Connecting evidence-based guidelines with clinical practice: strategies and lessons learned across a large USA integrated healthcare delivery system

Tags: Oral
Regidor D1, Wu H1
1Kaiser Permanente, USA

Background: Kaiser Permanente (KP) is an integrated healthcare delivery system with 10.2 million members in eight USA states, 41 hospitals, and 600+ medical offices. The KP Care Management Institute, Evidence Services Unit, facilitates the production of KP National Guidelines using a robust methodology for evidence synthesis and translation. These evidence-based resources are disseminated through KP’s internal, web and mobile app-based Clinical Library, and also by local champions engaged in the guideline development process.

Objectives: A range of locally led approaches have been used at KP to connect evidence-based guidelines with clinical practice. This presentation will highlight promising examples from across the KP system that illustrate how evidence does (or does not) move from a published study to a patient care encounter. It will report on opportunities and practical challenges that exist in the space between evidence and practice.

Methods: Case studies of guideline implementation activities from across the KP system, including: 1) continuing medical education (CME) modules; 2) electronic medical record functions; and 3) shared decision-making tools.

Results: KP has built an online continuing medical education (CME) training program that directly incorporates an osteoporosis guideline. The tool will be available to all clinicians across the KP system; evaluation data are forthcoming. Electronic medical record functions include 'Smart Set' templates customized to specific scenarios; Best Practice Alerts to identify screening, treatment, and patient safety opportunities; and companion products, such as clinical pathway algorithms and patient decision aids. A shared decision-making pilot effort incorporates evidence-based estimates of lung cancer mortality into an infographic that shows patients the risks and benefits of aggressive lung cancer screening.

Conclusions: There are promising examples of evidence being translated into practice at KP. Key operational barriers include maintenance of updated content when evidence changes; and evidence gaps for contextual questions such as sub-populations.