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Evidence-Based Medicine

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Organizational research can help clinicians make decisions about staff and IT systems

Two recently published articles by Irene Fraser, Ph.D., director of the Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, focus on using evidence to improve health care quality and safety. Dr. Fraser notes that in order to improve the quality of care, changes will be necessary in the organization of care and the payment systems that shape organizational priorities and behavior. By bringing potential users (hospital, health plan, and clinical leaders) into the research process, organizational research can help shape priorities and behavior at the organizational level, explains Dr. Fraser. AHRQ currently has three delivery-based networks that follow this approach: the Primary Care Practice-Based Research Network, the HIV Research Network, and the Integrated Delivery System Research Network.

Organizational research in nursing has already demonstrated that higher nurse staffing levels can improve care quality, improved information technology (IT) can free up nursing time, and use of dedicated AIDS units in hospitals can improve care for that patient group. Similar organizational research is needed to inform other high-priority questions, such as how to ensure good chronic care, how systems can best collaborate in the event of a bioterrorism attack, how to successfully implement a new IT system to reduce errors, and which kinds of financial and other incentives can improve quality of care.

AHRQ held six meetings between 2001 and 2003 with researchers and stakeholders (hospital, health plan, and provider leaders) to identify ways in which organizational, management, and policy research could be improved to maximize the likelihood that it will be translated into clinical practice. Stakeholders recommended designing studies to answer user questions with a focus on the "why" and "what if" rather than just the "what." Findings should be presented in leaders' time and space, defining evidence as they do, and identifying the generalizability of findings.

The incentive system for researchers should be changed to reward them for activities that maximize impact on decisionmaking. User-researcher collaborations and dialogue should be built. Finally, the way evidence is disseminated should change, with dissemination going through "early adopters," trade association meetings, consultants, and other avenues. In a second article, Dr. Fraser identifies steps to advance translation research and to achieve broader translation and use of evidence.

For details of both articles, see "Organizational research with impact: Working backwards," and "Translation research: Where do we go from here?" by Dr. Fraser, in the Third Quarter 2004 Worldviews on Evidence-Based Nursing 1(S1), pp. S52-S59, S78-S83.

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