The SUMAMOS EXCELENCIA Project: Assessment of Implementation of Best Practices in a National Health System

NCT03725774 | Completed DMC

• 1 other identifier: PI14CIII/00044
• Study Type: interventional
• Target: 300
• Locations: 0 countries
• Sites: N/A

Brief Summary

There is a gap between research and clinical practice, leading to variability in decision-making. Clinical audits are an effective strategy for improving implementation of best practices. Quasi-experimental, multicentre, before-and-after. Primary-care and hospital-care units and associated socio-healthcare structures, and the patients attended at both. Implementation of evidence-based recommendations by application of the Getting Research into Practice model (process of improvement by reference to a prior baseline clinical audit. Data will be collected at baseline and, during the first year of follow up, at months (3, 6, 9,12)

Conditions

Age Problem

Keywords

pain; accidental falls; urinary incontinence; clinical audit

Outcome Measures

Primary Outcomes (3)

• Urinary incontinence

  Assessment of presence of urinary incontinence. Total number of patients in whom the presence of urinary incontinence has been initially assessed, and who are registered / Total number of patients discharged in the assessment period) \* 100

  15 month

• Detection of pain, at admission

  Total number of patients who have been assessed for the presence of pain and is registered / Total number of patients discharged during the measurement period) \* 100 The assessment of the presence of pain will be measured in a dichotomous variable: Yes/No. For Yes, there must be registered evidence of pain assessment with a Visual Analogic Scale (VAS; 10 cm, 0=no pain, 10=maximum pain) or Numerical rating scale (NRS; 0=no pain, 10 =worse pain), or the FLACC scale tool or paediatric patients,(Face, Leg, Activity, Cry, Consolability). Categories is scored from 0-2. Total scale: 0 is relaxed and comfortable, 1-2 Moderate discomfort, 3-6 Moderate pain and 7-10 Severe pain/discomfort f or PAINAD scale tool for patient with dementia. Measure breathing, negative vocalization, facial expression, body language and capacity for relief. Each item can get a maximum score of 2. The total scores can be from 0 (no pain) to 10 (maximum pain)

  15 month

• Risk of falls

  Assessment of fall risk with a validated tool, at admission or onset of care.(Total number of patients to whom the risk of falls with a validated tool was initially assessed and registered / Total number of patients discharged during the measurement period) \* 100 The assessment of fall risk in clinical status will be measured in a dichotomous variable: Yes/No. For Yes, there must be registered evidence of fall risk with a validated tools.Tools: Hendrich II Fall Risk Model, score: 0-16. Patient without risk (0), risk (1-4 points) and high risk (\>5 points). H. Downton scale, score from 0 to 12. Patient without risk (0), low risk (1-2) and high risk (\> 3 points). Morse Falls Scale, score from 0 to 150. Patient without risk (0-25), low risk (25-50) and high risk (\> 50 points). Stratify or Stratify modified scale assesment includes five questions with dichotomous answer; obtaining two or more positive answer would classify the individual as a high risk patient to suffer a fall.

  15 month

Secondary Outcomes (31)

• Type of institution

  15 month

• Size of primary care unit

  15 month

• Size of socio-healthcare centres

  15 month

• Size of hospital unit

  15 month

• nurse/patient ratio

  15 month

Study Arms (1)

Quasi-experimental uncontrolled, before-and-after

EXPERIMENTAL

The intervention will consist of the use of the GRIP (Getting Research into Practice) model and implementation of its strategies in clinical practice, according to the study unit in question and the scope of action

Other: GRIP (Getting Research into Practice) model

Interventions

GRIP (Getting Research into Practice) model OTHER

The intervention will consist of the use of the GRIP (Getting Research into Practice) model and implementation of its strategies in clinical practice, according to the study unit in question and the scope of action. The GRIP model is a process of improvement by reference to a prior baseline clinical audit. It implies a local situation analysis, identifying the obstacles to improvements in clinical practice, and drawing up and implementing a plan of action for the purpose of improving adherence to pre-established criteria. The goal is to establish interprofessional processes within the teams, in order to: examine the obstacles that hinder the use of evidence in fostering best practices; and contribute to the development of implementation programmes for overcoming such obstacles.

