Evidence-based Practice In Health Care Research Articles

Success factors for evidence-based healthcare practice adoption

Success factors for evidence-based healthcare practice adoption

Identification and Illustration of Means to a Critical Assessment of Music and Health Research Literature

In 2019, the WHO released a scoping review investigating art therapies in evidence-based healthcare practices to identify and understand the gaps in the literature. However, the studies curated were not evaluated for their quality. To address this limitation, several assessment tools to critically appraise music-based research studies that investigate therapies pertaining to preventative healthcare were investigated. Two critical appraisal tools were selected for their robustness and appropriateness for the studies in question: the Joanna Briggs Institute checklists and the Music-Based Intervention Guidelines. These tools were tested by two assessors on a total of 23 music studies from the Preventative and Prevention Health section of the WHO report. Based on the requirements for each critical appraisal tool, seven studies received a full assessment utilizing both checklists. Of these seven, two studies scored on the higher index, indicating that the studies followed a detailed methodology to provide concrete and accurate results. The findings of the study highlighted the limitations of study designs and music-based interventions. With this information, beneficial recommendations for future research in this domain are provided to improve the quality of research, ensuring its place in evidence-based healthcare practices.

Preparing students for an evidence-based health service – a collaboration between the University Library and faculty

The Faculty of Health Sciences, OsloMet (Oslo Metropolitan University), first launched the joint course ‘Introduction to Evidence-Based Practice in Health Care’ in the fall semester 2020, with University Librarians as collaborative partners. The aim of the course is to ensure that OsloMet undergraduate students in the health sciences will be given the same platform for building their ability for evidence-based work. This best practice article is based on our presentation at the conference ‘Creating Knowledge 2021’. Here we shared some of our experiences of the collaboration with the faculty in the planning and implementation of this course, and the course design featuring flipped classroom structure and digital, student active teaching sessions. We will present examples of student course assignments, evaluation from students and faculty staff, and some course adjustments based on the feedback. This course gives both the library, the faculty and all our different health care students a common platform for teaching and learning evidence-based practice.

The Coat Hook Analogy and the Precision Implementation Approach® Solution

You probably have a coat hook at home and work. How often do you walk past that coat hook and simply throw your jacket on the back of a chair instead? If you have school-age children, how often are their coats and backpacks on the floor or some other spot that is not the coat hook? Ponder a moment and identify what contributes to you or your family not using the coat hook. Will education improve adoption or use of that coat hook? The coat hook is an analogy for certain Evidence-Based Practices (EBP) in your specialty. Education works when there is a knowledge gap, but often clinicians fail to adopt a practice change for other reasons. We need to rethink education as the solution to implementation. In this article, we will use simple household items to help explain why implementation planning is essential and how to be effective when planning implementation to promote adoption of EBP in healthcare.

Harnessing the Single-Session Intervention approach to promote scalable implementation of evidence-based practices in healthcare.

Effective implementation of evidence-based practices often involves multi-level strategies targeting individual-, organizational-, and system-level determinants of change. Although these multi-level implementation approaches can successfully facilitate EBP uptake, they tend to be complex and resource intensive. Accordingly, there is a need for theory-driven, generalizable approaches that can enhance efficiency, cost-effectiveness, and scalability of existing implementation approaches. We propose the Single-Session Intervention approach as an unexplored path to developing low-cost and scalable implementation strategies, especially those targeting individual-level behavior change. We argue that single-session strategies (S3) for implementation, which can simultaneously target myriad barriers to individual behavior change, may promote clinicians' EBP uptake and sustainment in a manner that is low-resource and scalable. We first overview the evidence-base supporting the Single-Session Intervention approach for patient-level outcomes; situate this approach within the implementation science literature by outlining its intersections with a leading framework, the Theoretical Domains Framework (TDF), as an exemplar; and illustrate how the TDF might directly inform the design and evaluation of single-session strategies for EBP implementation. Overall, single-session strategies (S3) for implementation reflect a promising but yet-to-be-tested means of streamlining and scaling individual-level behavior change efforts in healthcare settings. Future partnered research is needed to gauge the potential of this approach across diverse clinical and community contexts.

