Promoting the uptake and use of evidence: an overview of the problem.
Application of evidence-based practice principles in neonatology requires that the use of proved therapies is monitored and evaluated. Although studies of neonatal center practice variation are appearing in the literature, careful, population-based assessments of the use of proved therapies are lacking. Few center comparison studies focus on proved therapies or explore the patient-independent reasons for practice variation. For a specific proved neonatal therapy, the ideal studies would carefully determine the number of eligible patients and the proportion who receive the therapy and then evaluate the characteristics of hospitals, clinicians, parents, and other decision makers among users and non-users. This information may allow for targeted interventions to disseminate evidence to both clinicians and parents, train clinicians critically to appraise the evidence, address identified barriers, and train clinicians to recognize and deal with the inevitable uncertainties associated with changing practice. The authors suggest that studies designed to evaluate the net benefit of proposed new therapies include a plan for evaluating the extent of incorporation of the therapy into practice if and when the therapy is shown to be beneficial. Studies should also rigorously evaluate alternative methods of disseminating the primary study's findings and identify the characteristics of clinicians, patients, and parents associated with practice change.