Donaldson Nancy E, Rutledge Dana N, Ashley Jeffrey
UCSF Stanford Center for Research & Innovation in Patient Care, UCSF School of Nursing, San Francisco, CA 94143-0610, USA.
Worldviews Evid Based Nurs. 2004;1 Suppl 1:S41-51. doi: 10.1111/j.1524-475X.2004.04048.x.
The translation and diffusion of findings into health care validate the potential of evidence-based innovation to improve clinical practice and affirm the benefits of society's investment in advancing science.
This article briefly reviews key concepts in the knowledge use process, considers theoretical implications for measuring outcomes and uptake of innovation, discusses issues to consider in planning for measurement of adoption, and provides an example of confronting those challenges from a project now in progress. THEORETICAL PERSPECTIVES AND TRANSLATION OUTCOMES: Four principal conceptual frameworks related to translational science, Lewin, Rogers, Havelock, and Promoting Action on Research Implementation in Health Services (PARIHS), explicate a process that catalyzes new knowledge adoption and use by individuals and systems to solve problems. Each conceptual perspective suggests that translation is not complete until the extent and impact of use is examined and understood. Most perspectives support evaluation of impact of evidence-based practice using process measures that integrate clinician knowledge, actual performance of the practice, and patient/clinician outcomes. Based on the Agency for Healthcare Research and Quality (AHRQ) framework, additional measures might include changes in patterns of care and changes in policies, procedures, or protocols. CASE EXAMPLE: A description of process and outcome measures used in an in-progress quality improvement demonstration project, California Nursing Outcomes Coalition (CalNOC) Partners in Quality Translating Research into Practice to Reduce Patient Falls Project, is presented. IMPLICATION(S) FOR PRACTICE, RESEARCH, AND POLICY: Since the adoption of evidence-based innovation is a process that is often described along a continuum, investigators seeking to measure the impact of an evidence-based innovation must gather evidence that uptake of the innovation has occurred. The theoretical perspective and practical measurement issues of a given project will drive selection of process and outcome measures.
Efforts to change practice in order to enhance evidence-based patient care must integrate monitoring and evaluation of specific target outcomes of adoption as the basis for validating the impact of the change.
研究结果转化并应用于医疗保健领域，证实了循证创新改善临床实践的潜力，也肯定了社会对推动科学进步投资所带来的益处。
本文简要回顾知识应用过程中的关键概念，思考衡量创新成果及应用情况的理论意义，讨论规划创新采用情况衡量时需考虑的问题，并给出一个正在进行的项目应对这些挑战的实例。理论视角与转化成果：与转化科学相关的四个主要概念框架，即勒温、罗杰斯、哈夫洛克以及促进卫生服务研究成果应用（PARIHS）框架，阐述了一个促使个人和系统采用并运用新知识解决问题的过程。每个概念视角都表明，在考察和理解应用的程度及影响之前，转化过程并未完成。多数视角支持使用整合临床医生知识、实践实际表现以及患者/临床医生结果的过程指标，来评估循证实践的影响。基于医疗保健研究与质量局（AHRQ）框架，其他指标可能包括护理模式的变化以及政策、程序或方案的变化。案例示例：介绍了加利福尼亚护理结果联盟（CalNOC）质量转化研究实践以减少患者跌倒项目这一正在进行的质量改进示范项目中所使用的过程指标和结果指标。对实践、研究和政策的启示：由于采用循证创新是一个常被描述为连续统一体的过程，试图衡量循证创新影响的研究者必须收集创新已被采用的证据。给定项目的理论视角和实际衡量问题将推动过程指标和结果指标的选择。
为改善实践以加强循证患者护理所做的努力，必须将对采用的特定目标结果的监测和评估整合进来，作为验证变革影响的依据。