A comparison of a home parenteral nutrition service with the current European (ESPEN) guidelines on chronic intestinal failure in adults

Comprehensive evidenced based guidelines on appropriate and safe provision of home parenteral nutrition (HPN) have been developed by the European Society for Clinical Nutrition and Metabolism (ESPEN) in 2016 and 2020. These guidelines provide clinical standards of care against which the current practice of HPN services can be audited. The aim of this study was to audit a single center's current practice against 183 recommendations on supporting patients on HPN. The objective was to measure compliance and identify areas for quality improvement. A retrospective audit of the HPN service received by patients from January 2019-May 2021 was conducted. The ESPEN guidelines were used as a benchmark to measure compliance of healthcare practice. Compliance was evaluated for the 13 subject areas included in the 2016 guideline and the 6 subject areas included in the 2020 guideline. Compliance was calculated as the percentage of criteria fully met for each subject area and an overall compliance rate with each guideline. Overall, compliance with the recommendations from 2016 was 80% and compliance with the recommendations from 2020 was 65%. Within the 2020 guideline there were 24 recommendations where noncompliance was found, 15 of these were due to the absence of a nutrition support team and dedicated intestinal failure unit. This audit and evaluation of current practice has identified areas of good evidence-based healthcare practice providing HPN. However, the absence of funding of a nutrition support team to provide a service to patients on HPN was identified as a major barrier to compliance with ESPEN recommendations in this study.

Adapting to CONNECT: modifying a nursing home-based team-building intervention to improve hospital care team interactions, functioning, and implementation readiness

BackgroundClinical interventions often need to be adapted from their original design when they are applied to new settings. There is a growing literature describing frameworks and approaches to deploying and documenting adaptations of evidence-based practices in healthcare. Still, intervention modifications are often limited in detail and justification, which may prevent rigorous evaluation of interventions and intervention adaptation effectiveness in new contexts. We describe our approach in a case study, combining two complementary intervention adaptation frameworks to modify CONNECT for Quality, a provider-facing team building and communication intervention designed to facilitate implementation of a new clinical program.MethodsThis process of intervention adaptation involved the use of the Planned Adaptation Framework and the Framework for Reporting Adaptations and Modifications, for systematically identifying key drivers, core and non-core components of interventions for documenting planned and unplanned changes to intervention design.ResultsThe CONNECT intervention’s original context and setting is first described and then compared with its new application. This lays the groundwork for the intentional modifications to intervention design, which are developed before intervention delivery to participating providers. The unpredictable nature of implementation in real-world practice required unplanned adaptations, which were also considered and documented. Attendance and participation rates were examined and qualitative assessment of reported participant experience supported the feasibility and acceptability of adaptations of the original CONNECT intervention in a new clinical context.ConclusionThis approach may serve as a useful guide for intervention implementation efforts applied in diverse clinical contexts and subsequent evaluations of intervention effectiveness.Trial registrationThe study was registered at ClinicalTrials.gov (NCT03300336) on September 28, 2017.

Linking organizational climate for evidence-based practice implementation to observed clinician behavior in patient encounters: a lagged analysis

