Learning together for better health using an evidence-based Learning Health System framework: a case study in stroke.

BACKGROUND: In the context of expanding digital health tools, the health system is ready for Learning Health System (LHS) models. These models, with proper governance and stakeholder engagement, enable the integration of digital infrastructure to provide feedback to all relevant parties including clinicians and consumers on performance against best practice standards, as well as fostering innovation and aligning healthcare with patient needs. The LHS literature primarily includes opinion or consensus-based frameworks and lacks validation or evidence of benefit. Our aim was to outline a rigorously codesigned, evidence-based LHS framework and present a national case study of an LHS-aligned national stroke program that has delivered clinical benefit. MAIN TEXT: Current core components of a LHS involve capturing evidence from communities and stakeholders (quadrant 1), integrating evidence from research findings (quadrant 2), leveraging evidence from data and practice (quadrant 3), and generating evidence from implementation (quadrant 4) for iterative system-level improvement. The Australian Stroke program was selected as the case study as it provides an exemplar of how an iterative LHS works in practice at a national level encompassing and integrating evidence from all four LHS quadrants. Using this case study, we demonstrate how to apply evidence-based processes to healthcare improvement and embed real-world research for optimising healthcare improvement. We emphasize the transition from research as an endpoint, to research as an enabler and a solution for impact in healthcare improvement. CONCLUSIONS: The Australian Stroke program has nationally improved stroke care since 2007, showcasing the value of integrated LHS-aligned approaches for tangible impact on outcomes. This LHS case study is a practical example for other health conditions and settings to follow suit.

Potential parental determinants of the pace of evidence-based practice change in children's mental health care.

BACKGROUND: Strength of evidence is key to advancing children's mental health care but may be inadequate for driving practice change. The Designing for Accelerated Translation (DART) framework proposes a multifaceted approach: pace of implementation as a function of evidence of effectiveness, demand for the intervention, sum of risks, and costs. To inform empirical applications of DART, we solicited caregiver preferences on key elements. METHOD: In March-April 2022, we fielded a population-representative online survey in Illinois households (caregivers N = 1,326) with ≥1 child <8 years old. Six hypothetical scenarios based on the DART framework were used to elucidate caregivers' preferences on a 0-10 scale (0 = never; 10 = as soon as possible) for pace of implementation of a family-based program to address mental health concerns. RESULTS: Caregivers' pace preference scores varied significantly for each scenario. The highest mean score (7.28, 95% confidence interval [95% CI: 7.06, 7.50]) was for a scenario in which the child's provider thinks the program would be helpful (effectiveness) and the caregiver believes the program is needed (demand). In contrast, the lowest mean score (5.13, 95% CI [4.91, 5.36]) was for a scenario in which online information implies the program would be helpful (effectiveness) and the parent is concerned about the program's financial costs (cost). Caregivers' pace preference scores did not vary consistently by sociodemographic factors. CONCLUSION: In this empirical exploration of the DART framework, factors such as demand, cost, and risk, in combination with evidence of effectiveness, may influence caregivers' preferred pace of implementation for children's mental health interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Reliability and validity of intervention characteristic measures for assessing barriers to evidence-based practice use.

Assessing barriers before implementing an evidence-based practice can increase the chances of successful implementation. This project evaluated measures of intervention characteristics that could affect implementation: evidence strength and quality; relative advantage; adaptability; trialability; complexity; design quality and packaging; perceived cost; compatibility; observability; risk; and burden. Measures (109 items total) for each intervention characteristic were developed in a previous study, using prior measures, and expert feedback. Measures were scored such that higher scores meant a more positive view. Healthcare personnel implementing a new practice (n = 175) completed two surveys, 1 month apart. Participants completed the intervention characteristic item banks and questions on the use of the evidence-based practice. Reliability and validity were assessed for each item bank. All measures had Cronbach's alphas over 0.7 (range: 0.700-0.932) indicating good reliability. Frequent users of the practice reported better levels of each determinant at the first (Cohen's d range: -0.239 to -0.687) and second surveys (Cohen's d range: -0.043 to -1.081) except for costs (0.096) with use on the second survey. This preliminary test of measures to assess determinants of implementing evidence-based practice supports the validity and reliability of these tools. Additional studies are needed to further test the psychometric properties of the measures and develop short forms of each intervention characteristic measure.

