Bradley Elizabeth H, Webster Tashonna R, Schlesinger Mark, Baker Dorothy, Inouye Sharon K
Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, CT 06520-8034, USA.
Qual Saf Health Care. 2006 Oct;15(5):334-8. doi: 10.1136/qshc.2006.018820.
The effective translation of scientific evidence into clinical practice is paramount to improving the quality and safety of patient care. However, little is known about the patterns of diffusion of evidence-based programmes in healthcare.
To study the pattern of diffusion of an evidence-based programme to improve the quality and safety of care for hospitalised older adults.
The diffusion of the Hospital Elder Life Program (HELP), a multifaceted programme to reduce delirium in hospitalised adults, was examined. Using a survey of all hospitals that contacted the HELP Dissemination Project for more than 2 years, the proportion of hospitals that adopted the programme, the programme fidelity to the original design in terms of structure and process, and the perceived reasons for non-adoption were identified.
Programme fidelity was highest among structural features (eg, staffing levels); programme modifications were more commonplace in processes of care (eg, the participation of volunteers in patient care interventions). Senior management support and the programme expense were the most commonly cited reasons for non-adoption of HELP.
Diffusion and take-up rates for this evidence-based programme were substantial; however, programme fidelity was not complete and some hospitals did not adopt the programme at all. Clinicians, researchers and funding agents seeking to promote effective translation of research should be realistic about diffusion rates and recognise the critical ingredient of senior management support to propel adoption of evidence-based programmes to improve quality and safety.
将科学证据有效转化为临床实践对于提高患者护理质量和安全性至关重要。然而，关于循证项目在医疗保健领域的传播模式，我们知之甚少。
研究一项循证项目的传播模式，以提高住院老年人的护理质量和安全性。
对医院老年生活项目（HELP）的传播情况进行了研究，该项目是一项旨在减少住院成人谵妄的多方面项目。通过对所有与HELP传播项目联系超过两年的医院进行调查，确定了采用该项目的医院比例、该项目在结构和流程方面对原始设计的保真度，以及未采用该项目的可感知原因。
在结构特征（如人员配备水平）方面，项目保真度最高；在护理流程（如志愿者参与患者护理干预）方面，项目修改更为常见。高级管理层的支持和项目费用是未采用HELP项目最常被提及的原因。
该循证项目的传播和采用率很高；然而，项目保真度并不完整，一些医院根本没有采用该项目。寻求促进研究有效转化的临床医生、研究人员和资助机构应对传播率保持现实态度，并认识到高级管理层支持这一推动采用循证项目以提高质量和安全性的关键因素。
