Meerhoff G.1, van Dulmen S.2, Maas M.2,3, Heijblom K.1, Nijhuis-van der Sanden R.2, van der Wees P.2
1Royal Dutch Society for Physical Therapy (KNGF), Quality, Amersfoort, Netherlands, 2Radboud UMC, IQ Healthcare, Nijmegen, Netherlands, 3HAN University of Applied Sciences, Institute of Health Studies, Nijmegen, Netherlands
Background: The primary aim of modern healthcare systems is to realize optimal health outcomes for patients and populations and to deliver services that are of the highest possible quality. High quality healthcare has been defined as care that is safe, timely, equitable, effective, efficient, and patient-centered. In 2013 the Royal Dutch Society for Physical Therapy (KNGF) started the development and implementation of their national quality program “Quality in Motion”. The rationale behind this program was the desire to establish a system that stimulates patient-centered care and improves the effectiveness of care.
Purpose: This study describes the development of strategies for implementing the national quality program of the KNGF and it evaluates the success of the implementation. The program aims to collect patient-reported outcome measures (PROMs) data via a national registry. This data is fed back to physical therapists (PTs) to facilitate quality improvement activities via peer assessment sessions using a plan-do-check-act cycle.
Methods: A stepwise implementation, based on the 8-steps of Grol for the implementation of innovations in healthcare, was established in three consecutive pilots with a total of 355 PTs. Due to this stepwise implementation, improvements could be made to the strategy based on experiences in the previous pilots. Core component of the implementation was the introduction of knowledge brokers to support participants in establishing routine in using PROMs in their clinical reasoning, and to assist in executing the peer assessment sessions. PROMs-Data was collected in the registry via electronic health records. The implementation was evaluated using a self-assessment questionnaire, process evaluation, and the June and December 2014 datasets from the registry. Descriptive statistics and Chi-square analysis were used to estimate the feasibility of implementing PROMs as part of the national quality program.
Execution of this study is approved by the Medical Ethical Committee of Radboud university medical center (registration #2014/260) and conducted conform the Declaration of Helsinki.
Results: Although the initial implementation strategy was amended to improve its effect, all pilots showed a significant improvement on the self-assessment questionnaire regarding the use of PROMs and, the knowledge and attitude towards PROMs. Regarding the data gathered in the registry it is shown that in July 2014, 65% of the PT practices delivered data to the registry, which increased to 92% in December 2014, containing 19,222 completed patient records. In July 2014, pre- and post-treatment PROMs measurements were registered in 21.4% of patient records. This increased to 39.4% in December 2014.
Conclusion(s): The implementation strategies were successful in facilitating PROM-use in PT practice and quality improvement. The routine use of PROMs needs to increase before being suitable for external accountability. Using KBs in support of the participating PTs is promising for implementing the program via peer assessment sessions.
Implications: Data in the registry can be used for quality improvement purposes in safe settings, but is not yet robust enough for external accountability purposes. Participating PTs need increase their routine in PROM-use. The KBs are expected to play an important role in increasing this routine, since they function as a motivator and educator in the further implementation.
Funding acknowledgements: The program was funded by the KNGF, the different participating networks of physical therapists and two health insurance companies.
Topic: Professional issues
Ethics approval: Execution of this study is approved by the Medical Ethical Committee of Radboud university medical center (registration #2014/260).
All authors, affiliations and abstracts have been published as submitted.
