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TEAM-beta: Treatment and Evidence Algorithmic Mapping - a platform for an efficient decision support tool for clinicians, researchers and funders

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TEAM-beta: Treatment and Evidence Algorithmic Mapping - a platform for an efficient decision support tool for clinicians, researchers and funders ...

TEAM-beta: Treatment and Evidence Algorithmic Mapping - a platform for an efficient decision support tool for clinicians, researchers and funders

Presented by Dalton Wolfe at the Canadian Knowledge Mobilization Forum, June 19-20, 2012, Ottawa, Ontario, Canada

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    TEAM-beta: Treatment and Evidence Algorithmic Mapping - a platform for an efficient decision support tool for clinicians, researchers and funders TEAM-beta: Treatment and Evidence Algorithmic Mapping - a platform for an efficient decision support tool for clinicians, researchers and funders Presentation Transcript

    • TEAM-beta: Treatment and EvidenceAlgorithmic Mapping – a platform for anefficient decision support tool for clinicians,researchers and fundersDalton Wolfe1, Jane Hsieh2, Jennifer Hunter2, Amanda Khan1, Saagar Walia1 & theSpinal Cord Injury Knowledge Mobilization Network1: Parkwood Hospital, Lawson Health Research Institute2: Ontario Neurotrauma Foundation Canadian Knowledge Mobilization Forum 2012 - June 20, 2012
    • Foothills Medical Centre: SCIRehabilitation Clinic Glenrose Rehabilitation Hospital
    • OutlineObjective: to describe the rationale and early conceptdevelopment behind TEAMbeta (clinical decision makingsupport tool)• Problem Identification: Too Much Information, Not Enough Knowledge (Is Practice Evidence-Informed?)• Solution: TEAMbeta, a map to information that is clinically relevant  Knowledge  Action• Initial Features and Methods
    • A Vast Sea of Information: But is it Being Used in Practice (i.e. Behaviour Change)?Challenges for Knowledge Users• Ever increasing volume andcomplexity• Access hindered by multiplebarriers (competing demands,cost, feasibility)• Application hampered by inertiaand inability to apply appropriately• What to do??? (Information Knowledge  Action
    • Spinal Cord Injury Rehabilitation Evidence (SCIRE): Knowledge Product• Canadian collaboration between scientists and clinicians• www.scireproject.com• Expert synthesis  evidence statements
    • SCIRE: Knowledge Product Platform Standards of Care Knowledge Translation Research / Care1. Standards of Care 1. Case Studies Priorities (Informing SCI KMN, (Modeling Evidence 1. Consensus Priority etc.)  Practice) Setting Activities2. Outcome Measure 2. TEAMbeta (base on Gap Standardization (Outcome Measure 3. Outcome Analysis, strengths, Toolkit) Measurement “How- etc.)3. Clinical Practice to” Videos Development (e.g., 4. SCI-U (eLearning Canadian Physical modules directed to Activity / Pressure Ulcer the person with SCI = Guidelines self-management)
    • SCIRE: Influencing Decision-Making• Typical approaches to consensus-seeking activities do not place decision making in the context of practice• Ultimate goal … To influence practice so as to improve outcomes
    • Our Challenge• How do we get information to users in a way they will use it?• Goal: to enhance decision making and influence practice (action) by … – Clinicians – Researchers – Funders / Policy makers / Administrators
    • Our Solution: TEAMbeta • An algorithm to guide decision making that is consistent with the clinical situation (for pain management in persons with SCI)  Assessment  Diagnosis  Treatment • Each node represents links to further information
    • Applying the Solution to the Real World Identifying implementation targets for the Spinal Cord Injury Knowledge Mobilization Network (SCI KMN)• The SCI KMN is 6 Canadian rehab centres applying the principles of Implementation Science for best practice adoption Parkwood Hospital - London, ON Glenrose Hospital – Foothills Hospital – Edmonton, AB Calgary, AB IRDPQ – IRGLM– Québec City, QC Montreal, QC Toronto Rehab - Toronto, ON
    • Delphi: Selecting Practices as Targets for Implementation• Successive rounds of considering practice options and voting• Participants voted according to set criteria DRAFT 1. ASSESSMENT: Conduct a Canadian Best Practices Best Practices Practice comprehensive, systematic Guidelines on 1……………...23 1……………...12 assessment of risk factorsPressure Ulcers 2. EDUCATION: Provide 48 Practices structured pressure ulcer Round 1 Round 2 Round 3 prevention education• Before: this was done by reviewing long lists of informationabout evidence behind practice options• After TEAMbeta: this information will be provided in aclinically relevant way
    • Methods: Building the Content, Defining the SpecsPain Advisory Team (PAT)• 8 subject matter experts (variety of clinical perspectives)• Facilitated through collaboration platform (SharePoint)Specification and Features Advisory Team (SFAT)• 4 subject matter experts (2 IT, 2 clinical)Core Development Team (CDT)• Data abstraction from CPGs, systematic reviews, meta-analyses, etc.• Iterative prototyping with IT partner
    • TEAMbeta Features• The map will parallel the structure of the International SCI Pain (ISCIP) classification system, which first identifies pain sub- types and highlights associated treatment options• Web-based (platform independent) software system• Interactivity enabled by zoom and pan functions
    • TEAMbeta Features … • Overall shape and colour of treatment option will reflect aGabapentin class of treatment • Illustrative icons link to underlying information (i.e. active/greyed-out = info available/not) • Icon colour-coding will illustrate status at-a- glance associated with Tricyclic the underlying information …
    • TEAMbeta Features Gabapentin • By clicking on the ?????? appropriate icon, it will How-to take you to the GuidelinesEvidence underlying information• There is level 1 evidence that Gabapentin and pregabalin improve neuropathic pain post SCI.• There is level 4 evidence that the anticonvulsant Gabapentin is more effective when SCI pain is <6 months than >6 months.  Source: SCIRE; This evidence is based on these articles
    • Enabling the Delphi … Process • Icons to initiate voting and view past resultsGabapentin • Enable culling over successive rounds Tricyclic …
    • Lots of ideas – Long-term Development Gabapentin • Use gaming concepts (i.e., motivational Evidenc rewards, competition, How-to Guidelines etc.). How-to • Community of practiceMethod of Administration: Oral • Ideas emerging fromRecommended Dose: cc mg bidContraindications: safm dsein sdfdsoe dfs ssfs. Congratulations!! PAT / SFATSource: www.drquacky completed the quest to You have .com examine and apply 5 “How-To” sections for pain treatments. You will receive 5 gold bars …
    • Key Concept• Decision-making  Practice Change (Action) will be aided by placing information in an appropriate context. Comments?