Translating Evidence-Based Protocols Into the Home Healthcare Setting.
Activity-limiting pain is common among older home care patients and pain management is complicated by the high prevalence of physical frailty and multimorbidity in the home care population. A comparative effectiveness study was undertaken at a large urban home care agency to examine an evidence-based pain self-management program delivered by physical therapists (PTs). This article focuses on PT training, methods implemented to reinforce content after training and to encourage uptake of the program with appropriate patients, and therapists' fidelity to the program. Seventeen physical therapy teams were included in the cluster randomized controlled trial, with 8 teams (155 PTs) assigned to a control and 9 teams (165 PTs) assigned to a treatment arm. Treatment therapists received interactive training over two sessions, with a follow-up session 6 months later. Additional support was provided via emails, e-learning materials including videos, and a therapist manual. Program fidelity was assessed by examining PT pain documentation in the agency's electronic health record. PT feedback on the program was obtained via semistructured surveys. There were no between-group differences in the number of PTs documenting program elements with the exception of instruction in the use of imagery, which was documented by a higher percentage of intervention therapists (p = 0.002). PTs felt comfortable teaching the program elements, but cited time as the biggest barrier to implementing the protocol. Possible explanations for study results suggesting limited adherence to the program protocol by intervention-group PTs include the top-down implementation strategy, competing organizational priorities, program complexity, competing patient priorities, and inadequate patient buy-in. Implications for the implementation of complex new programs in the home healthcare setting are discussed.
Katherine L. Beissner, PT, PhD, is a Professor at Department of Physical Therapy Education, SUNY Upstate Medical University, Syracuse, New York. Eileen Bach, DPT, MEd, COS-C, CHC, is a Provider and Corporate Compliance Specialist at Compliance and Regulatory Affairs, Visiting Nurse Service of NY, New York, New York. Christopher M. Murtaugh, PhD, is an Associate Director at Center for Home Care Policy & Research, Visiting Nurse Service of NY, New York, New York. MaryGrace Trifilio, BA, is a Research Analyst I at Center for Home Care Policy & Research, Visiting Nurse Service of NY, New York, New York. Charles R. Henderson, Jr., PhD, is a Senior Research Associate at Department of Human Development, Cornell University, Ithaca, New York. Yolanda Barrón, MS, is a Senior Statistical Analyst at Center for Home Care Policy & Research, Visiting Nurse Service of NY, New York, New York. Melissa A. Trachtenberg, BA, is a Research Project Manager at Center for Home Care Policy & Research, Visiting Nurse Service of NY, New York, New York. M. Carrington Reid, MD, is an Associate Professor at Department of Medicine, Weill Cornell Medical Center, New York, New York.
Katherine L
KL
Beissner
Eileen
E
Bach
Christopher M
CM
Murtaugh
MaryGrace
M
Trifilio
Charles R
CR
Henderson
Yolanda
Y
Barrón
Melissa A
MA
Trachtenberg
M Carrington
MC
Reid
D000328:Adult; D000368:Aged; D002983:Clinical Competence; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D007318:Inservice Training / Q000379:methods*; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D026741:Physical Therapy Modalities / Q000193:education / Q000451:nursing*