School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia.
Department of Nutrition & Dietetics, Logan Hospital, Brisbane.
JBI Evid Implement. 2021 Nov 8;20(1):10-20. doi: 10.1097/XEB.0000000000000295.
Dissemination and local adaptation of best practice models of care are often poorly achieved in knowledge translation processes. Understanding and documenting the iterative cycles of improvement can elucidate barriers, enablers and benefits of the process for future adoption and service integration improvements. This project examined the process of local adaptation for a third stage translation of a gestational diabetes dietetic model of care through collaboration with two Queensland (Australia) hospitals.
Using a hub (research team)-spoke (sites) model, two Queensland Hospital and Health Service Districts were supported to assess and address evidence-practice dietetic model of care gaps in their gestational diabetes mellitus (GDM) services. Sites selected demonstrated strong GDM team cohesiveness and project commitment. The project phases were: Consultation; Baseline; Transition; Implementation; and Evaluation.
Despite strong site buy-in and use of a previously successful model of care dissemination and adoption strategy, unexpected global, organisational, team and individual barriers prevented successful implementation of the model of care at both sites. Barriers included challenges with ethics and governance requirements for health service research, capacity to influence and engage multidisciplinary teams, staff turnover and coronavirus disease 2019's (COVID-19's) disruption to service delivery.
This third iteration of the dissemination of a best practice model of nutrition care for GDM in two Queensland Hospital and Health Service Districts did not achieve successful clinical or process outcomes. However, valuable learnings and recommendations regarding future clinical and research health service redesign aligned with best practice are suggested.
在知识转化过程中，最佳实践护理模式的传播和本地化往往难以实现。理解和记录改进的迭代循环可以阐明该过程的障碍、促进因素和益处，以便为未来的采用和服务整合改进提供参考。本项目通过与昆士兰州（澳大利亚）的两家医院合作，研究了第三阶段将妊娠期糖尿病饮食护理模式本地化的过程。
使用一个中心（研究团队）-分支（站点）模型，为两个昆士兰州医院和卫生服务区提供支持，以评估和解决其妊娠期糖尿病（GDM）服务中证据-实践饮食护理模式的差距。选择的站点表现出强烈的 GDM 团队凝聚力和项目承诺。项目阶段包括：咨询、基线、过渡、实施和评估。
尽管站点强烈支持并采用了先前成功的护理模式传播和采用策略，但全球、组织、团队和个人障碍的出现，导致该模式在两个站点都无法成功实施。障碍包括卫生服务研究的伦理和治理要求、影响和参与多学科团队的能力、员工流动以及 2019 年冠状病毒病（COVID-19）对服务提供的干扰等方面的挑战。
在昆士兰州的两个医院和卫生服务区，第三次传播最佳的 GDM 营养护理模式未能实现临床或流程方面的成功结果。然而，提出了与最佳实践相一致的未来临床和研究卫生服务重新设计的宝贵经验教训和建议。
