Knowledge Translation: Practical Strategies for Success v1

431 views
327 views

Published on

A stepwise practical guide for successfully completing a Knowledge Translation intervention.

Published in: Health & Medicine, Education
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
431
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
11
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide
  • SmartArt custom animation effects: basic radial(Intermediate)To reproduce the SmartArt on this slide, do the following:On the Home tab, in the Slides group, click Layout, and then click Blank. On the Insert tab, in the Illustrations group, click SmartArt. In the Choose a SmartArt Graphic dialog box, in the left pane, click Relationship. In the Relationship pane, click Basic Radial (sixth row, second option from the left), and then click OK to insert the graphic into the slide. On the slide, select the SmartArt graphic, and then click one of the arrows on the left border. In the Type your text here dialog box, in the top level bullet, enter the text for the center circle of the graphic. In the second-level bullets, enter the text for all the other shapes in the SmartArt graphic. With the SmartArt graphic still selected, on the Design tab, in the Themes group, click Colors, and then select Median. Under SmartArtTools, on the Format tab, in the Size group, do the following:In the ShapeHeight box, enter 5”. In the ShapeWidth box, enter 7.5”.Under SmartArtTools, on the Design tab, in the SmartArtStyles group, click SmartArtStyles, and then under Best Match for Document select IntenseEffect (fifth option from the left).On the Home tab, in the Font group, click the button next to FontColor, and then under ThemeColors select Black, Text 1 (first row, second option from the left). On the Home tab, in the bottom right corner of the Drawing group, click the FormatShape dialog box launcher. In the FormatShape dialog box, click 3-D Format in the left pane, and in the 3-D Format pane, under Surface, do the following:In the Material list, under SpecialEffect, select SoftEdge (first row, second option from the left).In the Lighting list, under Neutral, select Harsh (first row, fourth option from the left).In the Angle box, enter 30°.Press and hold CTRL, and select all five shapes in the SmartArt graphic. On the Home tab, in the bottom right corner of the Drawing group, click the FormatShape dialog box launcher. In the FormatShape dialog box, click Shadow in the left pane. In the Shadow pane, in the Presets list, under Outer select OffsetBottom (first row, second option from the left), and then do the following:In the Transparency box, enter 65%.In the Size box, enter 103%.In the Blur box, enter 9 pt.In the Angle box, enter 90°.In the Distance box, enter 3 pt.To reproduce the SmartArt effects on this slide, do the following:On the slide, select the center circle in the SmartArt graphic, and then on the Home tab, in the bottom right corner of the Drawing group, click the FormatShape dialog box launcher. In the FormatShape dialog box, click 3-D Format in the left pane, and in the 3-D Format pane do the following:Under Bevel, in the Top list, under Bevel, select Circle (first row, first option from the left).Also under Bevel, to the right of the Top list, in the Width box, enter 24 pt. Also under Bevel, to the right of the Top list, in the Height box, enter 12 pt.On the slide, select the top circle in the SmartArt graphic, and then on the Home tab, in the bottom right corner of the Drawing group, click the FormatShape dialog box launcher. In the FormatShape dialog box, click Fill in the left pane, and in the Fill pane do the following:Click Solidfill.Click the button next to Color, and then under ThemeColors select Orange, Accent 2 (first row, sixth option from the left).Also in the FormatShape dialog box, click 3-D Format in the left pane, and in the 3-D Format pane do the following:Under Bevel, in the Top list, under Bevel, select Circle (first row, first option from the left).Also under Bevel, to the right of the Top list, in the Width box, enter 20 pt. Also under Bevel, to the right of the Top list, in the Height box, enter 15 pt.Press and hold SHIFT, and then on the top circle, drag a corner adjustment handle toward the center to decrease the size.On the Home tab, in the Font group, in the Font Size box, enter 20.Drag the top circle approximately 0.5” to the right.Select the right circle in the SmartArt graphic, and then on the Home tab, in the bottom right corner of the Drawing group, click the FormatShape dialog box launcher. In the FormatShape dialog box, click Fill in the left pane, and in the Fill pane do the following:Click Solidfill.Click the button next to Color, and then under ThemeColors click Gold, Accent 4 (first row, eighth option from the