Article type
Year
Abstract
Background: Health care delivery organizations are increasingly adopting models of collaborative guideline development that focus on centralized production and updating of existing systematic evidence reviews, and localization of knowledge translation and implementation efforts tailored to the specific context.
Objectives: To describe and evaluate a global evidence/local implementation model focused on centralized evidence production, including adoption and updating of Cochrane systematic reviews, as well as strategies for contextualizing the dissemination and implementation of evidence-based knowledge, conducted in a large U.S. health maintenance organization to improve colorectal cancer screening in adults aged 50 and older.
Methods: Graded evidence summaries were developed by a centralized analytic unit using existing systematic reviews and primary studies, and recommendations developed by a guideline team with representation from each of eight independent regions. Regions selected knowledge translation and implementation interventions geared to the local context. In one large region with more than 3.5 million patients, interventions aimed at the practitioner, patient and systems levels were tailored to promote annual fecal immunochemical testing (FIT) or colonoscopy screening. Practitioner interventions included a combination of passive and active strategies, including basic knowledge dissemination via e-mail and online resources, point-of-care electronic prompts, and workflow support. Patient-level interventions included point-of-care education, inreach/outreach activities, and mass mailing of FIT kits to patients’ homes. System-level interventions included centralized patient outreach letters and calls, computerized decision support, development of a safety-net system, and bimonthly data analysis to monitor performance.
Results: Centralized updating of existing systematic reviews and guideline development, combined with contextualized knowledge translation, resulted in consistent increases in colorectal screening rates over a 3-year period.
Conclusions: A model of guideline development focused on globalizing the evidence, updating existing systematic reviews, and localizing implementation can be an efficient and effective practice for health care delivery organizations.
Objectives: To describe and evaluate a global evidence/local implementation model focused on centralized evidence production, including adoption and updating of Cochrane systematic reviews, as well as strategies for contextualizing the dissemination and implementation of evidence-based knowledge, conducted in a large U.S. health maintenance organization to improve colorectal cancer screening in adults aged 50 and older.
Methods: Graded evidence summaries were developed by a centralized analytic unit using existing systematic reviews and primary studies, and recommendations developed by a guideline team with representation from each of eight independent regions. Regions selected knowledge translation and implementation interventions geared to the local context. In one large region with more than 3.5 million patients, interventions aimed at the practitioner, patient and systems levels were tailored to promote annual fecal immunochemical testing (FIT) or colonoscopy screening. Practitioner interventions included a combination of passive and active strategies, including basic knowledge dissemination via e-mail and online resources, point-of-care electronic prompts, and workflow support. Patient-level interventions included point-of-care education, inreach/outreach activities, and mass mailing of FIT kits to patients’ homes. System-level interventions included centralized patient outreach letters and calls, computerized decision support, development of a safety-net system, and bimonthly data analysis to monitor performance.
Results: Centralized updating of existing systematic reviews and guideline development, combined with contextualized knowledge translation, resulted in consistent increases in colorectal screening rates over a 3-year period.
Conclusions: A model of guideline development focused on globalizing the evidence, updating existing systematic reviews, and localizing implementation can be an efficient and effective practice for health care delivery organizations.