Measuring perceptions of healthcare personnel can help increase the use of evidence-based care. This study developed measures of eleven different types of perceptions. The measures were tested in a sample of 175 healthcare personnel. All eleven measures showed good reliability and validity. The measures can be used to assess perceptions in research and clinical care.

Assessing evidence-based practice competencies of undergraduate nursing students using a developed multi-criteria decision-analysis model.

AIM: The developed multi-criteria decision analysis model was used to identify the inter-influence relationships and key factors affecting the EBP competencies of UNSs, to assess the EBP competencies of UNSs and based on these results, to formulate an improvement strategy to enhance the EBP competencies of UNSs. BACKGROUND: EBP is considered a core competency in international nursing practice. However, few studies have developed EBP evaluation models and applied them to assessing and improving the EBP competencies of UNSs. DESIGN: This is a quantitative study with multi-criteria decision-analysis model. METHODS: Firstly, the questionnaire was designed based on the characteristics of the DEMATEL and VIKOR-AS methods, which was completed by 17 nursing experts from a case hospital in Zhejiang Province, China. Subsequently, the DEMATEL method was used to analyze the inter-influence relationships among various criteria to determine their respective weights. Finally, the VIKOR method is utilized to integrate multiple criteria and their relative weights to assign comprehensive scores to each UNSs. RESULTS: The use of the DEMATEL method reveals that "Knowledge (C1)", "Mastering the basic scientific research methods during the study of the undergraduate courses (C11)", "Being able to consult clinical experts appropriately when encountering problems in clinical practice (C23)" and "Understanding the importance of reading journals related to the nursing profession regularly (C34)" were critical influencing factors. "Skill (C2)," "Being able to explain the essential roles of the best research evidence in determining clinical practice (C15)," "Being able to apply the collected research evidence to the individual case in nursing care (C25)" and "Paying attention to using the evidence-based nursing practice concept to determine the best clinical practice (C35)" were the most influential factors. According to the VIKOR method, the performance of the UNSs in the case hospitals in terms of EBP competencies from highest to lowest was Student C, Student B and Student A. However, all of these students suffered from deficiencies at the knowledge level. CONCLUSIONS: The application of the DEMATEL and VIKOR methods provides a systematic and comprehensive approach to the assessment of EBP competencies of UNSs. The lack of EBP competencies of UNSs in case hospitals is mainly reflected in knowledge level. To improve UNSs' EBP competencies, medical schools and hospital educators should propose short- and long-term strategies to improve knowledge.

Engaging stakeholders to retrospectively discern implementation strategies to support program evaluation: Proposed method and case study.

BACKGROUND: Availability of evidence-based practices (EBPs) is critical for improving health care outcomes, but diffusion can be challenging. Implementation activities increase the adoption of EBPs and support sustainability. However, when implementation activities are a part of quality improvement processes, evaluation of the time and cost associated with these activities is challenged by the need for a correct classification of these activities to a known taxonomy of implementation strategies by implementation actors. DESIGN: Observational study of a four-stage, stakeholder-engaged process for identifying implementation activities and estimating the associated costs. RESULTS: A national initiative in the Veterans Health Administration (VHA) to improve Advance Care Planning (ACP) via Group Visits (ACP-GV) for rural veterans identified 49 potential implementation activities. Evaluators translated and reduced these to 14 strategies used across three groups with the aid of implementation actors. Data were collected to determine the total implementation effort and applied cost estimates to estimate the budget impact of implementation for VHA. LIMITATIONS: Recall bias may influence the identification of potential implementation activities. CONCLUSIONS: This process improved understanding of the implementation effort and allowed estimation of ACP-GV 's budget impact. IMPLICATIONS: A four-stage, stakeholder-engaged methodology can be applied to other initiatives when a pragmatic evaluation of implementation efforts is needed.