left).Also in the FormatShape dialog box, click 3-D Format in the left pane, and in the 3-D Format pane do the following:Under Bevel, in the Top list, under Bevel, select Circle (first row, first option from the left).Also under Bevel, to the right of the Top list, in the Width box, enter 24 pt. Also under Bevel, to the right of the Top list, in the Height box, enter 12 pt.Press and hold SHIFT, and then on the right circle, drag a corner adjustment handle toward the center to decrease the size.On the Home tab, in the Font group, in the Font Size box, enter 28 pt.Drag the right circle slightly toward the right corner of the slide.One the slide, select the bottom circle in the SmartArt graphic, and then on the Home tab, in the bottom right corner of the Drawing group, click the FormatShape dialog box launcher. In the FormatShape dialog box, click Fill in the left pane, and in the Fill pane do the following:Click Solidfill.Click the button next to Color, and then under ThemeColors click Green, Accent 5 (first row, ninth option from the left)Also in the FormatShape dialog box, click 3-D Format in the left pane, and in the 3-D Format pane do the following:Under Bevel, in the Top list, select Circle (first row, first option from the left).Also under Bevel, to the right of the Top list, in the Width box enter 24 pt. Also under Bevel, to the right of the Top list, in the Height box enter 12 pt.Press and hold SHIFT, and then on the bottom circle, drag a corner adjustment handle away from the center to increase the size.On the Home tab, in the Font group, in the Font Size box, enter 28.On the slide, select the left circle in the SmartArt graphic, and then on the Home tab, in the bottom right corner of the Drawing group, click the FormatShape dialog box launcher. In the FormatShape dialog box, click Fill in the left pane, and in the Fill pane do the following:Click Solidfill.In the Color list, under ThemeColors select Olive Green, Accent 3 (first row, seventh option from the left).Also in the FormatShape dialog box, click 3-D Format in the left pane, and in the 3-D Format pane do the following:Under Bevel, in the Top list, under Bevel, select Circle (first row, first option from the left).Also under Bevel, to the right of the Top list, in the Width box, enter 30 pt. Also under Bevel, to the right of the Top list, in the Height box, enter 30 pt.Press and hold SHIFT, and then on the left circle, drag a corner adjustment handle toward the center to decrease the size.On the Home tab, in the Font group, in the Font Size box, enter 40, and then click Bold.Drag the top circle slightly toward the bottom of the slide.To reproduce the line effects on this slide, do the following:Press and hold CTRL, and then select each of the four lines connecting the circles in the SmartArt graphic. On the Home tab, in the bottom right corner of the Drawing group, click the FormatShape dialog box launcher. In the FormatShape dialog box, click Line Color in the left pane, select Gradient line in the Line Color pane, and then do the following:In the Type list, select Linear.In the Direction list, select Linear Right (first row, fourth option from the left).Under Gradient stops, click Add or Remove until two stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 0%.Click the button next to Color, and then under Theme Colors click Black, Text 1 (first row, second option from the left). Select Stop 2 from the list, and then do the following: In the Stop position box, enter 100%.Click the button next to Color, and then under Theme Colors click Black, Text 1 (first row, second option from the left). In the Transparency box, enter 100%.Also in the FormatShape dialog box, click LineStyle in the left pane, and in the LineStyle pane do the following:In the Width box, enter 3.5 pt.In the Dashtype list, select RoundDot (second option from the top).To reproduce the animation effects on this slide, do the following:On the Animation tab, in the Animations group, click CustomAnimation. On the slide, select the SmartArt graphic, and then in the CustomAnimation task pane, to the following:Click AddEffect, point to Entrance, and select MoreEffects. In the AddEntranceEffect dialog box, under Moderate, select Zoom.Click the arrow to the right of the zoom entrance effect, and then select EffectOptions. In the Zoom dialog box, do the following:On the Effect tab, in the Zoom list, select In from ScreenCenter.On the Timing tab, in the Speed list, select 1 seconds (Fast). On the SmartArtAnimation tab, in the Group graphic list, select From center one by one. In the CustomAnimation task pane, expand the contents of the list by clicking the double arrow under the zoom entrance effect, and then do the following:Select the first effect (zoom entrance effect), and under Modify: Zoom, in the Start list, select