Implementation Of Evidence-based Health Care Research Articles

Implementation of stroke care & road safety in India: Lessons from Australia.

India is home to one-fifth of the world's population and is currently the fastest-growing economy. As the health industry is growing, India needs to develop robust implementation of evidence-based health care addressing the major public health issues. Two of such issues India is grappling with are the establishment of stroke care and the reduction of road accidents. Australia has achieved notable success in implementing stroke care and reducing road accidents. In stroke, Australian initiatives include dedicated stroke units, the development of clinical guidelines, the implementation of acute interventions, the establishment of a national stroke foundation, and the stroke registry. As a result, the combined, primary, and secondary prevention measures, acute treatment, and rehabilitation have reduced the total disease burden of stroke from 2003 to 2023 by 53 per cent, from 7.4 to 3.5 Disability Adjusted Life Years (DALYS) per 1,000 population, which is a 56 per cent decline in fatal burden and 23 per cent decline in non-fatal burden. For road safety, Australia implemented evidence-based practices such as education, legislation including mandatory use of seat belts, and other road safety initiatives. Data show that seat belt use reached 98 per cent in Australia in 2023. Furthermore, about 20 per cent of drivers as well as passengers who were killed in crashes in 2024 did not wear seat belts. The reduction of speed limits in built-up areas, the adoption of monitoring technology, and the clever use of infrastructure are proving to be effective in reducing fatalities and serious injuries. Australia's implementation research can provide valuable insights into the efforts of mitigating the impact of stroke and enhancing road safety in India.

Experiences and lessons learned from a patient-engagement service established by a national research consortium in the U.S. Veterans Health Administration.

Meaningful engagement of patients in the research process has increased over the past 20 years. Few accounts are available of engagement infrastructure and processes used by large research organizations. The Pain/Opioid Consortium of Research (Consortium) is a U.S. Department of Veterans Affairs (VA) research network that provides infrastructure to accelerate health research and implementation of evidence-based health care. The Consortium's key activities include facilitating Veteran-engaged research and building community between Veterans and VA researchers. This report sought to describe experiences and lessons learned from the first 3 years of a national research engagement service, featuring a Veteran Engagement (VE) Panel, established by the Consortium. We gathered authors' experiences to describe development and operation of the Consortium's VE Panel. Engagement staff collected program evaluation data about partners (Veterans and researchers), projects about which the VE Panel consulted, and meeting attendance during operation of the engagement service. We created a 12-member VE Panel; all of whom had lived experience with chronic pain, prescription opioid medication use, or opioid use disorder. Engagement staff and VE Panel members implemented an engagement service operational model designed to continuously learn and adapt. The panel consulted on 48 projects spanning the research process. Seventy-eight percent of panel members, on average, attended each monthly meeting. VE Panel members and participating researchers reported high satisfaction with the quality, ease, and outcomes of their engagement service experiences. This work provides an illustrative example of how a national research consortium facilitated Veteran-engaged research and built community between Veterans and VA researchers by developing and operating an ongoing engagement consulting service, featuring a VE Panel. The service, designed as a learning community, relied on skilled engagement staff to cultivate high quality experiences and outcomes for all partners.

2023 position statement on improving management for patients with heart failure in Aotearoa New Zealand.

Heart failure affects 1-3% of the population and remains a major public health problem, with high rates of hospitalisation and mortality. Health inequities in the incidence of heart failure have widened over the last 13 years in Aotearoa New Zealand. Urgent action is required to address the inequitable burden of heart failure among Māori and Pasifika. Regional and international heart failure guidelines now provide clear and consistent guidance on the contemporary approach to management for patients with heart failure. The purpose of this position statement is to ensure that all people in Aotearoa New Zealand have access to optimal healthcare delivery and pharmacotherapy for contemporary management of heart failure. Three main areas are addressed, including: 1) access to evidence-based pharmacotherapy for patients with heart failure, 2) the importance of early initiation and titration of pharmacotherapy, and 3) the workforce required to ensure timely delivery of heart failure therapies. Implementation of evidence-based healthcare will ensure all patients with heart failure in Aotearoa New Zealand have opportunity for substantial improvement in health.

