International Journal for Quality in Health Care Advance Access originally published online on November 6, 2008
International Journal for Quality in Health Care 2009 21(1):37-43; doi:10.1093/intqhc/mzn049
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The cycle of change: implementing best-evidence clinical practice
1 The Cancer Council Victoria, Carlton, Australia
2 The University of Melbourne, Parkville, Australia
3 National Institute of Clinical Studies, Melbourne, Australia
4 University of Newcastle, Newcastle, Australia
To improve health outcomes, effective and systematic mechanisms to foster the adoption of evidence-based guideline recommendations into routine practice need to be identified. A cyclical process for achieving this objective involving three key phases is suggested.
Phase 1. Writing actionable best-evidence guidelines that prioritize key recommendations while indicating the levels of adoption needed for population health benefits to be accomplished.
Phase 2. Developing implementation plans for the priority guideline recommendations. These should systematically consider skills training and accreditation; social influences including opinion leaders and patient influences; environmental factors; monitoring and feedback; and incentives for clinical change.
Phase 3. Pilot testing the effectiveness of proposed approaches in producing the desired clinical changes. If implementation requires system changes and evaluation at an organizational level, the use of alternative research designs to the randomized controlled trial could be considered. The purpose evaluation would be to enable refinement of the implementation plans before widespread dissemination.
Keywords: evidence-based practice, guidelines, guideline adherence, quality in healthcare
Address reprint requests to: Mariko Carey, Tel: +61 3 9635 5377; Fax: +61 3 9635 5380; E-mail: mariko.carey{at}cancervic.org.au
Accepted for publication October 2, 2008.