title: Combining training in knowledge translation with quality improvement reduced 30-day heart failure readmissions in a community hospital: a case study.
abstract: OBJECTIVE
  Training programmes in evidence-based practice (EBP) frequently fail to translate their content into practice change and care improvement. We linked multidisciplinary training in EBP to an initiative to decrease 30-day readmissions among patients admitted to a community teaching hospital for heart failure (HF).
  
  
  METHODS
  Hospital staff reflecting all services and disciplines relevant to care of patients with HF attended a 3-day innovative capacity building conference in evidence-based health care over a 3-year period beginning in 2009. The team, facilitated by a conference faculty member, applied a knowledge-to-action model taught at the conference. We reviewed published research, profiled our population and practice experience, developed a three-phase protocol and implemented it in late 2010. We tracked readmission rates, adverse clinical outcomes and programme cost.
  
  
  RESULTS
  The protocol emphasized patient education, medication reconciliation and transition to community-based care. Senior administration approved a full-time nurse HF coordinator. Thirty-day HF readmissions decreased from 23.1% to 16.4% (adjusted OR = 0.64, 95% CI = 0.42-0.97) during the year following implementation. Corresponding rates in another hospital serving the same population but not part of the programme were 22.3% and 20.2% (adjusted OR = 0.87, 95% CI = 0.71-1.08). Adherence to mandated HF quality measures improved. Following a start-up cost of $15 000 US, programme expenses balanced potential savings from decreased HF readmissions.
  
  
  CONCLUSIONS
  Training of a multidisciplinary hospital team in use of a knowledge translation model, combined with ongoing facilitation, led to implementation of a budget neutral programme that decreased HF readmissions.
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Wyer
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Zorica
authors.initials: Z
authors.lastname: Stojanovic
authors.affiliation: Center of Behavioral and Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Shaffer
authors.affiliation: Department of Nursing, Calvary Hospital, Bronx, NY, USA.
authors.forename: Mitzy
authors.initials: M
authors.lastname: Placencia
authors.affiliation: Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Klink
authors.affiliation: NewYork-Presbyterian Hospital and NewYork-Presbyterian Hospital Lower Manhattan, New York, NY, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fosina
authors.affiliation: Center for Family and Community Medicine, Columbia University Medical Center, Center for Family and Community Medicine, New York, NY, USA.
authors.forename: Susan X
authors.initials: SX
authors.lastname: Lin
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Beth
authors.initials: B
authors.lastname: Barron
authors.affiliation: University of Ottawa School of Nursing, Department of Epidemiology and Community Medicine, Ottawa, ON, Canada.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Graham
mesh_terms: D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006333:Heart Failure / Q000628:therapy*; D006764:Hospitals, Community / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D059065:Medication Reconciliation / Q000458:organization & administration; D010353:Patient Education as Topic / Q000458:organization & administration; D010359:Patient Readmission / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D000069341:Transitional Care / Q000458:organization & administration*; D057170:Translational Research, Biomedical
keywords: evaluation; evidence-based medicine; medical education