Systems for implementing best practice for a chronic disease: management of osteoarthritis of the hip and knee.
BACKGROUND
Effective implementation of evidence-based care has been associated with better health outcomes; however, evidence-based clinical practice guidelines have been used with varying success.


OBJECTIVE
This study aimed to develop integrative tools to support implementation of best practice recommendations for nonsurgical management of osteoarthritis (OA) of the hip and knee and to identify barriers to effective implementation.


METHODS
Published, peer reviewed clinical practice guidelines were updated and translated into an OA care pathway. Key decision nodes in the pathway were identified by a Multidisciplinary Working Group. Qualitative research methods were used to inform pathway development and to identify barriers and enablers for pathway implementation. Qualitative components included purposively selected stakeholder focus groups, key informant interviews and patient process mapping of 10 patient journeys in different settings over a 3-month period. All interviews, facilitated by a trained project officer, were semistructured, recorded, then thematically analysed and summarized.


RESULTS
An OA care pathway, clinician and patient toolkits were developed that met the needs of multidisciplinary end-users. Several system- and setting-specific barriers to pathway implementation were identified. Opportunities to improve patient access, interprofessional communication, patient information and education and continuity of care processes were identified.


CONCLUSIONS
Integrative tools for implementation of best evidence care for patients with OA of the hip and knee were tailored to end-user needs and preferences. Multiple barriers exist that potentially limit effective implementation of best evidence. Comprehensive assessment of barriers and enablers to effective guideline or pathway implementation is recommended before implementation and evaluation.
Brand
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Clinical Epidemiology & Health Service Evaluation Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia. caroline.brand@mh.org.au
Cox
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D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D019985:Benchmarking / Q000458:organization & administration*; D003131:Combined Modality Therapy; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000175:diagnosis / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000628:therapy*; D005791:Patient Care / Q000592:standards / Q000639:trends; D026741:Physical Therapy Modalities; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D018570:Risk Assessment; D012720:Severity of Illness Index; D013597:Systems Analysis; D014739:Victoria
D000700:Analgesics; D000893:Anti-Inflammatory Agents