Quality Improvement Content in Physical Therapist Education: A Scoping Review

Abstract

Objective The purpose of this study was to systematically review the literature regarding teaching quality improvement (QI) in physical therapist education based on the Institute of Medicine’s 6-element definition of QI. Educational activities in QI methods in physical therapist professional education curricula, their developmental stage, and their level of evaluation were described. Methods Keywords related to physical therapist students and QI educational activities were used to search studies indexed in PubMed, CINAHL, and ERIC published from 2004 through November 2020. This search yielded 118 studies. After applying inclusion and exclusion criteria, 13 studies were retained for full-text review, which was conducted independently by 2 reviewers. The University of Toronto framework was used to assess developmental stage, and Kirkpatrick’s taxonomy was used to assess the evaluation level of 4 retained studies. Results The scope of QI educational activities in the 4 retained studies was limited to 3 of the 6 elements of QI: identifying opportunities for improvement, designing and testing interventions, and identifying errors and hazards in care. None of the studies included educational activities to teach understanding and measuring quality of care. Three of the 4 studies spanned the first 2 stages of the University of Toronto framework (exposure and immersion); 1 study was limited to exposure. None of the studies assessed competence in QI methods. Evaluation of QI education was limited to Kirkpatrick levels 1 (reaction) or 2 (learning). None of the studies evaluated activities at level 3 (transfer of new behaviors) or level 4 (results). Conclusion Education in QI methods in professional physical therapist curricula may be limited in scope due to constraints in physical therapist education and the strategic objective of the profession to differentiate itself from other professions. Impact Entry-level physical therapists might not be educated to fully participate in interprofessional teams that use QI methods to continuously improve the quality of patient-centered care.

The Use of Quality Improvement in the Physical Therapy Literature: A Scoping Review

“…Most included studies were conducted in the USA ( n = 47, 67%). 27-58,74,75,88,89,93,95-98,100-105 The only other countries represented by more than two manuscripts are the United Kingdom ( n = 10, 14%) 59-67,99 and Australia ( n = 4, 5.7%). 68-71…”

“…There were six unique study designs applied to QI publications, of which 34 studies (49%) 28,32-34,36,37,39,41,42,45-48,50-53,55,58,59,67,68,70,72,74,77,95-102 used a pre-post design. The second most commonly used design was an adaptive-iterative design ( n = 17, 24%) 29,30,35,38,54,56,57,61,63-66,73,75,78,80,93 in which studies reported using multiple cycles of improvement that were informed and adapted based on initial successes or failures.…”

“…The second most commonly used design was an adaptive-iterative design (n 5 17, 24%) 29,30,35,38,54,56,57,61,[63][64][65][66]73,75,78,80,93 in which studies reported using multiple cycles of improvement that were informed and adapted based on initial successes or failures. Four review studies were included (5.7%) including two scoping reviews, 19,51 an integrative review, 71 and a summary review of three early mobility ICU studies. 103…”

“…Forty-nine different journals are represented in this review, although only seven journals published more than one QI study pertaining to PT. Ten studies (14%) [29][30][31]37,51,75,93,96,100,101 were published in Physical Therapy, whereas five (7.1%) were published in the Journal of Acute Care Physical Therapy. 58,88,89,98,105…”

“…[29][30][31][32]36,38,47,49,54,56,60,61,64,67,69,79,80,93,99 Other practice settings included inpatient rehabilitation (n 5 6, 8.6%), 36,43,57,65,75,76 home health (n 5 2, 2.9%), 44,63 other (n 5 2, 2.9%), 19,81 and academia (n 5 2, 2.9%). 35,51 The other category comprises a scoping review by Jesus et al 19 and a study by Steenbruggen et al 81 in which the practice setting was not made clear. There were two studies whose QI activities spanned across two practice settings.…”