How to promote, improve and test adherence to scientific evidence in clinical practice

摘要: Negative variation in the management of patients with same clinical condition is frequent, and affects quality care. Recent studies indicate that single interventions are not an effective solution. We aim to demonstrate a multifaceted strategy can favor introduction research into practice, assess its long-term effects on set common medical conditions exhibiting significant negative at our institution. The strategy, devised agreed upon by multidisciplinary group, was first applied one relevant – cerebral ischemic stroke. To test effectiveness quasi-experimental study conducted, comparing intervention group historical controls. After validation extended other pathologies, effect measured using evidence-based indicators. Adherence each indicator determined prospectively six-month basis for period least two consecutive years. Measures expressed as proportions 95% confidence intervals. Validation findings demonstrated improved compliance scientific evidence: percentage who received CT scan within 24 hours hospital presentation rose from 56% 75%, (χ2 = 7.43 p < 0.01); admissions selected wards increased 45% 64%, 7.81 number physical medicine visits request grew 59% 91% 14,40 0.001). Over four-year program gradually 14 conditions. Except 3 cases, pathway, i.e. eligible whom data care process collected, above minimum requirement 75%. Indicator adherence generally exhibited positive trend, though variability observed both among different between semesters pathology. According experience, incorporation practice be favored systematically applying shared, involving teams supported central coordination. Institutions should device tailor-made approach, train personnel implementation strategies, create cultural acceptance change. Just like experimental trials, human economic resources allocated health services allow achievement this objective.