Quality improvement in primary care physical therapy: the implementation of outcome measures; a process evaluation

Background: Through the recording, analysis and evaluation of outcome measures (OMs) it is possible to objectify quality of care and achieve professional development of health care providers. The barriers and facilitators of current use of OMs in everyday care have been studied before; no prior research has actually implemented a set of OMs and evaluated this implementation in physical therapy. Objectives: To determine the feasibility of and the experiences with the implementation of a set of OMs in primary care physical therapy. Design: A longitudinal mixed-method process evaluation. Methods: The physical therapists (PTs) of the Eindhoven Corporation of Primary Health Care Centers developed a quality improvement program (QIP). To investigate feasibility and experiences, a process evaluation was performed. Data were collected through the registered use of OMs, a self-analysis list, and focus groups. Quantitative data were assessed descriptively and an interpretative phenomenological approach was used for the qualitative data. Results: A high or prolonged use of OMs was not observed during the QIP. The PTs recognized that OMs have numerous possible benefits (objectivity, transparency of care, and uniformity of patient management) and identified several facilitators (key person, feedback on use, instructing and a set of OMs) and barriers (knowledge, experience, time, routine and registration) that modified the use of OMs. Conclusions: The QIP generated no high or prolonged use of OMs. The PTs recognize the benefits of OMs and the elements of the QIP were incentives to change. However, the reported barriers outweighed the possible benefits and facilitators