The dilemma of the split between theory and reality as experienced by primary healthcare professionals: a mixed methods study of evidence-based practice in a primary care context.

BACKGROUND: Primary care depends upon a good information flow across professional and structural boundaries to provide the best care for patients. Previous research has mainly focused on Evidence-Based Practice (EBP) within specific professions. Mapping of pan-professional experiences of and attitudes to EBP in publicly funded clinical practice is necessary to deepen the understanding of EBP and its implementation. Thus, this study aimed to investigate healthcare professionals' experiences of and attitudes towards working in accordance with EBP in primary care. METHODS: The study used a convergent mixed methods design divided into two strands: a quantitative enquiry tool (Evidence-Based Practice Attitude Scale, EBPAS) and a set of qualitative interviews analysed by means of qualitative content analysis. Both strands included all primary care employees with patient interaction in the studied county (n = 625), including doctors, nurses, physiotherapists, psychologists and assistant nurses. Out of the original 625 healthcare professionals, 191 finished the first strand and 8 volunteered for the second strand (2 nurses, 2 physiotherapists, 1 psychiatrist and 3 doctors). RESULTS: The EBPAS value of 2.8 (max 4) indicated a generally positive attitude towards EBP amongst the population, which was also evident in the interviews. However, there were additional experiences of not having the ability or resources to engage in EBP. This was illustrated by the theme that emerged from the qualitative content analysis: "The dilemma of the split between theory and reality". Due to the organisational and managerial focus on efficiency rather than quality of care, there were few or no incentives for promoting individual educational or research development. CONCLUSIONS: Although the general attitude towards EBP is positive, experiences of practising it differ. There is a need to increase knowledge of EBP concepts, requirements and implementation in the clinical setting. The absence of opportunities to do research and collegial debate about new ways of finding and implementing research-based evidence results might influence the quality of care.

A 10-month impact evaluation of a journal club among diagnostic radiographers in a single NHS Trust: A service evaluation study.

INTRODUCTION: Journal clubs (JC) have emerged as a popular tool within medical and health professions to deliver outcomes such as promotion of evidence-based practice (EBP), improvement of critical appraisal skills, as well as stimulation of research interest among participating professionals. However, the delivery of these outcomes within the diagnostic radiography profession has not been evidenced and this is the aim of this service evaluation. METHODS: This evaluation adopted a pre- and post-evaluation survey design to explore the impact of a novel JC introduced among diagnostic radiographers in a UK NHS Trust. Impact was assessed based on four pre-determined outcomes such as Knowledge of EBP, Attitude to EBP, Critical Appraisal Skill and Research interest. Open ended questions in the post evaluation survey were also used to obtain participants feedback on JC activities attended. RESULTS: Evaluation of the four pre-determined outcomes indicated that JC activities participated by diagnostic radiographers resulted in positive changes across all evaluated categories. Attitude to EBP was the only outcome to show a statistically significant positive change across all participants, highlighting that the JC affected EBP attitudes positively for those that attended. Furthermore, thematic analysis of open-ended questions indicated that the collaboration experienced among JC members during critical appraisal of articles was a motivation for continued participation while factors such as high clinical workload and absence of management in meetings were identified as mitigating barriers. CONCLUSION: Participation in the JC showed positive improvements in all pre-determined categories. The collaborative nature of JC was motivating for staff, however barriers such as management absence in meetings, and high clinical workload did cause some challenges. Research is recommended to look at the longer-term impact of JC activities amongst diagnostic radiographers.

