The E-SCOPE Initiative: A Strategic Approach to Identify and Accelerate Implementation of Evidence-Based Best Practices

Abstracts from the Kaiser Permanente2018 National Quality Conference


Joel Whittaker, MPH; Joanne Schottinger, MD; Michael H Kanter, MD; Marguerite Koster, LMFT, MA

From Southern California

Background: Proposed changes in front-line care often originate with clinician suggestions, but evaluating their merit is time-consuming and expensive. Focused evidence reviews may yield inconclusive findings that do not allow clear-cut decisions, and pilot studies are vulnerable to poor design and less-than-rigorous evaluation. Duplicating clinical trials is costly and inconsistent with our affordability mission. E-SCOPE offers an accelerated, more effective way to break the logjam of identifying and implementing evidence-based practices in the clinical care setting.
Methods: Problem: More than 36,000 clinical trials are published yearly, many demonstrating effectiveness of clinical interventions to improve the health of Kaiser Permanente (KP) members. Intervention: Combining proactive identification of high-quality evidence with stakeholder engagement, implementation support, and monitoring to accelerate delivery of evidence-based best practices. Comparison: Care improvement initiatives driven by expensive, time-consuming evaluation of anecdotal suggestions; focused evidence reviews with inconclusive results and no clear-cut decisions; poorly designed and evaluated pilot studies; duplicating costly clinical trials inconsistent with the KP affordability mission. Outcome: Timely, effective, and efficient identification and implementation of evidence-based best practices.
Results: Between 2014 and 2017, the E-SCOPE Initiative proactively identified and accelerated the launch of 17 evidence-based best practices to improve the effectiveness, safety, timeliness, and/or efficiency of care. The date from study publication to date of deployment for all E-SCOPE interventions ranged from 4 to 36 months, a reduction from the 17-year average implementation time documented in published literature (
Discussion: The E-SCOPE process can successfully identify and implement beneficial evidence-based practices; minimize reliance on costly, time-consuming, and less-than-rigorous pilot studies; and reduce the time gap between publication and delivery of important patient care interventions supported by high-quality published evidence. The Southern California region is developing knowledge management resources to share the identified evidence-based best practices and implementation strategies with other KP regions, and will seek feedback from workshop attendees on how best to provide E-SCOPE resources to meet existing clinical priorities, delivery system structures, and resources in other regions.

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