Evidence-based medicine, which is care guided by research findings usually combined with consensus recommendations by experts, is considered the gold standard in healthcare practice. While attractive in concept, the implementation of evidence-based clinical guidelines and pathways remains a challenge in many service settings. Despite evidence of their benefits in the acute care setting, the applicability, use, and effectiveness of evidence-based guidelines has received minimal attention in home care. This presentation will describe the development of a research project in its' first year of a multi-year AHRQ-grant funded project. The experiences include adapting evidence-based practice guidelines developed for two highly prevalent chronic health problems - congestive heart failure and cancer pain - for home care practice. The steps include comprehensively reviewing published guidelines, developing an understanding of the strengths and limitations of home care service, convening a panel of experts, and identifying those key elements of guidelines likely to be effective. The first year experience also includes the development of an intervention to promote these evidence-based recommendations in a non-institutional healthcare setting that serves a diverse and largely elderly patient population. Two information-based strategies to be developed and tested include (i) basic "just-in-time" e-mail reminders and (ii) augmented just-in-time e-mail reminders accompanied by a comprehensive nursing protocol and the support of an expert peer. Critical issues such as randomization, differential number of nursing visits, process of care monitoring, and outcomes measurement which were addressed during the study start up and which pose special challenges in homecare research will also be reviewed.
Learning Objectives: 1) To describe the process of adapting evidence-based clinical practice guidelines for home healthcare service; 2) To discuss the implementation of a research study that examines the effect of alternative information-based strategies in promoting behavioral change and improving patterns of care among home healthcare nurses
Keywords: Home Care, Elderly
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Visiting Nurse Service of New York
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.