BackgroundTheory and empirical research suggest organizational climate for evidence-based practice (EBP) implementation may be an important and malleable target to improve clinician use of EBPs in healthcare; however, this work has been criticized for overreliance on self-report measures of implementation outcomes and cross-sectional designs. This study combines data from two studies spanning 7 years to test the hypothesis that higher levels of organizational EBP implementation climate prospectively predicts improved clinician adherence to an EBP, cognitive behavioral therapy (CBT), as rated by expert observers.MethodsBiennial assessments of EBP implementation climate collected in 10 community mental health agencies in Philadelphia as part of a systemwide evaluation (time 1) were linked to subsequent observer ratings of clinician adherence to CBT in clinical encounters with 108 youth (time 2). Experts rated clinician adherence to CBT using the Therapy Process Observation Coding System which generated two primary outcomes (a) maximum CBT adherence per session (i.e., highest rated CBT intervention per session; depth of delivery) and (b) average CBT adherence per session (i.e., mean rating across all CBT interventions used; depth and breadth of delivery).ResultsOn average, time 2 clinician adherence observations occurred 19.8 months (SD = 10.15) after time 1 organizational climate assessments. Adjusting for organization, clinician, and client covariates, a one standard deviation increase in organizational EBP implementation climate at time 1 predicted a 0.63-point increase in clinicians’ maximum CBT adherence per session at time 2 (p = 0.000), representing a large effect size (d = 0.93; 95% CI = 0.63–1.24) when comparing organizations in the upper (k = 3) versus lower tertiles (k = 3) of EBP implementation climate. Higher levels of time 1 organizational EBP implementation climate also predicted higher time 2 average CBT adherence per session (b = 0.23, p < 0.001, d = 0.72). Length of time between assessments of climate and adherence did not moderate these relationships.ConclusionsOrganizational EBP implementation climate is a promising predictor of clinicians’ subsequent observed adherence to CBT. Implementation strategies that target this antecedent may improve the delivery of EBPs in healthcare settings.

Building Bridges Between Evidence and Policy in Mental Health Services Research: Introducing the Policy Review Article Type

Although it is widely accepted that patients do better when evidence-based health care practices are used, there is less acknowledgment of the positive outcomes associated with evidence-based policy making. To address the need for high-quality evidence to inform mental health policies, Psychiatric Services has recently launched a new article format: the Policy Review. This review type defines a specific policy-relevant issue affecting behavioral health systems, describes current knowledge and limitations, and discusses policy implications. Reviews can focus on mental health policies or examine how other health or social policies affect people with mental illness or substance use disorders. This brief overview of the need for a policy review article type describes differences between evidence-based policy making and practices and looks at research approaches focused on evidence-based policy making, as well as legislative and other efforts to support it. Broad guidelines for potential submissions are also provided.

A Qualitative Force Field Analysis of Facilitators and Barriers to Evidence-Based Practice in Healthcare Using an Implementation Framework.

Research has identified facilitators and barriers to implementation of evidence-based practices (EBPs). Few studies have evaluated which factors persist among healthcare clinicians with extensive education and training on EBP implementation. Therefore, the purpose of this study was to examine facilitators and barriers to EBP implementation across a national sample of specialty-prepared EBP mentors in healthcare settings. Healthcare clinicians participating in an immersive 5-day EBP knowledge and skill building program were invited to complete a follow-up survey 12 months later to report on implementation experiences. The Consolidated Framework for Implementation Research (CFIR) guided content analysis of responses. A force field analysis using Lewin’s change theory was used to assign numerical ‘weights’ to factors. Eighty-four individuals reported facilitators and barriers to implementation. The majority occurred within the inner setting of the CFIR model. Facilitators were strong leadership engagement (n = 15), positive EBP culture (n = 9), and resources (n = 4). Barriers included lack of resources (n = 21), poor leadership engagement (n = 19), implementation climate (n = 17), lack of relative priority (n = 12), and organizational characteristics (n = 9). Respondents also identified simultaneous facilitators and barriers within the process domain of the CFIR model. The construct of stakeholder engagement was a barrier when absent from the implementation process (n = 23), yet was a strong facilitator when present (n = 23). Implementation in healthcare settings appears most effective when conducted by an interprofessional team with strong leadership, resources, stakeholder engagement, and positive EBP culture. When these same factors are absent, they remain persistent barriers to implementation, even among specialty-trained healthcare clinicians.Supplementary InformationThe online version of this article (10.1007/s43477-022-00051-6) contains supplementary material, which is available to authorized users.