Educating for the implementation of evidence-based healthcare in Brazil: the JBI methodology

To present the JBI evidence implementation methodology and report the Brazilian experience in educating health professionals. This is an experience report on professional education in the Brazilian context as per the JBI methodology. In four years, 29 clinical fellows were trained in Brazil, with technical and scientific theoretical bases and tools for evidence-based practice, focusing on the transformation of the health contexts in which they are inserted. The JBI methodology offers systems and tools to evaluate existent practices; it also reinforces and disseminates evidence-based healthcare, potentializing the achievement of effective change in healthcare.

Erratum: Educating for the implementation of evidence-based healthcare in Brazil: the JBI methodology

Erratum: Educating for the implementation of evidence-based healthcare in Brazil: the JBI methodology

Erratum – Educating for the implementation of evidence-based healthcare in Brazil: the JBI methodology

Erratum – Educating for the implementation of evidence-based healthcare in Brazil: the JBI methodology

Identifying approaches for assessing methodological and reporting quality of systematic reviews: a descriptive study

BackgroundThe methodological quality and completeness of reporting of the systematic reviews (SRs) is fundamental to optimal implementation of evidence-based health care and the reduction of research waste. Methods exist to appraise SRs yet little is known about how they are used in SRs or where there are potential gaps in research best-practice guidance materials.The aims of this study are to identify reports assessing the methodological quality (MQ) and/or reporting quality (RQ) of a cohort of SRs and to assess their number, general characteristics, and approaches to ‘quality’ assessment over time.MethodsThe Cochrane Library, MEDLINE®, and EMBASE® were searched from January 1990 to October 16, 2014, for reports assessing MQ and/or RQ of SRs. Title, abstract, and full-text screening of all reports were conducted independently by two reviewers. Reports assessing the MQ and/or RQ of a cohort of ten or more SRs of interventions were included. All results are reported as frequencies and percentages of reports.ResultsOf 20,765 unique records retrieved, 1189 of them were reviewed for full-text review, of which 76 reports were included. Eight previously published approaches to assessing MQ or reporting guidelines used as proxy to assess RQ were used in 80% (61/76) of identified reports. These included two reporting guidelines (PRISMA and QUOROM) and five quality assessment tools (AMSTAR, R-AMSTAR, OQAQ, Mulrow, Sacks) and GRADE criteria. The remaining 24% (18/76) of reports developed their own criteria. PRISMA, OQAQ, and AMSTAR were the most commonly used published tools to assess MQ or RQ. In conjunction with other approaches, published tools were used in 29% (22/76) of reports, with 36% (8/22) assessing adherence to both PRISMA and AMSTAR criteria and 26% (6/22) using QUOROM and OQAQ.ConclusionsThe methods used to assess quality of SRs are diverse, and none has become universally accepted. The most commonly used quality assessment tools are AMSTAR, OQAQ, and PRISMA. As new tools and guidelines are developed to improve both the MQ and RQ of SRs, authors of methodological studies are encouraged to put thoughtful consideration into the use of appropriate tools to assess quality and reporting.

Implementation of evidence‐based health care using action research: An emancipatory approach

The aim of the study is to discuss the emancipatory approach to action research as an appropriate methodology for workers' meaningful implementation of evidence-based health care. Implementation of evidence-based health care using action research is well supported by the literature. There are various approaches to action research, and they are coherent with the objectives and methods elected to develop the investigation. It is not clear which approach of action research is responsible for meaningful worker engagement in changing praxis. This is a discussion paper based on our experiences and supported by literature on collective health. Health care is defined as a social praxis, dependent upon the capitalist mode of production in which health workers engage themselves in a labour process that has negative (as alienation) as well as positive (as creativity) meanings. Emancipatory changes of social praxis through implementation of evidence-based health care require that participants understand the positive and negative meanings of their work and engage health workers in a conscious and intentional collaborative educational process. Implementation of evidence-based health care through emancipatory action research is capable of overcoming alienation and changing social practice through a participatory meaningful process of knowledge translation.

