Research Benefits and Utilization Potential Measurement

Research Benefits and Utilization

Research benefits are measured by its potential of benefits and model to check or measure.

Assessing implementation potential

Some models of RU/EBP move directly from the conclusion that evidence supports a change in practice to the pilot testing of the innovation. Others include steps first to evaluate the appropriateness of innovation within the specific organizational context; in some cases, such an assessment (or aspects of it) may be warranted even before embarking on efforts to assemble best evidence. 

    Other models suggest evaluating issues of fit after the practice change has been implemented. We think a preliminary assessment of the implementation potential of an innovation is often sensitive, although there may be situations with little need for such a formal assessment. In determining the implementation potential of an innovation in a particular setting, several issues should be considered, particularly the transferability of the innovation, the feasibility of implementing it, and its cost-benefit ratio. some relevant assessment questions for these three issues.

Transferability: The main issue with regard to transferability is whether it makes good sense to implement an innovation in the new practice setting. If there is some aspect of the practice setting that is fundamentally incongruent with the innovation—in terms of its philosophy, types of clients served, personnel, or financial or administrative structure—then it might make little sense to try to adopt the innovation, even if it has been shown to be clinically effective in other contexts. One possibility, however, is that some organizational changes could be made to make the “fit” better.

Feasibility :The feasibility questions in addressing various practical concerns about the availability of staff and resources, the organizational climate, the need for and availability of external assistance, and the potential for clinical evaluation. An important issue here is whether nurses will have (or share) control over the innovation. When nurses do not have full control over the new procedure, it is important to recognize the interdependent nature of the project and to proceed as early as possible to establish the necessary cooperative arrangements.

Cost–benefit ratio : A critical part of any decision to proceed with an RU/EBP project is a careful assessment of the costs and benefits of the innovation. The cost-benefit assessment should encompass likely costs and benefits to various groups, including clients, staff, and the overall organization. Clearly, the most important factor is the client. If the degree of risk in introducing a new procedure is high, then the potential benefits must be great and the knowledge base must be extremely sound. A cost–benefit assessment should consider the opposite side of the coin as well: the costs and benefits of not instituting an innovation. 

    It is sometimes easy to forget that the status quo bears its own risks and that failure to change—especially when such change is based on a firm knowledge base—is costly to clients, to organizations, and to the entire nursing community. Developing, Implementing, and Evaluating the Innovation If the implementation criteria are met, the team can design and pilot the innovation. Building on the Iowa model, this phase of the project likely would involve the following activities:

1. Developing an evaluation plan (eg, identifying outcomes to be achieved, determining how many clients to involve in the pilot, deciding when and how often to take measurements);

2. Collecting baseline data relating to those outcomes, to develop a counterfactual against which the outcomes of the innovation would be assessed;

3. Developing a written EBP guideline based on the synthesis of evidence, preferably a guideline that is clear and user-friendly, and that uses such devices as flow charts and decision trees;

4. Training relevant staff in the use of the new guideline and, if necessary, "marketing" the innovation to users so that it is given a fair test;

5. Trying the guideline out on one or more units or with a sample of clients; other

6. Evaluating the pilot project, in terms of both process (eg, how was the innovation received, to what extent were the guidelines actually followed, what implementation problems were encountered?) and outcomes (in terms of client outcomes and cost-effectiveness) .

Key Points

    Research utilization (RU) and -based practice (EBP) are overlapping concepts that concern evidence efforts to use research as a basis for clinical decisions. RU starts with a research based innovation that gets evaluated for possible use in practice. EBP starts with a search for the best possible evidence for a clinical problem, with emphasis on research-based evidence. 

    Research utilization exists on a continuum, with direct utilization of some specific innovation at one end ( instrumental utilization ), and more diffuse situations in which users are influenced in their thinking about an issue based on research findings ( conceptual utilization ) at the other end .

    Rogers' Diffusion of Innovations Theory describes the innovation adoption process as occurring in five stages: the knowledge stage, persuasion stage, decision stage, implementation stage, and confirmation stage. • Several major utilization projects have been implemented (eg, the Conduct and Utilization of Research in Nursing or CURN project ) that have demonstrated that research utilization can be increased, but have also shed light on barriers to utilization.

    EBP, which de-emphasizes clinical decision making based on custom or ritual, integrates the best available research evidence with other sources of data, including clinical expertise and patient preferences. Two of the cornerstones of the EBP movement are the Cochrane Collaboration (which is based on the work of British epidemiologist Archie Cochrane), and the clinical learning strategy called evidence-based medicine developed at the McMaster Medical School.

    EBP typically involves weighing various types of evidence, and often an evidence hierarchy is used to rank studies and other information according to the strength of evidence provided.

    In nursing, EBP and RU efforts often face a variety of barriers, including methodologically weak or replicated studies, nurses' limited training in research and EBP, resistance to change, lack of organizational support, resource constraints, and limited communication and collaboration between practitioners and researchers.

    Many models of RU and EBP have been developed, including models for individual clinicians (eg, the Stetler model ) and ones for organizations or groups of clinicians (eg, the Iowa Model of Evidence-Based Practice to Promote Quality Care ).

    Most models of utilization involve the following steps: selecting a topic or problem; assembling and evaluating evidence; assessing the implementation potential of an evidence-based innovation; developing or identifying EBP guidelines or protocols; implementing the innovation; evaluating outcomes; and decide whether to adopt or modify the innovation or revert to prior practices. Assessing implementation potential includes the dimensions of transferability of findings, feasibility of using the findings in the new setting, and the cost–benefit ratio of a new practice.

    EBP relies on rigorous integration of research evidence on a topic through integrative reviews , which are rigorous, systematic inquiries with many similarities to original primary studies.

    Integrative reviews can involve either qualitative, narrative approaches to integration (including meta synthesis of qualitative studies), or quantitative (meta-analytic) methods.

    Integrative reviews typically involve the following activities: developing a question or hypothesis; assembling a review team; selecting a sample of studies to be included in the review; extracting and recording data from the sampled studies; doing quality assessments of the studies; analyzing the data; and writing up the review.

    Quality assessments (which may involve formal quantitative ratings) are sometimes used to exclude weak studies from integrative reviews, but can also be used in sensitivity analyzes to determine if including or excluding weaker studies changes conclusions.

    Meta-analysis involves the computation of an effect size index (which quantifies the magnitude of relationship between the independent and dependent variables) for every study in the sample, and averaging across studies.

    In meta-analyses, a fail-safe number can be calculated to estimate the number of studies with nonsignificant results that would be needed to reverse the conclusion of a significant effect.

    In narrative reviews, integration might use a procedure known as the voting method (tallying outcomes to see which outcome had greatest empirical support if there are inconsistencies), or might be done in a strictly narrative fashion, with a qualitative analysis of patterns in the data .