Evidence-Based Management: Using Serial Firm Trials to Improve Diabetes Care Quality

Goldberg, Harold I.; Neighbor, William E.; Hirsch, Irl B.; Cheadle, Allen; Ramsey, Scott D.; Gore, Ed

doi:10.1016/s1070-3241(02)28016-5

Cited by 14 publications

(18 citation statements)

References 24 publications

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“…They included 12 of the 13 papers in Clarke and Loudon's review, [97][98][99][100][101][102]104,105,[108][109][110][111] and an additional 21 papers, 103,106,107,[112][113][114][115][116][117][118][119][120][121][122][123][124][125][126][127][128][129] including 10 published since the beginning of 2009 [114][115][116][117][118][119]121,123,126,128 when Clarke and Loudon conducted their search. We had a broader remit and conducted our search in a different way, but we were able to benefit from knowing which papers they had included and ensuring that our search terms captured as many of these papers as possible.…”

Section: Chaptermentioning

confidence: 99%

“…Four papers make up the intervention group, [126][127][128][129] which contains papers that describe the impact of initiatives that consist of interventions aimed at improving health care by involving health-care staff in specific research studies. Three [126][127][128] come from the USA and one 129 from South Africa.…”

Section: Intervention Papersmentioning

confidence: 99%

“…Three [126][127][128] come from the USA and one 129 from South Africa. Two describe the VA's QI initiatives that involved research engagement interventions aimed at improving health-care performance.…”

Section: Intervention Papersmentioning

confidence: 99%

“…Finally, we classified one study 127 as mixed/negative because the improvements in health-care performance were examined over a longer period than the intervention project, but were soon reversed. Most of the improvement described in the studies was in health-care processes, but some small improvements in health outcomes were reported in a couple of the studies; however, one of these 127 was the study where the improved outcomes were soon reversed when the trial intervention was withdrawn, and so it was counted as a mixed/negative study and was not included in the list of positive studies that had resulted in improved outcomes.…”

Section: Onementioning

confidence: 99%

“…Of these, 12 102,110,111,[113][114][115][116][118][119][120][121][122] were of higher importance and 16 97,99,101,103-105.107,108,112,117,123-126,128,129 of less importance. Five studies 98,100,106,109,127 were negative (of which two 100,127 were mixed/negative). Of these, two 98,109 were of higher importance and three 100,106,127 of less importance.…”

Section: Overall Commentsmentioning

confidence: 99%

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Engagement in research: an innovative three-stage review of the benefits for health-care performance

Hanney

Boaz

Jones

et al. 2013

Health Services and Delivery Research

102

160

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BackgroundThere is a widely held assumption that research engagement improves health-care performance at various levels, but little direct empirical evidence.ObjectivesTo conduct a theoretically and empirically grounded synthesis to map and explore plausible mechanisms through which research engagement might improve health services performance. A review of the effects on patients of their health-care practitioner's or institution's participation in clinical trials was published after submission of the proposal for this review. It identified only 13 relevant papers and, overall, suggested that the evidence that research engagement improves health-care performance was less strong than some thought. We aimed to meet the need for a wider review.MethodsAn hourglass review was developed, consisting of three stages: (1) a planning and mapping stage; (2) a focused review concentrating on the core question of whether or not research engagement improves health care; and (3) a wider (but less systematic) review of papers identified during the two earlier stages. Studies were included inthe focused review if the concept of ‘engagementinresearch’ was an input and some measure of ‘performance’ an output. The search strategy covered the period 1990 to March 2012. MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and other relevant databases were searched. A total of 10,239 papers were identified through the database searches, and 159 from other sources. A further relevance and quality check on 473 papers was undertaken, and identified 33 papers for inclusion in the review. A standard meta-analysis was not possible on the heterogeneous mix of papers in the focused review. Therefore an explanatory matrix was developed to help characterise the circumstances in which research engagement might improve health-care performance and the mechanisms that might be at work, identifying two main dimensions along which to categorise the studies:the degree of intentionalityandthe scope of the impact.ResultsOf the 33 papers in the focused review, 28 were positive (of which six were positive/mixed) in relation to the question of whether or not research engagement improves health-care performance. Five papers were negative (of which two were negative/mixed). Seven out of 28 positive papers reported some improvement in health outcomes. For the rest, the improved care took the form of improved processes of care. Nine positive papers were at a clinician level and 19 at an institutional level. The wider review demonstrated, for example, how collaborative and action research can encourage some progress along the pathway from research engagement towards improved health-care performance. There is also evidence that organisations in which the research function is fully integrated into the organisational structure out-perform other organisations that pay less formal heed to research and its outputs. The focused and wider reviews identified the diversity in the mechanisms through which research engagement might improve health care: there are many circumstances and mechanisms at work, more than one mechanism is often operative, and the evidence available for each one is limited.LimitationsTo address the complexities of this evidence synthesis of research we needed to spend significant time mapping the literature, and narrowed the research question to make it feasible. We excluded many potentially relevant papers (though we partially addressed this by conducting a wider additional synthesis). Studies assessing the impact made on clinician behaviour by small, locally conducted pieces of research could be difficult to interpret without full knowledge of the context.ConclusionsDrawing on the focused and wider reviews, it is suggested that when clinicians and health-care organisations engage in research there is the likelihood of a positive impact on health-care performance. Organisations that have deliberately integrated the research function into organisational structures demonstrate how research engagement can, among other factors, contribute to improved health-care performance. Further explorations are required of research networks and schemes to promote the engagement of clinicians and managers in research. Detailed observational research focusing on research engagement within organisations would build up an understanding of mechanisms.Study registrationPROSPERO: CRD42012001990.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Chaptermentioning

confidence: 99%

Section: Intervention Papersmentioning

confidence: 99%

Section: Intervention Papersmentioning

confidence: 99%

Section: Onementioning

confidence: 99%

Section: Overall Commentsmentioning

confidence: 99%

See 3 more Smart Citations

Engagement in research: an innovative three-stage review of the benefits for health-care performance

