Barriers and Facilitators for Implementation of a Patient Prioritization Tool in Rehabilitation Settings

Abstract

Introduction. Prioritization tools aim to manage access to care by ranking patients equitably in waiting list based on determined criteria. Patient prioritization has been studied in a wide variety of clinical health services, including rehabilitation contexts. We created a web-based patient prioritization tool with the participation of stakeholders in two rehabilitation programs, which we aim to implement into clinical practice. Successful implementation of such innovation can be influenced by a variety of determinants. The goal of this study was to explore facilitators and barriers to the implementation of a patient prioritization tool in rehabilitation programs.Methods. We used two questionnaires and conducted two focus groups among service providers from two rehabilitation programs. We used descriptive statistics to report results of the questionnaires and qualitative content analysis based on Consolidated Framework for Implementation Research.Results. Key facilitators are the flexibility and relative advantage of the tool to improve clinical practices and produce beneficial outcomes on patients. Main barriers are the lack of training, financial support and human resources to sustain the implementation process.Conclusion. This is the first study that highlights organizational, individual and innovation levels facilitators and barriers for the implementation of a prioritization tool from service providers’ perspective.Contributions to the literatureMethods used in this study could be operationalized in future studies to investigate barriers and facilitators of the implementation of an innovative intervention in rehabilitation settings.We used a well-known implementation framework (CFIR) to classified the determinants of the implementation, which could help to compare the results with other similar studies in implementation science.The barriers and facilitators identified in this study are an important first step in the implementation process of a patient prioritization tool in rehabilitation programs.

Exploring the implementation and underlying mechanisms of centralized referral systems to access specialized health services in Quebec

“…The APSS-CRDS adopt these intervention features by relying on standardized forms with pre-requisites for referrals that FPs can complete (e.g., an ultrasound or MRI report and treatment failure are required before referring a patient for epicondylitis; a conforming EMG report is required before referring a patient for carpal tunnel) and a single-entry model (e.g., referrals by FPs working in primary care settings). Other examples use such features [ 23 – 25 ].…”

“…Recent reports highlight challenges in achieving APSS-CRDS target delays for clinical priorities and variability in the program’s implementation and use across regions [ 32 , 33 ], which to our knowledge are currently not formally evaluated. Emerging literature on centralized wait lists considers how these models are implemented and how they work across different contexts, as well as how these varying contexts can influence the reaching of anticipated effects [ 17 , 25 , 34 – 36 ].…”

An Improved Queuing Model for Reducing Average Waiting Time of Emergency Surgical Patients Using Preemptive Priority Scheduling

“…The present study used preemptive priority scheduling to provide service to emergency patients according to their priority and severity levels. The reason for using a priority-based preemption technique is to facilitate the decision-makers and clinicians to manage people on the waiting list of their institutions and the patients with low priority so the care could be continued and completed as soon as the server is available [26,27]. This study experienced by applying the preemptive priority scheduling technique, wait time of lowest priority patients, can significantly be reduced if the sufficient number of servers are available according to arrival rate and traffic intensity at each shift runs in the emergency department (ED).…”