Mary P. Nix

Translating research into evidence-based nursing practice and evaluating effectiveness.

Evidence-based practice must stand on a base of research that includes knowledge not only of what is efficacious but also of what is effective in the healthcare setting. Paul Glasziou and Brian Haynes conclude that highquality research is essential, but even awareness of this evidence does not predict impact on the quality of care provided without “attention to processes and systems of care.”2 There-

Quality tools to improve care and prevent errors.

A S THE largest healthcare professional group, involved at all levels of the healthcare system, nurses have an important role to play in the identification of aspects of practice and patient care that can be improved to increase quality, ensure patient safety and satisfaction, and improve the efficiency of care. The present nursing shortage has intensified the need for nurses to be able to access already-developed usable evidencebased information and tools that can be adapted to their clinical situation. Evidencebased nursing has been defined by DiCenso et al1 as the process by which nurses make clinical decisions using the best available research evidence, their clinical expertise, patient preferences, and available resources. The Agency for Healthcare Research and Quality (AHRQ) has funded the creation of quality tools and resources to provide accessible research evidence that can be readily adapted to clinical settings. Quality tools include Web sites, reports, databases, fact

Using Learning Communities to Support Adoption of Health Care Innovations

BACKGROUND Diffusion of innovations can be a slow process, posing a major challenge to quality improvement in health care. Learning communities can provide a rich, collaborative environment that supports the adoption of health care innovations and motivates organizational change. From 2014-2016, the Agency for Healthcare Research and Quality (AHRQ) Health Care Innovations Exchange established and supported three learning communities focused on adopting innovations in three high-priority areas: (1) advancing the practice of patient- and family-centered care in hospitals, (2) promoting medication therapy management for at-risk populations, and (3) reducing non-urgent emergency services. METHODS Members of each learning community worked collaboratively in facilitated settings to adapt and implement strategies featured in the Health Care Innovations Exchange, receiving technical assistance from content experts. Project staff conducted a mixed methods evaluation of the initiative, both formative and summative. RESULTS The activities and outcomes of the three learning communities provided insights about how this approach can support local implementation efforts, and about factors influencing innovation adoption. Using a qualitative synthesis method, lessons were identified related to learning community startup (recruitment and goal setting), learning community operations (engagement, collaborative decision-making, and sustainability), and innovation implementation (changing care delivery processes and/or policies). CONCLUSIONS Findings from this work indicate that the learning community model of group learning can serve as an effective method to support dissemination and implementation of innovations, and to achieve desired outcomes in local settings.

039 Guideline Developers’ Self-Perceptions of Adherence to and Intentions to Adhere to the IOM Standards

Background The 2011 IOM report called for more rigorous and transparent development of guidelines. Compliance with the IOM Standards may be challenging for developers. Developer perception of their current adherence to the Standards gives insight into their understanding of them and the likelihood of adhering to them in the future. Objectives (1) Assess developers’ self-perceptions of adherence to the IOM standards (2) Assess developers’ intentions to adhere to the IOM standards. Methods This AHRQ funded work used a mixed-methods approach. We performed semi-structured telephone interviews and surveys to query developers about impressions of and intentions to implement the IOM standards in their CPGs. We also performed our own assessments of guidelines and compared them with developer self-ratings. Results Of 14 developers, 43% utilised a systematic review to underpin their guidelines, and 57% felt they would in the future. Funding sources were not disclosed by 46% of the developers. While 80% utilised an evidence rating scheme, fewer rated the recommendations. Notable differences between developer self-ratings and researcher assessments of adherence occurred in several areas. Discussion While some developers intend to improve processes to meet the Standards, others acknowledged they will not. Yet still others felt they already met the standards, but our assessment suggested a different estimation, revealing varying understanding among developers of the Standards. Implications for Guideline Developers/Users The IOM standards will help identify rigorous and transparent evidence-based guidelines, but will pose implementation challenges. Education of developers on the Standards and expectations around them will be critical.

091 If we Build It, Will you Search for It? Finding Multiple Chronic Condition Guidelines in the National Guideline Clearinghouse

Background In the US, it is estimated more than 25% of Americans have multiple chronic conditions (MCCs) and their care accounts for approximately 66% of total health care spending. Few clinical practice guidelines address MCCs. Objectives Determine the number and scope of guidelines represented in the National Guideline Clearinghouse (NGC), funded by the Agency for Healthcare Research and Quality, addressing MCCs and provide strategies to identify these guidelines and facilitate quick retrieval by NGC users. Methods We searched for guidelines within NGC to identify those that address MCCs. We characterised these guidelines defining the number and type of MCCs addressed, the number of recommendations addressing MCCs, whether they addressed treatment, diagnosis, prevention or counselling, whether they graded the level of evidence, and whether the MCCs were concordant/discordant with the guideline’s primary disease/condition. Results Final analysis of information collected and recommendations and strategies for facilitating retrieval of this content in NGC will be completed by June 2013. Discussion Traditionally, guidelines focus on individual diseases so their application to the growing MCC population is limited. At the same time, evidence supporting recommendations for MCCs is lacking. Although our preliminary findings indicate that there are some guidelines addressing MCCs, there has been no obvious way to locate them on NGC. Implications for Guideline Developers/Users Guideline developers need to create guidelines addressing MCCs. NGC aims to create ways to highlight MCC guidelines and make them easier to find and use.