A synthesis of evidence for policy from behavioural science during COVID-19.

Scientific evidence regularly guides policy decisions1, with behavioural science increasingly part of this process2. In April 2020, an influential paper3 proposed 19 policy recommendations ('claims') detailing how evidence from behavioural science could contribute to efforts to reduce impacts and end the COVID-19 pandemic. Here we assess 747 pandemic-related research articles that empirically investigated those claims. We report the scale of evidence and whether evidence supports them to indicate applicability for policymaking. Two independent teams, involving 72 reviewers, found evidence for 18 of 19 claims, with both teams finding evidence supporting 16 (89%) of those 18 claims. The strongest evidence supported claims that anticipated culture, polarization and misinformation would be associated with policy effectiveness. Claims suggesting trusted leaders and positive social norms increased adherence to behavioural interventions also had strong empirical support, as did appealing to social consensus or bipartisan agreement. Targeted language in messaging yielded mixed effects and there were no effects for highlighting individual benefits or protecting others. No available evidence existed to assess any distinct differences in effects between using the terms 'physical distancing' and 'social distancing'. Analysis of 463 papers containing data showed generally large samples; 418 involved human participants with a mean of 16,848 (median of 1,699). That statistical power underscored improved suitability of behavioural science research for informing policy decisions. Furthermore, by implementing a standardized approach to evidence selection and synthesis, we amplify broader implications for advancing scientific evidence in policy formulation and prioritization.

Establishing a Protocol for Determining the Costs of an Integrated Set of Evidence-based Practices Aimed at Reducing Opioid Overdose Deaths.

OBJECTIVES: In the midst of the opioid overdose crisis, local jurisdictions face a choice of public health interventions. A significant barrier when considering evidence-based practices (EBPs) is the lack of information regarding their implementation cost. This protocol paper provides the methodological foundation for the economic cost evaluations of community-wide strategies on the scale of a national study. It can serve as a resource for other communities, local policymakers, and stakeholders as they consider implementing possible public health strategies in their unique settings. METHODS: We present a protocol that details (1) the process of identifying, reviewing, and analyzing individual strategies for study-funded and non-study-funded costs; (2) prospective costing tool designation, and; (3) data collection. To do this, we set up working groups with community stakeholders, reviewed financial invoices, and surveyed individuals with detailed knowledge of their community implementation. DISCUSSION: There were 3 main challenges/limitations. The first was the lack of a standard structure for documenting nonfunded costs associated with each strategy. The second was the need for timely implementation of cost data. The third was generalizability because our study designed its strategies for selected communities due to their high opioid overdose mortality rates. Future steps include more tailored questions to ask during the categorization/filter process and establishing realistic expectations for organizations regarding documenting. CONCLUSIONS: Data collected will provide a critical methodological foundation for costing large community-based EBP strategies and provide clarity for stakeholders on the cost of implementing EBP strategies to reduce opioid overdose deaths.

Changes in evidence-based practice self-efficacy among nursing students and the impact of clinical competencies: Longitudinal descriptive study.

INTRODUCTION: Evidence-based practice (EBP) is essential to ensure patient safety and improve the quality of nursing care. Nursing students' self-efficacy in employing EBP is crucial for the formation of a culture of EBP in healthcare organizations. OBJECTIVE: This study aimed to investigate the changes in nursing students' self-efficacy in employing EBP and the extent to which clinical performance affects these changes. METHODS: This study was a longitudinal descriptive study. Participants were nursing students who had received education on EBP theory and had clinical practice experience. Convenience sampling was used to select nursing students in their third year of study at a nursing college located in the southern region of Korea in 2020. The researcher measured EBP self-efficacy and clinical competence using an online survey tool at three time points (second semester of third year, first semester of fourth year, and second semester of fourth year). Multilevel modeling was used to identify factors affecting changes in EBP self-efficacy. RESULTS: The results showed that nursing students' EBP self-efficacy increased over time. Nursing leadership (p = .022), nursing skills (p = .028), communication (p < .001), and nursing process (p = .003) were significant factors that affected the changes in EBP self-efficacy. Individual differences in initial levels and change rates were still observed. CONCLUSION: Systematic education on EBP theory and practical training should be provided to nursing students from the beginning of their studies to graduation to deepen their EBP and clinical competence.

