Feldman Penny Hollander, McDonald Margaret V
Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY 10021, USA.
Worldviews Evid Based Nurs. 2004;1(1):49-59. doi: 10.1111/j.1741-6787.2004.04007.x.
Home care organizations are relatively isolated from academic health centers, university-based schools of nursing, and centers of health services research that have advanced the knowledge base for quality improvement. Thus limited information exists about how best to promote evidence-based practice in this setting.
This article examines research and translation issues posed by the decentralized home care setting and considers how these issues compare to issues in other settings.
A case study approach is used to frame a discussion of the contextual and practical factors that can influence the design and future acceptance of different translation strategies in the home care setting. Use of a recently concluded randomized trial that tested the effectiveness of two interventions designed to improve the adoption of evidence-based practices by home health nurses has been made to inform this discussion.
Effective translation interventions in home health care need to address the unique nature of this setting including the dispersed, generalist workforce that serves a diverse patient population and lacks strong peer contact or on-site support and supervision. Proactive push translation strategies such as reminders that have been effective in other settings show promise in this service area but had a differential effect across conditions. Significantly, the cost-effectiveness analysis of this intervention showed that net patient care costs actually increased for one condition.
The study described in this article demonstrates that rigorous translation research can be conducted in highly decentralized practice settings. It also points to the value of assessing different levels of intensity of interventions in a single study, looking at process measures and patient outcomes, and conducting a cost-effectiveness analysis. To encourage broader adoption of translation strategies, additional incentives from purchasing or regulatory agencies may be needed.
家庭护理机构相对独立于学术健康中心、大学护理学院以及推动质量改进知识库发展的卫生服务研究中心。因此，关于如何在这种环境中最佳地促进循证实践的信息有限。
本文探讨分散式家庭护理环境所带来的研究与转化问题，并思考这些问题与其他环境中的问题相比情况如何。
采用案例研究方法来构建对情境和实际因素的讨论，这些因素会影响家庭护理环境中不同转化策略的设计及未来接受度。利用一项近期结束的随机试验来为此次讨论提供信息，该试验测试了两种旨在提高家庭健康护士采用循证实践的干预措施的有效性。
家庭健康护理中的有效转化干预需要考虑该环境的独特性质，包括服务多样化患者群体的分散、多面手式劳动力，他们缺乏紧密的同行联系或现场支持与监督。诸如提醒等在其他环境中有效的积极推动式转化策略在该服务领域显示出前景，但在不同条件下效果存在差异。重要的是，该干预措施的成本效益分析表明，在一种情况下患者护理净成本实际上增加了。
本文所述研究表明，严谨的转化研究可在高度分散的实践环境中开展。它还指出了在单一研究中评估不同干预强度水平、考察过程指标和患者结局以及进行成本效益分析的价值。为鼓励更广泛地采用转化策略，可能需要采购或监管机构提供额外激励措施。
