Evidence to Care: Mobilizing Childhood Disability Research into Practice
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Evidence to Care: Mobilizing Childhood Disability Research into Practice

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Evidence to Care: Mobilizing Childhood Disability Research into Practice ...

Evidence to Care: Mobilizing Childhood Disability Research into Practice

Dr. Shauna Kingsnorth
Evidence to Care Lead
Clinical Study Investigator
Assistant Professor (status), Department of Occupational Science
and Occupational Therapy, University of Toronto
Holland Bloorview Kids Rehabilitation Hospital
skingsnorth@hollandbloorview.ca

Presented at: Canadian Knowledge Mobilization Forum
Saskatoon, Saskatchewan June 9, 2014

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Evidence to Care: Mobilizing Childhood Disability Research into Practice Presentation Transcript

  • 1. Evidence to Care: Mobilizing Childhood Disability Research into Practice Canadian Knowledge Mobilization Forum Saskatoon, Saskatchewan June 9, 2014 Dr. Shauna Kingsnorth Evidence to Care Lead Clinical Study Investigator Assistant Professor (status), Department of Occupational Science and Occupational Therapy, University of Toronto Holland Bloorview Kids Rehabilitation Hospital skingsnorth@hollandbloorview.ca
  • 2. Healthcare in Ontario: Ministry of Health and Long-Term Care • Provincial governing body for healthcare services • Patient-focused, results-driven, integrated and sustainable, publicly funded • Provide strategic direction on provincial priorities; establish sustainable funding models, legislation, monitoring, reporting, and policies MOHLTC. (2013). http://www.health.gov.on.ca/en/common/ministry
  • 3. Legislation: What is ECFAA? The Excellent Care for All Act (ECFAA), which came into law in June of 2010, puts Ontario patients first and helps define quality for the health care sector, by reinforcing shared responsibility for quality of care, building and supporting boards’ capability to oversee the delivery of high quality of care, and ensuring health care organizations make information on their commitment to quality publicly available MOHLTC. (2012). http://www.health.gov.on.ca/en/public/programs/ecfa
  • 4. What is the aim of ECFAA? •To ensure that: –Best practices information is supported by available scientific evidence –This information is translated into materials for employees and persons providing services within the health care organization –The use of these materials is monitored through user-based surveys and standards of care Ontario Government. (2010). http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_10e14_e.htm
  • 5. ECFAA as a Social Innovation •Places the patient at the centre of care •Creates an enduring organizational focus on quality and continuous improvement •As a regulatory systems driver, ECFAA creates conditions to support, enable and compel quality improvement Quality improvement for better outcomes
  • 6. 6 Holland Bloorview Kids Rehabilitation Hospital
  • 7. Discovering Evidence Use at Holland Bloorview Indicator Audit Validated Tool Best practices? Focus Groups 7 To what extent is current research evidence being used in clinical practice?
  • 8. Results: How evidence-friendly are we? 0 10 20 30 40 50 60 70 1 2 3 4 5 6 7 Anchored Scale (-/+) Percentfrequency 8 Waste of time Fundamental! Mode • Solid understanding of evidence-informed best practice • Strong appreciation of value and need • Very positive attitudes
  • 9. Results: Is it easy is it to access? •Described as limited and self-directed –Research Librarian fundamental for direct access –Conference attendance key learning vehicle –Collaborative research partnerships not optimized –No systematic organizational push/pull processes 9
  • 10. Conclusions: Enablers and Barriers to Use •Resource drivers – Individual skill – Organizational capacity •Evidence enablers – Quality and fit – Availability •Professional drivers – Colleges and associations (i.e., regulated roles) – Colleagues 10
  • 11. ECFAA at Holland Bloorview Evidence to Care Evidence Informed Best Practice Excellent Care for All Act (ECFAA) Health Quality Ontario
  • 12. Evidence to Care (EtC): A Catalyst for Knowledge Translation "The collaborative and systematic review, assessment, identification, aggregation, and practical application of high-quality disability and rehabilitation research by key stakeholders for the purpose of improving the lives of individuals with disabilities.” 12 NCDDR. (2005). http://www.ncddr.org/knowledge_trans_over.html
  • 13. What is Evidence to Care? •Our vision is to promote the best available research evidence to inform care in childhood disability •A bridge between research and clinical care and policy 13
