Article type
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Abstract
Background: The Cochrane Library provides a rich source of evidence-based systematic reviews that can be used by healthcare organizations to improve the quality and delivery of patient care. However, little is known about the processes by which healthcare organizations translate Cochrane reviews into action within the healthcare setting.
Objectives: To describe and evaluate evidence translation strategies used by a large US health maintenance organization to improve care quality for adults with chronic obstructive pulmonary disease (COPD).
Methods: Existing knowledge syntheses from Cochrane reviews were used to develop and localize content for a clinical practice guideline on diagnosis and management of COPD. Interventions aimed at the practitioner, patient and systems levels were then tailored to facilitate awareness and implementation of the guideline recommendations. Practitioner interventions included a combination of passive and active strategies, including basic knowledge dissemination (distribution of guidelines via direct mail and online), interactive online continuing medical education, development of point-of-care job aids, and audit/feedback. Patient-level interventions included point-of-care education booklets, online resources for COPD self-management, and proactive outreach for spirometry testing. Interventions at the systems level included development and provision of patient outreach lists and computerized decision support, as well as site visits to implement and evaluate workflows and outreach processes and obtain feedback from local leaders and champions. Monthly reporting and review of three measures (spirometry testing for assessment and diagnosis of COPD, and management of COPD exacerbations with systematic corticosteroids and bronchodilators) was conducted to monitor performance.
Results: Over a two-year period (2008 to 2010), continued increases in the rates of spirometry testing and management of COPD exacerbations with systemic corticosteroid and bronchodilator medications were observed.
Conclusions: Evidence translation strategies incorporating Cochrane systematic reviews have the capacity to significantly improve the quality and delivery of patient care.
Objectives: To describe and evaluate evidence translation strategies used by a large US health maintenance organization to improve care quality for adults with chronic obstructive pulmonary disease (COPD).
Methods: Existing knowledge syntheses from Cochrane reviews were used to develop and localize content for a clinical practice guideline on diagnosis and management of COPD. Interventions aimed at the practitioner, patient and systems levels were then tailored to facilitate awareness and implementation of the guideline recommendations. Practitioner interventions included a combination of passive and active strategies, including basic knowledge dissemination (distribution of guidelines via direct mail and online), interactive online continuing medical education, development of point-of-care job aids, and audit/feedback. Patient-level interventions included point-of-care education booklets, online resources for COPD self-management, and proactive outreach for spirometry testing. Interventions at the systems level included development and provision of patient outreach lists and computerized decision support, as well as site visits to implement and evaluate workflows and outreach processes and obtain feedback from local leaders and champions. Monthly reporting and review of three measures (spirometry testing for assessment and diagnosis of COPD, and management of COPD exacerbations with systematic corticosteroids and bronchodilators) was conducted to monitor performance.
Results: Over a two-year period (2008 to 2010), continued increases in the rates of spirometry testing and management of COPD exacerbations with systemic corticosteroid and bronchodilator medications were observed.
Conclusions: Evidence translation strategies incorporating Cochrane systematic reviews have the capacity to significantly improve the quality and delivery of patient care.