Effectiveness of research implementation strategies for evidence informed healthcare policy and practice

Research output: ThesisDoctoral Thesis

Abstract

Background: Globally, health systems fail to use scientific evidence optimally. This is demonstrated by time lags between study conduct and uptake into healthcare policy and practice. The delay in research implementation leads to healthcare inefficiency, and failure to benefit from potential improvements in mortality, quality of life and other health outcomes. Research implementation strategies such as education, knowledge brokering, and audit and feedback are increasingly seen as a means to reduce the gap between research evidence and healthcare policy and practice. However, a systematic review conducted as part of this thesis identified only three experimental studies evaluating the effectiveness of research implementation strategies for promoting evidence informed policy and management decisions in healthcare. Therefore, comparative effectiveness studies using randomised controlled designs are needed in order to justify further investment of public health resources towards research implementation strategies. The aim of this doctoral research is to explore the application of different methodological approaches to determine the effectiveness of research implementation strategies for facilitation of evidence-informed healthcare resource allocation decisions.

Method: This program of doctoral research consisted of five studies. These studies focussed on applying conventional implementation study designs and the novel application of counterbalanced methodology in implementation settings. A conventional implementation study design was applied to implement weekend allied health service recommendations in Australian and New Zealand hospitals. This conventional application commenced with a systematic review and meta analysis evaluating the effectiveness of additional weekend allied health service provision in specific hospital settings (Chapter 4) to determine readiness for implementation. Chapter 5 then presents a cluster randomised controlled trial protocol to implement evidence based weekend service recommendations into healthcare policy and practice. The novel application of counterbalanced methodology focussed on implementing evidence for falls prevention and deep vein thrombosis management. This commenced with a methodological description of a helix counterbalanced study design and how this can be applied to implementation trials (Chapter 6). A counterbalanced randomised controlled implementation study design was then applied to compare the effectiveness of video and written knowledge translation strategies in Chapter 7, allowing the concurrent evaluation of implementation strategies across multiple contexts.

Results: Applying a conventional study design to implement weekend allied health service recommendations in Chapter 4 and 5 begun with a systematic review and meta-analysis finding additional weekend allied health service provision reduced hospital length of stay in subacute rehabilitation wards but had no identified benefit for acute general medical and surgical wards (Chapter 4). The subsequent cluster randomised controlled trial protocol to implement evidence based weekend service recommendations for allied health managers (Chapter 5) will be completed postdoctoral conferral. A novel application of helix counterbalanced methodology to implement evidence for falls prevention and management of deep vein thrombosis using video and written knowledge translation strategies in Chapter 6 and 7 resulted in the recruitment of 119 nursing and allied health participants. Exposure to the video modality increased the likelihood of a knowledge test response that was aligned with the research evidence compared to the no information control, but this was not the case for exposure to written modality.

Conclusions: A number of different methodological approaches can facilitate the use of high-level randomised controlled experiments to evaluate research implementation strategies. Novel application of counterbalanced methodology identified that the provision of video knowledge translation strategies to nursing and allied health professionals increases the likelihood they will understand the main findings from research articles. It is hoped that applying a conventional cluster randomised controlled trial to implement evidence based weekend service recommendations leads to socially meaningful improvements in patient and organisational outcomes.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • Monash University
Supervisors/Advisors
  • Haines, Terry P., Supervisor, External person
  • Bowles, Kelly-Ann, Supervisor, External person
  • Skinner, Elizabeth, Supervisor, External person
  • White, Jennifer, Supervisor, External person
Award date28 Oct 2019
DOIs
Publication statusUnpublished - 2018
Externally publishedYes

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