Have Got a for Knowledge Translation in Health

Have Got a for Knowledge Translation in Health Care: Moving from Evidence to Practice (2013, 2 nd edition) Ian D Graham, Ph. D, FCAHS Professor, Epidemiology and Community Medicine, UOttawa Senior Scientist, OHRI October 9, 2014 KT Canada

Disclosures • Originator of the K 2 A cycle • Editor of KT in Healthcare • All royalties go to KT Canada STIHR for student fellowships (V 1 royalties went into CIHR fund for students) • Sharon is making me do this!

Session Objectives • Understand the K 2 A Cycle • KT in Health Care, what’s included, what new • Anything else?

The Warning Signs and Symptoms • Eye rolling • Sighing • Involuntary utterances – OMG – HML – JKMN • Hyperventilating • Fainting • More common among physicians and males What is it?

TAS Theory Averse Syndrome FAS Framework Averse Syndrome

Monitor Knowledge Use Kn ow led Knowledge Inquiry Ta Synthesis Adapt Knowledge to Local Context Evaluate Outcomes ge KNOWLEDGE CREATION ing Assess Barriers/ Supports to Knowledge Use from: Graham et al: Lost in Knowledge Translation: Time for a Map? ilor Select, Tailor, Implement Interventions Products/ Tools Identify Problem Identify, Review, Select Knowledge Sustain Knowledge Use

How to move research knowledge into practice? use the knowledge to action cycle to improve implementation and uptake of research

Chapter format • Key learning points • Background • Evidence • Future research • Summary • References

Section 1: Introduction • Chapter 1. 1 Intro to KT; What it is and what it isn’t (Straus, Tetroe, Graham) • Chapter 1. 2 Integrated KT (Bowen, Graham) (new)

ge led ow Kn rin g Synthesis Ta ilo Knowledge Inquiry Products/ Tools • studies using all types of study designs • primary research needs to be targeted to fill the known gaps in our knowledge base • primary research needs to be solutions-based • need data on effectiveness/impact of practices and hence methods of evaluation

ge led ow Kn rin g Synthesis Ta ilo Synthesis Knowledge Inquiry Products/ Tools • need for synthesis to determine what we already know (or should know if we were to summarize the existing knowledge) • can take the form of systematic reviews, meta analyses, realist reviews, etc. • need to determine where there is a strong evidence base and move that evidence into action • Chapter 2. 0: Introduction: the K in KT: Knowledge Creation (Straus) • Chapter 2. 1: Knowledge Synthesis (Tricco, Tetzlaff, Moher)

Products/ Tools • • ge led ow Kn rin g Synthesis Ta ilo Knowledge Products/Tools Knowledge Inquiry Algorithms Decision rules Decision aids Guidelines • Chapter 2. 2: Knowledge translation tools (Brouwers, Stacey, O’Connor) • Chapter 2, 3 Searching for research findings and the KT literature (Mc. Kibbon, Lokker) • Chapter 2. . 4: Knowledge Dissemination: End of Grant KT (Graham, Tetroe, Gagnon) (new)

Monitor Knowledge Use Select, Tailor, Implement Interventions Section 3: the Action cycle Chapter 3. 0: Introduction (Straus) Evaluate Outcomes Assess Barriers/ Supports to Knowledge Use Start here Adapt Knowledge to Local Context Identify Problem Identify, Review, Select Knowledge Sustain Knowledge Use

Monitor Knowledge Use Identify Problem Select, Tailor, Implement Interventions KNOWLEDGE CREATION Evaluate Outcomes dg wle ilor ing Kn o Synthesis Adapt Knowledge to Local Context Products/ Tools Ta Identify, Review, Select Knowledge e Knowledge Inquiry Assess supports/ Barriers to Knowledge Use Sustain Knowledge Use Identify Problem • EITHER Identify, Review, Select Knowledge Start with problem/issue concern and look for research to solve the problem • How to determine if and what research is needed? – from an individual and a systems perspective • Who should identify the need for research? • Does the research question address an issue of relevance to the end user? • Are all the relevant stakeholders involved?

