Effectiveness of knowledge brokering and recommendation dissemination for influencing healthcare resource allocation decisions: A cluster randomised controlled implementation trial

<h4>Background</h4> Implementing evidence into clinical practice is a key focus of healthcare improvements to reduce unwarranted variation. Dissemination of evidence-based recommendations and knowledge brokering have emerged as potential strategies to achieve evidence implementation by i...

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Autores principales:	Mitchell N. Sarkies, Lauren M. Robins, Megan Jepson, Cylie M. Williams, Nicholas F. Taylor, Lisa O’Brien, Jenny Martin, Anne Bardoel, Meg E. Morris, Leeanne M. Carey, Anne E. Holland, Katrina M. Long, Terry P. Haines
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/620ac6ab03c54d4298df82d9c70b2283
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institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Mitchell N. Sarkies Lauren M. Robins Megan Jepson Cylie M. Williams Nicholas F. Taylor Lisa O’Brien Jenny Martin Anne Bardoel Meg E. Morris Leeanne M. Carey Anne E. Holland Katrina M. Long Terry P. Haines Effectiveness of knowledge brokering and recommendation dissemination for influencing healthcare resource allocation decisions: A cluster randomised controlled implementation trial
description	<h4>Background</h4> Implementing evidence into clinical practice is a key focus of healthcare improvements to reduce unwarranted variation. Dissemination of evidence-based recommendations and knowledge brokering have emerged as potential strategies to achieve evidence implementation by influencing resource allocation decisions. The aim of this study was to determine the effectiveness of these two research implementation strategies to facilitate evidence-informed healthcare management decisions for the provision of inpatient weekend allied health services. <h4>Methods and findings</h4> This multicentre, single-blinded (data collection and analysis), three-group parallel cluster randomised controlled trial with concealed allocation was conducted in Australian and New Zealand hospitals between February 2018 and January 2020. Clustering and randomisation took place at the organisation level where weekend allied health staffing decisions were made (e.g., network of hospitals or single hospital). Hospital wards were nested within these decision-making structures. Three conditions were compared over a 12-month period: (1) usual practice waitlist control; (2) dissemination of written evidence-based practice recommendations; and (3) access to a webinar-based knowledge broker in addition to the recommendations. The primary outcome was the alignment of weekend allied health provision with practice recommendations at the cluster and ward levels, addressing the adoption, penetration, and fidelity to the recommendations. The secondary outcome was mean hospital length of stay at the ward level. Outcomes were collected at baseline and 12 months later. A total of 45 clusters (n = 833 wards) were randomised to either control (n = 15), recommendation (n = 16), or knowledge broker (n = 14) conditions. Four (9%) did not provide follow-up data, and no adverse events were recorded. No significant effect was found with either implementation strategy for the primary outcome at the cluster level (recommendation versus control β 18.11 [95% CI −8,721.81 to 8,758.02] p = 0.997; knowledge broker versus control β 1.24 [95% CI −6,992.60 to 6,995.07] p = 1.000; recommendation versus knowledge broker β −9.12 [95% CI −3,878.39 to 3,860.16] p = 0.996) or ward level (recommendation versus control β 0.01 [95% CI 0.74 to 0.75] p = 0.983; knowledge broker versus control β −0.12 [95% CI −0.54 to 0.30] p = 0.581; recommendation versus knowledge broker β −0.19 [−1.04 to 0.65] p = 0.651). There was no significant effect between strategies for the secondary outcome at ward level (recommendation versus control β 2.19 [95% CI −1.36 to 5.74] p = 0.219; knowledge broker versus control β −0.55 [95% CI −1.16 to 0.06] p = 0.075; recommendation versus knowledge broker β −3.75 [95% CI −8.33 to 0.82] p = 0.102). None of the control or knowledge broker clusters transitioned to partial or full alignment with the recommendations. Three (20%) of the clusters who only received the written recommendations transitioned from nonalignment to partial alignment. Limitations include underpowering at the cluster level sample due to the grouping of multiple geographically distinct hospitals to avoid contamination. <h4>Conclusions</h4> Owing to a lack of power at the cluster level, this trial was unable to identify a difference between the knowledge broker strategy and dissemination of recommendations compared with usual practice for the promotion of evidence-informed resource allocation to inpatient weekend allied health services. Future research is needed to determine the interactions between different implementation strategies and healthcare contexts when translating evidence into healthcare practice. <h4>Trial registration</h4> Australian New Zealand Clinical Trials Registry ACTRN12618000029291. In a cluster randomized controlled implementation trial, Dr. Mitchell N Sarkies and colleagues examine the effectiveness of knowledge brokering and recommendation dissemination in influencing healthcare resource allocation decisions in Australia and New Zealand. Author summary <h4>Why was this study done?