Evidence-Based Practice Competencies among Nutrition Professionals and Students: A Systematic Review.

BACKGROUND: Evidence-based practice (EBP) promotes shared decision-making between clinicians and patients. OBJECTIVE: The aim was to determine EBP competencies among nutrition professionals and students reported in the literature. METHODS: We conducted a systematic review by searching Medline, Embase, CINAHL, ERIC, CENTRAL, ProQuest Dissertations and Theses Global, BIOSIS Citation Index, and clinicaltrials.gov up to March 2023. Eligible primary studies had to assess one of the 6 predefined EBP competencies: formulating clinical questions; searching literature for best evidence; assessing studies for methodological quality; effect size; certainty of evidence for effects; and determining the applicability of study results considering patient values and preferences. Two reviewers independently screened articles and extracted data, and results were summarized for each EBP competency. RESULTS: We identified 12 eligible cross-sectional survey studies, comprising 1065 participants, primarily registered dietitians, across 6 countries, with the majority assessed in the United States (n = 470). The reporting quality of the survey studies was poor overall, with 43% of items not reported. Only 1 study (8%) explicitly used an objective questionnaire to assess EBP competencies. In general, the 6 competencies were incompletely defined or reported (e.g., it was unclear what applicability and critical appraisal referred to and what study designs were appraised by the participants). Two core competencies, interpreting effect size and certainty of evidence for effects, were not assessed. CONCLUSIONS: The overall quality of study reports was poor, and the questionnaires were predominantly self-perceived, as opposed to objective assessments. No studies reported on competencies in interpreting effect size or certainty of evidence, competencies essential for optimizing clinical nutrition decision-making. Future surveys should objectively assess core EBP competencies using sensible, specific questionnaires. Furthermore, EBP competencies need to be standardized across dietetic programs to minimize heterogeneity in the training, understanding, evaluation, and application among dietetics practitioners. This study was registered at PROSPERO as CRD42022311916.

SEEK™: A Program to Implement Evidence-Based Practice and Transform Oncology Nursing Practice.

BACKGROUND: Evidence-based practice (EBP) uses current and best evidence, clinical expertise, and patient values to drive clinical decisions. Organizations struggle with building and sustaining an EBP-focused culture. OBJECTIVES: This article shares the development and implementation of SEEK™ (Spirit of Inquiry, Expanding EBP Knowledge), an educational initiative on how to apply EBP processes at a Magnet®- and National Cancer Institute- designated comprehensive cancer center. METHODS: Participants learned principles of the EBP process using didactic sessions, small group exercises, and article critiques. With mentor guidance, participants searched for and appraised evidence, proposed interventions, designed an implementation plan, and developed metrics to measure results. FINDINGS: To date, 56 SEEK projects are in various stages of development and implementation. Based on postprogram survey results, SEEK participants and mentors demonstrated increased EBP knowledge.

A Study of Medical Surgical Nurses Leaders' Evidence-Based Practice Attributes: Critical Implications for Practice.