The Association between Evidence-Based Healthcare Practices and Outcomes among Preterm Births in China

Introduction: Very preterm infants are at high risk of early death or severe brain injury, with potential for impaired long-term neurodevelopmental function and physical health. There are evidence-based healthcare practices that can reduce the incidence. Materials and Methods: Infants born at 24–316 weeks gestational age and admitted within 24 h to NICUs participating in the Chinese Neonatal Network in 2019 were included. We examined the association between 4 evidence-based practices: inborn (born in a tertiary hospital in the Chinese Neonatal Network), ACS (any antenatal corticosteroid), MgSO4 (prenatal magnesium sulfate), and NT (normothermic temperature [36.0–37.5°C] at admission) and early death and/or severe brain injury in the study population. Results: Of 6,035 eligible infants, the incidence of early death and/or severe brain injury was 10.6%. Exposure to ACS only was associated with significant lower incidence of death and/or severe brain injury than none (aOR, 0.71; 95% CI: 0.57–0.88), but not MgSO4 only (aOR, 0.97; 95% CI: 0.81–1.17), NT only (aOR, 0.91; 95% CI: 0.76–1.08), or inborn only (aOR, 0.91; 95% CI: 0.72–1.15). The association between number of practices and incidence of early death and/or severe brain injury is as follows: none = 23% (31/138), any 1 = 14% (84/592), any 2 = 12% (185/1,538), any 3 = 9% (202/2,285), and all 4 = 9% (140/1,482). Discussion/Conclusion: More comprehensive use of evidence-based practices was associated with improved survival without severe brain injury among very preterm infants born at <32 weeks gestational age.

Information work of hospital librarians: Making the invisible visible

The aim of this paper is to explore and to make visible how the information work of hospital librarians is enacted in key practices where services of the hospital library are employed to support evidence-based practice. The empirical material was produced at three hospital libraries in three different regions in Sweden between January and March 2020. A practice-oriented approach using the theoretical lens information work is employed to analyze nine semi-structured interviews with hospital librarians and hospital library managers, together with field notes from observations of interactions between hospital librarians and healthcare practitioners. The analysis investigates the conditions for information work performed by hospital librarians as they participate in three key practices: clinical practices, information seeking practices, and HTA-practices. The results of the analysis are related to four categories of invisible information work, and the nature of the information work done to counter different types of invisibilities within the key practices is discussed. The findings suggest that a substantial amount of the information work of hospital librarians is invisible to clinicians. At the same time, considerable efforts are made by hospital librarians to counter different types of invisibility, for example through building relationships with healthcare staff and to develop and make specialized competencies visible. In particular, the importance assigned to evidence-based practice in healthcare allows for the librarians to be regarded by clinicians as legitimate partners with clearly defined competencies in specific situations.

A study to assess the knowledge towards evidence- based healthcare among the healthcare professionals of Vadodara: A Cross-Sectional Study

Objectives: The present study is to assess the Knowledge of Evidence Based Healthcare amongst healthcare professionals of Vadodara in India. Methods/Statistical analysis: A cross-sectional design as the study evaluates the present level of knowledge towards the practice of evidence-based healthcare among 186 healthcare professionals through a structured closeended questionnaire in April 2019. The data was analyzed using SPSS version 21 and an independent-sample t-test was carried out to evaluate the difference in the level of knowledge among the healthcare professionals based on gender. Findings: The mean difference in the score among males and females of the on evidence-based healthcare is -2.794 indicating that the knowledge of the female respondents was more than male respondents. The significant p-value (less than 0.05) and confidence interval (narrow and one-sided) shows there is a significant difference in knowledge of evidence-based healthcare among males and females. The present study concludes that the level of knowledge among the healthcare professionals is low related to the practice of evidence-based healthcare and proper interventional methods must be designed to enhance their knowledge. The knowledge would help them to have a positive attitude towards the practice of evidence-based healthcare. Novelty: Evidence based healthcare caught the interest of healthcare professionals since a decade. The study aims to address the knowledge of the healthcare professionals towards this emerging concept to keep them abreast with the emerging trends in the global scenario. Keywords: Evidence Based Practice; Knowledge; Healthcare; Evidence based; Healthcare

Cooperation networks of ambulatory health care providers: exploration of mechanisms that influence coordination and uptake of recommended cardiovascular care (ExKoCare): a mixed-methods study protocol

