Evaluating Implementation Context to Prepare for Scaling Up the Integration of Interdisciplinary Healthcare Providers in Rheumatology Practices: A Rheumatology Workforce Survey
Bibliographic record
Abstract
OBJECTIVE: Interdisciplinary healthcare providers (IHPs) can support effective delivery of optimal rheumatology care. To inform widespread implementation efforts, we assessed rheumatology workforce characteristics and determinants of integrating of IHPs within rheumatology practices in Ontario, Canada. METHODS: A convergent mixed methods design included an environmental scan to identify clinically active rheumatologists and a workforce survey guided by the Consolidated Framework for Implementation Research (CFIR) 2.0. Quantitative data were analyzed descriptively and stratified by subgroups. Qualitative responses were analyzed using conventional content analysis. Integration of findings enabled a comprehensive understanding of implementation determinants. RESULTS: Of the 293 Ontario rheumatologists identified by the environmental scan (as of 2025), 26 were nearing retirement, leaving potentially 267 eligible for the survey. One hundred ninety-seven rheumatologists participated in the survey, yielding a response rate of 74% and coverage of > 90% of practice sites. Pediatric rheumatologists and those in hospital-based settings had more structural and collaborative supports than community-based rheumatologists. Overall, 177 (91%) indicated they were interested in adding IHPs, with 126 (65%) preferring an extended role/scope provider. Although inadequate funding was the key deterrent to adoption, motivational readiness was high: 92% perceived an IHP team-based model as an improvement, 86% saw it as a good fit, and 83% considered it a priority to better meet patient needs. Many noted a lack of supportive climate, including that of resources and processes, to enable this practice change. CONCLUSION: Rheumatologists report high motivation for practice change to integrate IHPs. System- and practice-level implementation strategies are needed to support workforce transformation.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.017 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".