From Evidence to Action: Implementing Cochrane Systematic Reviews Into Clinical Practice
One of the tenets of Cochrane’s knowledge translation strategy is to encourage policy makers and healthcare managers to integrate Cochrane evidence into clinical practice. Cochrane reviews are among the most valuable, high-quality sources of evidence for improving quality and care delivery, but strategies used by healthcare organizations to implement the findings of these reviews are less well-understood.
Objectives: To describe the knowledge translation and implementation strategies used by Kaiser Permanente Southern California, a healthcare delivery system serving more than 4.6 million patients, and the Evidence Scanning for Clinical, Operational and Practice Efficiencies (E-SCOPE) program, to integrate Cochrane systematic reviews into clinical practice.
Methods: E-SCOPE staff identify published Cochrane reviews through searches of the Cochrane library and other scientific databases. A priority is placed on identifying high-quality Cochrane reviews of diagnostic and therapeutic interventions that yield improved health outcomes, quality, and/or efficiency of care delivery. E-SCOPE staff then work closely with clinical and operational stakeholders to interpret and translate Cochrane evidence into a feasible implementation plan, leveraging existing organizational processes and resources. E-SCOPE project managers oversee implementation efforts, facilitate practice owner identification, and as needed, create measurement plans utilizing data drawn from electronic health systems and other data sources.
Results: The E-SCOPE program has implemented 18 practices based on results from Cochrane systematic reviews to improve the overall quality of care provided to patients. The time from review publication to implementation averages 16 months (ranging from 4 to 36 months).
Conclusions: E-SCOPE enhances Cochrane knowledge translation processes by making optimal use of Cochrane reviews, translating the evidence and findings to clinical stakeholders, and leveraging existing organizational channels for practice implementation. Prioritizing the identification of practices with an established, high-quality, and high-confidence evidence base is generalizable and can efficiently and effectively promote adoption of Cochrane reviews within any healthcare system. Approaches to knowledge translation prioritizing Cochrane systematic reviews have the capacity to significantly improve the quality and delivery of patient care. Examples of Cochrane review-based E-SCOPE initiatives will be discussed. Patient, public, and/or healthcare consumer involvement: Patient values and preferences are key determining factors in every implementation plan undertaken by E-SCOPE.