Hanney

Boaz

Jones

et al. 2013

Health Services and Delivery Research

102

160

View full text Add to dashboard Cite

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The effects of on-screen, point of care computer reminders on processes and outcomes of care

Shojania

Jennings²,

Mayhew

et al. 2009

Cochrane Database of Systematic Reviews

361

339

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Background The opportunity to improve care by delivering decision support to clinicians at the point of care represents one of the main incentives for implementing sophisticated clinical information systems. Previous reviews of computer reminder and decision support systems have reported mixed effects, possibly because they did not distinguish point of care computer reminders from e-mail alerts, computer-generated paper reminders, and other modes of delivering ‘computer reminders’. Objectives To evaluate the effects on processes and outcomes of care attributable to on-screen computer reminders delivered to clinicians at the point of care. Search methods We searched the Cochrane EPOC Group Trials register, MEDLINE, EMBASE and CINAHL and CENTRAL to July 2008, and scanned bibliographies from key articles. Selection criteria Studies of a reminder delivered via a computer system routinely used by clinicians, with a randomised or quasi-randomised design and reporting at least one outcome involving a clinical endpoint or adherence to a recommended process of care. Data collection and analysis Two authors independently screened studies for eligibility and abstracted data. For each study, we calculated the median improvement in adherence to target processes of care and also identified the outcome with the largest such improvement. We then calculated the median absolute improvement in process adherence across all studies using both the median outcome from each study and the best outcome. Main results Twenty-eight studies (reporting a total of thirty-two comparisons) were included. Computer reminders achieved a median improvement in process adherence of 4.2% (interquartile range (IQR): 0.8% to 18.8%) across all reported process outcomes, 3.3% (IQR: 0.5% to 10.6%) for medication ordering, 3.8% (IQR: 0.5% to 6.6%) for vaccinations, and 3.8% (IQR: 0.4% to 16.3%) for test ordering. In a sensitivity analysis using the best outcome from each study, the median improvement was 5.6% (IQR: 2.0% to 19.2%) across all process measures and 6.2% (IQR: 3.0% to 28.0%) across measures of medication ordering. In the eight comparisons that reported dichotomous clinical endpoints, intervention patients experienced a median absolute improvement of 2.5% (IQR: 1.3% to 4.2%). Blood pressure was the most commonly reported clinical endpoint, with intervention patients experiencing a median reduction in their systolic blood pressure of 1.0 mmHg (IQR: 2.3 mmHg reduction to 2.0 mmHg increase). Authors’ conclusions Point of care computer reminders generally achieve small to modest improvements in provider behaviour. A minority of interventions showed larger effects, but no specific reminder or contextual features were significantly associated with effect magnitude. Further research must identify design features and contextual factors consistently associated with larger improvements in provider behaviour if computer reminders are to succeed on more than a trial and error basis.

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Computer-generated reminders delivered on paper to healthcare professionals; effects on professional practice and health care outcomes

Arditi

Rège‐Walther

Durieux

et al. 2012

Cochrane Database of Systematic Reviews

119

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Background Clinical practice does not always reflect best practice and evidence, partly because of unconscious acts of omission, information overload, or inaccessible information. Reminders may help clinicians overcome these problems by prompting them to recall information that they already know or would be expected to know and by providing information or guidance in a more accessible and relevant format, at a particularly appropriate time. This is an update of a previously published review. Objectives To evaluate the effects of reminders automatically generated through a computerized system (computer-generated) and delivered on paper to healthcare professionals on quality of care (outcomes related to healthcare professionals' practice) and patient outcomes (outcomes related to patients' health condition). Search methods We searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers up to 21 September 2016 together with reference checking, citation searching and contact with study authors to identify additional studies. Selection criteria We included individual-or cluster-randomized and non-randomized trials that evaluated the impact of computer-generated reminders delivered on paper to healthcare professionals, alone (single-component intervention) or in addition to one or more co-interventions (multi-component intervention), compared with usual care or the co-intervention(s) without the reminder component. Data collection and analysis Review authors working in pairs independently screened studies for eligibility and abstracted data. For each study, we extracted the primary outcome when it was defined or calculated the median effect size across all reported outcomes. We then calculated the median improvement and interquartile range (IQR) across included studies using the primary outcome or median outcome as representative outcome. We assessed the certainty of the evidence according to the GRADE approach.

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Evidence-Based Management: Using Serial Firm Trials to Improve Diabetes Care Quality

Cited by 14 publications

References 24 publications

Engagement in research: an innovative three-stage review of the benefits for health-care performance

Engagement in research: an innovative three-stage review of the benefits for health-care performance

The effects of on-screen, point of care computer reminders on processes and outcomes of care

Computer-generated reminders delivered on paper to healthcare professionals; effects on professional practice and health care outcomes

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