E. Andrew Balas (
Wendy W. Chapman is chair of and a professor in the Department of Biomedical Informatics at the University of Utah, in Salt Lake City.
Health Aff (Millwood). 2018 Feb;37(2):198-204. doi: 10.1377/hlthaff.2017.1155.
New scientific knowledge and innovation are often slow to disseminate. In other cases, providers rush into adopting what appears to be a clinically relevant innovation, based on a single clinical trial. In reality, adopting innovations without appropriate translation and repeated testing of practical application is problematic. In this article we provide examples of clinical innovations (for example, tight glucose control in critically ill patients) that were adopted inappropriately and that caused what we term a malfunction. To address the issue of malfunctions, we review various examples and suggest frameworks for the diffusion of knowledge leading to the adoption of useful innovations. The resulting model is termed an integrated road map for coordinating knowledge transformation and innovation adoption. We make recommendations for the targeted development of practice change procedures, practice change assessment, structured descriptions of tested interventions, intelligent knowledge management technologies, and policy support for knowledge transformation, including further standardization to facilitate sharing among institutions.
新的科学知识和创新往往传播缓慢。在其他情况下，提供者根据单一临床试验匆忙采用看似具有临床相关性的创新。实际上，在没有适当的翻译和对实际应用的反复测试的情况下采用创新是有问题的。在本文中，我们提供了一些临床创新的例子（例如，危重病患者的严格血糖控制），这些创新被不当采用，并导致了我们所说的故障。为了解决故障问题，我们回顾了各种例子，并为知识传播提出了框架，以促成有用创新的采用。由此产生的模型被称为协调知识转化和创新采用的综合路线图。我们为有针对性地制定实践变革程序、实践变革评估、经过测试的干预措施的结构化描述、智能知识管理技术以及知识转化的政策支持提出建议，包括进一步的标准化以促进机构间的共享。
