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Facilitating the Implementation of EPC Reports in Learning Health Systems Engaged in Quality Initiatives: an EPC Pilot Project on ADHD

Research Report
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Purpose of Report

To evaluate and enhance the utility of an Evidence-based Practice Center (EPC) report by a health system engaged in QI (quality improvement).

Key Messages

  • We developed an implementation guide based on a published EPC report to support Learning Health Systems engaged in QI initiatives.
  • Post publication processing of EPC reports is needed to cater to a health system QI needs. It is difficult for EPC report authors to know in advance which information is most useful for a particular QI effort.
  • A product with narrow focus is critical for QI initiatives. EPC reports are large and cover a variety of interventions and outcomes. It is overwhelming to stakeholders to find and apply the information in QI initiatives.
  • Engagement of stakeholders is essential to determine what information is important to health systems at a given time.
  • Data need to be re-extracted from the studies included in the EPC report.
  • Additional sources of data from outside the report are commonly required. Cost information is a clear example.

Structured Abstract

Background. Evidence synthesis reports prepared by the Evidence-based Practice (EPC) program are critical to providing evidence for clinical practice and guideline development. However, from the perspective of a health system focused on quality improvement (QI), such large evidence reports with wide scope are difficult to implement within a QI initiative.

Methods. We consulted with two health systems to identify a published EPC report on a topic of interest to future quality initiatives. After identifying the target report on attention deficit hyperactivity disorder (ADHD), we gathered feedback from the health system to determine what information on ADHD treatments is the most relevant to their quality initiatives and the most useful way to deliver this information. We then developed a prototype product derived from the original EPC report, supplemented by newly abstracted contextual material from the included studies as well as outside resources. We presented the tool to representatives from two health systems and two parents of children with ADHD to obtain feedback and modify/enhance the product in an iterative fashion. A designer assisted in improving the usability, readability, and presentation of the product.

Results. Stakeholders requested practical information to support applying the findings of the evidence report, including a parent and family education guide, resources to recommend for parents, current best practices from leading practitioners, and advise on medication management. We developed a parent and family education guide that included example curricula based on three randomized trials identified by the report. Cost information was explicitly requested but was difficult to obtain. Health system stakeholders and parents of children valued the guide, suggesting possible new products for the EPC program. The lessons learned from this pilot project include; (1) Post publication processing of EPC reports is needed to cater to a health system QI needs, (2) A product with narrow focus is critical for QI initiatives, (3) Engagement of stakeholders is essential, (4) Data need to be re-extracted from included studies, and (5) Additional sources of data from outside the report are commonly required.

Conclusion. An implementation tool derived from an EPC report and developed with stakeholder feedback may facilitate implementation of evidence in a health system engaged in a quality improvement initiative.

Citation

Suggested citation: Morrow AS, Butler M, Murad MH. Facilitating the Implementation of EPC Reports in Learning Health Systems Engaged in Quality Initiatives: an EPC Pilot Project on ADHD. Methods Research Report. (Prepared by the Mayo Clinic and Minnesota Evidence-based Practice Center under Contract No. 290-2015-00013-I; 290-2015-00008-I.) AHRQ Publication No. 19(20)-EHC029-EF. Rockville, MD: Agency for Healthcare Research and Quality; October 2019. Posted final reports are located on the Effective Health Care Program search page.
DOI: http://doi.org/10.23970/AHRQEPCMETHQUALIMPRFACILITATING.