Implementation of a people-like-me tool for personalized rehabilitation after total knee arthroplasty: A mixed methods pilot study

Abstract

Objective We piloted a decision support tool that promotes a people-like-me (PLM) approach to rehabilitation after total knee arthroplasty (TKA). The PLM approach encourages person centered care by using historical outcomes data from similar (past) patients as a template of what to expect for a new patient. In this study, we evaluated how successfully the PLM tool was implemented and examined contextual factors that may have influenced its implementation. Methods Two outpatient physical therapy clinics (Clinics A and B) piloted the PLM tool from September 2020 to December 2022. We gathered data related to its implementation from multiple sources including the electronic health record, the tool itself, and surveys and interviews with patients and clinicians. We based our primary outcomes on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance), and we set pre-defined targets for a subset of these outcomes. We used an explanatory sequential mixed methods design to analyze the data overall and separately by each clinic. Results Overall, the clinics met implementation targets related to Reach, Effectiveness, Adoption, and fidelity, but did not use the tool as frequently as intended. Both clinics identified time, technology, and scheduling barriers to using the tool, but Clinic A scored higher in nearly every outcome. Clinic As success may have been related to its clinicians higher level of experience, more positive attitudes towards the tool, and more active approach to implementation compared to Clinic B clinicians. Conclusions The clinics met most of our pre-specified RE-AIM targets, but Clinic A experienced more implementation success than Clinic B. Future efforts to implement this PLM tool should (1) mitigate time, technology, and scheduling barriers, (2) engage clinicians as active implementation participants, (3) enhance or better communicate the tools usefulness to increase clinician uptake, and (4) refine the tools design to alter clinician behavior more effectively.