Lynch Elizabeth A, Lassig Chris, Turner Tari, Churilov Leonid, Hill Kelvin, Shrubsole Kirstine
Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Campus, GPO Box 2100, Adelaide, SA, 5001, Australia.
Adelaide Nursing School, University of Adelaide, Level 4 AHMS Building, Adelaide, 5005, Australia.
Health Res Policy Syst. 2021 May 22;19(1):85. doi: 10.1186/s12961-021-00734-w.
Implementation of evidence-based care remains a key challenge in clinical practice. Determining "what" to implement can guide implementation efforts. This paper describes a process developed to identify priority recommendations from clinical guidelines for implementation, incorporating the perspectives of both consumers and health professionals. A case study is presented where the process was used to prioritize recommendations for implementation from the Australian Stroke Clinical Guidelines.
The process was developed by a multidisciplinary group of researchers following consultation with experts in the field of implementation and stroke care in Australia. Use of the process incorporated surveys and facilitated workshops. Survey data were analysed descriptively; responses to ranking exercises were analysed via a graph theory-based voting system.
The four-step process to identify high-priority recommendations for implementation comprised the following: (1) identifying key implementation criteria, which included (a) reliability of the evidence underpinning the recommendation, (b) capacity to measure change in practice, (c) a recommendation-practice gap, (d) clinical importance and (e) feasibility of making the recommended changes; (2) shortlisting recommendations; (3) ranking shortlisted recommendations and (4) reaching consensus on top priorities. The process was applied to the Australian Stroke Clinical Guidelines between February 2019 and February 2020. Seventy-five health professionals and 16 consumers participated. Use of the process was feasible. Three recommendations were identified as priorities for implementation from over 400 recommendations.
It is possible to implement a robust process which involves consumers, clinicians and researchers to systematically prioritize guideline recommendations for implementation. The process is generalizable and could be applied in clinical areas other than stroke and in different geographical regions to identify implementation priorities. The identification of three clear priority recommendations for implementation from the Australian Stroke Clinical Guidelines will directly inform the development and delivery of national implementation strategies.
循证护理的实施仍是临床实践中的一项关键挑战。确定“实施什么”能够指导实施工作。本文描述了一个为从临床指南中识别实施的优先建议而开发的过程，该过程纳入了消费者和卫生专业人员的观点。文中呈现了一个案例研究，其中该过程被用于确定澳大利亚卒中临床指南中实施建议的优先级。
该过程由一组多学科研究人员在咨询澳大利亚实施领域和卒中护理领域的专家后开发。该过程的使用包括调查和促进性研讨会。对调查数据进行描述性分析；通过基于图论的投票系统分析对排序练习的回答。
识别实施的高优先级建议的四步过程包括以下内容：（1）确定关键实施标准，其中包括（a）支持该建议的证据的可靠性，（b）衡量实践变化的能力，（c）建议与实践的差距，（d）临床重要性以及（e）进行建议更改的可行性；（2）筛选建议；（3）对筛选出的建议进行排序；（4）就首要优先事项达成共识。该过程在2019年2月至2020年2月期间应用于澳大利亚卒中临床指南。75名卫生专业人员和16名消费者参与其中。该过程的使用是可行的。从400多条建议中确定了三条建议作为实施的优先事项。
有可能实施一个强大的过程，该过程涉及消费者、临床医生和研究人员，以系统地确定指南建议实施的优先级。该过程具有可推广性，可应用于卒中以外的临床领域以及不同地理区域，以确定实施优先级。从澳大利亚卒中临床指南中确定三条明确的实施优先建议将直接为国家实施策略的制定和实施提供信息。
