Using the TRANSLATE Framework to Support Practice Transformation: Perspectives of a Practice Facilitator.

BACKGROUND: In 2008, the Minnesota Department of Health (MDH) awarded Statewide Health Improvement Partnership (SHIP) funding to community health boards (CHBs), directing them to partner with schools, worksites, communities, and health care to address obesity and tobacco use/exposure. METHODS: Each CHB selected one of two health care strategies: implement obesity and healthy lifestyle guidelines or connect clinics to community resources. The CHB in rural west-central Minnesota chose to champion clinical guideline implementation, assigning one of its own county-level public health nurses the role of practice facilitator (PF). This decision set the stage for a novel community partnership between public health, clinical guideline developers, and local providers of relevant clinical services. LESSONS LEARNED: This community perspective describes how the PF organized support for clinical guideline implementation using the TRANSLATE framework, and explores the capacity of the TRANSLATE framework to accommodate particularities of clinical partners that is necessary in working to transform evidence-based knowledge into real-world practice.

Translation of obesity practice guidelines: interprofessional perspectives regarding the impact of public health nurse system-level intervention.

OBJECTIVE: The purpose of the study was to investigate the perceptions of administrators and clinicians regarding a public health facilitated collaborative supporting the translation into practice of the Institute for Clinical Systems Improvement (ICSI) Adult Obesity Guideline. DESIGN AND SAMPLE: This qualitative study was conducted with 10 health care organizations participating in a voluntary, interprofessional obesity management collaborative. A purposive sample of 39 participants included two to three clinicians and an administrator from each organization. Interview analysis focused on how the intervention affected participants and their practices. RESULTS: Four themes described participant experiences of obesity guideline translation: (1) a shift from powerlessness to positive motivation, (2) heightened awareness coupled with improved capacity to respond, (3) personal ownership and use of creativity, and (4) a sense of the importance of increased interprofessional collaboration. CONCLUSIONS: The investigation of interprofessional perspectives illuminates the feelings and perceptions of clinician and administrator participants regarding obesity practice guideline translation. These themes suggest that positive motivation, improved capacity, personal creative ownership, and interprofessional collaboration may be conducive to successful evidence-based obesity guideline implementation. Further research is needed to evaluate these findings relative to translating the ICSI obesity guideline and other guidelines into practice in diverse clinical settings.

Translation of obesity practice guidelines: measurement and evaluation.

OBJECTIVE(S): A public health nurse (PHN) in the Midwestern United States (U.S.) led a collaborative system-level intervention to translate the Institute of Clinical Systems Improvement (ICSI) Adult Obesity Guideline into interprofessional practice. This study (1) evaluated the extent of guideline translation across organizations and (2) assessed the Omaha System as a method for translating system-level interventions and measuring outcomes. DESIGN AND SAMPLE: This retrospective, mixed methods study was conducted with a purposeful sample of one administrator (n = 10) and two to three clinicians (n = 29) from each organization (n = 10). MEASURES: Omaha System Problem Rating Scale for Outcomes Knowledge, Behavior, and Status (KBS). KBS ratings gathered from semi-structured interviews and Omaha System documentation were analyzed using standard descriptive and inferential statistics and triangulated findings with participant quotes. RESULTS: KBS ratings and participant quotes revealed intervention effectiveness in creating sustained system-level changes. Self-reported and observed KBS ratings demonstrated improvement across organizations. There was moderate to substantial agreement regarding benchmark attainment within organizations. On average, self-reported improvement exceeded observer improvement. CONCLUSIONS: System-level PHN practice facilitator interventions successfully translated clinical obesity guidelines into interprofessional use in health care organizations. The Omaha System Problem Rating Scale for Outcomes reliably measured system-level outcomes.