. "4 Strengthening the Evidence Base and Quality Improvement Infrastructure." Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series. Washington, DC: The National Academies Press, 2006.
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Improving the Quality of Health Care for Mental and Substance-Use Conditions
instruments have demonstrated reasonable reliability, their clinical feasibility and accuracy in routine practice are not well established (Lewczyk et al., 2003). Other initiatives have provided clinicians with education and guidelines to improve their recognition and treatment of mental illnesses (Lin et al., 2001; Thompson et al., 2000).
The committee concludes that multiple strategies are needed to improve diagnostic accuracy in M/SU health care. First, existing evidence-based diagnostic tools and assessment practices should be identified and applied in practice, just as must be done for evidence-based treatment. More age-appropriate diagnostic instruments also should be developed that are reliable and practicable for routine use, and information about these tools should be included in initiatives to better disseminate evidence-based practices. Further, clinicians should be encouraged to employ standardized clinical assessment instruments to measure target symptoms consistently and systematically, and document results over the course of treatment (American Psychiatric Association Task Force for the Handbook of Psychiatric Measures, 2000).
As discussed earlier in this chapter, however, even when evidence-based practices are known, their adoption by all relevant practitioners—in both general and M/SU health care—is too slow. Accordingly, many public and private organizations are actively engaged in efforts to strengthen the dissemination and uptake of effective clinical practices. Yet these activities themselves are not always consistent with the evidence on effective dissemination and uptake of new knowledge. Improving the effectiveness of dissemination activities is thus the next essential step in improving the effectiveness of M/SU health care.
BETTER DISSEMINATION OF THE EVIDENCE
Research has been under way for many years, in health care as well as other fields of study, to identify the multiple contributors to successful dissemination and adoption of new practices and innovations by their targeted users. An extensive and systematic review of empirical evidence and related theoretical literature from multiple disciplines (Greenhalgh et al., 2004) identified the following key factors in successful dissemination and adoption of innovations: (1) the characteristics of the innovation itself, (2) the characteristics of the individuals targeted to adopt it, (3) sources of communication and influence regarding the innovation, (4) structural and cultural characteristics of organizations targeted to adopt it, (5) external influences on targeted individuals or organizations, (6) organizations’ uptake processes, and (7) the linkages among these six factors (see Box 4-2).
Although some of the factors affecting the adoption of new practices (e.g., characteristics of individual adopters) may not be very amenable to