Harris Claire, Allen Kelly, Waller Cara, Dyer Tim, Brooke Vanessa, Garrubba Marie, Melder Angela, Voutier Catherine, Gust Anthony, Farjou Dina
School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia.
BMC Health Serv Res. 2017 Jun 21;17(1):430. doi: 10.1186/s12913-017-2388-8.
This is the seventh in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE Program was a systematic, integrated, evidence-based program for resource allocation within a large Australian health service. It aimed to facilitate proactive use of evidence from research and local data; evidence-based decision-making for resource allocation including disinvestment; and development, implementation and evaluation of disinvestment projects. From the literature and responses of local stakeholders it was clear that provision of expertise and education, training and support of health service staff would be required to achieve these aims. Four support services were proposed. This paper is a detailed case report of the development, implementation and evaluation of a Data Service, Capacity Building Service and Project Support Service. An Evidence Service is reported separately.
Literature reviews, surveys, interviews, consultation and workshops were used to capture and process the relevant information. Existing theoretical frameworks were adapted for evaluation and explication of processes and outcomes.
Surveys and interviews identified current practice in use of evidence in decision-making, implementation and evaluation; staff needs for evidence-based practice; nature, type and availability of local health service data; and preferred formats for education and training. The Capacity Building and Project Support Services were successful in achieving short term objectives; but long term outcomes were not evaluated due to reduced funding. The Data Service was not implemented at all. Factors influencing the processes and outcomes are discussed.
Health service staff need access to education, training, expertise and support to enable evidence-based decision-making and to implement and evaluate the changes arising from those decisions. Three support services were proposed based on research evidence and local findings. Local factors, some unanticipated and some unavoidable, were the main barriers to successful implementation. All three proposed support services hold promise as facilitators of EBP in the local healthcare setting. The findings from this study will inform further exploration.
本文是一系列论文中的第七篇，报告了在当地医疗环境中通过有效分配资源实现医疗保健可持续性（SHARE）的情况。SHARE项目是澳大利亚一个大型医疗服务机构内进行资源分配的系统、综合、循证项目。其目的是促进对研究证据和本地数据的积极利用；进行包括撤资在内的资源分配的循证决策；以及撤资项目的开发、实施和评估。从文献以及当地利益相关者的反馈来看，显然需要为医疗服务人员提供专业知识、教育、培训和支持，以实现这些目标。为此提出了四项支持服务。本文是关于数据服务、能力建设服务和项目支持服务的开发、实施和评估的详细案例报告。证据服务将另行报告。
采用文献综述、调查、访谈、咨询和研讨会来收集和处理相关信息。对现有的理论框架进行调整，以评估和阐述过程及结果。
调查和访谈确定了决策、实施和评估过程中证据使用的当前实践；工作人员对循证实践的需求；本地医疗服务数据的性质、类型和可得性；以及教育和培训的首选形式。能力建设和项目支持服务成功实现了短期目标；但由于资金减少，未对长期结果进行评估。数据服务根本没有实施。讨论了影响过程和结果的因素。
医疗服务人员需要获得教育、培训、专业知识和支持，以实现循证决策，并实施和评估这些决策所带来的变化。基于研究证据和本地调查结果提出了三项支持服务。本地因素，有些是意外的，有些是不可避免的，是成功实施的主要障碍。所有三项提议的支持服务都有望成为当地医疗环境中循证实践的促进因素。本研究的结果将为进一步的探索提供参考。
