Table 3 Summary of the quantitative primary research studies included in the review

[37]

2006

Component of a randomized controlled trial.

Intervention = multifaceted.

Randomisation determined whether the intervention was to begin in the operating room or in the intensive care unit (and not to assign the patient to a study group).

Project leaders and teams were established to implement evidence-based practice to reduce central line infections.

Adherence to evidence-based process indicators, as a proportion of CR-BSI reported during the previous year.

Catheter-related blood-stream infections (CR BSI).

Process adherence increased from 0% to 85%. CR BSI dropped by more than 50% (from 1.7 to 0.4 per 1000 line days, p < 0.05).

The success of this intervention across nine healthcare systems and ten hospitals was attributed by the authors to the direct involvement of the hospital leadership (within each hospital) in marketing and promoting the intervention and the development of local CoPs.

[45]

2006

Case-study of the establishment of a CoP following the bringing together of individuals known to work in the area of web-assisted tobacco intervention.

Potential emergence of a CoP.

Social network methods were used to demonstrate the establishment of networks following the initial meeting.

[32]

2007

Intervention trial.

Intervention = multifaceted Managing Obstetric Risk Efficiently (MORE) program.

Implementation at each of the 28 hospitals was led by a core inter-professional team.

Core clinical knowledge assessment.

Culture change assessed using a culture change assessment tool.

Frequency of liability claims and liability carrier (hospital) incurred costs.

Clinical core knowledge increased significantly, demonstrated by increase in test scores following completion of training modules.

Improvement in the six elements - empowering people, learning, open communication, patient safety, teamwork, valuing individuals - was demonstrated using a culture change assessment tool developed for the program.

In all of the 28 hospitals that provided data, the frequency of liability claims dropped over a three-year period, and liability carrier (hospital) costs showed a decreasing trend compared to pre-MORE program. This is in contrast to all other healthcare services, which showed a trend towards increase in costs. The development and annual operating costs were recovered by the end of three years.

[38]

2008

Intervention trial.

Intervention = Regional cancer-collaborative to implement a regional approach to learning.

Care-process leaders worked with teams to plan and implement practice change. Regional CoPs were established as a forum for sharing ideas, identifying resources, and encouraging action.

Establishment of regional and local CoPs was encouraged.

Process evaluation of implementation activities.

Breast, cervical and colon cancer screening rates.

Some processes were more difficult to implement than others, and implementation was easier at some sites and not others. Three of the four participating organisations implemented local CoPs.

Screening documentation increased with all four cancers.

Colon cancer screening-rates increased from 8.6% to 21.2%. This increase was seen in 3 of the 4 sites (the 4^th showed a drop). Authors concluded that improvements may be achieved in carefully selected organisations.

[26]

2008

Intervention trial.

Intervention = multifaceted. The Caledonian Model designed to promote evidence-based practice included membership of a CoP.

Impact on nursing practice was assessed by baseline and post-intervention audits of policies, resources and education. The revised nurse-working index was used to explore perceived impact of the model on the nurses' work.

Facilities' audit results demonstrated improved practice through development of local guidelines and policies; use of validated screening tools; implementing guidelines; and ongoing training for staff. Patients' audits demonstrated more relationship-centred approach to care-provision; improved recording of patient and family feelings and expectations; assessment of individual needs; risk-screening; and greater involvement of the patient in decision-making. The authors acknowledge the limitations imposed by their inability to control for confounding events occurring concurrently.

[41]

2009

Intervention trial.

Intervention = CoP established to improve standards in general practice, focussing specifically on quality of referral letters written to specialists.

Quality of letters written by GPs, scored using benchmarks established by members of the CoP.

Only five of the 15 recruited GPs completed the study; 102 referral letters were submitted by these 5 GPs. Statistically significant improvements in scores were reported from the scoring of the history and examinations components in the referral letters.

[28]

2009

Randomised trial. Participants randomised to CoP-supported or practice-as-usual arm of trial.

Content knowledge on assessment tool; self-reported change in practice; use of the Child and Adolescent Functional Assessment Scale (CAFAS) tool; and use of, and satisfaction with, implementation support.

The difference between the CoP and practice-as-usual groups, in terms of self-reported practice change, was not statistically significant. However, the CoP group demonstrated greater knowledge of the assessment tool at the end of the 12 months and greater use of the tool compared to the practice-as-usual group. The authors conclude that CoPs may be a useful strategy for promoting the implementation of evidence-based practice; but caution against generalisation, due to small size of the sample and one-year follow-up period.