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

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

Published in: Health & Medicine, Education
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TEAM-beta: Treatment and Evidence Algorithmic Mapping - a platform for an efficient decision support tool for clinicians, researchers and funders

  1. 1. TEAM-beta: Treatment and Evidence Algorithmic Mapping – a platform for an efficient decision support tool for clinicians, researchers and funders Dalton Wolfe1, Jane Hsieh2, Jennifer Hunter2, Amanda Khan1, Saagar Walia1 & the Spinal Cord Injury Knowledge Mobilization Network 1: Parkwood Hospital, Lawson Health Research Institute 2: Ontario Neurotrauma Foundation Canadian Knowledge Mobilization Forum 2012 - June 20, 2012
  2. 2. Foothills Medical Centre: SCI Rehabilitation Clinic Glenrose Rehabilitation Hospital
  3. 3. Outline Objective: to describe the rationale and early concept development behind TEAMbeta (clinical decision making support 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
  4. 4. A Vast Sea of Information: But is it Being Used in Practice (i.e. Behaviour Change)? Challenges for Knowledge Users • Ever increasing volume and complexity • Access hindered by multiple barriers (competing demands, cost, feasibility) • Application hampered by inertia and inability to apply appropriately • What to do??? (Information  Knowledge  Action
  5. 5. Spinal Cord Injury Rehabilitation Evidence (SCIRE): Knowledge Product • Canadian collaboration between scientists and clinicians • • Expert synthesis  evidence statements
  6. 6. SCIRE: Knowledge Product Platform Standards of Care 1. Standards of Care (Informing SCI KMN, etc.) 2. Outcome Measure Standardization (Outcome Measure Toolkit) 3. Clinical Practice Development (e.g., Canadian Physical Activity / Pressure Ulcer Guidelines Knowledge Translation 1.Case Studies (Modeling Evidence  Practice) 2.TEAMbeta 3.Outcome Measurement “How- to” Videos 4.SCI-U (eLearning modules directed to the person with SCI = self-management) Research / Care Priorities 1.Consensus Priority Setting Activities (base on Gap Analysis, strengths, etc.)
  7. 7. 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
  8. 8. 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
  9. 9. 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
  10. 10. 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 Toronto Rehab - Toronto, ON Glenrose Hospital – Edmonton, AB Foothills Hospital – Calgary, AB IRDPQ – Québec City, QC IRGLM– Montreal, QC
  11. 11. Delphi: Selecting Practices as Targets for Implementation • Successive rounds of considering practice options and voting • Participants voted according to set criteria DRAFT Canadian Practice Guidelines on Pressure Ulcers 48 Practices Best Practices 1……………...23 Best Practices 1……………...12 1. ASSESSMENT: Conduct a comprehensive, systematic assessment of risk factors 2. EDUCATION: Provide structured pressure ulcer prevention educationRound 1 Round 2 Round 3 • Before: this was done by reviewing long lists of information about evidence behind practice options • After TEAMbeta: this information will be provided in a clinically relevant way
  12. 12. Methods: Building the Content, Defining the Specs Pain 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
  13. 13. 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
  14. 14. TEAMbeta Features • Overall shape and colour of treatment option will reflect a 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 the underlying information Gabapentin Tricyclic … …
  15. 15. Gabapentin Evidence Guidelines How-to ?????? • 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 TEAMbeta Features • By clicking on the appropriate icon, it will take you to the underlying information
  16. 16. Gabapentin Tricyclic Enabling the Delphi Process… … • Icons to initiate voting and view past results • Enable culling over successive rounds
  17. 17. Lots of ideas – Long-term Development • Use gaming concepts (i.e., motivational rewards, competition, etc.). • Community of practice • Ideas emerging from PAT / SFAT Gabapentin How-to Guidelines How-to Evidenc Method of Administration: Oral Recommended Dose: cc mg bid Contraindications: safm dsein sdfdsoe dfs ssfs. Source: www.drquacky .com Congratulations!! You have completed the quest to examine and apply 5 “How-To” sections for pain treatments. You will receive 5 gold bars …
  18. 18. Comments? Key Concept • Decision-making  Practice Change (Action) will be aided by placing information in an appropriate context.