OBJECTIVE: The purpose of this study was to determine medical-surgical nurse leaders' evidence-based practice (EBP) attributes, perceived barriers to EBP, and whether there were differences in leaders' EBP competencies and EBP implementation by demographic and organizational factors. BACKGROUND: Leaders are crucial to the development of cultures that support EBP implementation, but little is known about medical-surgical nurse leaders' capacity to perform this aspect of their role. METHODS: A cross-sectional design using survey methodology was used. The survey contained demographic/work setting questions and 3 instruments to measure EBP beliefs, implementation, and competencies. RESULTS: Senior leaders self-reported higher EBP attributes compared with nurses in other roles; nurses with an MSN or higher reported greater frequency of EBP implementation. A regression revealed that EBP competencies, EBP beliefs, having a DNP degree, and working in an Academy of Medical-Surgical Nurses Premier Recognition In the Specialty of Med-surg unit or a Pathway to Excellence® organization had significant, positive effects on EBP implementation scores ( R2 = 0.37). CONCLUSIONS: Findings demonstrate there is a range of EBP beliefs and competencies, and barriers to EBP among medical-surgical nurse leaders. Because medical-surgical nursing is the largest acute care practice specialty in the United States and many other countries, leaders fully integrating EBP into their practice would be a substantial contribution to advancing EBP in healthcare.

Screening, prevention, and management of patients with poststroke depression in a tertiary hospital in China: a best practice implementation project.

INTRODUCTION: Poststroke depression (PSD) is common but insufficiently addressed by health professionals, and management is not always evidence-based. OBJECTIVES: This evidence implementation project aimed to improve adherence to evidence-based practice for screening, prevention, and management of patients with PSD in the neurology ward of the Fifth Affiliated Hospital of Zunyi Medical University, China. METHODS: This project was based on the JBI methodological approach and was conducted in three phases, from January to June 2021: a baseline audit, implementation of strategies, and a follow-up audit. We utilized the JBI Practical Application of Clinical Evidence System software and the Getting Research into Practice tools. Fourteen nurses, 162 stroke patients, and their caregivers participated in this study. RESULTS: The results of the baseline audit showed that compliance with evidence-based practice was poor, with 3/6 criteria showing 0% adherence and the other three audit criteria showing 5.7, 10.3, and 49.4% adherence, respectively. Through feedback to nurses regarding the baseline audit results, the project team identified five barriers and adopted a battery of strategies to overcome these barriers. The follow-up audit revealed significantly enhanced outcomes across all the best practice criteria, and the compliance of each criterion reached at least 80%. CONCLUSION: The implementation program designed to screen, prevent, and manage PSD in a tertiary hospital in China improved nurses' knowledge and compliance with evidence-based management of PSD. Further testing of this program in more hospitals is needed.

Evidence-based practice models and frameworks in the healthcare setting: a scoping review.

OBJECTIVES: The aim of this scoping review was to identify and review current evidence-based practice (EBP) models and frameworks. Specifically, how EBP models and frameworks used in healthcare settings align with the original model of (1) asking the question, (2) acquiring the best evidence, (3) appraising the evidence, (4) applying the findings to clinical practice and (5) evaluating the outcomes of change, along with patient values and preferences and clinical skills. DESIGN: A Scoping review. INCLUDED SOURCES AND ARTICLES: Published articles were identified through searches within electronic databases (MEDLINE, EMBASE, Scopus) from January 1990 to April 2022. The English language EBP models and frameworks included in the review all included the five main steps of EBP. Excluded were models and frameworks focused on one domain or strategy (eg, frameworks focused on applying findings). RESULTS: Of the 20 097 articles found by our search, 19 models and frameworks met our inclusion criteria. The results showed a diverse collection of models and frameworks. Many models and frameworks were well developed and widely used, with supporting validation and updates. Some models and frameworks provided many tools and contextual instruction, while others provided only general process instruction. The models and frameworks reviewed demonstrated that the user must possess EBP expertise and knowledge for the step of assessing evidence. The models and frameworks varied greatly in the level of instruction to assess the evidence. Only seven models and frameworks integrated patient values and preferences into their processes. CONCLUSION: Many EBP models and frameworks currently exist that provide diverse instructions on the best way to use EBP. However, the inclusion of patient values and preferences needs to be better integrated into EBP models and frameworks. Also, the issues of EBP expertise and knowledge to assess evidence must be considered when choosing a model or framework.

