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Measures for assessing practice change in medical practitioners.
Sharon Hakkennes1, Sally Green
1School of Physiotherapy, La Trobe University, Victoria, Australia. sharonh@barwonhealth.org.au
Implementation Science : IS
|December 8, 2006
Summary
Most studies on changing clinical practice focus on health practitioners' behavior and knowledge, not patient outcomes. Future research should prioritize measuring the impact of interventions on patient health status.
Area of Science:
- Health Services Research
- Clinical Practice Improvement
- Evidence-Based Practice Implementation
Background:
- Growing number of randomized trials and systematic reviews evaluate interventions for clinical practice change.
- Research findings guide strategies for increasing the uptake of evidence into clinical practice.
- Understanding measured outcomes is crucial for interpreting current research, informing future studies, and facilitating systematic reviews and meta-analyses.
Purpose of the Study:
- To identify methods used to measure changes in health professionals' clinical practices after interventions.
- To analyze outcome measures in trials focused on implementing evidence into practice.
- To assess the scope of outcome measurement in clinical practice change research.
Main Methods:
- Systematic review of 228 trials from a Health Technology Assessment on implementing clinical practice guidelines.
- Data extraction focused on methods and results sections of included trials.
- Standardized data extraction form used by a single reviewer.
Main Results:
- Health practitioner behavior change was the most common outcome measure (88.8%).
- Patient-level changes (actual or surrogate) were measured in 28.8% and 36.7% of studies, respectively.
- Health practitioner knowledge/attitudes (22.8%) and organizational changes (17.6%) were also assessed.
Conclusions:
- Most trials measure intervention effects at the practitioner level (behavior, knowledge, or attitude).
- Less than one-third of trials assessed whether practice changes led to improved patient health status.
- There is a need to prioritize patient health status as an outcome in clinical practice change research.
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