A climate for evidence-based practice implementation in the patient-centred medical home

J Eval Clin Pract. 2019 Aug;25(4):637-647. doi: 10.1111/jep.13050. Epub 2018 Oct 23.

Abstract

Introduction: The patient-centred medical home (PCMH) is an important part of health care reform. While there is hope, the PCMH model can facilitate the provision of higher quality care, the extent to which organizational climate within the PCMH supports the implementation of evidence-based practices (EBPs) is unknown. Identifying and addressing factors that facilitate implementation and use of EBPs within the PCMH are crucial for improving the health and health care of the United States.

Methods: This study used mixed methods to assess EBP implementation climate (ie, the extent to which organizational members perceive that the adoption and use of EBPs is expected, supported, and rewarded) and attitudes about EBPs in two PCMH clinics.

Results: Staff and physicians from two Rhode Island PCMHs, the Family Care Centre (FCC; n = 39) and Internal Medicine Clinic (IMC; n = 21), participated in this study. Results identified differences between FCC and IMC with regard to attitudes toward EBPs and implementation climate. Compared with the IMC, FCC staff and physicians reported significantly more positive attitudes toward EBPs and greater willingness to adopt EBPs. FCC staff and physicians reported significantly greater educational support for EBPs than IMC staff and physicians. Analysis of in-depth interviews revealed themes regarding attitudes toward EBPs. Most physicians reported valuing EBPs, although a number of barriers to EBP use were identified including time pressure, disjointed coordination of services, complexity of patients' presenting health concerns, and patient choice.

Conclusions: Understanding factors that facilitate EBP implementation in the PCMH is important given widespread adoption of the PCMH model. Barriers to EBP implementation in the PCMH must be addressed for the sustainable implementation of EBP in the PCMH. Improving implementation climate may be an effective strategy to aid in creating an organizational context conducive to consideration and use of EBPs.

Keywords: evidence-based practice; family medicine; implementation climate; internal medicine; mixed-methods; patient-centred medical home.

MeSH terms

  • Attitude of Health Personnel*
  • Evidence-Based Practice* / methods
  • Evidence-Based Practice* / standards
  • Humans
  • Needs Assessment
  • Organizational Culture
  • Organizational Innovation*
  • Organizational Objectives
  • Patient-Centered Care* / methods
  • Patient-Centered Care* / organization & administration
  • Quality Improvement / organization & administration
  • Rhode Island
  • Social Environment*