Climate for evidence-based mental health care implementation in Germany: psychometric investigation of the Implementation Climate Scale (ICS).

Organizational implementation climate is an important construct in implementation research to describe to what extent implementation is expected, supported, and rewarded. Efforts in bridging the research-practice gap by implementing evidence-based practice (EBP) can benefit from consideration of implementation climate. The Implementation Climate Scale (ICS) is a psychometrically strong measure assessing employees' perceptions of the implementation climate. The present cross-sectional study aimed at providing a German translation and investigating its psychometric properties. The translation followed standard procedures for adapting psychometric instruments. German psychotherapists (N = 425) recruited online completed the ICS, the Evidence Based Practice Attitudes Scale (EBPAS-36D) and the Intention Scale for Providers (ISP). We conducted standard item and reliability analyses. Factorial validity was assessed by comparing an independent cluster model of Confirmatory Factorial Analysis (ICM-CFA), a Bifactor CFA, a Second-order CFA and an (Bifactor) Exploratory Structural Equation Model (ESEM). Measurement invariance was tested using multiple-group CFA and ESEM, convergent validity with correlation analysis between the ICS and the ISP subjective norms subscale (ISP-D-SN). The mean item difficulty was pi = .47, mean inter-item correlation r = .34, and mean item-total correlation ritc = .55. The total scale (ω = 0.91) and the subscales (ω = .79-.92) showed acceptable to high internal consistencies. The model fit indices were comparable and acceptable (Second-order CFA: RMSEA [90% CI] = .077 [.069; .085], SRMR = .078, CFI = .93). Multiple-group CFA and ESEM indicated scalar measurement invariance across gender and presence of a psychotherapy license. Psychotherapists in training reported higher educational support for EBP than licensed psychotherapists (T = 2.09, p = .037, d = 0.25). The expected high correlation between the ICS and the ISP-D-SN was found (r = .59, p < .001). Results for the German ICS confirm good psychometric properties including validity.

How to Perform Economic Evaluation in Implementation Studies: Imaging-Specific Considerations and Comparison of Financial Models.

Economic evaluation for implementation science merits unique considerations for a local context, including the main audience of local decision makers. This local context is in contrast with traditional methods for developing coverage policy for medical tests and interventions, which typically emphasize benefits and costs more broadly, for society. Regardless of the strength of evidence backing the efficacy or effectiveness of a clinical intervention, local context is paramount when implementing evidence-based practices. Understanding the costs throughout the processes of implementing a program will inform the decision of whether to plan for and adopt the program, how to sustain the program, and whether to scale up widely. To guide economic evaluation for implementation of evidence-based imaging practices, we describe approaches that consider local stakeholders' needs and connect these with outcomes of cost and clinical utility. Illustrative examples of implementation strategies and economic evaluation are explored in areas of cancer screening and care delivery.

Evidence-based practice improves patient outcomes and healthcare system return on investment: Findings from a scoping review.

BACKGROUND: Evidence-based practice and decision-making have been consistently linked to improved quality of care, patient safety, and many positive clinical outcomes in isolated reports throughout the literature. However, a comprehensive summary and review of the extent and type of evidence-based practices (EBPs) and their associated outcomes across clinical settings are lacking. AIMS: The purpose of this scoping review was to provide a thorough summary of published literature on the implementation of EBPs on patient outcomes in healthcare settings. METHODS: A comprehensive librarian-assisted search was done with three databases, and two reviewers independently performed title/abstract and full-text reviews within a systematic review software system. Extraction was performed by the eight review team members. RESULTS: Of 8537 articles included in the review, 636 (7.5%) met the inclusion criteria. Most articles (63.3%) were published in the United States, and 90% took place in the acute care setting. There was substantial heterogeneity in project definitions, designs, and outcomes. Various EBPs were implemented, with just over a third including some aspect of infection prevention, and most (91.2%) linked to reimbursement. Only 19% measured return on investment (ROI); 94% showed a positive ROI, and none showed a negative ROI. The two most reported outcomes were length of stay (15%), followed by mortality (12%). LINKING EVIDENCE TO ACTION: Findings indicate that EBPs improve patient outcomes and ROI for healthcare systems. Coordinated and consistent use of established nomenclature and methods to evaluate EBP and patient outcomes are needed to effectively increase the growth and impact of EBP across care settings. Leaders, clinicians, publishers, and educators all have a professional responsibility related to improving the current state of EBP. Several key actions are needed to mitigate confusion around EBP and to help clinicians understand the differences between quality improvement, implementation science, EBP, and research.

