Research

9 • Supporting and Evaluating Coninuous Quality Improvement

Background

A consistent finding in health services research is that the transfer of research findings into practice is unpredictable. One common policy strategy to promote continuous quality improvement is the production of clinical guidance which in Scotland is the responsibility of the Scottish Dental Clinical Effectiveness Programme (SDCEP). However, the publication of guidance does not necessarily result in professional behaviour change. Other knowledge transfer interventions have shown varied effectiveness, much of this unexplained. The need for further translation research, and the development of a generalisable, theory-based, knowledge transfer framework has been identified.

Progress

Since 1998, a multidisciplinary collaboration of clinical and academic experts, involving implementation science researchers from across the UK and Canada, has been developing a programme of knowledge transfer research embedded in the SDCEP guidance development process. The aim of the Translation Research in a Dental Setting (TRiaDS) Programme, funded by NHS Education for Scotland (NES), is to improve the quality and safety of dental health care in Scotland by establishing a practical evaluative framework to support and provide continuous evaluation of the impact of guidance on the quality of health care in General Dental Practice. Professor Clarkson, DHSRU, and Dr Craig Ramsay, Health Services Research Unit, University of Aberdeen, are Joint Principal Investigators.

The TRiaDS programmatic evaluation uses a standardised method. At the start of the SDCEP guidance development process, information is gathered about current dental care activities. Key recommendations and their associated behaviours are identified and prioritised. Potential barriers and enablers towards these are identified by Stakeholder questionnaires and interviews. Routinely collected data is used to measure compliance with the guidance and to inform decisions on the need for a knowledge translation intervention. Interventions are theory-based and informed by evidence gathered during the diagnostic phase and prior published evidence. They are evaluated using experimental and quasi-experimental trial designs, and, where possible, data collection will continue beyond the intervention to investigate the sustainability of an intervention effect.

The TRiaDS evaluative process is now fully embedded into the SDCEP guidance development process. Programme activities in 2010 included diagnostic analyses for SDCEP’s guidance on ‘Prevention and Management of Dental Caries in Children’ and ‘Oral Health Management of Patients Prescribed Bisphosphonates’. For both these, the data suggests a gap between current practice and key guidance recommendations. An example of the evaluation of a knowledge translation intervention is the conduct of a randomised controlled trial (RCT) investigating the impact of theory-based, individualised practice support visits on the implementation of the SDCEP ‘Cleaning of Dental Instruments’ guidance. Two hundred and two general dental practices have participated in this RCT and the results will be reported in 2011.

Images below

A graphic showing how the TRiaDS evaluative programme works in partnership with the SDCEP guidance development process and the front cover of the TRiaDS Study Protocol.

Impact Statement

The embedding of TRiaDS within the SDCEP guidance development process offers an unparalleled opportunity to influence patient safety by shaping the guidance development process to promote the implementability of the guidance. It also provides a unique platform to study the sustainability of getting evidence into routine clinical practice. The TRiaDS evaluative process is readily transferable across professional disciplines and serves the wider health system using dentistry as an example.