Monitor Knowledge Use Identify Problem Select, Tailor, Implement Interventions KNOWLEDGE CREATION Evaluate Outcomes dg wle ilor ing Kn o Synthesis Adapt Knowledge to Local Context Products/ Tools Ta Identify, Review, Select Knowledge e Knowledge Inquiry Assess supports/ Barriers to Knowledge Use Sustain Knowledge Use Identify Problem Identify, Review, Select Knowledge OR Become aware of current research/systematic review/guideline and assess whether current practice is in keeping with it Is it high quality evidence? If using a guideline, does it adhere to the AGREE and IOM quality criteria?

Know-do gap • Chapter 3: Identifying knowledge to action gaps (Kitson, Straus)

Monitor Knowledge Use W O KN E E CR ed iry N qu sis Adapt Knowledge to Local Context IO In e wledg g Kno AT ge he / ts uc od ls Pr Too Tailorin Evaluate outcomes DG LE l ow Kn nt Assess supports/ Barriers to Knowledge Use Sy Adapt Knowledge to Local Context Select, Tailor, Implement Interventions Sustain Knowledge Use Identify Problem Identify, Review, Select Knowledge • To apply knowledge, one needs to contextualize or adapt it for local use • e. g. ADAPTE Collaboration (for guideline adaptation); CAN-IMPLEMENT • How might the guideline need to be adapted for local use? • What are the specific contextual variables that need to be taken into account for the context in which you are working? • Chapter 3. 2: Adapting knowledge to local context (Harrison, Graham, Fervers, van den Hoek)

Select, Tailor, Implement Interventions ed ge Adapt Knowledge to Local Context TION Inquiry Kn ow l KNOWLE DGE CREA ing Knowledge Ta ilo r Synthesis Assess supports/ barriers to Knowledge Use Products/ Tools Assess barriers/ supports to knowledge use Monitor Knowledge Use Evaluate outcomes Sustain Knowledge Use • Assess barriers and supports related to: – the innovation – the potential adopters – the practice setting • What might be the individual (patient or provider), organizational and team barriers to uptake of best practice? • What might be the individual, organizational and team supports to uptake of best practice? Identify Problem Identify, Review, Select Knowledge • Chapter 3. 3 a: Barriers and facilitators: strategies for identification and measurement (Legare, Zhang) • Chapter 3. 3 b: Mapping KT interventions to barriers and facilitators (Colquhoun, Grimshaw, Wensign) (new)

Select, Tailor, Implement Interventions Evaluate outcomes O l e LE W ed g Sustain Knowledge Use N TI O EA CR ry E ui DG In q dge Adapt Knowledge to Local Context KN no w he Assess supports barriers to Knowledge Use K Sy nt sni owle Pr o g. K s To aduilcorin Tol ts/ s Select, Tailor, Implement Interventions Monitor Knowledge Use Identify Problem Identify, Review, Select Knowledge Tailor interventions as much as possible, based on the barriers and supports identified, select or tailor interventions to move knowledge to practice • Consider the context in which you are trying to implement change – what interventions are more or less likely to be effective? • Chapter 3. 4 a: Developing and selection KT interventions (Wensign, Bosch, Grol) • Chapter 3. 4 b: Formal educational interventions (Davis, Johnson) • Chapter 3. 4 c: Linkage and exchange (Salsberg, Macaulay) (newish) • Chapter 3. 4 d: Audit and feedback interventions (Foy, Eccles) • Chapter 3. 4 e: Informatics interventions (Gupta, Mc. Kibbon)

Selecting KT interventions con’td • Chapter 3. 4 f: Patient-directed and patient mediated KT interventions (Stacey, Hill) (new) • Chapter 3. 4 g: Organizational interventions (Ferlie) • Chapter 3. 4 h: Shared decision making (Legare, Zhang) • Chapter 3. 4 i: Financial incentive interventions (Flodgren, Eccles, Scott, Sheppard) (new)

Monitor Knowledge Use Products/ Tools Ta ilo Synthesis ge wle d Assess supports/ barriers to Knowledge Use Knowledge Inquiry KNOWLEDGE CREATION Adapt Knowledge to Local Context Evaluate outcomes g. K no rin Monitor Knowledge Use Select, Tailor, Implement Interventions Sustain Knowledge Use Identify Problem Identify, Review, Select Knowledge • Instrumental (behaviour): guideline adherence, use/adoption of innovation • Conceptual (knowledge & attitudes & intentions), • Symbolic knowledge use • identify appropriate indicators of use of the innovation • identify the level(s) (system, team, practitioner, patient) where you need to measure the knowledge use

