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10 Dissemination and Implementation
Pages 221-236

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From page 221...
... However, such efforts are imperative in order to improve the quality of care, patient outcomes, and population health. Several reports of the Institute of Medicine describe opportunities for the implementation of evidence to improve population health and health care delivery (IOM, 2009, 2011a,b, 2012, 2013, 2015)
From page 222...
... In some cases, however, a sufficient research base may not be available, and health care decision making relies on other evidence sources, such as scientific principles, case reports, and outcomes of quality improvement projects. Dissemination research in health is the scientific study of the targeted distribution of evidence-based information and intervention materials to specific public health or clinical practice audiences with the intent of spreading and sustaining knowledge use and evidence-based interventions (HHS, 2018)
From page 223...
... . The challenges facing implementation include the inconsistent terminology used in naming and defining implementation strategies, the lack of an agreedupon taxonomy, and the variations in how the implementation strategies are operationalized (e.g., who is targeted, who delivers it, temporality)
From page 224...
... . Reminders embedded in electronic health records have small to modest effects on clinician behavior and appear to be more effective when included as part of multi-faceted implementation strategies than when used alone (Anderson and Titler, 2019)
From page 225...
... . Implementation strategies that have demonstrated effectiveness in improving evidence-based practices of the users include performance gap assessment, audit and feedback, trying the evidence-based practice, engaging with the recipients of the evidence-based practices to address their values and preferences (e.g., shared decision making)
From page 226...
... When engaging patients, families, groups, and communities in health care decision making, it is important to be attuned to health literacy, health numeracy, and primary language. Health literacy, or the ability to understand written information about health, and health numeracy, the ability to understand quantitative data or information presented as numbers or graphs, are important for health care decision making.
From page 227...
... When selecting communication strategies, it is important to be clear about the types of audiences to be reached and the information sources they use. This section describes the following communication strategies to promote implementation: • Mass media and social media • Education • Opinion leadership and change champions • Educational outreach Mass Media and Social Media Mass media and social media can help to address the initial steps of implementation -- knowledge and shared understanding.
From page 228...
... 228 FIGURE 10-2 Stages of the decision-making process. SOURCE: Rogers, 2003.
From page 229...
... More research using rigorous designs is needed to fully explicate the impact of social media on improving the knowledge, skills, and application of evidence in health care. When using social and mass media, the considerations about messaging include knowing the audience, defining the customer, specifying the message and framing it, and selecting the communication channels (Brownson et al., 2018a; Steensma et al., 2018)
From page 230...
... . There is moderate evidence that educational meetings that include both didactic and interactive learning are more effective in aligning professional practice behaviors with the evidence-based practices than didactic meetings alone or interactive learning alone (Forsetlund et al., 2009)
From page 231...
... For example, if an evidence-based practice tool to assess social isolation is being implemented across multiple primary care practices in a health system, to implement the practice, one nurse and one physician opinion leader could work across the practice sites in collaboration with change champions who are located in each primary care setting. This will be key to the implementation of Recommendation 7-1 (assessing for social isolation and loneliness)
From page 232...
... . The organizational capacity needed includes strong leadership, a clear strategic vision, good managerial relationships, visionary staff in key positions, a climate conducive to experimentation and risk taking, and effective systems for data capture and transforming data into information (Brownson et al., 2018b; Riley et al., 2018; Titler and Anderson, 2019)
From page 233...
... . Clinical information systems may need to be revised in order to support practice changes; documentation systems that fail to readily support the new practice thwart change (IOM, 2011b)
From page 234...
...   1. Use implementation strategies that address the needs and context of the organization.
From page 235...
... As the evidence base for effective interventions in health care settings for social isolation and loneliness in older adults is improved (as discussed in previous chapters) , consideration of best practices for dissemination and implementation of this information is needed both in the planning of the intervention to be tested as well as in consideration of any implementation plan.


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