Characteristics of Outpatient Care Settings Associated with Implementation Outcomes for a Group Physical Therapy Program

IMPORTANCE: Novel care models, like group-based physical therapy (Group Physical Therapy), improve outcomes and operational efficiency, but implementation is challenging and understudied. OBJECTIVE: The objective was to assess associations of organizational and contextual characteristics with implementation of Group Physical Therapy for knee osteoarthritis. DESIGN: This study involved secondary analysis of a cluster randomized hybrid type III implementation trial. SETTING: The study involved outpatient physical therapy departments in the Department of Veterans Affairs Health Administration (VHA). PARTICIPANTS: Participants were VHA sites that agreed to deliver a Group Physical Therapy program (n = 19). EXPOSURES: Exposures included facility organizational and contextual characteristics. MAIN OUTCOMES AND MEASURES: Implementation outcomes were adoption (overall and time to adopt) and penetration (number of Veterans enrolled over 12 months). Site characteristics included: organizational readiness to implement change (ORIC), organizational resilience via the benchmark resilience tool (BRT), implementation climate scale (ICS), prior implementation experience, enrollment approach (cohort vs. rolling entry), delivery modality (in person vs. telehealth), rurality, and facility complexity. Descriptive statistics were computed for implementation outcomes. RESULTS: Overall, 14 sites (74%) adopted Group Physical Therapy, and the mean number of days to adopt was 230 (standard deviation [SD] = 74). High rurality sites (serving ≥50% rural Veterans) were less likely to adopt than low rurality sites (50% vs 80%) and took longer to adopt. Sites delivering Group Physical Therapy via telehealth and those using cohort enrollment were later adopters. High rural sites and those using a cohort enrollment approach had lower penetration. The ORIC, BRT and ICS scores were all high, and there were no substantial differences in adoption or penetration based on these measures. CONCLUSION: Rural sites may need additional support when implementing new physical therapy programs. Telehealth delivery and cohort-based enrollment may also present challenges that need to be addressed during pre-implementation planning. RELEVANCE: Results provide considerations for the implementation planning process to bridge the gap from research to real world clinical practice in the rehabilitation setting.