College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.
Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales, Australia.
Implement Sci. 2018 Sep 24;13(1):123. doi: 10.1186/s13012-018-0820-z.
Dissemination of clinical practice guidelines alone is insufficient to create meaningful change in clinical practice. Quality improvement collaborative models have potential to address the evidence-practice gap in dementia care because they capitalise on known knowledge translation enablers and incorporate optimal approaches to implementation. Non-pharmacological interventions focused on promoting independence are effective and favoured by people with dementia and their carers but are not routinely implemented. The objective of this translational project is to assess the impact of quality improvement collaboratives (QICs) on adherence to non-pharmacological recommendations from the Clinical Practice Guidelines for Dementia in Australia.
This project will employ an interrupted time-series design with process evaluation to assess the impact, uptake, feasibility, accessibility, cost, and sustainability of the QICs over 18 months. Thirty clinicians from across Australia will be invited to join the QICs to build their capacity in leading innovation in dementia care. Clinicians will participate in a training program and be supported to develop and implement a quality improvement project unique to their service context using plan-do-study-act cycles. Regular online meetings with their peers in the QIC will facilitate benchmarking and problem-solving. Clinicians will describe their practice via monthly checklists, and guideline adherence will be determined against a set of defined criteria. Phone interviews with up to 180 client dyads will be used to assess satisfaction with care and client outcomes. Clinician interviews and field note data will be used to explore implementation and costs. Involvement of people with dementia and carers will be embedded in the study design, conduct, and reporting, in addition to clinical and industry expertise.
The quality of dementia care in Australia is largely dependent on the clinician involved and the extent to which they apply best available evidence in their practice. This study will determine the elements of this multifaceted implementation strategy that contributed to guideline adherence and client outcomes. The findings will inform future translational approaches to improving care and outcomes for people with dementia and their carers.
Registered with the Australian New Zealand Clinical Trials Registry 21 February 2018 ( ACTRN12618000268246 ).
仅传播临床实践指南不足以在临床实践中产生有意义的改变。质量改进合作模式有可能解决痴呆症护理中的证据与实践差距问题，因为它们利用了已知的知识转化促进因素，并纳入了实施的最佳方法。以促进独立性为重点的非药物干预措施是有效的，并且受到痴呆症患者及其照顾者的青睐，但并未常规实施。本转化项目的目的是评估质量改进合作（QIC）对澳大利亚《临床实践指南》中痴呆症非药物建议的依从性的影响。
该项目将采用中断时间序列设计并进行过程评估，以在 18 个月内评估 QIC 的影响、采用情况、可行性、可及性、成本和可持续性。将邀请来自澳大利亚各地的 30 名临床医生参加 QIC，以提高他们在痴呆症护理创新方面的能力。临床医生将参加培训计划，并在同行的支持下，使用计划-执行-研究-行动循环，根据其服务背景制定和实施独特的质量改进项目。定期的 QIC 在线会议将促进基准测试和解决问题。临床医生将通过每月的清单描述他们的实践，并且将根据一套定义的标准确定指南的遵守情况。将对多达 180 对客户对进行电话访谈，以评估对护理的满意度和客户结果。将使用临床医生访谈和实地记录数据来探索实施和成本。除了临床和行业专业知识外，还将在研究设计、实施和报告中嵌入痴呆症患者及其照顾者的参与。
澳大利亚的痴呆症护理质量在很大程度上取决于参与的临床医生以及他们在实践中应用最佳现有证据的程度。本研究将确定这一多方面实施策略的要素，这些要素有助于指南的遵守和客户的结果。研究结果将为改善痴呆症患者及其照顾者的护理和结果的未来转化方法提供信息。
澳大利亚新西兰临床试验注册中心于 2018 年 2 月 21 日注册（ACTRN12618000268246）。