Leadership and Implementation of Evidence-based Practices in Health Care Organizations

Making organizations helpful in health care generally means ensuring the delivery of cost-effective approaches to reduce human suffering. Strong leadership can facilitate implementation of innovations and evidence-based health care by fostering an organizational context that is supportive of change, encouraging buy-in from staff, and increasing both implementation fidelity (fidelity to the implementation strategy) and intervention fidelity (fidelity to the clinical intervention). In the current era of health care reform, in which provider accountability for cost-effective intervention is paramount, examining the role of transformational leadership in the implementation process of evidence-based care is critical. Transformational leadership has great potential to support the enactment of changes in health care organizations. In addition, although there has been some criticism, transformational leadership has a great deal of empirical support across settings, cultures, and countries. Despite a growing body of support, there is limited knowledge regarding how organizational culture and climate embedding mechanisms are utilized and how these are a function of or relate to transformational leaders’ influence on followers’ implementation behaviors. Each of the four different studies included in this symposium addresses one or more of these issues related to embedding factors associated with the implementation context. Together, the papers help to advance knowledge about the role of leadership in shaping followers’ attitudes and behaviors about implementation of evidence-based treatment practices in mental health and addiction health service organizations. Each of the four papers relies on unique samples and advanced quantitative and qualitative methods to provide a multifaceted perspective on leadership and implementation, an underresearched area in health care. Together, the papers in this symposium advance implementation science by providing concrete understanding of leadership in real-world health care settings. Implications for methods, theory, and translation of findings into practice are discussed. Leadership and Climates for Implementation of Culturally Responsive and Evidence-Based Practices Presenter: Erick Guerrero; U. of Southern California Presenter: Yinfei Kong; U. of Southern California Presenter: Gina Rosen; U. of Southern California Leadership Intervention to Improve the Implementation of Evidence-Based Health Care Practices Presenter: Howard Padwa; U. of California, Los Angeles Presenter: Lesley Harris; U. of Louisville Organizational Support Moderates the Effect of Leadership on Organizational Citizenship Behavior Presenter: Gregory A. Aarons; U. of California, San Diego Presenter: Mark G. Ehrhart; San Diego State U. Presenter: Elisa Maria Torres; UC San Diego The Effects of Transformational Leadership and Leader-Member Exchange on Attitudes toward Feedback Presenter: Karissa Fenwick; U. of Southern California, School of Social Work Presenter: Kim Brimhall; U. of Southern California

Improving Chronic Diseases Management Through the Development of an Evidence-Based Resource.

There is a large gap between evidence and practice within health care, particularly within the field of chronic disease. To reduce this gap and improve the management of chronic disease, a collaborative partnership between two schools within a large university and two industry partners (a large regional rural hospital and a rural community health center) in rural Victoria, Australia, was developed. The aim of the collaboration was to promote the development of translation science and the implementation of evidence-based health care in chronic disease with a specific focus on developing evidence-based resources that are easily accessed by clinicians. A working group consisting of members of the collaborating organizations and an internationally renowned expert reference group was formed. The group acted as a steering committee and was tasked with developing a taxonomy of the resources. In addition, a peer review process of all resources was established. A corresponding reference group consisting of researchers and clinicians who are clinical experts in various fields was involved in the review process. The resources developed by the group include evidence summaries and recommended practices made available on a web-based database, which can be accessed via subscription by clinicians and researchers worldwide. As of mid-2014, there were 109 new evidence summaries and 25 recommended practices detailing the best available evidence on topics related to chronic disease management including asthma, diabetes, heart failure, dementia, and others. Training sessions and a newsletter were developed for clinicians within the node to enable them to use the content effectively. This paper describes the processes involved in the successful development of the collaborative partnership and its evolution into producing a valuable resource for the translation of evidence into practice in the areas of chronic disease management. The resource developed is being used by clinicians to inform practice and support their clinical decision making.