</h4> Healthcare delivery does not always reflect the most up-to-date research evidence. There are high levels of evidence to suggest that inpatient allied health services provided during weekends achieve greatest benefits in subacute rehabilitation wards. Most weekend allied health services are provided to acute general medical and surgical wards, where there is uncertain evidence of impact. Translation of evidence into practice is constrained by a limited understanding of which implementation strategies are most effective for specific settings. <h4>What did the researchers do and find?</h4> We conducted a cluster randomised controlled implementation trial to compare the effectiveness of two research implementation strategies across 132 hospitals in Australia and New Zealand. We provided hospital managers with either evidence-based weekend allied health practice recommendations or access to a knowledge broker in addition to the recommendations, over a 12-month period. Neither implementation strategy was able to be shown effective for ensuring better alignment of weekend allied health provision with practice recommendations; no impacts on hospital length of stay were identified. <h4>What do the findings mean?</h4> Evidence dissemination and knowledge brokering are thought to facilitate the translation of research evidence into practice. Our study was unable to find whether either of these strategies substantially influenced weekend allied health service decision-making by hospital managers. It is possible to study the impact of research implementation using robust trial designs; however, challenges achieving adequate statistical power are a barrier to these evaluations.
format	article
author	Mitchell N. Sarkies Lauren M. Robins Megan Jepson Cylie M. Williams Nicholas F. Taylor Lisa O’Brien Jenny Martin Anne Bardoel Meg E. Morris Leeanne M. Carey Anne E. Holland Katrina M. Long Terry P. Haines
author_facet	Mitchell N. Sarkies Lauren M. Robins Megan Jepson Cylie M. Williams Nicholas F. Taylor Lisa O’Brien Jenny Martin Anne Bardoel Meg E. Morris Leeanne M. Carey Anne E. Holland Katrina M. Long Terry P. Haines
author_sort	Mitchell N. Sarkies
title	Effectiveness of knowledge brokering and recommendation dissemination for influencing healthcare resource allocation decisions: A cluster randomised controlled implementation trial
title_short	Effectiveness of knowledge brokering and recommendation dissemination for influencing healthcare resource allocation decisions: A cluster randomised controlled implementation trial
title_full	Effectiveness of knowledge brokering and recommendation dissemination for influencing healthcare resource allocation decisions: A cluster randomised controlled implementation trial
title_fullStr	Effectiveness of knowledge brokering and recommendation dissemination for influencing healthcare resource allocation decisions: A cluster randomised controlled implementation trial
title_full_unstemmed	Effectiveness of knowledge brokering and recommendation dissemination for influencing healthcare resource allocation decisions: A cluster randomised controlled implementation trial
title_sort	effectiveness of knowledge brokering and recommendation dissemination for influencing healthcare resource allocation decisions: a cluster randomised controlled implementation trial
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/620ac6ab03c54d4298df82d9c70b2283
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spelling	oai:doaj.org-article:620ac6ab03c54d4298df82d9c70b22832021-11-11T05:41:36ZEffectiveness of knowledge brokering and recommendation dissemination for influencing healthcare resource allocation decisions: A cluster randomised controlled implementation trial1549-12771549-1676https://doaj.org/article/620ac6ab03c54d4298df82d9c70b22832021-10-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8570499/?tool=EBIhttps://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4> Implementing evidence into clinical practice is a key focus of healthcare improvements to reduce unwarranted variation. Dissemination of evidence-based recommendations and knowledge brokering have emerged as potential strategies to achieve evidence implementation by influencing resource allocation decisions. The aim of this study was to determine the effectiveness of these two research implementation strategies to facilitate evidence-informed healthcare management decisions for the provision of inpatient weekend allied health services. <h4>Methods and findings</h4> This multicentre, single-blinded (data collection and analysis), three-group parallel cluster randomised controlled trial with concealed allocation was conducted in Australian and New Zealand hospitals between February 2018 and January 2020. Clustering and randomisation took place at the organisation level where weekend allied health staffing decisions were made (e.g., network of hospitals or single hospital). Hospital wards were nested within these decision-making