Using shared goal setting to improve access and equity: a mixed methods study of the Good Goals intervention in children%26apos;s occupational therapy

作者：Kolehmainen Niina^*; MacLennan Graeme; Ternent Laura; Duncan Edward A S; Duncan Eilidh M; Ryan Stephen B; McKee Lorna; Francis Jill J

来源：Implementation Science, 2012, 7: 76.

DOI：10.1186/1748-5908-7-76

Background: Access and equity in children%26apos;s therapy services may be improved by directing clinicians%26apos; use of resources toward specific goals that are important to patients. A practice-change intervention (titled %26apos;Good Goals%26apos;) was designed to achieve this. This study investigated uptake, adoption, and possible effects of that intervention in children%26apos;s occupational therapy services. %26lt;br%26gt;Methods: Mixed methods case studies (n = 3 services, including 46 therapists and 558 children) were conducted. The intervention was delivered over 25 weeks through face-to-face training, team workbooks, and %26apos;tools for change%26apos;. Data were collected before, during, and after the intervention on a range of factors using interviews, a focus group, case note analysis, routine data, document analysis, and researchers%26apos; observations. %26lt;br%26gt;Results: Factors related to uptake and adoptions were: mode of intervention delivery, competing demands on therapists%26apos; time, and leadership by service manager. Service managers and therapists reported that the intervention: helped therapists establish a shared rationale for clinical decisions; increased clarity in service provision; and improved interactions with families and schools. During the study period, therapists%26apos; behaviours changed: identifying goals, odds ratio 2.4 (95% CI 1.5 to 3.8); agreeing goals, 3.5 (2.4 to 5.1); evaluating progress, 2.0 (1.1 to 3.5). Children%26apos;s LoT decreased by two months [95% CI -8 to +4 months] across the services. Cost per therapist trained ranged from 1,003 pound to 1,277 pound, depending upon service size and therapists%26apos; salary bands. %26lt;br%26gt;Conclusions: Good Goals is a promising quality improvement intervention that can be delivered and adopted in practice and may have benefits. Further research is required to evaluate its: (i) impact on patient outcomes, effectiveness, cost-effectiveness, and (ii) transferability to other clinical contexts.

• 出版日期2012-8-16