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  1. Diana Blair-Fish

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    This journal scan covers a selection of papers relating to the quality of health care in general. They were chosen from papers identified by a MEDLINE search for English language articles with abstracts relating to “quality improvement” and published from June to August 2000 inclusive in the following journals: BMJ, JAMA, Journal of Advanced Nursing, Journal of Nursing Care Quality, Lancet, and New England Journal of Medicine.

    Getting evidence based health care into practice

    Evaluating interventions for getting clinical evidence into practice among groups of health care staff and promoting organisational change have been less encouraging in randomised controlled trials than initial observational studies. Through evaluation and discussion of an exploratory trial in general practice, Rogers et al produced a detailed analysis of issues arising in such studies and a summary framework that offers an approach to successful trial design in primary care.

    Rogers S, Humphrey C, Nazareth I, et al. Designing trials of interventions to change professional practice in primary care: lessons from an exploratory study of two change strategies.

    BMJ 2000;320:1580–3.

    Abstract adapted from original article.

    Objective—To determine whether inherent difficulties in randomised controlled trials might influence evaluation of interventions for getting clinical evidence into practice.

    Design—Exploratory randomised controlled trial, with a factorial design, of the independent and combined effects of teaching evidence based medicine and facilitated change management on implementation of cardiovascular disease guidelines in primary care. All practices were sent guidelines on five cardiovascular disease topics then allocated to evidence based medicine teaching, facilitated change management, both, or neither by using a restricted randomisation procedure.

    Participants—Eight of 25 eligible practices in the Medical Research Council General Practice Research Framework in North West Thames, England.

    Interventions—One day practice based workshop on evidence based medicine (appraisal of trials, systematic reviews, guidelines) based on workshops developed at McMaster University, and facilitated change management programme comprising a one day workshop introducing principles of continuous quality improvement as taught at the Institute for Health care Improvement (change management, …

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