TRANSLATING RESEARCH INTO PRACTICE

The translation of research into practice requires the integration of three processes: disseminating research evidence to the clinician, critically analyzing such evidence, and applying such evidence to practice. The latter two steps are embedded in EBP and are discussed later in this chapter.

Historically, there have been several models (diffusion, systematic reviews, industrial commodity, system engineering, and social innovation) that were developed to explain how research evidence reaches the clinician and to identify how this evidence translates into practice (Scott, 2007). The early diffusion model depicts information from journals and conferences as being transferred by "osmosis." The stronger the evidence, the more likely it was that research would filter down to the practitioner and find its way into practice. Unfortunately, this method did not assist the clinician in applying the evidence to the clinical arena.

Systematic reviews, meta-analyses, and clinical guidelines were developed to simplify the process. Experts would analyze and summarize the research and make recommendations, thus facilitating the application of the evidence into practice. Some practitioners resisted the application of guidelines because there was not always consensus among experts and some clinicians believed the guidelines were prescriptive and did not allow for patient variability.

The industrial commodity approach, like clinical practice guidelines, was an effort to distribute information and improve its use in clinical practice. Health care industry stakeholders (e.g., regulatory and insurance agencies) used case reviews, audits, and educational outreach programs to change clinical practice. Change was sometimes avoided because providers thought they were no longer in control of health care decisions.

Systems engineering, the utilization of early electronic information systems to improve access to information, did not interface well with clinical practices; their reliability came into question, and individual adoption of this methodology was limited. Recently this model has received a great deal of attention (Squires et al, 2011).

Social innovation, examines the motivators of behavior change within social systems, utilizing the characteristics of change and social learning to distribute new information and facilitate its application to practice. In essence, this model assesses the provider's readiness for change and tailors an educational program and materials with this variable in mind. Additionally, opinion leaders, peer networks, and key players in social networks (e.g., patients, insurers, administrators) are used to influence provider behavior. Interestingly, there is strong evidence that patient-mediated interventions or patient/consumer education is a powerful motivator for change.

In general, the failure of these models to change practice may be related to the "disconnect" between research and implementation into practice. Some research is not clinically relevant, and other research is preliminary or done with unsound methodology (Dogherty, Harrison, Graham, Vandyk, & Keeping-Burke, 2013). When the research is clinically relevant and methodologically sound, there can still be separation between research and practice. Several variables such as sample characteristics, the lack of comparisons, and the feasibility of the interventions contribute to the failure of adopting and applying research evidence to practice. From a clinician's viewpoint, "the right patients," or representative patients (e.g., ethnic and racial minorities, the underserved), are often excluded from clinical trials (Koh et al., 2010), and most intervention trials are all or none (e.g., treatment versus placebo) rather than comparisons of less expensive alternatives.

One missing component in the aforementioned models is knowledge translation, which is described as a "dynamic and iterative process that includes synthesis, dissemination, exchange, and ethically-sound application of knowledge to improve the health" (Menear, Grindrod, Clouston, Norton, & Legare, 2012, p. 623). Knowledge translation enables the clinician to view the research from a socioeconomic and cultural perspective rather than from a disease state. Furthermore, it facilitates the application of research to practice.

Another factor that may be absent is the flow of information. Typically, research flows from the researcher to the clinician when it should be bidirectional (Carpenter et al., 2012). Practitioners should be active in identifying salient issues found in clinical practice that researchers should address. Researchers should seek input from clinicians to design research studies to examine relevant questions and models for imp lementation.

Another component is the disconnect between the community-based physician and academic research centers. However, in 2000, Congress charged the Agency for Healthcare Research and Quality (AHRQ) with assisting in the development of primary care practice-based research networks (PBRNs) to close the "reality gap" between the clinical evidence and what clinicians and patients want to know (AHRQ, 2012; Carpenter et al, 2012). PBRNs are collaborative relationships between academic centers and community-based practitioners. Although PBRNs are primarily comprised of physician networks, APRN networks also exist (American Academy of Nurse Practitioner Network for Research, Advanced Practice Nurse-Ambulatory Research Consortium, and Advanced Practice Nurse Research Network, ahrq.gov). PBRNs are a source for ongoing health services research, clinical research, and prevention research that is specific to a community or state. These forums for research improve its relevance to patients and clinicians and ease the transfer of clinical data into clinical practice.

Finally, with a refinement and resurgence in the use of information, technology systems may facilitate the transfer of research and guide implementation into practice. Recently, expansion of the utilization of electronic medical records and Web 2.0 applications can be the new tools for the transfer of research to practice to providers and consumers (Bernhardt, Mays, & Kreuter, 2011). Web 2.0 technologies have the capability to share information through electronic messaging, video conferencing, and blogs. Social networking (Twitter, wikis, Facebook, Linkedln, etc.) is another Web 2.0 application that can connect clinical researchers, clinicians, consumers, and policy makers (Bernhardt et al., 2011).

 
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