WithPrevious.Select the second effect (zoom entrance effect), click Change, point to Entrance, and then select MoreEffects. In the ChangeEntranceEffect dialog box, under Basic, select Wipe.Click the arrow to the right of the second effect (now wipe effect) and select Effect Options, and then in the Wipe dialog box dothe following:On the Effect tab, in the Direction list, select FromBottom.On the Timing tab, in the Delay box, enter 0.5.On the Timing tab, in the Speed list, select 0.5 seconds (VeryFast).Select the fourth effect (zoom entrance effect), click Change, point to Entrance, and select MoreEffects. In the ChangeEntranceEffect dialog box, under Basic, select Wipe.Click the arrow to the right of the fourth effect (now wipe effect) and select Effect Options, and then in the Wipe dialog box, dothe following:On the Effect tab, in the Direction list, select FromLeft.On the Timing tab, in the Delay box, enter 0.5.On the Timing tab, in the Speed list, select 0.5 seconds (VeryFast).Select the sixth effect (zoom entrance effect), click Change, point to Entrance, and select MoreEffects. In the ChangeEntranceEffect dialog box, under Basic, select Wipe.Click the arrow to the right of the sixth effect (now wipe effect) and select Effect Options, and then in the Wipe dialog box, dothe following:On the Effect tab, in the Direction list, select FromLeft.On the Timing tab, in the Delay box, enter 0.5.On the Timing tab, in the Speed list, select 0.5 seconds (VeryFast).Select the eighth effect (zoom entrance effect), click Change, point to Entrance, and then select MoreEffects. In the ChangeEntranceEffect dialog box, under Basic, select Wipe.Click the arrow to the right of the eighth effect (now wipe effect) and select Effect Options, and then in the Wipe dialog box, dothe following:On the Effect tab, in the Direction list, select FromRight.On the Timing tab, in the Delay box, enter 0.5.On the Timing tab, in the Speed list, select 0.5 seconds (VeryFast).To reproduce the background on this slide, do the following:Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Radial.In the Direction, list click From Center (third option from the left).Under Gradient stops, click Add or Remove until two stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 0%.Click the button next to Color, and then under Theme Colors click Black, Text 1, Lighter 35% (third row, second option from the left). Select Stop 2 from the list, and then do the following: In the Stop position box, enter 100%.Click the button next to Color, and then under Theme Colors click Black, Text 1 (first row, second option from the left).
  • SmartArt custom animation effects: continuous picture list(Basic)To reproduce the SmartArt effects on this slide, do the following:On the Home tab, in the Slides group, click Layout, and then click Blank. On the Insert tab, in the Illustrations group, click SmartArt. In the Choose a SmartArt Graphic dialog box, in the left pane, click List. In the List pane, double-click Continuous Picture List (third row, fourth option from the left) to insert the graphic into the slide.On the slide, select the graphic. Under SmartArt Tools, on the Format tab, click Size, and then do the following:In the Height box, enter 5.05”.In the Width box, enter 7.57”.Under SmartArt Tools, on the Format tab, click Arrange, click Align, and then do the following:Click Align to Slide.Click Align Middle. Click Align Center. Select the graphic, and then click one of the arrows on the left border. In the Type your text here dialog box, enter text.Select the graphic. Under SmartArtTools, on the Design tab, in the SmartArtStyles group, click More, and then under Best Match for Document clickselect Moderate Effect (fourth option from the left).Click each of the three picture placeholders in the SmartArt graphic, and then in the Insert Picture dialog box, select a picture and click Insert.Press and hold CTRL, and then select the three circle pictures on the slide. Under PictureTools, on the Format tab, in the PictureStyles group, click PictureEffects, point to Glow, and then do the following:Under Glow Variations, click Accent color 1, 8 pt glow (second row, first option from the left).Point to MoreGlowColors,and then under Theme Colors click Orange, Accent 6, Lighter 80% (second row, 10th option from the left).Select the left-right arrow at the bottom of the SmartArt graphic. Under SmartArtTools, on the Format tab, in the ShapeStyles group, click the arrow next to ShapeFill, point to Gradient, and then click MoreGradients. In the Format Shape dialog box, click Fill in the left pane,select Gradient fill in the Fill pane, and then do the following:In the Type list, select Linear.Click the button next to Direction, and then select Linear Right (first row, fourth option from the left).Under Gradient