Quasi-experimental uncontrolled, before-and-after

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• For the purposes of this study, a "unit" is defined as any service, centre or institution that delivers health services to a homogeneous group of patients who share similar characteristics.
• Pain: persons admitted to hospital centres who may potentially suffer from some type of pain. Patients will be classified according to whether they are adults or children (paediatric patients), and according to whether they experience chronic pain, acute postoperative pain, or acute pain due to other causes.
• Incontinence: community-dwelling or institutionalised persons prone to present with urinary incontinence. Patients will be classified according to whether they are 65 years of age or over.
• Falls: persons aged over 65 years who display one or more fall risk factors according to the assessment criteria established by the risk assessment instrument used.

Sponsors & Collaborators

• Teresa Moreno Casbas: lead
• Fondo de Investigacion Sanitaria: collaborator

Related Publications (36)

• Albornos-Muñoz, L., González-María, E., Moreno-Casbas, T. (2015). Implantación de Guías de Buenas Prácticas en España. Programa de Centros Comprometidos con la Excelencia en Cuidados® (Best Practice Guidelines Implementation in Spain. Best Practice Spotlight Organizations ® Programme). MedUNAB, 17(3), pp. 163-69.

  BACKGROUND

• Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, Robertson N. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2010 Mar 17;(3):CD005470. doi: 10.1002/14651858.CD005470.pub2.

  PMID: 20238340 RESULT

• Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychol. 2015 Sep 16;3(1):32. doi: 10.1186/s40359-015-0089-9.

  PMID: 26376626 RESULT

• Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group. BMJ. 1998 Aug 15;317(7156):465-8. doi: 10.1136/bmj.317.7156.465. No abstract available.

  PMID: 9703533 RESULT

• Bornbaum CC, Kornas K, Peirson L, Rosella LC. Exploring the function and effectiveness of knowledge brokers as facilitators of knowledge translation in health-related settings: a systematic review and thematic analysis. Implement Sci. 2015 Nov 20;10:162. doi: 10.1186/s13012-015-0351-9.

  PMID: 26589972 RESULT

• Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009 Aug 7;4:50. doi: 10.1186/1748-5908-4-50.

  PMID: 19664226 RESULT

• Davies B, Edwards N, Ploeg J, Virani T. Insights about the process and impact of implementing nursing guidelines on delivery of care in hospitals and community settings. BMC Health Serv Res. 2008 Feb 2;8:29. doi: 10.1186/1472-6963-8-29.

  PMID: 18241349 RESULT

• Dobbins M, Cockerill R, Barnsley J, Ciliska D. Factors of the innovation, organization, environment, and individual that predict the influence five systematic reviews had on public health decisions. Int J Technol Assess Health Care. 2001 Fall;17(4):467-78.

  PMID: 11758291 RESULT

• Estabrooks CA. The conceptual structure of research utilization. Res Nurs Health. 1999 Jun;22(3):203-16. doi: 10.1002/(sici)1098-240x(199906)22:33.0.co;2-9.

  PMID: 10344701 RESULT

• Flodgren G, Deane K, Dickinson HO, Kirk S, Alberti H, Beyer FR, Brown JG, Penney TL, Summerbell CD, Eccles MP. Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in overweight and obese people. Cochrane Database Syst Rev. 2010 Mar 17;(3):CD000984. doi: 10.1002/14651858.CD000984.pub2.

  PMID: 20238311 RESULT

• Forbes A, Griffiths P. Methodological strategies for the identification and synthesis of 'evidence' to support decision-making in relation to complex healthcare systems and practices. Nurs Inq. 2002 Sep;9(3):141-55. doi: 10.1046/j.1440-1800.2002.00146.x.

  PMID: 12199878 RESULT

• Mc Goldrick EL, Crawford T, Brown JA, Groom KM, Crowther CA. Identifying the barriers and enablers in the implementation of the New Zealand and Australian Antenatal Corticosteroid Clinical Practice Guidelines. BMC Health Serv Res. 2016 Oct 28;16(1):617. doi: 10.1186/s12913-016-1858-8.