structures. Three conditions were compared over a 12-month period: (1) usual practice waitlist control; (2) dissemination of written evidence-based practice recommendations; and (3) access to a webinar-based knowledge broker in addition to the recommendations. The primary outcome was the alignment of weekend allied health provision with practice recommendations at the cluster and ward levels, addressing the adoption, penetration, and fidelity to the recommendations. The secondary outcome was mean hospital length of stay at the ward level. Outcomes were collected at baseline and 12 months later. A total of 45 clusters (n = 833 wards) were randomised to either control (n = 15), recommendation (n = 16), or knowledge broker (n = 14) conditions. Four (9%) did not provide follow-up data, and no adverse events were recorded. No significant effect was found with either implementation strategy for the primary outcome at the cluster level (recommendation versus control β 18.11 [95% CI −8,721.81 to 8,758.02] p = 0.997; knowledge broker versus control β 1.24 [95% CI −6,992.60 to 6,995.07] p = 1.000; recommendation versus knowledge broker β −9.12 [95% CI −3,878.39 to 3,860.16] p = 0.996) or ward level (recommendation versus control β 0.01 [95% CI 0.74 to 0.75] p = 0.983; knowledge broker versus control β −0.12 [95% CI −0.54 to 0.30] p = 0.581; recommendation versus knowledge broker β −0.19 [−1.04 to 0.65] p = 0.651). There was no significant effect between strategies for the secondary outcome at ward level (recommendation versus control β 2.19 [95% CI −1.36 to 5.74] p = 0.219; knowledge broker versus control β −0.55 [95% CI −1.16 to 0.06] p = 0.075; recommendation versus knowledge broker β −3.75 [95% CI −8.33 to 0.82] p = 0.102). None of the control or knowledge broker clusters transitioned to partial or full alignment with the recommendations. Three (20%) of the clusters who only received the written recommendations transitioned from nonalignment to partial alignment. Limitations include underpowering at the cluster level sample due to the grouping of multiple geographically distinct hospitals to avoid contamination. <h4>Conclusions</h4> Owing to a lack of power at the cluster level, this trial was unable to identify a difference between the knowledge broker strategy and dissemination of recommendations compared with usual practice for the promotion of evidence-informed resource allocation to inpatient weekend allied health services. Future research is needed to determine the interactions between different implementation strategies and healthcare contexts when translating evidence into healthcare practice. <h4>Trial registration</h4> Australian New Zealand Clinical Trials Registry ACTRN12618000029291. In a cluster randomized controlled implementation trial, Dr. Mitchell N Sarkies and colleagues examine the effectiveness of knowledge brokering and recommendation dissemination in influencing healthcare resource allocation decisions in Australia and New Zealand. Author summary <h4>Why was this study done?</h4> Healthcare delivery does not always reflect the most up-to-date research evidence. There are high levels of evidence to suggest that inpatient allied health services provided during weekends achieve greatest benefits in subacute rehabilitation wards. Most weekend allied health services are provided to acute general medical and surgical wards, where there is uncertain evidence of impact. Translation of evidence into practice is constrained by a limited understanding of which implementation strategies are most effective for specific settings. <h4>What did the researchers do and find?</h4> We conducted a cluster randomised controlled implementation trial to compare the effectiveness of two research implementation strategies across 132 hospitals in Australia and New Zealand. We provided hospital managers with either evidence-based weekend allied health practice recommendations or access to a knowledge broker in addition to the recommendations, over a 12-month period. Neither implementation strategy was able to be shown effective for ensuring better alignment of weekend allied health provision with practice recommendations; no impacts on hospital length of stay were identified. <h4>What do the findings mean?</h4> Evidence dissemination and knowledge brokering are thought to facilitate the translation of research evidence into practice. Our study was unable to find whether either of these strategies substantially influenced weekend allied health service decision-making by hospital managers. It is possible to study the impact of research implementation using robust trial designs; however, challenges achieving adequate statistical power are a barrier to these evaluations.Mitchell N. SarkiesLauren M. RobinsMegan JepsonCylie M. WilliamsNicholas F. TaylorLisa O’BrienJenny MartinAnne BardoelMeg E. MorrisLeeanne M. CareyAnne E. HollandKatrina M. LongTerry P. HainesPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 18, Iss 10 (2021)

Effectiveness of knowledge brokering and recommendation dissemination for influencing healthcare resource allocation decisions: A cluster randomised controlled implementation trial

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