stops, click Add or Remove until three stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 0%.Click the button next to Color, and then under Theme Colors click Orange, Accent 6, Darker 25% (fifth row, 10th option from the left).Select Stop 2 from the list, and then do the following: In the Stop position box, enter 50%.Click the button next to Color, and then click MoreColors. In the Colors dialog box,on the Custom tab, enter values for Red: 255, Green: 192, Blue: 0.Select Stop 3 from the list, and then do the following: In the Stop position box, enter 100%.Click the button next to Color, and then under Theme Colors click Orange, Accent 6, Darker 25% (fifth row, 10th option from the left).Press and hold CTRL, and then select the three rounded rectangles on the slide. On the Home tab, in the Font group, select Gill Sans MT from the Font list, enter 30 pt in the Font Size box, click the arrow next to Font Color, and then click White, Background 1 (first row, first option from the left).Under SmartArtTools, on the Format tab, in the ShapeStyles group, click Shape Effects, point to Reflection, and then under ReflectionVariations click Tight reflection, touching (first row, first option from the left).Under SmartArtTools, on the Format tab, in the ShapeStyles group, click Shape Fill, point to Gradient, and then click More Gradients. In the Format Shape dialog box, in the left pane, click Fill, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Linear.In the Direction list, select Linear Down (first row, second option from the left).Under Gradient stops, click Add or Remove until two stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 19%.Click the button next to Color, and then under Theme Colors click Black, Text 1 (first row, second option from the left). Select Stop 2 from the list, and then do the following: In the Stop position box, enter 100%.Click the button next to Color, and then under Theme Colors click Black, Text 1, Lighter 50% (second row, second option from the left).To reproduce the animation effects on this slide, do the following:On the Animations tab, in the Animations group, click CustomAnimation.On the slide, select the graphic. In the Custom Animation task pane, do the following:Click Add Effect, point to Entrance, and then click MoreEffects. In the Add Entrance Effect dialog box, under Moderate, click Stretch. Under Modify: Stretch, in the Speed list, select Fast.Also in the CustomAnimation task pane, click the arrow to the right of the animation effect, and then click Effect Options. In the Stretch dialog box, on the SmartArtAnimation tab, in the Group graphic list, select One by One.Also in the CustomAnimation task pane, click the double arrows under the animation effect to expand the list of effects. Press and hold CTRL, and then select all of the animation effects in the Custom Animation task pane. Under Modify: Stretch, in the Start list, select With Previous.Select the first animation effect (stretch effect for the left-right arrow) in the CustomAnimation task pane. Under Modify: Stretch, click the arrow to the right of the effect, and then click Timing. In the Stretch dialog box, on the Timing tab, do the following: In the Delay box, enter 0.5. In the Speed box, enter 1.5 seconds.Press and hold CTRL, and then select the second and third animation effects (stretch effects for the left panel) in the CustomAnimation task pane. Under Modify: Stretch, in the Direction list, select From Right. Also in the Custom Animation task pane, with the second and third animation effects still selected, click the arrow to the right of one of those effects, and then click Timing. In the Stretch dialog box, on the Timing tab, in the Delay box, enter 1, and then click OK.Press and hold CTRL, and then select the sixth and seventh animation effects (stretch effects for the right panel) in the Custom Animation task pane. Under Modify: Stretch, in the Direction list, select From Left. Also in the Custom Animation task pane, with the sixth and seventh animation effects still selected, click the arrow to the right of one of those effects, and then click Timing. In the Stretch dialog box, on the Timing tab, in the Delay box, enter 1.To reproduce the background effects on this slide, do the following:Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Radial.Click the button next to Direction, and then click From Center (third option from the left). Under Gradient stops, click Add or Remove until two stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 0%.Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left).Select Stop 2 from the list, and then do the following: In the Stop position box, enter 100%.Click the button next to Color, and then under Theme Colors click Black, Text 1, Lighter 25% (fourth row, second option from the left).
