Patterns of diffusion of evidence-based clinical programmes: a case study of the Hospital Elder Life Program
- 1Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, Connecticut, USA
- 2Aging Brain Center, Hebrew SeniorLife, Boston, Massachusetts, USA
- 3Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, Connecticut, USA
- 4Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, USA
- Correspondence to: E H Bradley Department of Epidemiology and Public Health, Yale School of Medicine, 60 College Street, New Haven, CT 06520-8034, USA;
- Accepted 30 July 2006
Background: The effective translation of scientific evidence into clinical practice is paramount to improving the quality and safety of patient care. However, little is known about the patterns of diffusion of evidence-based programmes in healthcare.
Objectives: To study the pattern of diffusion of an evidence-based programme to improve the quality and safety of care for hospitalised older adults.
Methods: The diffusion of the Hospital Elder Life Program (HELP), a multifaceted programme to reduce delirium in hospitalised adults, was examined. Using a survey of all hospitals that contacted the HELP Dissemination Project for more than 2 years, the proportion of hospitals that adopted the programme, the programme fidelity to the original design in terms of structure and process, and the perceived reasons for non-adoption were identified.
Results: Programme fidelity was highest among structural features (eg, staffing levels); programme modifications were more commonplace in processes of care (eg, the participation of volunteers in patient care interventions). Senior management support and the programme expense were the most commonly cited reasons for non-adoption of HELP.
Conclusion: Diffusion and take-up rates for this evidence-based programme were substantial; however, programme fidelity was not complete and some hospitals did not adopt the programme at all. Clinicians, researchers and funding agents seeking to promote effective translation of research should be realistic about diffusion rates and recognise the critical ingredient of senior management support to propel adoption of evidence-based programmes to improve quality and safety.
Funding: This research was supported by grants from the Commonwealth Fund (numbers 20000484 and 990912), the Retirement Research Foundation (number 99-361), the Alzheimer’s Foundation of America, The Institute for Incentives in Health Care, The National Library of Medicine (G08LM08085) and the Claude D Pepper Older Americans Independence Center at Yale (number P30AG21342). EHB is supported in part by the Patrick and Catherine Weldon Donaghue Medical Research Foundation (no DF02-102 and no DF98-105). SKI is also supported partly by grants from the National Institute on Aging (numbers R21AG025193 and K24AG00949).
Competing interests: None.