Journal of Rehabilitation Medicine 51-11 | Page 20

J Rehabil Med 2019; 51: 834–840 SPECIAL REPORT DEVELOPMENT AND APPLICATION OF IMPLEMENTATION TOOLS FOR REHABILITATION GUIDELINES Raija SIPILÄ, MD, PhD 1 , Marja MIKKELSSON, MD, PhD 2 , Mari HONKANEN, MSocSci 1 , Antti MALMIVAARA, MD, PhD 1,3 and Jorma KOMULAINEN, MD, PhD 1 From the 1 The Finnish Medical Society Duodecim, Current Care Guidelines, Helsinki, 2 Joint Authority for Päijät-Häme Health and Social Care, Lahti and 3 Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland Objective: To describe a project to develop guideli- ne implementation tools (GItools) for rehabilitation guidelines, and a collaboration between a guideline producer and a healthcare organization to imple- ment guidelines into care pathways. Design: Descriptive case study. Methods: A national guideline organization in Fin- land launched a 3-year project in 2015 to imple- ment rehabilitation recommendations. Usability of the GItools was evaluated and improved, based on literature, workshops and surveys. An implementa- tion plan guided the production of the GItools. An implementation plan was developed to integrate the shoulder disorders guideline into a care pathway at Päijät-Häme district rehabilitation unit. The imple- mentation plan was produced in 3 facilitated work- shops, which included brainstorming, snowballing, prioritizing and short lectures. Results: Twenty implementation plans and 119 dif- ferent GItools for 22 guidelines were developed. The GItools, in particular patient material, were percei- ved as useful for the facilitation of guideline imple- mentation. Four seminars and 14 sessions of conti- nuous medical education were arranged. A plan was developed and executed for the implementation of the shoulder disorders guideline. Conclusion: It is feasible for a guideline producer to systematically include GItools into rehabilitation guidelines. This implementation project was an ex- ample of a successful collaboration between a guide- line producer and a healthcare organization. Key words: rehabilitation; guideline adherence; implementa- tion science. Accepted Aug 21, 2019; Epub ahead of print Sep 9, 2019 J Rehabil Med 2019; 51: 834–840 Correspondence address: Raija Sipilä, The Finnish Medical Society Duodecim, Current Care Guidelines, PO Box 713, FI-00101 Helsinki, Finland. E-mail: [email protected] T he Institute of Medicine (IOM) defines clinical practice guidelines as “statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options” (1). Clinical guidelines usually include recommendations on diagnosis and treatment. In Fin- land, it has been acknowledged that national Current LAY ABSTRACT This article describes a 3-year project to develop tools to facilitate guideline implementation. The project tar- geted clinical practice guidelines related to rehabilita- tion. The article also describes the planning of a local implementation project in collaboration with a health- care organization (Päijät-Häme district, rehabilitation unit) to put into practice the shoulder disorders guide- line. First, the usability of available tools was evaluated and improved, based on literature, workshops and sur- veys. Twenty implementation plans for rehabilitation- related guidelines were produced. For each guideline, implementation objectives were defined. In total 119 implementation tools were produced for 22 guidelines. An implementation plan was developed to integrate the shoulder disorders guideline into a care pathway at Pä- ijät-Häme. In conclusion, it is feasible for a guideline producer to systematically include implementation tools in rehabilitation guidelines. This implementation project was an example of a successful collaboration between a guideline producer and a healthcare organization. Care (CC) Guidelines do not systematically include rehabilitation. Therefore, in 2012 a 3-year project was launched to include rehabilitation into the CC Guidelines (1, 2). Knowledge transfer is the continuum from evidence development (research) to active implementation of the new evidence in practice (3, 4). Different stakeholders are engaged during the process of knowledge transfer. The guidelines are a bridge between research findings and implementation. However, guideline recommen- dations do not translate into clinical practice without effort. Diffusion is the first step, during which active recipients search for the information they need. In the second step, dissemination, the message is tailored to meet the needs of the target group. The third step is to use active methods for implementation (Fig. 1). The actual implementation (4–6) of guidelines ideally happens within healthcare organizations, be- cause success is dependent on the context; there are local barriers and facilitators for change. Guideline developers, however, can facilitate adaptation. One method is to develop guideline implementation tools (GItools). GItools can be categorized into patient support (information and guideline summaries in lay language, self-management support), clinician This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2597 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977