Key Points Question Are hospital-at-home interventions consisting of, at minimum, home visits from nurses or physicians associated with better patient outcomes for adult patients with a chronic disease who present to an emergency department? Findings This systematic review of 9 randomized clinical trial studies, including 959 adult patients with a chronic disease, found that although patients receiving hospital-at-home care had an average length of treatment of 5.4 days longer than that of in-hospital patients and a similar mortality risk, they had a lower risk for readmission by 26% and a lower risk for long-term care admission relative to the in-hospital group. Patients who received hospital-at-home care also had lower depression and anxiety scores than patients receiving in-hospital care, but there was no difference in functional status. Meaning This systematic review provides further evidence that hospital-at-home interventions with at least 1 home visit from a nurse or physician may be a promising substitute to in-hospital care, especially for patients with chronic diseases who present to the emergency department.

Rationale Despite the available evidence to support optimal practices in rehabilitation, significant knowledge practice gaps persist. Opinion leaders (OLs) and knowledge brokers (KBs) can enhance the success of knowledge translation (KT) interventions and improve uptake of best practices among clinicians. However, the literature on the mechanisms underpinning OLs'/KBs' activities, and guidance on the type of support needed for successful implementation of these roles in rehabilitation contexts is scarce. This research aimed to highlight the differences and similarities between OLs and KBs with respect to context, mechanism, and outcomes as well as describe the common patterns of OLs and KBs by creating a context‐mechanism‐outcomes configuration. Methods We conducted a realist review to synthesize the available evidence on OLs/KBs as active KT strategies. A search was conducted across five databases up to November 2019. Two independent reviewers extracted the data using a structured form. A context‐mechanism‐outcome configuration was used to conceptualize a cumulative portrait of the features of OLs/KBs roles. Results The search identified 3282 titles after removing duplicates. Seventeen studies (reported in 20 articles) were included in the review. Findings suggest a number of desirable features of OLs/KBs roles that may maximize the achievement of targeted outcomes namely being (a) embedded within their organization as “insiders”; (b) adequately skilled to perform their role; (c) identified as able to fulfil the role; (d) appropriately trained; and (e) able to use different KT interventions. Conclusion Findings of this realist review converge to create a context‐mechanism‐outcomes configuration with suggestions to optimally utilize OLs/KBs in rehabilitation. The configurations suggest desirable features that can lead to a greater potential to achieve targeted goals. It is preferable that OLs/KBs be embedded in the organization and that they are adequately skilful and well‐trained. Also, OLs/KBs should perform the required roles using KT interventions adapted to the local context.

Background: Knowledge brokers (KBs) can help promote the uptake of the latest research evidence into clinical practice. Little is known about who they are, the type of work they do, and their training. Establishing a portrait of Canadian KBs working in the rehabilitation sector may inform health care organizations and knowledge translation specialists on how best to advance KBs practices. The overall goal was to describe the pro le of KBs working to promote the uptake of evidence within rehabilitation settings in Canada. Speci cally, this study aimed to describe the sociodemographic and professional characteristics, work activities, and training of KBs.Methods: A cross-sectional online survey was administered to KBs working in rehabilitation settings across Canada. The survey included 20 questions covering sociodemographic and professional characteristics, work activities, and training opportunities. Response frequency and percentage were calculated for all categorical variables, and the weighted-average "WA" for each role was calculated across participants. Descriptive analysis was conducted for all open-ended questions.Results: Of 475 participants accessing the website, 198 completed the survey questionnaire, including 99 clinicians, 35 researchers, and 26 managers. While over two-third of respondents had completed a graduate degree, only 38% reported receiving KBs-related training. The respondents' primary roles corresponded to a linking agent (WA=1.84), followed by capacity builder (WA=1.76), information manager (1.71), facilitator (WA=1.41), and evaluator (WA=1.32).Conclusions: KBs are mostly expert clinicians who tend to perform brokering activities part-time targeting their peers. Participants mostly perform linking agents, capacity builder, and information roles. Moreover, few participants received formal training to perform brokering activities. BackgroundHealth care administrators and decision-makers emphasize the importance of evidence-based practices (EBP) as a means to improve e ciency and effectiveness in service delivery. [1] However, ensuring optimal use of EBP in health-related settings remains an ongoing challenge for decision-makers and practitioners alike. [2] Knowledge translation (KT) is a process used to promote EBP in healthcare [3] and reduce the gap between routine practice and best available evidence. [4] Several systematic reviews and meta-analyses have reported on the effectiveness of KT interventions for promoting EBP. [5][6][7][8][9][10][11] Overall, the use of passive KT interventions such as dissemination of printed educational materials (PEMs) [12] and professional educational conferences [9] show a 2-6% absolute improvement in professional practice compared to no intervention. In contrast, active KT interventions, including audit and feedback [5] and educational outreach [13] have been shown to be more effective in changing professional behavior, [14] with approximately a 10% practice change. [14-17] Several reviews suggest that the use of intermediary individuals [18,19] is...