Speeding the Translation of Research into Evidence‐Based Practice and Conducting Projects That Impact Healthcare Quality, Patient Outcomes and Costs: The “So What” Outcome Factors

Abstract

Although healthcare systems could reduce their spending by 30% if patients receive evidence-based health care, the cost of healthcare delivery continues to increase in many countries across the globe (PricewaterhouseCoopers’ Health Research Institute, 2009). Poor-quality health care and wasteful healthcare spending are continued challenges. Further, medical errors that result in death, many of which could have been prevented with evidence-based practice (EBP), continue to be a global problem in healthcare systems. Fragmentation of care in healthcare systems is another huge problem (Carter, 2010). For example, in the United States, it is now not unusual for a typical Medicare patient to see two primary care providers and five specialists working in four medical practices (Thorpe, Ogden, & Galactionova, 2010). Our healthcare systems cannot sustain these rising healthcare costs, wasteful spending, and lack of EBPs without a collapse of the entire system. Although evidence-based guidelines and recommendations on various topics have long been published throughout the globe, their uptake by clinicians in real-world practice settings is often less than desirable. It often takes decades to translate evidence-based interventions into real-world practice settings to improve healthcare quality and outcomes as well as lower costs. The current critical condition of healthcare systems across the globe is calling for innovative studies and programs of research that will lead to evidence-based intervention strategies as well as new models of transdisciplinary care that enhance patient outcomes and, at the same time, decrease healthcare costs. This is no small feat, but it can be accomplished with a common vision, rigorous research, acceleration of EBP, and funding directed to high-priority areas that will make a difference in the most prevalent conditions negatively impacting health outcomes across the globe. Over the years, I have mentored many new investigators and students through their PhD and DNP programs. Because of the pressures associated with achieving tenure, it is common for tenure track faculty in research-intensive universities to place emphasis on obtaining peer-reviewed funding and publishing data-based articles in journals with high impact factors. Although dissemination of our work is critical, research is not complete until the findings from our studies are translated into clinical care and communities to positively impact outcomes (i.e., the quality of healthcare delivery and health of people). I have always said that I do not want to get to the end of my research career, having invested decades into conducting a program of intervention research with terrific outcomes for children and families, and have no one implementing my evidence-based intervention programs. We must help our students and colleagues to focus more on the “so what” factors as they begin their programs of research, especially our PhD students who will be experts at generating evidence and our DNP students who will be experts at generating internal evidence and translating external evidence into practice in their own clinical settings (Melnyk & Morrison-Beedy, 2012). Planting these seeds in individuals as they enter our academic programs and mentoring them to engage in high-impact work that makes a difference in outcomes is necessary to make a positive difference in our healthcare systems, our patients, and the communities in which we live. Without this approach, we risk continuing to generate a large number of research findings that are disseminated through publications and presentations, but to a large extent do not make it into the real world to positively impact healthcare quality, patient outcomes, and costs. Throughout my career, one of my greatest passions has been improving the health outcomes of highly vulnerable children, adolescents, and their families. Specifically, my sustained research trajectory over the past 25 years has focused on the development and testing of theory-based interventions to improve coping and mental health outcomes in hospitalized or critically ill children, premature infants, and their parents, and translating those interventions into clinical care to improve healthcare quality and patient outcomes through EBP. Over a period of two decades, I conducted a total of six experimental studies (three of which were funded by the National Institutes of Health/National Institute of Nursing Research) testing my Creating Opportunities for Parent Empowerment (COPE) program for parents of hospitalized young children, critically ill children, and premature babies. The COPE program is a manualized educational-behavioral skills building intervention that can be delivered by nurses or other health professionals at the bedside. It teaches parents about: (a) what to expect in the behaviors, emotional, and physical characteristics of their children, and (b) how best to parent their children while hospitalized along with strategies to enhance their children's developmental and psychological outcomes. Skills-building activities are incorporated into the program through a parent workbook so that parents can put into practice the content they are learning from the educational CD-ROMs and written information, which are part of the program. Overall, findings from this series of six intervention studies indicated that parents who received COPE, in comparison to those who received an attention control program, reported: less stress, anxiety, depressive symptoms, and post-traumatic stress during and following hospitalization; and provided greater support to their children as well as had more positive parent–child interactions during hospitalization (Melnyk, 1994; Melnyk, Alpert-Gillis, Hensel, Cable-Beiling, & Rubenstein, 1997; Melnyk et al., 2001, 2004, 2006; Vulcan [Melnyk] & Nikulich-Barrett, 1988). In addition, children whose parents received COPE had less negative behaviors, up to a year following discharge, and better developmental outcomes, up to 3 years following discharge from the neonatal intensive care unit. Along with studying the effects of COPE on child and parent outcomes, our team studied the process through which COPE worked by empirically identifying parental cognitive beliefs as the key mediator of the effects of the intervention on parent mental health outcomes and participation in their children's care (Melnyk, 1995; Melnyk, Crean, Feinstein, & Alpert-Gillis, 2007). Structural equation modeling also supported that parental emotional outcomes mediated the effects of COPE on child outcomes (Melnyk, Crean, Feinstein, & Fairbanks, 2008). These findings filled a gap in the science of understanding the processes through which the COPE psychosocial intervention exerted its positive effects. Although the findings from these studies were important and I received numerous inquiries about the program from across the United States and globe from both researchers and clinicians, the programs were not being implemented in hospitals and, as such, families were not benefiting from the COPE programs. The breakthrough for the COPE program's implementation in hospitals was not realized until we published the findings from our full-scale clinical trial with 260 premature infants and their parents, which indicated that the preemies of parents who received COPE were discharged by a mean of 4 days sooner than preemies of attention control parents. This earlier discharge rate resulted in a cost saving of nearly $5,000 per COPE infant (Melnyk & Feinstein, 2009). Further, COPE preterm infants less than 32 weeks' gestational age were discharged an average of 8 days sooner than attention control preterms. As a result, routinely delivering the COPE neonatal intensive care unit (NICU) program to parents of the over 500,000 preterm infants that are born in the United States every year could save our healthcare system at least $2.5 billion dollars every year. The “so what” outcome factor here is that not only does COPE improve important parent and infant outcomes, but it also shortens length of hospital stay and saves substantial costs for the hospitals who implement it. Once the cost-effectiveness analysis on COPE for parents of preterm infants was published, hospitals throughout the globe became interested in implementing COPE. It is now standard practice in several NICUs throughout the United States and Europe. Without demonstrating the “so what” outcome factors of reducing length of hospital stay and costs, I am certain that the uptake of COPE in real-world practice settings would not have become a reality. Nursing and the other health sciences professions have long suggested solutions for how to improve health care and the health of our nation. With the addition of cost analyses and the measurement of key “so what” outcomes that healthcare systems currently value, our research and quality improvement and EBP change projects will be more potent to drive needed effective solutions to the world's most pressing problems.