Factors affecting innovation diffusion of the medical model dietitian charting tool.

摘要

Dietitians need to improve the quality of patient care by developing written communication tools that facilitate interdisciplinary communication using a common language. Therefore, the factors affecting innovation diffusion of a "Dietitian Charting Tool" using the medical model were evaluated. Study participants (N=161) were non-random, volunteers from the outpatient clinical and private practice population of dietitians who were employed in ten cities where training workshops were scheduled. Participants completed at least one questionnaire. The data were analyzed using a two way contingency table with chi square statistics and Cramer's V for effect size. Results confirmed that study factors (healthcare climate, individual characteristics, knowledge and use of the American Dietetic Association practice tools (PTs), and workshop content and methods significantly (p .05) affected the innovation acceptance by early adopters and the highest stage of concern (SoC) for innovation acceptance. Dissatisfaction with charting (53.6% dissatisfied, 46.4% satisfied) was significantly related (p .02) to poor communication, low reimbursement, and lack of utility for current PTs. Positive communication with physicians (quality of communication p = .0001 and two-way communication p = .0001) and familiarity and use of PTs (MNT guidelines p = .037 and nutrition care process p = .048) were significantly more frequent for participants with high impact concerns (SoC 4, 5, and 6) than participants with a logistical concerns (SoC 2 and 3). The intrinsic motivation inventory (IMI) supported that the case modeling task fostered a sense of choice, but may have contributed to feelings of pressure for higher intensity SoC 0 and 3 participants. IMI was significantly correlated with reimbursement and PTs variables. Early adopters (n = 13, 10 advanced degrees, 1 special certification) were interested in quality communication, reimbursement improvements, and had knowledge of the nutrition care process and nutrition diagnosis. They did not use MNT forms. The charting tool improved nutrition assessment and enhanced PTs use. The primary motivator for early adoption and higher SoC was the desire to add value to clinical practice not dissatisfaction. The research identified complex issues for effective innovation diffusion and reinforced that a systems approach to dietetic practice change is of paramount importance.