Facilitating large-scale implementation of evidence based health care: insider accounts from a co-operative inquiry.

BackgroundFacilitators are known to be influential in the implementation of evidence-based health care (EBHC). However, little evidence exists on what it is that they do to support the implementation process. This research reports on how knowledge transfer associates (KTAs) working as part of the UK National Institute for Health Research ‘Collaboration for Leadership in Applied Health Research and Care’ for Greater Manchester (GM CLAHRC) facilitated the implementation of EBHC across several commissioning and provider health care agencies.MethodsA prospective co-operative inquiry with eight KTAs was carried out comprising of 11 regular group meetings where they reflected critically on their experiences. Twenty interviews were also conducted with other members of the GM CLAHRC Implementation Team to gain their perspectives of the KTAs facilitation role and process.ResultsThere were four phases to the facilitation of EBHC on a large scale: (1) Assisting with the decision on what EBHC to implement, in this phase, KTAs pulled together people and disparate strands of information to facilitate a decision on which EBHC should be implemented; (2) Planning of the implementation of EBHC, in which KTAs spent time gathering additional information and going between key people to plan the implementation; (3) Coordinating and implementing EBHC when KTAs recruited general practices and people for the implementation of EBHC; and (4) Evaluating the EBHC which required the KTAs to set up (new) systems to gather data for analysis. Over time, the KTAs demonstrated growing confidence and skills in aspects of facilitation: research, interpersonal communication, project management and change management skills.ConclusionThe findings provide prospective empirical data on the large scale implementation of EBHC in primary care and community based organisations focusing on resources and processes involved. Detailed evidence shows facilitation is context dependent and that ‘one size does not fits all’. Co-operative inquiry was a useful method to enhance KTAs learning. The evidence shows that facilitators need tailored support and education, during the process of implementation to provide them with a well-rounded skill-set. Our study was not designed to demonstrate how facilitators contribute to patient health outcomes thus further prospective research is required.

Implementation of evidence-based healthcare in Papua New Guinea

The aim of this research was to understand how health workers in developing countries reach diagnostic and treatment decisions. In developing countries, health workers are often forced to make diagnostic and treatment decisions based on limited knowledge, unhelpful information, infrequent and low technology back-up services and without the support of more senior staff. Yet patients continue to be treated. This paper investigates how primary healthcare workers in such contexts reach these diagnostic and treatment decisions. Using a qualitative methodology, 58 primary healthcare workers from the three primary healthcare facilities in Papua New Guinea--aid posts, sub-health centres and health centres--participated in an in-depth interview, in order to investigate how diagnostic and treatment decisions were made. Although participants were originally trained in the biomedical model, they lived and worked in a context where other belief systems operated to diagnose and treat illness. This led to the coexistence of at least three models of treatment: the biomedical model, traditional indigenous health practices and Christian beliefs. Thus, a homogenous biomedical understanding of health and well-being was not possible in this setting, and treatment options did not always follow the biomedical recommendations. In developing countries where competing medical frame works exist, evidence-based practices may be more difficult to implement. Although the skill and knowledge of the provider and availability of treatment resources are still important, belief in the accuracy of the diagnosis and the potency of the treatment by the patient and the patient's community as well as the health provider may be just as significant.