  PMID: 27793150 RESULT

• Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N. Lost in knowledge translation: time for a map? J Contin Educ Health Prof. 2006 Winter;26(1):13-24. doi: 10.1002/chp.47.

  PMID: 16557505 RESULT

• Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993 Nov 27;342(8883):1317-22. doi: 10.1016/0140-6736(93)92244-n.

  PMID: 7901634 RESULT

• Grimshaw J, Eccles M, Thomas R, MacLennan G, Ramsay C, Fraser C, Vale L. Toward evidence-based quality improvement. Evidence (and its limitations) of the effectiveness of guideline dissemination and implementation strategies 1966-1998. J Gen Intern Med. 2006 Feb;21 Suppl 2(Suppl 2):S14-20. doi: 10.1111/j.1525-1497.2006.00357.x.

  PMID: 16637955 RESULT

• Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE. Knowledge translation of research findings. Implement Sci. 2012 May 31;7:50. doi: 10.1186/1748-5908-7-50.

  PMID: 22651257 RESULT

• Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, Wensing M, Dijkstra R, Donaldson C. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004 Feb;8(6):iii-iv, 1-72. doi: 10.3310/hta8060.

  PMID: 14960256 RESULT

• Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care. Lancet. 2003 Oct 11;362(9391):1225-30. doi: 10.1016/S0140-6736(03)14546-1.

  PMID: 14568747 RESULT

• Hunskaar S, Lose G, Sykes D, Voss S. The prevalence of urinary incontinence in women in four European countries. BJU Int. 2004 Feb;93(3):324-30. doi: 10.1111/j.1464-410x.2003.04609.x.

  PMID: 14764130 RESULT

• Kajermo KN, Bostrom AM, Thompson DS, Hutchinson AM, Estabrooks CA, Wallin L. The BARRIERS scale -- the barriers to research utilization scale: A systematic review. Implement Sci. 2010 Apr 26;5:32. doi: 10.1186/1748-5908-5-32.

  PMID: 20420696 RESULT

• Kitson A, Ahmed LB, Harvey G, Seers K, Thompson DR. From research to practice: one organizational model for promoting research-based practice. J Adv Nurs. 1996 Mar;23(3):430-40. doi: 10.1111/j.1365-2648.1996.tb00003.x.

  PMID: 8655816 RESULT

• Kreindler SA. What if implementation is not the problem? Exploring the missing links between knowledge and action. Int J Health Plann Manage. 2016 Apr;31(2):208-26. doi: 10.1002/hpm.2277. Epub 2014 Nov 25.

  PMID: 25424863 RESULT

• Langley PC, Ruiz-Iban MA, Molina JT, De Andres J, Castellon JR. The prevalence, correlates and treatment of pain in Spain. J Med Econ. 2011;14(3):367-80. doi: 10.3111/13696998.2011.583303. Epub 2011 May 17.

  PMID: 21574899 RESULT

• Meijers JM, Janssen MA, Cummings GG, Wallin L, Estabrooks CA, Y G Halfens R. Assessing the relationships between contextual factors and research utilization in nursing: systematic literature review. J Adv Nurs. 2006 Sep;55(5):622-35. doi: 10.1111/j.1365-2648.2006.03954.x.

  PMID: 16907795 RESULT

• Milner M, Estabrooks CA, Myrick F. Research utilization and clinical nurse educators: A systematic review. J Eval Clin Pract. 2006 Dec;12(6):639-55. doi: 10.1111/j.1365-2753.2006.00632.x.

  PMID: 17100863 RESULT

• Pallen N, Timmins F. Research-based practice: myth or reality? A review of the barriers affecting research utilisation in practice. Nurse Educ Pract. 2002 Jun;2(2):99-108. doi: 10.1054/nepr.2002.0058.

  PMID: 19036286 RESULT

• Pearson A. Getting research into practice. Int J Nurs Pract. 2004 Oct;10(5):197-8. doi: 10.1111/j.1440-172X.2004.00486.x. No abstract available.