BackgroundAs the number of elderly and multimorbid patients increases, healthcare has become more complex. This requires good coordination of treatment and care given the various health care professionals involved (e.g. general practitioners, medical specialists, physicians’ assistants). Lack of coordination jeopardizes seamless, evidence-based treatment and care, and eventually reduces clinical effectiveness. The aim of the study is a) to describe and explore information transfer and interprofessional collaboration in ambulatory cardiac care, b) to describe and explore the role of provider networks from the perspective of patients and providers, focusing on healthcare coordination and the uptake of recommended practices.MethodsTwo related studies are planned: a) an observational study of healthcare provider networks, involving 600 patients with chronic (atherosclerosis-related) cardiovascular disease from 40 general practices and up to 320 healthcare providers (general practitioners, medical specialist, physicians’ assistants), and b) a qualitative interview study with up to 80 healthcare professionals and patients. Furthermore, we will analyse claims data of a large German health insurer to explore provider networks in ambulatory cardiac care.DiscussionThe project aims to provide insight into factors, processes and mechanisms of information transfer and interprofessional collaboration, which affect seamless, evidence-based healthcare practice. This will contribute to the design of strategies for improving health care practice and to the development of measures of coordination for future research.Trial registrationWe registered the study prospectively on 7 November 2019 at the German Clinical Trials Register (DRKS, www.drks.de) under ID no. DRKS00019219.

A 24-step guide on how to design, conduct, and successfully publish a systematic review and meta-analysis in medical research.

To inform evidence-based practice in health care, guidelines and policies require accurate identification, collation, and integration of all available evidence in a comprehensive, meaningful, and time-efficient manner. Approaches to evidence synthesis such as carefully conducted systematic reviews and meta-analyses are essential tools to summarize specific topics. Unfortunately, not all systematic reviews are truly systematic, and their quality can vary substantially. Since well-conducted evidence synthesis typically involves a complex set of steps, we believe formulating a cohesive, step-by-step guide on how to conduct a systemic review and meta-analysis is essential. While most of the guidelines on systematic reviews focus on how to report or appraise systematic reviews, they lack guidance on how to synthesize evidence efficiently. To facilitate the design and development of evidence syntheses, we provide a clear and concise, 24-step guide on how to perform a systematic review and meta-analysis of observational studies and clinical trials. We describe each step, illustrate it with concrete examples, and provide relevant references for further guidance. The 24-step guide (1) simplifies the methodology of conducting a systematic review, (2) provides healthcare professionals and researchers with methodologically sound tools for conducting systematic reviews and meta-analyses, and (3) it can enhance the quality of existing evidence synthesis efforts. This guide will help its readers to better understand the complexity of the process, appraise the quality of published systematic reviews, and better comprehend (and use) evidence from medical literature.

Single screening or double screening for study selection in systematic reviews?

​Recent systematic reviews provide evidence on the need for more than one reviewer when screening studies for inclusion in systematic reviews . Systematic reviews are important tools for the practice...

Designing a 21st century chiropractic educational program: A time for reflection, a time for action.

The first new doctor of chiropractic program in the United States since 2003 started in 2016 and offered an opportunity to incorporate medical educational innovations and design principles from the experience of those involved in starting new health care programs. Thus, while the goal of the new program was to create a curriculum focused on evidence-based health care practices, it was also possible to use best evidence in the design of the new curriculum. Many innovative and evidence-based curricular elements were incorporated in the new program, including early and sustained clinical experience, case-based clinical education, and integration of basic and clinical sciences.

Conceptual approach of shared decision making in physical therapy: An approach for betterment of patients?

