Knowledge translation in health: how implementation science could contribute more.

Background: Despite increasing interest in research on how to translate knowledge into practice and improve healthcare, the accumulation of scientific knowledge in this field is slow. Few substantial new insights have become available in the last decade.

Main Body: Various problems hinder development in this field.

Evaluating Adherence to Guideline-Based Quality Indicators for Postpartum Hemorrhage Care in the Netherlands Using Video Analysis.

Objective: To assess adherence to the national postpartum hemorrhage guideline and Managing Obstetric Emergencies and Trauma course instructions and its determinants in the Netherlands.

Methods: A prospective observational multicenter study in 16 Dutch hospitals analyzing data from medical records of 398 women at high risk for postpartum hemorrhage, of which 293 were supplemented with data from prospective video recordings. Adherence to guideline-based quality indicators for prevention, management, and organization of postpartum hemorrhage care was measured.

Development of a tailored strategy to improve postpartum hemorrhage guideline adherence.

Background: Despite the introduction of evidence based guidelines and practical courses, the incidence of postpartum hemorrhage shows an increasing trend in developed countries. Substandard care is often found, which implies an inadequate implementation in high resource countries. We aimed to reduce the gap between evidence-based guidelines and clinical application, by developing a strategy, tailored to current barriers for implementation.

From Postpartum Haemorrhage Guideline to Local Protocol: A Study of Protocol Quality.

Objective Postpartum hemorrhage (PPH) has a continuously rising incidence worldwide, suggesting suboptimal care. An important step in optimizing care is the translation of evidence-based guidelines into comprehensive hospital protocols. However, knowledge about the quality of these protocols is lacking.

Influencing factors for high quality care on postpartum haemorrhage in the Netherlands: patient and professional perspectives.

Background: Postpartum haemorrhage (PPH) remains a major contributor to maternal morbidity even in high resource settings, despite the development and dissemination of evidence-based guidelines and Advance-Trauma-Life-Support (ATLS) based courses for optimal management of PPH. We aimed to assess current influencing factors (obstacles and facilitators) for the delivery of high quality PPH-care from both patient and professional perspective.

Methods: We qualitatively explored influencing factors for delivering high quality PPH-care, by having individual interviews with PPH-patients and focus group interviews with the different types of professionals working in the delivery room.

Guideline-based development of quality indicators for prevention and management of postpartum hemorrhage.

Introduction: To systematically develop a set of guideline-based quality indicators for postpartum hemorrhage (PPH) as a tool to measure guideline adherence in actual PPH care.

Material And Methods: A Rand-modified Delphi procedure was used to systematically achieve consensus among a panel of 22 experts on PPH care on recommendations extracted from evidence-based guidelines, Managing-Obstetrics-Emergencies-Trauma (MOET) instructions and international literature. The selected recommendations were individually rated on health gain (prevention of maternal mortality and morbidity) and overall efficiency by the expert panel.

The challenge of transferring an implementation strategy from academia to the field: a process evaluation of local quality improvement collaboratives in Dutch primary care using the normalization process theory.

Rationale, Aims And Objectives: A quality improvement strategy consisting of comparative feedback and peer review embedded in available local quality improvement collaboratives proved to be effective in changing the test-ordering behaviour of general practitioners. However, implementing this strategy was problematic. We aimed for large-scale implementation of an adapted strategy covering both test ordering and prescribing performance.

Understanding resident ratings of teaching in the workplace: a multi-centre study.

Providing clinical teachers with feedback about their teaching skills is a powerful tool to improve teaching. Evaluations are mostly based on questionnaires completed by residents. We investigated to what extent characteristics of residents, clinical teachers, and the clinical environment influenced these evaluations, and the relation between residents' scores and their teachers' self-scores.

The balanced incomplete block design is not suitable for the evaluation of complex interventions.

Objectives: In quality of care research, the balanced incomplete block (BIB) design is regularly claimed to have been used when evaluating complex interventions. In this article, we reflect on the appropriateness of using this design for evaluating complex interventions.

Study Design And Setting: Literature study using PubMed and handbooks.

What are the key ingredients for effective public involvement in health care improvement and policy decisions? A randomized trial process evaluation.

Context: In the past 50 years, individual patient involvement at the clinical consultation level has received considerable attention. More recently, patients and the public have increasingly been involved in collective decisions concerning the improvement of health care and policymaking. However, rigorous evaluation guiding the development and implementation of effective public involvement interventions is lacking.

Involving patients in setting priorities for healthcare improvement: a cluster randomized trial.

Background: Patients are increasingly seen as active partners in healthcare. While patient involvement in individual clinical decisions has been extensively studied, no trial has assessed how patients can effectively be involved in collective healthcare decisions affecting the population. The goal of this study was to test the impact of involving patients in setting healthcare improvement priorities for chronic care at the community level.

Implementing guidelines for depression on antidepressant prescribing in general practice: a quasi-experimental evaluation.

Background: Internationally, guidelines for depression recommend a stepped care approach, implying that antidepressant medication should not be offered as a first step treatment to patients with sub-threshold or mild depression. In the Netherlands, antidepressant prescribing rates in general practice as a first treatment step are considered to be high. The aim of this study was to evaluate the implementation of guideline recommendations on antidepressant prescribing.

