- Title
- Evidence-based implementation of evidence-based asthma guidelines in rural hospital emergency departments
- Creator
- Doherty, Steven
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2009
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Knowledge translation refers to the process whereby the findings from high quality clinical research are incorporated into clinical practice. Knowledge translation is therefore a key step in improving health care and ensuring that the benefits of clinical research flow onto patients. A gap currently exists between research and clinical practice because of uncertainty surrounding the best strategies to achieve knowledge translation. Evidence-Based Implementation is a concept that builds on the principals of evidence-based medicine and can be described as judicious use of the best available evidence to implement change in health care systems. This thesis describes a body of work that lead to the development of an Evidence-Based Implementation (EBI) strategy for asthma management in rural emergency departments. The strategy was based on a review of the existing literature about achieving change in clinical practice, and the participation of the author in several workshops during a three year National Institute of Clinical Studies Research Fellowship, that sought to indentify the core elements required to achieve changes in clinical behaviour. At the time this study was being developed the literature indicated that a 10% improvement in clinical care would represent a successful implementation project. The hypothesis posed in this body of research was that greater improvements in the proportion of patients receiving care consistent with best practice could be achieved through using an EBI. Asthma was chosen as the clinical condition to test the effectiveness of an EBI. Asthma was chosen because it is a common presentation to all Emergency Departments. There was also an abundance of literature available that allowed the development of a range of clinical indicators that would signal that a patient with asthma had received evidenced based, best practice health care. These markers also allowed the impact of the EBI to be accurately measured. Small and large rural Emergency Departments were used to assess the EBI in the format of controlled and before and after trials to further improve the validity of the estimated impact on clinical behaviour. These departments were individual workplace settings separated by hundreds of kilometres. Key elements of the EBI strategy used in these studies included use of reminders, audit and feedback, outreach visits and education, anticipating barriers to change and use of opinion leaders. The evolution of the author as a broker between clinical practice and knowledge translation is another element that is discussed within the thesis. These elements were chosen as they were considered to be the most relevant for the clinical environments studied, this constitutes the judicious aspect of an EBI. Each of the studies in this series of papers demonstrated that the EBI strategy was able to achieve improvements in clinical indices of effective asthma management of 20-40% above baseline levels of clinical performance. This thesis demonstrates that in the environment of the rural emergency department, clinical indices for best practice asthma care can be improved using an EBI strategy. Further research is required to document if such improvements in clinical performance lead to actual improvements in patient outcomes and whether this approach to knowledge translation is applicable to other clinical scenarios. Further research is also required to determine which components of the EBI strategy had greatest impact in changing clinician behaviour.
- Subject
- asthma; evidence-based medicine; implementation; knowledge translation; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1061133
- Identifier
- uon:16888
- Rights
- Copyright 2009 Steven Doherty
- Language
- eng
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| View Details Download | ATTACHMENT02 | Thesis | 7 MB | Adobe Acrobat PDF | View Details Download |