title: Provincial prenatal record revision: a multiple case study of evidence-based decision-making at the population-policy level.
abstract: BACKGROUND
  There is a significant gap in the knowledge translation literature related to how research evidence actually contributes to health care decision-making. Decisions around what care to provide at the population (rather than individual) level are particularly complex, involving considerations such as feasibility, cost, and population needs in addition to scientific evidence. One example of decision-making at this "population-policy" level involves what screening questions and intervention guides to include on standardized provincial prenatal records. As mandatory medical reporting forms, prenatal records are potentially powerful vehicles for promoting population-wide evidence-based care. However, the extent to which Canadian prenatal records reflect best-practice recommendations for the assessment of well-known risk factors such as maternal smoking and alcohol consumption varies markedly across Canadian provinces and territories. The goal of this study is to better understand the interaction of contextual factors and research evidence on decision-making at the population-policy level, by examining the processes by which provincial prenatal records are reviewed and revised.
  
  
  METHODS
  Guided by Dobrow et al.'s (2004) conceptual model for context-based evidence-based decision-making, this study will use a multiple case study design with embedded units of analysis to examine contextual factors influencing the prenatal record revision process in different Canadian provinces and territories. Data will be collected using multiple methods to construct detailed case descriptions for each province/territory. Using qualitative data analysis techniques, decision-making processes involving prenatal record content specifically related to maternal smoking and alcohol use will be compared both within and across each case, to identify key contextual factors influencing the uptake and application of research evidence by prenatal record review committees. All study participants will be required to give written informed consent prior to participating in data collection.
  
  
  CONCLUSIONS
  This study will advance knowledge in the field of evidence-based decision-making by illustrating the complex interaction of contextual factors and evidence on health policy decision-making by provincial-level committees. By increasing the transparency of decision-making within provincial prenatal record committees, this study will help inform more effective strategies for enhancing the integration of best-practice evidence into prenatal records.
authors.affiliation: University of Ottawa, Roger Guindon Pavilion 1118, Ottawa, Ontario, Canada. nedwards@uottawa.ca
authors.forename: Nancy
authors.initials: N
authors.lastname: Edwards
authors.forename: Sonia
authors.initials: S
authors.lastname: Semenic
authors.forename: Shahirose
authors.initials: S
authors.lastname: Premji
authors.forename: Phyllis
authors.initials: P
authors.lastname: Montgomery
authors.forename: Beverly
authors.initials: B
authors.lastname: Williams
authors.forename: Joanne
authors.initials: J
authors.lastname: Olson
authors.forename: Omaima
authors.initials: O
authors.lastname: Mansi
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects; D002170:Canada; D003657:Decision Making; D055416:Evidence-Based Emergency Medicine; D005260:Female; D006801:Humans; D008499:Medical Records; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods / Q000592:standards*; D011364:Professional Practice; D016540:Smoking Cessation