. "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
displayed in clinical flowcharts that offer decision support to VHA clinicians (VHA, 2005). VHA’s Quality Enhancement Research Initiative facilitates the translation of research findings into routine care by (1) conducting research to fill gaps in knowledge about what constitutes best treatment practices, (2) undertaking demonstration projects that implement already known best practices, (3) identifying enhancements to VHA’s information systems, and (4) conducting research and demonstration projects to accelerate the uptake of evidence-based practices (Fischer et al., 2000). The initiative includes projects in mental health (schizophrenia and depression) and substance-use illnesses (improving the quality of methadone maintenance therapy).
As discussed above, many professional bodies are actively engaged in dissemination activities. These activities are often connected with their development and distribution of practice guidelines.
Underused Sources of Communication and Influence
The dissemination activities described above are conducted by organizations that generally are perceived as specialty M/SU organizations and thus may be most likely to communicate and have influence with specialty M/SU health care providers. As described in Chapter 7, however, primary care providers deliver a substantial portion of mental health services and are a critical source for the detection of M/SU conditions, referral, and subsequent treatment. Other non–M/SU specialty providers also have key roles to play in detection, treatment, and referral. However, data show that these general health care providers need to adopt evidence-based practices to better detect, treat, and appropriately refer individuals in need of M/SU health care. Thus it is important that dissemination of the evidence on effective M/SU health care reach all providers, not just those specializing in M/SU care.
However, the key current dissemination efforts described above may be less likely to influence primary care providers and other non–M/SU specialty clinicians. Research on the effective dissemination of innovations described above (Box 4-2) shows that individuals’ and organizations’ adoption of new practices is greatly influenced by their social networks. Successful dissemination occurs most easily among individuals with similar educational, professional, and cultural backgrounds. Opinion leaders within a field also strongly influence the dissemination and uptake of innovations. Formal dissemination programs will be more successful if they are aware of and address potential adopters’ needs and perspectives, and tailor their