Maximizing research value: adequate reporting and effective (de-)implementation strategies

Field: Health Professions (Health Sciences)

The term evidence-based medicine (EBM) refers to the process of integrating research findings (evidence) with clinical expertise and patient preferences in making decisions for individual patients. EBM requires useful research reports. Furthermore, additional activities are usually needed to ensure the uptake of research evidence in routine clinical practice. This thesis aims to explore and improve the methods to report healthcare research and implement research findings, which are both essential components to facilitate EBM. \n \nThe first part of the thesis focuses on prediction model studies and the TRIPOD reporting guideline. It describes an evaluation of the reporting of this study type and provides a systematic method for such an evaluation. We found that, in general, prediction models were poorly reported and that information essential for their identification, use in individual risk prediction, or for external validation often was not detailed enough. Following these findings, we developed additional guidance for reporting prediction model studies in abstracts. TRIPOD for Abstracts is a checklist of 12 items that is applicable to all types of prediction model studies (including development, external validation, added value and model updating studies), regardless the clinical domain or the statistical approach used. Furthermore, we assessed the endorsement of TRIPOD and other reporting guidelines by medical journals and conducted an online survey among editors to reveal potential barriers and facilitators to the implementation of reporting guidelines \n \nThe second part of the thesis addresses the implementation of evidence recommending to abandon the routine use of a specific healthcare practice of low-value, so called de-implementation. It presents an evidence synthesis regarding factors influencing de-implementation. For a large part these factors were related to the individual healthcare provider, and rather to attitude than to knowledge or behaviour, but also factors related to the patient, social context, organizational context and economical/political context were identified. Although future research should investigate this more specifically, it seems that patient-provider interaction, the fear of consequences of withholding a test or treatment, and financial incentives are more important factors in de-implementation than in implementation. Through a systematic review of the literature we found that many de-implementation strategies achieve a considerable reduction of low-value care, especially those applying a multifaceted strategy, including reminders, audit and feedback, or patient-targeted interventions. Details regarding sustainability of effect and impact on health outcomes were often not evaluated. This is, however, essential information for interpretation and application of findings with regard to rolling out successful de-implementation strategies at a larger scale. \n \nBoth concepts explored in this thesis show that it requires a combination of quantitative and qualitative research to collect all the necessary information to design and evaluate effective strategies to promote the uptake of research findings in clinical practice. Only then we can let patients benefit from the available evidence and maximize the value of our research.