Background:

'Health for Kids’ (HFK) is a government-funded initiative embracing all children’s health services in the large catchment area of a tertiary paediatric centre in Melbourne, Australia.

Objectives:

The project aims to improve health outcomes for children through implementation of a range of evidence-based practice and system changes that facilitate best practice and partnerships.

Methods:

The concept of evidence-based practice (EBP), defined as integration of best available research evidence with clinical expertise in the context of the individual patient, is well accepted in the healthcare system. Building on the foundation of EBP, the Health for Kids team has developed an evidence-based approach to development, implementation and evaluation of sustainable change to improve the quality of healthcare delivery.
This 'evidence-based process' incorporates input from consumers, clinicians, the research literature and locally collected data at each step of the implementation of change. The methodology has been developed on the basis of current theories of change and has been enhanced by our practical experiences in the HFK project, taking place in a complex, resource limited clinical environment. The focus is on a system that enables evidence-based practice change in a sustainable, ongoing quality framework rather than 'one off' interventions.

Results:

The development of our Evidence-Based Guidelines for the Management of Asthma in Children is one example of the application of our evidence-based decision making process. At each stage of the process, identifying the need for change, developing a proposal for change, implementing the change, and evaluating the extent and impact of the change, input was sought from clinicians, consumers and research (both published literature and locally collected data). The richness and value of this evidence-based process was demonstrated on many occasions.

Conclusions:

A practical framework for evidence-based decision making can be used as the basis for designing and implementing system and practice changes in a complex clinical setting. This framework is likely to be useful for those implementing change in other environments.