Background: Shared decision making (SDM) depicts the work that patients and clinicians do together to consider the relative benefits of accessible administration choices and choose an arrangement that fits the patient objectives, inclinations and setting. SDM decreases the authoritative control between the patient and physical therapist. SDM allows a balanced relationship between a clinician and patient. The practical application of evidence-based practice in health care is always been a challenge for clinician. The objective of this study was to explore the use of shared decision making among physical therapists in Karachi.&#x0D; Methodology: A cross-sectional study was conducted at the Institute of physical medicine and rehabilitation (IPM&amp;R) department of Dow University of Health Sciences from 3 August 2017 till 13 April 2018. A total of 232 physiotherapists from different hospital and rehabilitation centers of Karachi participated in the study. SDM Q-Doc 9 (a physician version) questionnaire and questions regarding barriers were used to collect data. Those participants who fulfilled the inclusion criteria i.e. graduate physiotherapists and postgraduates and completed the entire survey were included in this study. Following participants were excluded undergraduate physical therapist (PT’s), house officers, internees, technicians, and academic staff of physiotherapy, non- practicing PT’s and other healthcare professionals. Data was analyzed by using SPSS version 20.00. Categorical variables were reported as frequency/percentage, while numerical data was presented as Mean±SD. Descriptive statistics test were applied.&#x0D; Results: The result showed that use of SDM was moderate (70.3%) among physiotherapists and the barriers included were: physician’s instructions (67.7%), lack of time (53.6%) and misconception of patient about disease or treatment (65.9%) which resisted in utilization of SDM.&#x0D; Conclusion: In conclusion we can state that the institutional physical therapists would prefer to use SDM moderately and it could be due to a relatively new concept.

Feasibility and usefulness of a leadership intervention to implement evidence-based falls prevention practices in residential care in Canada

BackgroundLeadership is critical to supporting and facilitating the implementation of evidence-based practices in health care. Yet, little is known about how to develop leadership capacity for this purpose. The aims of this study were to explore the (1) feasibility of delivering a leadership intervention to promote implementation, (2) usefulness of the leadership intervention, and (3) participants’ engagement in leadership to implement evidence-based fall prevention practices in Canadian residential care.MethodsWe conducted a mixed-method before-and-after feasibility study on two units in a Canadian residential care facility. The leadership intervention was based on the Ottawa model of implementation leadership (O-MILe) and consisted of two workshops and two individualized coaching sessions over 3 months to develop leadership capacity for implementing evidence-based fall prevention practices. Participants (n = 10) included both formal (e.g., managers) and informal (e.g., nurses and care aids leaders). Outcome measures were parameters of feasibility (e.g., number of eligible candidates who attended the workshops and coaching sessions) and usefulness of the leadership intervention (e.g., ratings, suggested modifications). We conducted semi-structured interviews guided by the Implementation Leadership Scale (ILS), a validated measure of 12-item in four subcategories (proactive, supportive, knowledgeable, and perseverant), to explore the leadership behaviors that participants used to implement fall prevention practices. We repeated the ILS in a focus group meeting to understand the collective leadership behaviors used by the intervention team. Barriers and facilitators to leading implementation were also explored.ResultsDelivery of the leadership intervention was feasible. All participants (n = 10) attended the workshops and eight participated in at least one coaching session. Workshops and coaching were rated useful (≥ 3 on a 0–4 Likert scale where 4 = highly useful) by 71% and 86% of participants, respectively. Participants rated the O-MILe subcategories of supportive and perseverant leadership highest for individual leadership, whereas supportive and knowledgeable leadership were rated highest for team leadership.ConclusionsThe leadership intervention was feasible to deliver, deemed useful by participants, and fostered engagement in implementation leadership activities. Study findings highlight the complexity of developing implementation leadership and modifications required to optimize impact. Future trials are now required to test the effectiveness of the leadership intervention on developing leadership for implementing evidence-based practices.

Methodische Anleitung für Scoping Reviews (JBI-Methodologie)

Reviews of primary research studies are becoming increasingly important as the concept of evidence-based practice in healthcare is gaining more and more influence and the number of research projects is increasing enormously. One of the less well-known types of review is the “scoping review.” Scoping reviews are conducted when one first needs to take stock of the research literature. For example, scoping reviews are conducted in order to establish provisional working definitions or to define topics or subject areas conceptually. Preparing a scoping review also makes sense if the literature has not yet been comprehensively assessed or if it contains a complex or heterogeneous problem so that a more precise systematic review of the evidence is not appropriate. Scoping reviews can also serve to determine the scope and significance of a prospective classical systematic review. Finally, scoping reviews are also a good way to bundle and communicate research results, identify research gaps, and formulate recommendations for future research. This article explains the methodology of scoping reviews, their differences as compared to systematic reviews, and the reasons why they could be conducted. This guide to conducting scoping reviews is based on the methodology developed by the Joanna Briggs Institute (JBI).