The Assimilation of Evidence-Based Healthcare Innovations: A Management-Based Perspective.

Decision Support Services, Inc, 4449 Easton Way Suite 2012, Columbus, OH, 43219, USA, .
The Journal of Behavioral Health Services & Research (Impact Factor: 0.78). 11/2012; DOI: 10.1007/s11414-012-9294-y
Source: PubMed

ABSTRACT In order to reap the benefits of the nation's vast investments in healthcare discoveries, evidence-based healthcare innovations (EBHI) must be assimilated by the organizations that adopt them. Data from a naturalistic field study are used to test a management-based model of implementation success which hypothesizes strategic fit, climate for EBHI implementation, and fidelity will explain variability in the assimilation of EBHIs by organizations that adopted them under ordinary circumstances approximately 6 years earlier. Data gathered from top managers and external consultants directly involved with these long-term EBHI implementation efforts provide preliminary support for predicted positive linkages between strategic fit and climate; climate and fidelity; and fidelity and assimilation. Mediated regression analyses also suggest that climate and fidelity may be important mediators. Findings raise important questions about the meaning of assimilation, top managers' roles as agents of assimilation, and the extent to which results represent real-world versus implicit models of assimilation.

  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE This federally funded study examined implementation and outcomes of the Six Core Strategies for Reduction of Seclusion and Restraint (6CS) in 43 inpatient psychiatric facilities. METHODS A prototype Inventory of Seclusion and Restraint Reduction Interventions (ISRRI) tracked fidelity over time. Outcome measures-seclusion and restraint events as percentages of total inpatient population and seclusion and restraint hours as percentages of total inpatient hours-conformed to licensed Behavioral Health Performance Measurement System specifications. Independent variables were facility and patient characteristics. Facilities were classified into five implementation types based on ISRRI scores: stabilized (N=28), continued (N=7), decreased (N=5), discontinued (N=1), or never implemented (N=2). For the stabilized group, linear modeling and random-effects meta-analysis compared the contribution of individual facilities to an overall effect. Subgroup analyses explored relationships between facility characteristics and outcomes. Dose-effect analysis tested the hypothesis that the stabilized group would have more positive outcomes. RESULTS Overall, the stabilized group reduced the percentage secluded by 17% (p=.002), seclusion hours by 19% (p=.001), and proportion restrained by 30% (p=.03). The reduction in restraint hours was 55% but nonsignificant (p=.08). Individual facility effect sizes varied; some rates increased for some facilities. The dose-effect hypothesis was supported for two outcomes, seclusion hours and percentage restrained. The order of implementation group effects in relation to each outcome varied unpredictably. CONCLUSIONS The 6CS was feasible to implement and effective in diverse facility types. Fidelity over time was nonlinear and varied among facilities. Further research on relationships between facility characteristics, fidelity patterns, and outcomes is needed.
    Psychiatric services (Washington, D.C.) 12/2013; · 2.81 Impact Factor


Available from
May 16, 2014