Practices Among Local Public Health Agencies to Support Evidence-Based Decision Making: A Qualitative Study.

OBJECTIVES: Evidence-based decision making (EBDM) capacity in local public health departments is foundational to meeting both organizational and individual competencies and fulfilling expanded roles. In addition to on-the-job training, organizational supports are needed to prepare staff; yet, less is known in this area. This qualitative study explores supportive management practices instituted as part of a training and technical assistance intervention. DESIGN: This qualitative study used a semistructured interview guide to elicit participants' descriptions and perceptions via key informant interviews. Verbatim transcripts were coded and thematic analyses were conducted. SETTING: Local public health departments in a US Midwestern state participated in the project. PARTICIPANTS: Seventeen middle managers and staff from 4 local health departments participated in remote, audio-recorded interviews. INTERVENTION: Following delivery of a 3½-day in-person training, the study team met with health department leadership teams for department selection of supportive agency policies and procedures to revise or newly create. Periodic remote meetings included collaborative problem-solving, sharing of informational resources, and encouragement. MAIN OUTCOME MEASURES: Included management practices instituted to support EBDM and impact on day-to-day work as described by the interview participants. RESULTS: Leadership and middle management practices deemed most helpful included dedicating staff; creating specific guidelines; setting expectations; and providing trainings, resources, and guidance. Health departments with a preexisting supportive organizational culture and climat e were able to move more quickly and fully to integrate supportive management practices. Workforce development included creation of locally tailored overviews for all staff members and onboarding of new staff. Staff wanted additional hands-on skill-building trainings. Several worked with partners to incorporate evidence-based processes into community health improvement plans. CONCLUSIONS: Ongoing on-the-job experiential learning is needed to integrate EBDM principles into day-to-day public health practice. Management practices established by leadership teams and middle managers can create supportive work environments for EBDM integration.

Systematic education has a positive impact on nurses' evidence-based practice: Intervention study results.

AIMS: To evaluate how an education program on evidence-based practice (EBP) affected nurses´ knowledge, practices, and attitudes related to EBPs in patient care. METHODS: Nurses of one Finnish university hospital participated in two separate EBP education programs in 2016-2017 and 2018-2019. Data was collected by a questionnaire given before and after each program. Reliable instruments for measuring EBP were used: The Evidence-Based Practice Questionnaire (24 items) and the Attitudes to Evidence-Based Practice Questionnaire (17 items). Means and frequencies were evaluated with the Mann-Whitney U test and linear regression. RESULTS: Nurses reported that their EBP practice, skills and the Work based on EBPs improved substantially after the education program. We found that scores on the Work based on EBPs and the attitudes towards EBP could predict the nurses' overall self-evaluations of practices, attitudes, and skills. DISCUSSION: EBP education affects positively on implementation of nurses' practices and skills. There is still a need to change attitudes towards evidence based practice. IMPLICATIONS FOR PRACTICE, RESEARCH, POLICY, MANAGEMENT, AND EDUCATION: Organizations need to maintain and develop efficient, attractive EBP educational programs to promote lifelong learning. CONCLUSIONS: When designing EBP educational content, it is crucial to teach participants to develop evidence-based methods and consider how to implement them in practice.