Suchergebnisse

This article is the outcome of a consensus building workshop entitled, "Overcoming Barriers to Implementation and Dissemination" convened at the 2009 Academic Emergency Medicine Consensus Conference, "Public Health in the ED: Surveillance, Screening, and Intervention." The participants were asked to address potential methods for overcoming barriers to the dissemination and implementation in the emergency department (ED) of evidenced-based practices to improve public health. The panel discussed three broad areas of interest including methods for disseminating evidence-based practices, barriers encountered during the process of implementation, and the importance of involvement in activities outside the ED including engagement in policy development and improvement. Four recommendations were discussed in detail and consensus was reached. The recommendations included 1) researchers and advocates should disseminate findings through multiple forums beyond peer-reviewed publications when an ED-based public health intervention has enough evidence to support integration into the routine practice of emergency care; 2) local barriers to implementation of public health interventions should be recognized and well understood from multiple perspectives prior to implementation; 3) innovation must be put into place and adapted based on local institutional context and culture as barriers and the best methods for overcoming them will vary across institutions; and 4) use of legislation, regulation, and incentives outside of the ED should support and strengthen ED-based interventions. For each area of interest, research dimensions to extend the current understanding of methods for effectively and efficiently implementing evidence-based public health interventions in the ED were discussed and consensus was achieved.

Since 1996, states have been implementing and enhancing their graduated driver licensing (GDL) programs. Increased licensing restrictions could steer new drivers to bypass training and licensing altogether. Unlicensed driving is associated with increased fatal crashes and high-risk behaviors that have been shown to adversely affect passenger safety behaviors like restraint use. The objective of this study was to assess the impact of varying state level GDL programs on rates of unlicensed driving and on passenger restraint use. De-identified data from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System from years 1996–2010 was analyzed. Fatal crashes involving drivers (15–24 yrs) and their passengers (15–24 yrs) were included. Using a validated system, each state's GDL laws at a given month were rated as poor, marginal, fair, or good. The association between GDL strength and unlicensed driving was analyzed graphically and by chi-square test. Multivariate logistic regression with generalized estimating equations were undertaken to assess the relationship between GDL strength and passenger restraint use. From January 1996 to December 2010, 26,504 (23.4%) passengers were involved in fatal crashes taking place in states with GDL programs rated poor, 21,366(18.9%) marginal, 33,603 (29.6%) fair, and 31,903 (28.1%) good. Rates of unlicensed driving ranged from 16.4% in state-months rated marginal versus 21.5% in state-months rated good (p<0.001). In the multivariate model, compared to states with poor GDL ratings, each additional rating boost was associated with an increased odds of passenger safety restraint use (OR 1.15, 95% CI 1.13–1.18). Our findings suggest that stronger GDL law can mitigate passenger risk in fatal crashes by encouraging passenger restraint use. Our study provides evidence that stronger legislation in these states may reduce overall risk to young drivers and their passengers.