A conceptual model of clinical practice guideline implementation
Subtitle: the case study of long-term care in Ontario.
Published: 2005
Language: eng
Number of pages: 242
Description: This dissertation develops a conceptual model of clinical practice guideline (CPG) implementation and applies it to long-term care (LTC) settings (nursing homes, municipal homes for the aged and charitable homes for the aged) in Ontario, Canada. Uptake of CPGs has been disappointing both nationally and internationally (Worrall, Chaulk & Freake, 1997). In attempting to identify reasons for poor uptake of CPGs, most research has focused on micro-level factors influencing the practice patterns of individual providers with the autonomy to make care decisions. Yet, despite efforts to change practice patterns through techniques including continuing education, audit and performance feedback, implementation of CPGs remains inconsistent at best. The CPG literature has not considered meso- and macro-level factors likely to impact on implementation efforts such as profit status, funding and regulatory structures specific to particular care settings.The case study of LTC in Ontario demonstrates that meso/macro-level system pressures exert considerable influence on the extent of CPG implementation across the sector, thereby challenging some of the assumptions often made in the CPG literature about the importance of micro-level factors. While micro-level approaches are important, they are insufficient to explain where and when CPG implementation will work successfully. This model has broader implications for other proximate healthcare settings where the balance of influence between micro-, meso- and macro-level factors impacting CPG implementation differ. Given ongoing health system restructuring in Ontario, application of the conceptual model to other care settings is a topic for future research.The theoretical framework for this study was derived from three distinct research literatures. The CPG literature assisted in describing the influence of micro-level provider characteristics on implementation efforts. The organizational behaviour and innovation literatures were used to inform meso-level factors, while neo-institutionalism assisted in addressing macro-level system factors such as funding and regulation. A combination of research methods were used in this study: document analyses, qualitative interviews of key informants from the LTC sector, a teleconference with a panel of LTC experts, and a province-wide survey of Directors of Care conducted in May 2003.
Notes: Source: Dissertation Abstracts International, Volume: 66-10, Section: B, page: 5306.

Thesis (Ph.D.)--University of Toronto, 2005.

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