Use of the iPRISM webtool in a learning community to assess implementation context and fit of a novel clinical decision support tool for physical therapy triage in acute care hospitals

Abstract

BackgroundThe iPRISM webtool is an interactive tool designed to aid the process of applying the Practical, Robust Implementation and Sustainability Model (PRISM) for the assessment of and fit with context. A learning community (LC) is a multidisciplinary group of partners addressing a complex problem. Our LC coproduced the Physical TheraPy frEqueNcy Clinical decIsion support tooL (PT‐PENCIL) to guide the use of physical therapist services in acute care hospitals.ObjectiveTo describe our LC's activities to co‐produce the PT‐PENCIL, use of the iPRISM webtool to assess its preimplementation context and fit, and develop a multicomponent implementation strategy for the PT‐PENCIL.DesignA descriptive research design.SettingThree tertiary care hospitals.ParticipantsThirteen LC partners: six clinical physical therapists, three rehabilitation managers, three researchers, and a bioinformaticist.InterventionsNot applicable.Outcome MeasuresUsing the iPRISM webtool, expected fit of the PT‐PENCIL was rated 1 (not aligned) to 6 (well aligned) for each PRISM domain and expected reach, effectiveness, adoption, implementation, and maintenance were rated 1 (not likely at all) to 6 (very likely). Discrete implementation strategies were identified from the Expert Recommendations for Implementing Change.ResultsThe process spanned 18 meetings over 8 months. Ten LC partners completed the iPRISM webtool. PRISM domains with the lowest expected alignment were the “implementation and sustainability infrastructure” (mean = 4.7 out of 6; range = 3–6) and the “external environment” (mean = 4.9 of 6; range = 4–6). Adoption was the outcome with the lowest expected likelihood (mean = 4.5 out of 6; range = 1–6). Six discrete implementation strategies were identified and combined into a multicomponent strategy.ConclusionsWithin a LC, we used existing implementation science resources to co‐produce a novel clinical decision support tool for acute care physical therapists and develop a strategy for its implementation. Our methodology can be replicated for similar projects given the public availability of each resource used.