The role of the middle manager in the implementation of evidence-based health care

The present study reflects on the role of the middle manager in the implementation of what has become known as evidence-based health care. This movement advocates that clinical practice is continually informed by the results of robust research and evidence. In our work exploring the complexity of ensuring that practice is informed by evidence we have found that general managers have relatively little influence when compared with clinicians especially doctors. We argue that local professional groups work together in communities of practice, which are frequently uniprofessional. These boundaries affect the motivations for seeking improvement and upgrading and the way evidence and knowledge is perceived and interpreted. We argue that if the quality of health care is to be improved, we need to understand the complex historically and contextually informed interactions between different professional groups and to design diffusion strategies that acknowledge this complexity.

Evidence based primary care? A multi-tier, multiple stakeholder perspective from Chile.

A new challenge in health policy is the implementation of evidence-based practice. It is useful to look at international experiences which go beyond the conventional USA and UK examples. Health sector restructuring in Chile has as its goals: using evidence-based decision-making to reduce variations of practice, contain costs and increase the effectiveness of clinical practice. A key area of change is within primary health care. But how does the implementation of evidence-based health care proceed in reality? In order to understand this, it was decided to assess the policy environment using stakeholder analysis. Fifteen stakeholders from the public health sector were interviewed in depth using a snowball strategy for sampling. Material relating to perceptions, thoughts and aspirations about evidence-based innovations in primary health care was collected. Content analysis of the material produced a matrix of criteria and indicators of operational power. Concepts of evidence and effectiveness are different according to the role of each stakeholder in the health system. Most innovations proposed by government are related to management and stakeholders considered them as not being evidence-based. Informal mechanisms of decision-making predominated over the formal. Political issues are more important than formal evidence. All stakeholders felt they had power to define policy criteria but not to implement them. Implementation difficulties are related to how the system is organized and the culture within each organization. Most stakeholders indicated the need for human resources with appropriate knowledge and personal skills in order to implement these changes. These findings reveal again the importance of human factors within organizations. Policy-making should consider such processual aspects in order to implement changes in practices in Chilean health care system more effectively.

Personal and organizational competencies requisite for the adoption and implementation of evidence-based healthcare.

Personal and organizational competencies requisite for the adoption and implementation of evidence-based healthcare.

Changing clinical practice: evidence-based primary care in Australia.

Evidence-based health care (EBHC) is a concept which in the past decade has gained momentum internationally. Its emphasis on linking practice and policy more closely to evidence from research and literature has challenged many assumptions and established practices in health care, whilst helping the move away from an over-reliance on medical authority and accumulated wisdom. Since the concepts of EBHC were first introduced their relevance for primary care has been examined and there has been active debate over the extent to which primary care should be restructured to accommodate these new concepts. Many argue, for example, that they devalue important but less measurable aspects of primary care. Furthermore, little is known about whether EBHC has changed practice in primary care, despite a range of implementation strategies having been put in place. This paper focuses on the response of primary care practitioners and policy makers to the challenges of EBHC in Australia. Government investment in EBHC infrastructure is detailed, and the implementation of EBHC is described from the perspective of primary care providers, individuals with chronic illnesses and other consumers of primary care services. Current issues facing Australian primary care in implementing EBHC include the relative paucity of direction from a policy framework, the dearth of multi-disciplinary primary care teams and the lack of experience in Australia of primary care health service reform.

Evidence-based practice in primary care: past, present and future.

As in other health care specialities, evidence-based practice is beginning to have an impact on the philosophy and workings of primary care. Some practising clinicians, however, may wish to question its relevance to their everyday work, and whether general practitioners and other members of the primary health care team can realistically adopt a new approach to clinical decision making, at a time of such high workload and competing priorities. Major changes have taken place during the last 20 years as a result of the National Health Service (NHS) reforms, the development of general practice and primary care research, and other health service innovations such as the introduction of new technologies, which have had an important impact on primary care. Issues such as the availability and use of different research methods, the role of experts, and the development of guidelines, audit and evaluation of care, are becoming subject to renewed scrutiny. Within this context, this article explores the potential of an evidence-based approach in the primary care setting, and discusses possible strategies for change to assist the dissemination of research into practice and the implementation of evidence-based health care.