Effective Implementation of Research into Practice: An Overview of Systematic Reviews of the Health Literature

Boaz, A., Baeza, J., Fraser, A., Grimshaw, J., McAuley, L., et. al. (2011). Effective implementation of research into practice: An overview of systematic reviews of the health literature. BMC Research Notes, 4(1), 212. doi: 10.1186/1756-0500-4-212 
Background: The gap between research findings and clinical practice is well documented and a range of interventions has been developed to increase the implementation of research into clinical practice.
Findings: A review of systematic reviews of the effectiveness of interventions designed to increase the use of research in clinical practice. A search for relevant  systematic reviews was conducted of Medline and the Cochrane Database of Reviews 1998-2009. 13 systematic reviews containing 313 primary studies were included. Four strategy types are identified: audit and feedback; computerized decision support; opinion leaders; and multifaceted interventions. Nine of the reviews reported on multifaceted interventions. This review highlights the small effects of single interventions such as audit and feedback, computerised decision support and opinion leaders. Systematic reviews of multifaceted interventions claim an improvement in effectiveness over single interventions, with effect sizes ranging from small to moderate. This review found that a number of published systematic reviews fail to state whether the recommended practice change is based on the best available research evidence.
Conclusions: This overview of systematic reviews updates the body of knowledge relating to the effectiveness of key mechanisms for improving clinical practice and service development. Multifaceted interventions are more likely to improve practice than single interventions such as audit and feedback. This review identified a small literature focusing explicitly on getting research evidence into clinical practice. It emphasizes the importance of ensuring that primary studies and systematic reviews are precise about the extent to which the reported interventions focus on changing practice based on research evidence (as opposed to other information codified in guidelines and education materials).
This is a review of systematic review articles. It seeks to understand the best evidence on the ways that research can inform health practice. A systematic review is a powerful tool for KMb. A systematic review asks what the research literature says about a carefully crafted question. Systematic reviewers then systematically review all the literature on the question, frequently starting with thousands of titles and weeding out those that do not directly or rigorously answer the question resulting in a manageable number (often less than 100 papers) and synthesize the key lessons learned from the literature. John Lavis has written that policy or practice related decisions are best informed by actionable messages derived from bodies of knowledge or from systematic reviews (Lavis, J. N., Robertson, D., Woodside, J., McLeod, C. & Abelson J. (2003). How can research organizations more effectively transfer research knowledge to decision makers? The Milbank Quarterly, 81, 221-248).Systematic reviews have been championed by two international associations, the Cochrane Collaboration (health and medical sciences) and the Campbell Collaboration (research in social welfare, crime and justice, education,).
The authors reviewed 58 systematic reviews but could find only 13 that satisfied their rigid inclusion/exclusion criteria. These 13 systematic reviews looked at different methods for getting research into practice. This review of reviews found that:
Audit & feedback

  • Audit and feedback is a method that provides written or verbal feedback on clinical (or other) practice over time.
  • One systematic review found that audit and feedback was able to influence health practitioners’ prescribing and preventative care behaviours but had no effect on more complex tasks of chronic disease management and diagnosis

Computerized decision support

  • Computerized decision support uses electronic technologies to  help health care providers make decisions in a clinical setting.
  • Two systematic reviews had equivocal conclusions about the role of computerized decision support.

Opinion leaders

  • Opinion leaders are sought to influence the practice of physicians and health care providers.
  • One systematic review considered the role of opinion leaders.  “The authors suggest that opinion leaders can successfully promote evidence-based practice, however, the difficulty of identifying opinion leaders and the labour intensive nature of assessing their impact may limit the use of opinion leaders as a knowledge transfer intervention.”

Multifaceted interventions

  • Multifaceted interventions are interventions that embody multifaceted approaches…naturally.
  • The majority of systematic reviews reviewed multifaceted approaches but despite their predominance multifaceted approaches had only small to moderate effects.

In conclusion, the authors note that only 13 of 58 “systematic reviews looking exclusively and explicitly at implementing research findings into practice; conversely 43 reviews either focused on the implementation of non-evidenced based findings or were not explicit about the nature of the findings”. They also recognize that effectiveness studies (such as those reviewed by these systematic reviews) do not capture the complexity inherent in bridging the gap between research and practice. “A deeper understanding may be gained by complementing these studies with the findings from social science research that considers the important issues of context and process.”
Key Points for Discussion:

  1. It is important to realize that a multifaceted approach to bridging the research to practice gap is likely to produce a greater effect than a single intervention.  By extension (although this is subject to evaluation) any particular KMb opportunity will likely need multiple methodologies and approaches to maximize the impact of research on decision makers.
  2. The equivocal findings on computerized support align with our experience of KMb support services.  Electronic tools such as yaffle, social media and on line research summaries are tools that support but do not replace the role of the knowledge broker.

As a final thought, there are two schools of thought on the role of systematic reviews and KMb.  Some feel that systematic reviews are the most powerful format for linking evidence to practice since systematic reviewers provide the best research evidence on a question.  Others including RIR-York, agree that systematic reviews are a powerful tool but they have their limitations when considering KMb services and actions. Decision makers, particularly in a policy setting, cannot afford the12 months and $100,000 (the amount provided by CIHR for a systematic review grant) to find out what the literature says on a particular, narrowly construed question, especially when that answer often contains the recommendation that more research is required on the topic. Systematic reviews are important tools and brokers need to use them as on tool in our broker kit; however, look in Campbell and Cochrane and What Works Clearing House (for educations and learning outcomes) for a systematic review that might help your decision makers and then support that with other KMb activities.
RIR (ResearchImpact-RéseauImpactRecherche) is producing this journal club series as a way to make evidence on KMb more accessible to knowledge brokers and to create on line discussion about research on knowledge mobilization. It is designed for knowledge brokers and other knowledge mobilization stakeholders. Read this open access article. Then come back to this post and join the journal club by posting your comments.