Research, evidence and quality improvementJennifer Tieman, CareSearch DirectorDeb Rawlings, CareSearch Research Fellow

PCNA, April 2014

Overview• Why does this matter• Differences and synergies • CareSearch approaches and strategies• CareSearch evaluation studies• Implications

Why this matters

“Between the healthcare we have and the care we could have lies not a

gap but a chasm”.Institute of Medicine, Crossing the Quality Chasm, 2001

Adapted from North Dakota Centre for Nursing Comparison of Evidence based Practice, Quality Improvement and Nursing Research, December 2013

Comparison of EBP, QI and Research

QI EBP Research

Definition Evaluate effectiveness of current process and improve care processes locally

Integration of research evidence into clinical decision

Formal, systematicinquiry to generate knowledge

Purposes Bring about improvement in this settingCompare to standards or benchmarks

Translate research into practiceIncrease effectiveness of treatment

Answer a research questionGenerate new knowledge

Methods PDSA PICO/PICOT Scientific methods

Independent or complementary?

Adapted from Glasziou, Ogrinc & Goodman 2011 Can evidence based medicine and clinical quality improvement learn from each other? BMJ Qual Saf 20:113-117

Clinical decisionsDo right things (EBP)

Process and system change Do things right

(QI)

Good patient careDo right things right (EBP & QI)

Nurses’ roles• Nursing practice

– Expectations as to knowledge and competency in QI, EBP and research

• Specific roles– QI activities (eg NSAP, PCOC)– Research studies (eg PaCCSC)– EBP (eg journal clubs)

CareSearch Strategies• Making evidence accessible

– PubMed Searches– Clinical Evidence

• Encouraging evidence use– Nurses Hub (and Nurses Hub News)– My Learning

• Partnerships in QI– WTCF– Information on QI

• Supporting research – RDMS– Research Resources

Evaluation Studies• RDMS• Nurses Hub• Search Filters• WTCF

Nurses Hub• Nurses Hub

– Evidence and resources contextualised for, and specific to, nurses

– All settings of care• Study Methodology

– Online survey (n=233)– Stakeholder interviews (n=10)

• Key Findings– ¾ of respondents had used information found on Hub– 30% said information had assisted them in making changes in their

practice– Issues reported relating to access to technology and time for EBP and

literature

RDMS• RDMS

– Online data collection system– Facilitates multisite research

• Study Methodology– User survey (n=44)– Stakeholder interviews (n=10)

• Key Findings– Cost savings provided by a common resource– Research value of ability to have multiple site data entry– Helps to focus and professionalise research

Search Filters• PubMed Topic Searches

– Brokered access to literature– Facilitate evidence use

• Study Methodology– Online survey (n=82)

• Key Findings– 1/3 look for information daily– 95% indicated that PubMed searches found information they

hadn’t seen– Less than 1/3 felt their own personal search would have

found the same information

WTCF• Partnership

– NSAP, PCOC, CareSearch– WTCF (Structured approach to

quality improvement activity that incorporates evidence)

• Study Methodology– Workshop evaluation (n=81)

• Key Findings– 86% felt the content was relevant to needs in QI– 70% of workshop participants felt more confident in

implementing change

So What?• Nurses face increasing demands in practice and

expectations around knowledge and skills in EBP, research and QI

• CareSearch has developed evidence based resources and supports for those providing direct clinical care

• CareSearch is working to support the processes and activities that underpin research, QI and EBP

• CareSearch runs an evaluation program to assess whether these strategies and approaches are effective

CareSearch would like to thank the many people who contribute their time and expertise to the project, including members of the National Advisory Group and the Knowledge Network Management Group.

CareSearch is funded by the Australian Government Department of Health.

www.caresearch.com.au