，更具体地说，过去的收养努力可能如何影响未来的收养选择。过去的文献倾向于关注高绩效的人，造成了关于后来采用的人的信息的匮乏。7，14本论文试图解决这些差距。这篇拟议的论文将使用2012-2013年全国医生组织调查(NSPO)的数据，该调查收集了描述全美医生组织特征的数据，包括采用循证做法，特别关注四种关键的慢性疾病(哮喘、充血性心力衰竭、抑郁症和糖尿病)。这篇论文将使用解释性顺序混合方法设计2来检验影响医生组织在慢性护理条件下采用循证实践的组织因素。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)使用规模分析探索循证实践的采用模式；2)使用两部分模型确定与不采用相关的组织特征；3)通过计算预测的采用概率并将预测的采用选择与实际采用选择进行对比，确定尽管与未采用者具有相似特征但仍采用了做法的积极偏离者的特征。在第二阶段，对积极偏离和低采纳率的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、领导力和组织优先事项在决定采用循证实践中的作用。来自四个积极偏离者和四个低采用率医生组织的三名关键信息者将为模板分析提供数据。如果更好地了解影响采用模式的因素环境，特别是在采用率较低的实践中，就可以制定和传播更好的循证实践采用战略。

 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.