Residents provide feedback to their clinical teachers: reflection through dialogue.

Background: Physicians play a crucial role in teaching residents in clinical practice. Feedback on their teaching performance to support this role needs to be provided in a carefully designed and constructive way.

Aims: We investigated an evaluation system for evaluating supervisors and providing formative feedback.

Follow-up after telephone consultations at out-of-hours primary care.

Background: After a contact with a primary care physician (PCP) cooperative for out-of-hours care, many patients have subsequent contact with health care. Little is known about the factors associated with these follow-up contacts. The objective of this study was to examine whether patient experiences with nurse telephone consultations and the cooperative's organizational characteristics were associated with the probability of follow-up contact.

Repeated evaluations of the quality of clinical teaching by residents.

Many studies report on the validation of instruments for facilitating feedback to clinical supervisors. There is mixed evidence whether evaluations lead to more effective teaching and higher ratings. We assessed changes in resident ratings after an evaluation and feedback session with their supervisors.

No identifiable Hb1Ac or lifestyle change after a comprehensive diabetes programme including motivational interviewing: a cluster randomised trial.

Objective: To study the effectiveness of a comprehensive diabetes programme in general practice that integrates patient-centred lifestyle counselling into structured diabetes care. Design and setting. Cluster randomised trial in general practices.

Explaining the effects of two different strategies for promoting hand hygiene in hospital nurses: a process evaluation alongside a cluster randomised controlled trial.

Background: There is only limited understanding of why hand hygiene improvement strategies are successful or fail. It is therefore important to look inside the 'black box' of such strategies, to ascertain which components of a strategy work well or less well. This study examined which components of two hand hygiene improvement strategies were associated with increased nurses' hand hygiene compliance.

Minimal improvement of nurses' motivational interviewing skills in routine diabetes care one year after training: a cluster randomized trial.

Background: The effectiveness of nurse-led motivational interviewing (MI) in routine diabetes care in general practice is inconclusive. Knowledge about the extent to which nurses apply MI skills and the factors that affect the usage can help to understand the black box of this intervention. The current study compared MI skills of trained versus non-trained general practice nurses in diabetes consultations.

Survey of 5 European countries suggests that more elements of patient-centered medical homes could improve primary care.

The patient-centered medical home is a US model for comprehensive care. This model features a personal physician or registered nurse who is augmented by a proactive team and information technology. Such a model could prove useful for advanced European systems as they strive to improve primary care, particularly for chronically ill patients.

Cost-effectiveness of a team and leaders-directed strategy to improve nurses' adherence to hand hygiene guidelines: a cluster randomised trial.

Background: Many strategies have been designed and evaluated to address poor hand hygiene compliance. Unfortunately, well-designed economic evaluations of hand hygiene improvement strategies are lacking.

Objective: To compare the cost-effectiveness of two successful implementation strategies for improving nurses' hand hygiene compliance and reducing hospital acquired infections (HAI's).

Cardiovascular risk management in patients with coronary heart disease in primary care: variation across countries and practices. An observational study based on quality indicators.

Background: Primary care has an important role in cardiovascular risk management (CVRM) and a minimum size of scale of primary care practices may be needed for efficient delivery of CVRM . We examined CVRM in patients with coronary heart disease (CHD) in primary care and explored the impact of practice size.

Methods: In an observational study in 8 countries we sampled CHD patients in primary care practices and collected data from electronic patient records.

Assessment of a pay-for-performance program in primary care designed by target users.

Background: Evidence for pay-for-performance (P4P) has been searched for in the last decade as financial incentives increased to influence behaviour of health care professionals to improve quality of care. The effectiveness of P4P is inconclusive, though some reviews reported significant effects.

Objective: To assess changes in performance after introducing a participatory P4P program.

A systematic review of hand hygiene improvement strategies: a behavioural approach.

Background: Many strategies have been designed and evaluated to address the problem of low hand hygiene (HH) compliance. Which of these strategies are most effective and how they work is still unclear. Here we describe frequently used improvement strategies and related determinants of behaviour change that prompt good HH behaviour to provide a better overview of the choice and content of such strategies.

Experiences of general practices with a participatory pay-for-performance program: a qualitative study in primary care.

The involvement of target users in the design choices of a pay-for-performance program may enhance its impact, but little is known about the views of participants in these programs. To explore general practices' experiences with pay-for-performance in primary care we conducted a qualitative study in general practices in the Netherlands. Thirty out of 65 general practices participating in a pay-for-performance program, stratified for bonus, were invited for a semistructured interview on feasibility, feedback and the bonus, spending of the bonus, unintended consequences, and future developments.

Impact of a team and leaders-directed strategy to improve nurses' adherence to hand hygiene guidelines: a cluster randomised trial.

Background: Improving hand hygiene compliance is still a major challenge for most hospitals. Innovative approaches are needed.

Objective: We tested whether an innovative, theory based, team and leaders-directed strategy would be more effective in increasing hand hygiene compliance rates in nurses than a literature based state-of-the-art strategy.