Abstract:
BACKGROUND:Implementing change in primary care is difficult, and little practical guidance is available to assist small primary care practices. Methods to structure care and develop new roles are often needed to implement an evidence-based practice that improves care. This study explored the process of change used to implement clinical guidelines for primary and secondary prevention of cardiovascular disease in primary care practices that used a common electronic medical record (EMR). METHODS:Multiple conceptual frameworks informed the design of this study designed to explain the complex phenomena of implementing change in primary care practice. Qualitative methods were used to examine the processes of change that practice members used to implement the guidelines. Purposive sampling in eight primary care practices within the Practice Partner Research Network-Translating Researching into Practice (PPRNet-TRIP II) clinical trial yielded 28 staff members and clinicians who were interviewed regarding how change in practice occurred while implementing clinical guidelines for primary and secondary prevention of cardiovascular disease and strokes. RESULTS:A conceptual framework for implementing clinical guidelines into primary care practice was developed through this research. Seven concepts and their relationships were modelled within this framework: leaders setting a vision with clear goals for staff to embrace; involving the team to enable the goals and vision for the practice to be achieved; enhancing communication systems to reinforce goals for patient care; developing the team to enable the staff to contribute toward practice improvement; taking small steps, encouraging practices' tests of small changes in practice; assimilating the electronic medical record to maximize clinical effectiveness, enhancing practices' use of the electronic tool they have invested in for patient care improvement; and providing feedback within a culture of improvement, leading to an iterative cycle of goal setting by leaders. CONCLUSION:This conceptual framework provides a mental model which can serve as a guide for practice leaders implementing clinical guidelines in primary care practice using electronic medical records. Using the concepts as implementation and evaluation criteria, program developers and teams can stimulate improvements in their practice settings. Investing in collaborative team development of clinicians and staff may enable the practice environment to be more adaptive to change and improvement.
journal_name
Implement Scijournal_title
Implementation science : ISauthors
Nemeth LS,Feifer C,Stuart GW,Ornstein SMdoi
10.1186/1748-5908-3-3subject
Has Abstractpub_date
2008-01-16 00:00:00pages
3issn
1748-5908pii
1748-5908-3-3journal_volume
3pub_type
杂志文章abstract:BACKGROUND:The fields of implementation and improvement sciences have experienced rapid growth in recent years. However, research that seeks to inform health care change may have difficulty translating core components of implementation and improvement sciences within the traditional paradigms used to evaluate efficacy ...
journal_title:Implementation science : IS
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journal_title:Implementation science : IS
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journal_title:Implementation science : IS
pub_type: 杂志文章,评审
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abstract:BACKGROUND:The adoption and diffusion of clinical information systems has become one of the critical benchmarks for achieving several healthcare organizational reform priorities, including home care, primary care, and integrated care networks. However, these systems are often strongly resisted by the same community tha...
journal_title:Implementation science : IS
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abstract:BACKGROUND:Children with emotional and behavioural disorders should be able to count on receiving care that meets their needs and is based on the best scientific evidence available, however, many do not receive these services. Implementation of evidence-based practice (EBP) relies, in part, on the research utilization ...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-3-19
更新日期:2008-04-09 00:00:00
abstract:BACKGROUND:How humans think and make decisions is important in understanding behaviour. Hence an understanding of cognitive processes among physicians may inform our understanding of behaviour in relation to evidence implementation strategies. A personality theory, Cognitive-Experiential Self Theory (CEST) proposes a r...
journal_title:Implementation science : IS
pub_type: 杂志文章
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更新日期:2008-04-25 00:00:00
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journal_title:Implementation science : IS
pub_type: 杂志文章
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更新日期:2007-07-03 00:00:00
abstract:BACKGROUND:While the emergency department (ED) is often a first point of entry for children and youth with mental health (MH) concerns, there is a limited capacity to respond to MH needs in this setting. Child MH systems are typically fragmented among multiple ministries, organizations, and providers. Communication amo...
journal_title:Implementation science : IS
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abstract:BACKGROUND:There is growing interest in the use of cognitive, behavioural, and organisational theories in implementation research. However, the extent of use of theory in implementation research is uncertain. METHODS:We conducted a systematic review of use of theory in 235 rigorous evaluations of guideline disseminati...
journal_title:Implementation science : IS
pub_type: 杂志文章
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更新日期:2010-02-09 00:00:00
abstract:BACKGROUND:Evidence-based health promotion programs developed and tested in the general population typically exclude people with disabilities. To address this gap, a set of methods and criteria were created to adapt evidence-based health promotion programs for people with disabilities. In this first study, we describe ...
journal_title:Implementation science : IS
pub_type: 杂志文章
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更新日期:2014-08-14 00:00:00
abstract:BACKGROUND:Large-scale implementation of evidence-based psychotherapies (EBPs) such as cognitive processing therapy (CPT) for posttraumatic stress disorder can have a tremendous impact on mental and physical health, healthcare utilization, and quality of life. While many mental health systems (MHS) have invested heavil...
journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
doi:10.1186/s13012-017-0544-5
更新日期:2017-03-06 00:00:00
abstract:BACKGROUND:An important gap exists between research production and its utilization. Few studies have examined the factors affecting knowledge utilization in the field of child and family social services. METHODS:The objectives of the study are to describe knowledge utilization by child protection administrators and pr...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-5-41
更新日期:2010-06-03 00:00:00
abstract:BACKGROUND:The effectiveness of many interventions to promote health and prevent disease has been well established. The imperative has therefore shifted from amassing evidence about efficacy to scale-up to maximise population-level health gains. Electronic implementation monitoring, or 'e-monitoring', systems have been...
journal_title:Implementation science : IS
pub_type: 杂志文章,多中心研究
doi:10.1186/s13012-017-0686-5
更新日期:2017-12-06 00:00:00
abstract::In 2004 a UK charity, The Health Foundation, established the 'Engaging with Quality Initiative' to explore and evaluate the benefits of engaging clinicians in quality improvement in healthcare. Eight projects run by professional bodies or specialist societies were commissioned in various areas of acute care. A develop...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-3-46
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abstract:BACKGROUND:The recent growth in organized efforts to advance dissemination and implementation (D & I) science suggests a rapidly expanding community focused on the adoption and sustainment of evidence-based practices (EBPs). Although promising for the D & I of EBPs, the proliferation of initiatives is difficult for any...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-017-0673-x
更新日期:2017-11-21 00:00:00
abstract:BACKGROUND:This paper describes the intervention planning process for the Home and Online Management and Evaluation of Blood Pressure (HOME BP), a digital intervention to promote hypertension self-management. It illustrates how a Person-Based Approach can be integrated with theory- and evidence-based approaches. The Pe...
journal_title:Implementation science : IS
pub_type: 杂志文章,评审
doi:10.1186/s13012-017-0553-4
更新日期:2017-02-23 00:00:00
abstract:BACKGROUND:Osteoarthritis is a leading cause of pain and disability worldwide. Despite research supporting best practice, evidence-based guidelines are often not followed. Little is known about the implementation of non-surgical models of care in routine primary care practice. From a knowledge mobilisation perspective,...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-020-01055-2
更新日期:2020-10-28 00:00:00
abstract:BACKGROUND:Experts recommend that alcohol-related care be integrated into primary care (PC) to improve prevention and treatment of unhealthy alcohol use. However, few healthcare systems offer such integrated care. To address this gap, implementation researchers and clinical leaders at Kaiser Permanente Washington (KPWA...
journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
doi:10.1186/s13012-018-0795-9
更新日期:2018-08-06 00:00:00
abstract:BACKGROUND:CAREX Canada has identified solar ultraviolet radiation (UV) as the second most prominent carcinogenic exposure in Canada, and over 75 % of Canadian outdoor workers fall within the highest exposure category. Heat stress also presents an important public health issue, particularly for outdoor workers. The mos...
journal_title:Implementation science : IS
pub_type: 杂志文章
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更新日期:2015-07-10 00:00:00
abstract:BACKGROUND:Improved quality of care is a policy objective of health care systems around the world. Implementation research is the scientific study of methods to promote the systematic uptake of clinical research findings into routine clinical practice, and hence to reduce inappropriate care. It includes the study of in...
journal_title:Implementation science : IS
pub_type: 杂志文章
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journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
doi:10.1186/1748-5908-6-114
更新日期:2011-10-03 00:00:00
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journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
doi:10.1186/s13012-016-0460-0
更新日期:2016-08-11 00:00:00
abstract:BACKGROUND:Over the past years, implementation science has gained more and more importance in German-speaking countries. Reliable and valid questionnaires are needed for evaluating the implementation of evidence-based practices. On an international level, several initiatives focused on the identification of questionnai...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-018-0837-3
更新日期:2018-12-12 00:00:00
abstract:BACKGROUND:This study examined the effectiveness of seven different interventions designed to increase the proportion of general practitioners (GPs) accepting an offer of free access to an online evidence-based resource. METHODS:Australian GPs (n = 14,000) were randomly selected and assigned to seven intervention grou...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-4-68
更新日期:2009-10-20 00:00:00
abstract:BACKGROUND:Planning a public health initiative is both a science and an art. Public health practitioners work in a complex, often time-constrained environment, where formal research literature can be unavailable or uncertain. Consequently, public health practitioners often draw upon other forms of knowledge. METHODS:T...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-7-20
更新日期:2012-03-20 00:00:00
abstract:BACKGROUND:It is difficult to foster research utilization among allied health professionals (AHPs). Tailored, multifaceted knowledge translation (KT) strategies are now recommended but are resource intensive to implement. Employers need effective KT solutions but little is known about; the impact and viability of multi...
journal_title:Implementation science : IS
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1186/1748-5908-8-132
更新日期:2013-11-13 00:00:00
abstract:BACKGROUND:The importance of behaviour change in improving health is illustrated by the increasing investment by funding bodies in the development and evaluation of complex interventions to change population, patient, and practitioner behaviours. The development of effective interventions is hampered by the absence of ...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-6-10
更新日期:2011-02-07 00:00:00
abstract:BACKGROUND:A knowledge broker (KB) is a popular knowledge translation and exchange (KTE) strategy emerging in Canada to promote interaction between researchers and end users, as well as to develop capacity for evidence-informed decision making. A KB provides a link between research producers and end users by developing...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-4-23
更新日期:2009-04-27 00:00:00