Closing the Quality Chasm in Public Health: Lessons from Practice-Based Research Networks

Studies from the past three decades have found evidence of wide variation in public health practices across states and communities despite an expanding evidence base of efficacious public health programs and policies. Gaps in the adoption of effective, evidence-based practices (EBPs) have been identified in a wide range of service areas, including nutrition and physical activity programming, tobacco control, emergency preparedness, food safety, injury prevention, and communicable disease control. Relatively little is known about the factors that facilitate and inhibit EPB adoption in public health, and about the most effective strategies for improving adoption. To address these deficits, this session profiles five new research projects being conducted across the U.S. that use practice-based research networks (PBRNs) to investigate the comparative effectiveness of strategies for enhancing the adoption of evidence-based prevention practices in public health agencies. These projects bring researchers and practitioners together through the Robert Wood Johnson Foundation's Public Health PBRN Program to conduct comparative studies with public health agencies in Colorado, Kentucky, Massachusetts, North Carolina, and Washington. The projects employ rigorous quasi-experimental research designs and natural experiments to evaluate how quality improvement strategies, community partnerships, financing and budgetary changes, and regionalization approaches impact EBP adoption. Findings elucidate the roles of information, incentives, community resources, and leadership and decision-making structures in shaping adoption outcomes. Collectively, the projects advance the science of measuring evidence-based practices in public health. Most importantly, the projects suggest which strategies work best in which contexts to enhance the effectiveness of public health practice.