  • Knowledge Translation: Practical Strategies for Success v1

    1. 1. Knowledge Translation Moving from Best Evidence to Best Practice Dr. Imad Salah Ahmed Hassan MD (UK) FACP FRCPI MSc MBBS Consultant Physician & Pulmonologist Chairman, Knowledge Translation Committee Department of Medicine KAMC Riyadh Kingdom of Saudi Arabia imadsahassan@gmail.com
    2. 2. Patients Colleagues Q: What Scares Doctors? A: Being Patients Administration
    3. 3. Time cover story - May 1, 2006 Q: What Scares Doctors? A: Being the Patient
    4. 4. Updated September 21, 2012, 10:56 p.m. ET How to Stop Hospitals From Killing Us???? Medical errors kill enough people to fill four jumbo jets a week Stop making mistakes… STOP WORKING!
    5. 5. Quality Chasm • 439 indicators of clinical quality of care • 30 acute and chronic conditions, plus prevention • Medical records for 6712 patients • Participants had received 54.9% of scientifically indicated care (Acute: 53.5%; Chronic: 56.1%; Preventive: 54.9%) Conclusion: The “Defect Rate” in the technical quality of American health care is approximately 45%!!!!!!! McGlynn, et al: The quality of health care delivered to adults in the United States. NEJM 2003; 348: 2635-264 .
    6. 6. “Crossing the Quality Chasm” Institute Of Medicine 2001 • Under use – helpful services not delivered • Overuse – useless interventions • Mistakes – inevitable human error Crossing the Quality Chasm: A New Health System for the 21st Century, available at: http://www.nap.edu/books/0309072808/html/
    7. 7. Other “Failure Modes in KT”       Folic acid supplements pre-pregnancy Promoting and supporting breast feeding Promoting use of preventers in chronic asthma Achieving blood pressure control Optimizing care for stroke patients Preventing osteoporosis related fractures reoccuring
    8. 8. What is KT & why is it important? How to Do It? A Framewor k for KT. Practical Example.
    9. 9. Many terms, same basic idea … 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Applied health research Diffusion Dissemination Getting knowledge into practice Impact Implementation Knowledge communication Knowledge cycle Knowledge exchange Knowledge management Knowledge translation 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. Knowledge to action Knowledge mobilization Knowledge transfer Linkage and exchange Participatory research Research into practice Research transfer Research translation Transmission Utilization
    10. 10. What is Knowledge Translation? Knowledge Translation is about:  Making users aware of knowledge and facilitating its use to improve health and health care systems  Closing the gap between what we know and what we do (reducing the know-do gap)  Moving knowledge into action Knowledge Translation research (KT Science) is about:  Studying the determinants of knowledge use and effective methods of promoting the uptake of knowledge
    11. 11. E E to B M P Bridging the Gaps  Knowledge Practice  Resources Expenditure
    12. 12. Current State of Knowledge Translation  “health care systems globally have failed to timely, consistently and comprehensively apply new knowledge at both the macro and micro levels of care” 1,2,3.4     McGlynn E, Asch S, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA. The quality of health care delivered to adults in the United States. N Engl J Med 2003;348:2635-45. Grol R. Successes and failures in the implementation of evidence-based guidelines for clinical practice. Med Care 2001; 39:II46II54. Shah BR, Mamdani M, Jaakkimainen L, Hux JE. Risk modification for diabetic patients. Are other risk factors treated as diligently as glycemia? Can J Clin Pharmacol 2004;11(2):e239-e244. Kennedy J, Quan H, Ghali WA, Feasby TE. Variations in rates of appropriate and inappropriate carotid endarterectomy for stroke prevention in 4 Canadian provinces. CMAJ 2004; 171(5):455-459.
