‘Translating Maternal and Infant Community Health Needs Into Evidence-Based, Patient-Centered Care’

It’s hard to believe that the 24th International Breastfeeding and MAINN Conference is just a few weeks away. It’s just as hard to imagine that the upcoming conference could get any better than years’ past, but something tells me this one could be the best of all!

If you’re still considering registering, let me give you another reason to attend. Her name is Elizabeth Crabtree, PhD, MPH, Director of Clinical Integration and Evidence-Based Practice at Oregon Health and Science University (OHSU). Dr. Crabtree will present “Translating Maternal and Infant Community Health Needs Into Evidence-Based, Patient-Centered Care”.

Her presentation details how a highly engaged, multidisciplinary group of stakeholders addressed community health needs within a health system through the creation of a guideline that incorporates patient values and preferences, clinical expertise, and best available evidence in an effort to maximize patient outcomes.

Maternal child health has always been an interest of Dr. Crabtree’s.

“…Healthy moms and babies seem to be elemental components of a healthy community,” she begins. “I think it’s natural for anyone interested in health promotion to care deeply about maternal child health as there’s so much research that shows the importance of and connections between the mother/child relationship and the quality of interactions a child has in the first few years of life, to success and well-being in later years.”

During a graduate school internship at a safety net hospital’s emergency room, Dr. Crabtree surveyed women for mental health and intimate partner violence concerns.

“It was clear to see how a lack of needed resources and care in the perinatal period and early childhood resulted in poor health outcomes for both moms and children,” she reflects.

Dr. Crabtree has a two-year-old daughter, and she says the “privilege and challenges of motherhood” have made her even more invested in maternal/child health promotion.

Prior to joining OHSU, Dr. Crabtree worked at the Medical University of South Carolina (MUSC) and Texas Children’s Hospital. At MUSC, Dr. Crabtree worked with College of Medicine faculty to offer a project-based evidence-based practice course to second-year medical students. Small teams of medical students partnered with interprofessional clinical teams at MUSC’s hospital to engage students in conducting evidence reviews that informed practice guidelines and the development of clinical decision support tools.

For nearly a decade, Dr. Crabtree has led interprofessional clinical teams to develop and implement evidence-based plans of care. Collaboration has proven an essential element.

“It’s been remarkable to see the collaboration and advancements made in care standardization and coordination just by giving clinicians the opportunity to sit at the same table,” she says. “We also provide free lunch, which certainly helps get people to the table!”

A partnership of multidisciplinary teams of clinicians and patient representatives develop guidelines at OHSU; any discipline or specialty that will have interaction with a patient is represented on the guideline development team, Dr. Crabtree explains.

What evidence do Dr. Crabtree and her team consider? She defines evidence as published literature in peer-reviewed journals, acknowledging that just because something is published doesn’t mean it’s good evidence or reliable.

Moreover, she goes on, retrieval and review of primary literature can be burdensome for busy, practicing clinicians.

“The value of clinical practice guidelines and systematic reviews is that, if done well, they attend to quality concerns, and in a systematic and critical way appraise and synthesize studies to guide clinicians in their decision-making,” Dr. Crabtree explains.

She makes clear that clinicians shouldn’t be directed by evidence alone. Instead, evidence-based practice is about care that’s based on best available evidence, while remaining mindful of biases and expertise, and patients’ values and preferences.

“Delivering evidence-based care is the art of determining how to apply a given best practice or recommendation to the patient sitting in front of you in the exam room,” she says.

Dr. Crabtree reports that evidence-based guidelines can markedly shorten the time it takes for the translation of research to policy and practice to occur, from 17 to 7 years.

“There’s been a paucity of research assessing how to effectively implement best practices, and health systems often aren’t structured in such a way to successfully support and engage clinicians in these efforts,” Dr. Crabtree explains.

These insufficiencies highlight the importance of designing systems of care that support integrating best research into practice.

At the local health system level, Dr. Crabtree and colleagues at OHSU provide the opportunity for clinicians to build consensus around guideline development and how care should be delivered, and help to design workflows that make it easier for clinicians to “do the right thing.”

“I really believe it’s the duty of health systems to create the appropriate systems of care that support clinicians in integrating best research evidence and delivering evidence-based care in a consistent manner,” she notes. “It’s not realistic to expect an individual clinician to evaluate and translate all existing relevant literature on her own. Health system leaders and administrators need to make it easier through system design.”

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