Integrating evidence-based practices into care processes

Closing the know-do gap between proven, high-impact interventions and their reliable implementation as part of everyday processes of care for every patient when needed is at the heart of improving the effectiveness of care, one of the six dimensions of quality defined by the Institute of Medicine.

Multiple studies demonstrate that even relatively simple clinical interventions, such as immediate post-partum administration of oxytocin to reduce risk of post-partum hemorrhage, require deliberate change efforts to integrate a best practice (i.e., an evidence-based standard) into a process of immediate post-partum care for every woman. Improving health care processes requires integrating content of care (proven best practices) into the improvement of care processes (Batalden & Stolz 1993).

A strong design of improvement efforts that clearly defines and prioritizes evidence-based best practices based on high-burden conditions is essential for improving health outcomes. The investment of resources in the initial design phase of an improvement effort pays dividends in the long run.

To achieve the aims, it is essential to define clear, measurable improvement aims, based on proven interventions for an important health or social problem, in association with a set of simple process and outcome measures to track whether progress is being made. Equally important is identifying specific local barriers to achieving the aims and deliberately planning tests of change to overcome these barriers.