    13. 13. Progress Bridging the Implementation Gap Scientific understanding Implementation Gap Patient care Time
    14. 14. Current State of Knowledge Translation  “Bridging this so called Knowledge-to-Action gap has been extremely slow sometimes taking years following the availability of new knowledge”   Paul Glasziou and Brian Haynes. The paths from research to improved health Outcomes. Evidence-Based Medicine 2005; 10:4-7. Balas EA, Boren SA. Managing clinical knowledge for health care improvement. Yrbk of Med Informatics 2000; 6570
    15. 15. Knowledge Application (Action Cycle) includes: 1 • Identify the problem 2 • Measure Magnitude and Determine the Root-Cause 3 • Pass to your KT Team 4 • Find (& Appraise) the Evidence 5 • Assess barriers and facilitators to knowledge use. 6 • Adapt knowledge to local context 7 • Select and implementing interventions 8 • Monitor knowledge use: Process & Outcome 9 • Sustain knowledge use
    16. 16. Step 1: Identifying the problem- Identify the Knowledge-To-Action Gap Resources: Gap or Error Detection • Organization level: • Health records • Chart audits e.g. M&M reports • Provider level: • Direct observation • Questionnaires • Patient Level: • Patient Complaints • Questionnaires Skills for Problem Detection • Process Change Skills
    17. 17. Step 2: Identify the Magnitude of the Problem- (for future comparison post-intervention) & Its Root-Cause Resources: Gap or Error Detection • Organization level: • Health records • Chart audits e.g. M&M reports • Provider level: • Direct observation • Questionnaires • Patient Level: • Patient Complaints • Questionnaires Skills/Tools for Root Cause Analysis/Detection • Process Change Skills • • • • • • • • • • Check Sheet Cause-and-Effect Diagram Flow Charting Pareto Chart Scatter Diagram Probability Plot Histogram Control Charts Brainstorming 5 Whys Tool
    18. 18. Step 3: Pass to your KT Team Composition of A KT Team • • • • • • • • • • Multidisciplinary Clinicians Pharmacists Nursing Trainees Quality Mgt staff Monitors Statistician Librarian (EBM) Patient Representative Skills/Tools for Team Work • Process Change Skills • Roles: • System leadership • Technical leadership • Day-to-day leadership
    19. 19. Step 4: Find the Evidence: Searching & Appraising Evidence Resources: EBM Resources • AHRQ Agency for Healthcare Research and Quality http://www.ahrq.gov/ • NICE National Institute for Health and Clinical Excellence: www.nice.org.uk • Guidelines Clearinghouse: http://www.guideline.gov/ Skills for EBM Practice • EBM Skills • Ask • Acquire • Appraise
    20. 20. Step 5: Find the Barriers- Assess Barriers to Knowledge Use Barriers to Change • Organizational (Structure: equipment & Process: time) • Individual • Knowledge • Attitude • Skills • Social (acceptability by society & patients) Skills for Management of Change • Process Change Skills
    21. 21. Step 6: Adaptation Phase- Adapt Knowledge to Local Context (Adaptability) Barriers to Use • Adequate resources: • Manpower • Economic/Financial • Leadership • Political • Etc. Skills for Adaptation • Process Change Skills • EBM Skills (The ADAPT Tool)
    22. 22. Step 7: Find the Tools- Select, Tailor & Implement Interventions Tools for Implementation • Organization directed: • Legislation/Leadership Commitment • Policies & Procedures -Reminder Systems: Clinical Pathways, Order Sets, Checklists • System Redesign • Individual directed • Training Program • Certification • Patient directed : • Education, Partnership agreements etc Skills for Successful Implementation • Process Change Skills • EBM Skills: ApplyEBM Implementation Tools • System Redesign
    23. 23. Hierarchy of Evidence-Based Implementation Tools The Implementation Pyramid Interventions of variable effectiveness •Audit and feedback •Use of local opinion leaders •Local consensus processes (ownership) •Patient mediated interventions Consistently effective interventions •Educational outreach visits •Reminders (manual or computerized) •Multifaceted interventions* •Interactive educational meetings (workshops) •Financial Incentives Interventions that have little or no effect •Educational materials (Printed practice guidelines, audiovisual materials, and electronic publications) •Didactic educational meetings (such as lectures) * (a combination that includes two or more of the following: audit and feedback, reminders, local consensus processes, or marketing)
    24. 24. What is System Redesign?    System redesign is a new concept in healthcare reform. It entails specific redesign in care delivery both in its structure and in its process in order to re-align a faulty system and improve outcomes. The whole structure or process of care is redesigned to an “ideal process” based on evidence.