  PMID: 15461688 RESULT

• Rycroft-Malone J. Theory and knowledge translation: setting some coordinates. Nurs Res. 2007 Jul-Aug;56(4 Suppl):S78-85. doi: 10.1097/01.NNR.0000280631.48407.9b.

  PMID: 17625479 RESULT

• Ruzafa-Martinez M, Gonzalez-Maria E, Moreno-Casbas T, del Rio Faes C, Albornos-Munoz L, Escandell-Garcia C. [The Spanish best practice guidelines implementation project 2011-2016]. Enferm Clin. 2011 Sep-Oct;21(5):275-83. doi: 10.1016/j.enfcli.2011.07.013. Epub 2011 Sep 15. Spanish.

  PMID: 21924654 RESULT

• Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13;312(7023):71-2. doi: 10.1136/bmj.312.7023.71. No abstract available.

  PMID: 8555924 RESULT

• Schuster MA, McGlynn EA, Brook RH. How good is the quality of health care in the United States? Milbank Q. 1998;76(4):517-63, 509. doi: 10.1111/1468-0009.00105.

  PMID: 9879302 RESULT

• Shaneyfelt TM, Mayo-Smith MF, Rothwangl J. Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature. JAMA. 1999 May 26;281(20):1900-5. doi: 10.1001/jama.281.20.1900.

  PMID: 10349893 RESULT

• Squires JE, Estabrooks CA, Gustavsson P, Wallin L. Individual determinants of research utilization by nurses: a systematic review update. Implement Sci. 2011 Jan 5;6:1. doi: 10.1186/1748-5908-6-1.

  PMID: 21208425 RESULT

• Stergiou-Kita M. Implementing Clinical Practice Guidelines in occupational therapy practice: recommendations from the research evidence. Aust Occup Ther J. 2010 Apr;57(2):76-87. doi: 10.1111/j.1440-1630.2009.00842.x.

  PMID: 20854572 RESULT

• Thomas L, Cullum N, McColl E, Rousseau N, Soutter J, Steen N. Guidelines in professions allied to medicine. Cochrane Database Syst Rev. 2000;(2):CD000349. doi: 10.1002/14651858.CD000349.

  PMID: 10796531 RESULT

• Escobar-Aguilar G, Moreno-Casbas MT, Gonzalez-Maria E, Martinez-Gimeno ML, Sanchez-Pablo C, Orts-Cortes I. The SUMAMOS EXCELENCIA Project. J Adv Nurs. 2019 Jul;75(7):1575-1584. doi: 10.1111/jan.13988. Epub 2019 Apr 2.

  PMID: 30816569 DERIVED

MeSH Terms

Conditions

Pain; Urinary Incontinence

Interventions

Hand Strength; Models, Biological

Condition Hierarchy (Ancestors)

Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Urination Disorders; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Lower Urinary Tract Symptoms; Urological Manifestations

Intervention Hierarchy (Ancestors)

Muscle Strength; Physical Examination; Diagnostic Techniques and Procedures; Diagnosis; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Models, Theoretical; Investigative Techniques

Study Officials

• TERESA MORENO CASBAS, DOCTOR

  Instituto de Salud Carlos III

  STUDY DIRECTOR

• ESTHER GONZALEZ MARIA, DOCTOR

  Instituto de Salud Carlos III

  STUDY CHAIR

• ISABEL ORTS CORTÉS, DOCTOR

  UNIVERSIDAD DE ALICANTE

  STUDY CHAIR

• CLARA SANCHEZ PABLO, RN

  Instituto de Salud Carlos III

  STUDY CHAIR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER GOV
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Head Of Nursing Research Unit

Model Details: Uncontrolled before-and-after study

Study Record Dates

• First Submitted: April 18, 2018
• First Posted: October 31, 2018
• Study Start: June 1, 2016
• Primary Completion: September 1, 2017
• Study Completion: December 1, 2017
• Last Updated: October 31, 2018

Record last verified: 2018-05

Data Sharing

• IPD Sharing: Will not share