Encouraging Best Practice in Residential Aged Care Program: Final Evaluation Report
3.8 - Systems and use of data to support the use of evidence
- Key Messages
- Executive Summary
- About This Report
1 - Introduction- 2 - Evidence, Changes in Practice and the EBPRAC Program
3 - Program Delivery/Implementation- 3.1 - Introduction
- 3.2 - Implementation delays
- 3.3 - Model of change/implementation
- 3.4 - The nature of the changes in practice
- 3.5 - Context for change
- 3.6 - Demonstrable benefit
- 3.7 - Adequate resources
- 3.8 - Systems and use of data to support the use of evidence
- 3.9 - Stakeholder engagement, participation and commitment
- 3.10 - Key success factors - perceptions of lead organisations and facility staff
- 3.11 - Summary - incentives and barriers to sustained implementation
- 4 - Program Impact
- 5 - Capacity Building
- 6 - Generalisability
- 7 - Sustainability
- 8 - Dissemination
- 9 - Appropriateness
- 10 - Cost Implications for Government and Aged Care Providers
- 11 - Perceptions of High-Level Stakeholders
- 12 - Discussion and Conclusions
- 13 - Recommendations
- References
- Appendices 1 to 6
- Appendices 7 to 12
- Appendices 13 to 17
The use of audit and feedback was the commonest way in which systems and data supported the implementation of evidence. Audit and feedback is defined as ‘any summary of clinical performance of health care over a specified period of time … the information may have been obtained from medical records, computerised databases, or observations’ (Cochrane Effective Practice and Organisation of Care Review Group (EPOC) 2007). The effects of audit and feedback are generally ‘small to moderate’ and are likely to be more effective when baseline performance compared to recommended practice is low (Jamtvedt, Young et al. 2006). Differences in the characteristics of feedback (e.g. timeliness, credibility of source, format and punitive/non-punitive nature) may influence its effectiveness (Hysong, Best et al. 2006). Audit and feedback has not been widely studied in nursing (Dulko 2007).
Four of the Round 1 projects and five of the Round 2 projects undertook various forms of auditing of clinical performance. The auditing was extensive with some very comprehensive reports produced. However, extensive auditing does not lend itself to being maintained in the absence of a project with dedicated resources and expertise for such work.
There appear to have been few attempts to link the work of the EBPRAC projects into existing systems of data collection and review within facilities. The main issue that arose in terms of incorporating what the projects did with existing systems was the difficulty of integrating a new tool (e.g. assessment tool, care planning tool) into medical record systems, particularly if the medical record system was computerised and/or part of a larger corporate system used by a chain of facilities, a situation that can create additional work:
A number of the facilities that we worked in had a larger organisation with multiple facilities and it’s a major thing for them to adopt a new tool, whatever it might be, because it’s got to be rolled across every facility and they had no money to change all the tools at all the other facilities. To some extent that’s an impediment, because it just means although the facility that was in the project were doing it, in some cases they were actually also doing the one that the organisation themselves had suggested. (P)
As identified elsewhere in this report (Section 3.11) having systems in place to support the use of evidence was not a particularly important factor influencing implementation overall. It may be that such systems are more important for sustainability than implementation (see Section 7).
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