Monitor Knowledge Use ts/ duc Pro ools T esis uiry nth Sy Inq ge led K D LE OW Sustain Knowledge Use KN Adapt Knowledge to Local Context now AT RE C GE Assess supports barriers to Knowledge Use Evaluate Outcomes Tailoring Knowledge Evaluate Outcomes ION Select, Tailor, Implement Interventions Identify Problem Identify, Review, Select Knowledge • Determine impact of using the guideline or uptake of the innovation – Patient health outcomes (eg. relief of symptoms, mobility HRQo. L) – Provider outcomes (eg. satisfaction) – System/organization outcomes (eg. Wait times, expenditures, readmissions) – Unintended impacts • Identify outcomes/impacts to measure and methods for doing so • Determine your evaluation plan at the outset and in consultation with all stakeholders • Chapter 3. 5: Monitoring knowledge use and evaluating outcomes (Straus, Tetroe, Bhattacharyya, Zwarenstein, Graham)

Monitor Knowledge Use g Prod rin uiloc To. Toa ts/ ls K thes owle nis dg e Evaluate Outcomes Syn ATIO N quiry ge In CRE DGE wled Kno WLE Assess supports Barriers to Knowledge Use KNO Sustain Knowledge Use Select, Tailor, Implement Interventions Adapt Knowledge to Local Context Sustain Knowledge Use Identify Problem Identify, Review, Select Knowledge • Are interventions needed to sustain ongoing use of the innovation? • Is there a role for quality improvement processes? • What ongoing monitoring of use and impacts needed? • How long are the skills/knowledge maintained? • Consider sustainability issues at the beginning to optimize moving research knowledge into practice • Chapter 3. 6: Sustaining knowledge use (Davies and Edwards)

Chapter 3. 7: Case examples • Chapter 3. 7 a: Illustrating the knowledge to action cycle: an integrated knowledge translation research approach to wound care (Graham, Harrison) (new) • Chapter 3. 7 b: Tips on implementation (Ritchie) (new)

FAS & TAS Alert Section 4: Theories and models of knowledge to action • Chapter 4. 1: Planned action theories (Graham, Tetroe) • Chapter 4. 2: Cognitive psychology theories of change in provider behavior (Hutchison, Estabrooks) • Chapter 4. 3: Education theories (Hutchison, Estabrooks) • Chapter 4. 4: Organizational theories (Denis, Lehoux) • Chapter 4. 5: Quality improvement theories (Sales) (new)

Section 5: Evaluation of knowledge to action • Chapter 5. 1: Methodologies to evaluate effectiveness of knowledge translation interventions (Bhattacharyya, Zwarenstein) • Chapter 5. 2: Economic evaluation of knowledge translation interventions (Quinn, Mitton, Ward) (new)

Section 6: Ethics • Chapter 6. 1: Ethics in the science lifecycle: broadening the scope of ethical analysis (Allen, Flamenbaum) (new) • Chapter 6. 2: Ethical issues in Cluster-randomized trials in KT (Taljaard, Weijer, Grimshaw) (new)

KT in Health Care - Moving from Evidence to Practice: A KT Handbook Chapters cover: • Knowledge creation • Knowledge-to-Action cycle • Theories and Models of Knowledge-to-Action • Knowledge exchange/i. KT • Evaluation of Knowledge-to-Action Available at: http: //ca. wiley. com/Wiley. CDA/Wiley. Title/product Cd-1405181060, desc. Cd-description. html Presentations based on chapters available at: http: //www. cihr-irsc. gc. ca/e/40618. html

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Knowledge, if it does not determine action, is dead to us. Plotinus (Roman philosopher 205 AD-270 AD)

Knowledge, if it does not determine action, is dead to us. Plotinus Moher (Roman philosopher 205 AD-270 AD)

Take a Minute to Reflect on the Session’s Objectives • Understand the K 2 A Cycle • KT in Health Care, what’s included, what new

Questions? I don’t get it