University of North Carolina at Chapel Hill, USA.
J Safety Res. 2011 Dec;42(6):419-22. doi: 10.1016/j.jsr.2011.10.002. Epub 2011 Oct 31.
As the evidence-based movement has advanced in public health, changes in public health practices have lagged far behind creating a science to service gap. For example, science has produced effective falls prevention interventions for older adults. It now is clearer WHAT needs to be done to reduce injury and death related to falls. However, issues have arisen regarding HOW to assure the full and effective uses of evidence-based programs in practice.
Lessons learned from the science and practice of implementation provide guidance for how to change practices by developing new competencies, how to change organizations to support evidence-based practices, and how to change public health systems to align system functions with desired practices. The combination of practice, organization, and system change likely will produce the public health benefits that are the promise of evidence-based falls prevention interventions. IMPACT ON PUBLIC HEALTH: For the past several decades, the emphasis has been solely on evidence-based interventions. Public health will benefit from giving equal emphasis to evidence-based implementation.
We now have over two decades of research on the effectiveness of fall prevention interventions. The quality of this research is judged by a number of credible international organizations, including the Cochrane Collaboration (http://www.cochrane.org/), the American and British Geriatrics Societies, and the Campbell Collaboration (http://www.campbellcollaboration.org/). These international bodies were formed to ponder and answer questions related to the quality and relevance of research. These developments are a good first step. However, while knowing WHAT to do (an evidence-based intervention) is critical, we also need to know HOW to effectively implement the evidence. Implementation, organization change, and system change methods produce the conditions that allow and support the full and effective use of evidence-based interventions. It is time to focus on utilization of implementation knowledge in public health. Without this focus the vast amount on new evidence being generated on the prevention of falls and related injuries among older adults will have little impact on their health and safety.
随着循证运动在公共卫生领域的推进，公共卫生实践的变化远远落后于创建服务科学的步伐。例如，科学已经为老年人提供了有效的跌倒预防干预措施。现在更清楚的是，为了减少与跌倒相关的伤害和死亡，需要做些什么。然而，在如何确保在实践中充分有效地使用基于证据的项目方面出现了问题。
从实施的科学和实践中吸取的经验教训为如何通过发展新的能力来改变实践、如何改变组织以支持基于证据的实践以及如何改变公共卫生系统使系统功能与期望的实践保持一致提供了指导。实践、组织和系统变革的结合可能会产生基于证据的跌倒预防干预措施所承诺的公共卫生效益。
在过去的几十年里，重点仅仅放在了基于证据的干预措施上。公共卫生将从同等重视基于证据的实施中受益。
我们现在有二十多年关于跌倒预防干预措施有效性的研究。这项研究的质量由许多有公信力的国际组织进行评估，包括 Cochrane 协作组织（http://www.cochrane.org/）、美国和英国老年医学会以及 Campbell 协作组织（http://www.campbellcollaboration.org/）。这些国际组织的成立是为了思考和回答与研究质量和相关性有关的问题。这些发展是一个良好的开端。然而，虽然知道做什么（基于证据的干预措施）是至关重要的，但我们还需要知道如何有效地实施证据。实施、组织变革和系统变革方法创造了允许和支持充分有效利用基于证据的干预措施的条件。现在是时候将重点放在公共卫生中的实施知识利用上了。如果没有这种关注，大量关于预防老年人跌倒和相关伤害的新证据的产生将对他们的健康和安全几乎没有影响。