  • 14. What is Evidence to Care? Position Holland Bloorview as a ‘go to’ hub for: • Systematic reviews • Clinical practice guidelines • Evidence-informed best practices CIHR. (2014). http://www.cihr-irsc.gc.ca/e/39033.html
  • 15. Aligning Evidence with the Pillars • Accelerate Knowledge • Provide expertise in best practices in the field of knowledge translation • Hold events that promote and showcase using evidence to enhance care • Support BRI grant requests through suggesting creative knowledge translation strategies • Lead the System • Identify gaps in evidence-informed best practice in childhood disability • Generate systematic reviews and clinical practice guidelines to meet our needs • Raise Holland Bloorview’s knowledge translation
  • 16. Aligning Evidence with the Pillars • Transform Care • Identify, appraise and communicate research evidence • Develop and implement clinical practice guidelines • Evaluate changes in care related to evidence use • Inspire our People • Develop a strategy that enhances staff’s ability to use evidence • Create opportunities for researchers and clinicians (and families where possible) to work together to solve issues using evidence • Promote evidence use in all programs throughout the organization
  • 17. Funding • Foundation • Partnership with MOHLTC • Grant funding
  • 18. EtC in Action: Energy in the System ● Success contingent on inter-professional cooperation ● Partnerships and key enablers: − Academic health science centre − Commitment to research − Collaborative structures − Senior management engagement − Change champions − Expertise
  • 19. Progression of the Model: In Practice 19 Organizational partners EtC Steering Committee Core Staff Associates Teaching & Learning Institute Hospital CEO Lead Collaborative Practice Leaders Bloorview Research Institute VPs Knowledge Brokers(2) Research Librarian Senior Directors Knowledge Translation Specialist (2) Scientists & Clinicians Directors Administrative Assistant Communications & Public Affairs EtC Lead Research Assistant Family & Youth Leaders
  • 20. Organizational Impact •Embedding KT Competencies in: –Research Curriculum –KT Consultations –HR Interview Questions –Investigator Performance Appraisal –Key Performance Indicator Reporting –Grant application process
  • 21. EtC in Action: Best Practice Projects 21 Phase 2: Evidence appraisal Phase 3: Product develop and tailoring to context Phase 4: Dissemination, Implementation & Evaluation Integrated Knowledge Translation Strategy Phase 1: Identify Priority Area
  • 22. EtC in Action: Best Practice Projects Chronic Pain and Cerebral Palsy Project Develop and implement a best practice recommendation for the assessment of chronic pain among paediatric outpatients with cerebral palsy
  • 23. Cerebral Palsy Chronic Pain Toolbox 23 Multi-phase approach identified: • Registered Nurses Association of Ontario (RNAO) Best Practice Guideline (BPG) for Pain Assessment Recommendations6 • Cerebral Palsy specific care and practice points • 7 pain interference tools
  • 24. Knowledge Translation Activities - Printed Educational Materials - Champions - Educational Meetings (e.g. workshops, huddles) - Audit and Feedback - Reminders Chronic Pain and Cerebral Palsy Implementation: Knowledge Translation Strategies
  • 25. EtC in Action: Best Practice Projects Children with Medical Complexity Project Engage in a best practice project to develop a compendium of evidence informed resources for children with medical complexity
  • 26. Children with Medical Complexity Project Identifying Best Practice: How are best practices advanced when the evidence doesn't exist? Scoping Review of the Evidence Stakeholder Engagement for Product Development Leading Practices Scan Engaging Families is Critical!
  • 27. Early Learnings • Emerging field of KT – Advancing a model of 'on the ground' learning • Building skills while building products – Big investment short-term long-term pay offs • 'Evidence-informed Practice' vs. 'Practice-informed Evidence ' – Medical advance, technology and societal attitudes are changing – Disability research is not simple or easy • Early wins to foster culture of change
  • 28. Social Innovation Social innovation is a process of change emerging from the creative re-combination of existing assets, the aim of which is to achieve socially recognized goals in a new way - Ezio Manzini (2014) Evidence to Care bridges the gap between research and clinical practice to create a world of possibility for kids with disability
  • 29. Evidence to Care acts as a bridge between research and clinical care and policy. Our vision is to promote the best available research evidence to inform care in childhood disability. Find us on the web at: www.hollandbloorview.ca/TeachingLearning/EvidencetoCare
  • 30. Thank you! Evidence to Care