    25. 25. StructureDivision e.g. KT Division • New • New Team e.g. Anticoagulation Team • Revised Job-description e.g. KT Monitor Process • Redesign Training Programs • Computerized Decision Support Systems • Electronic Orders/Pathways/Protocols and Reminders • SBAR • Checklists Outcome • Patient Satisfaction Surveys • Staff Satisfaction Surveys
    26. 26. If you do not know where you want to go………   1. 2. 3. 4. 5. 6. 7. 8. Implementation/KT websites Quality Improvement website AHRQ Agency for Healthcare Research and Quality http://www.ahrq.gov/ NICE National Institute for Health and Clinical Excellence: www.nice.org.uk Clinical Improvement Skills: http://www.improvementskills.org/index.cfm Institute for Healthcare Improvement: http://www.ihi.org/IHI/Topics/LeadingSystemImprovement/ Knowledge Translation Clearinghouse: http://ktclearinghouse.ca/ ICSI Institute for Clinical Systems Improvements http://www.icsi.org/index.aspx Society of Hospital Medicine: http://www.hospitalmedicine.org/ Innovations Exchange for New Ideas of Care http://innovations.ahrq.gov/
    27. 27. Step 8a: Monitor the Change- Monitor Knowledge Use (The Process) Tools for Monitoring the Process • Process Variance (Audit) • Knowledge use by providers: • Knowledge use by patients: Skills for MonitoringImplementati on • Process Change Skills
    28. 28. Step 8b: Monitor the Change- Monitor Knowledge Use (The Outcome) Tools for Monitoring the Process • Outcome Variance (Audit) • Impact on: • Patients • Providers • Organization Skills for Monitoring Implementation • Process Change Skills
    29. 29. Step 9: Sustain the Improvement Tools for Encouraging Compliance • • • • Regular Audit Regular Update Incentives Competency-based Training • Certification: Individual & Organizational Skills for Sustaining Change • Process Change Skills
    30. 30. The necessary building blocks for successful KT based on the above:      Process Change skills EBM Skills Implementation of Change Tools System Redesign Skills KT Competency/Competency-Based Training Curricula
    31. 31. The Five-Component Model for a Successful Knowledge Translation Undertaking
    32. 32. How Can I Do It???
    33. 33. KT of a Classic PT Case: Can it be Done?  Documentation o f Red Flags in referrals to PT with Low Back Pain  Red flags are warning signs that suggest that physician referral may be warranted.
    34. 34. LBP Red Flags             Thoracic pain Widespread neurological deficit Lower limb weakness Drug abuse/human immunodeficiency virus Age <20 or >55 years Weight loss Persistent severe restriction of lumbar flexion Constant progressive, nonmechanical pain Night pain Positive cough/sneeze Previous history of cancer Recent history of trauma Cauda equina symptoms     Altered bladder control Saddle anesthesia Altered bowel control Widespread neurological deficit
    35. 35. Documentation of RED Flags in LBP Referrals to PT: POOR KT!  USA     Saddle Anesthesia Night Pain LL Neurodeficits Bladder Dysfunction 19% of Cases 68% 19% 13.8%  UK    Scotland 33% Leerar PJ, BoissonnauttW, Domholdt E, Roddey T. Documentation of red flags by physical therapists for patients with low back pain. J Man Manipul Ther 2007;15:42–9. Ferguson F, Holdsworth L, Rafferty D. Physiotherapy. Low back pain and physiotherapy use of red flags: the evidence from Scotland. 2010 ;96(4):282-8.
    36. 36. Physical Therapists’ Use of Interventions With High Evidence of Effectiveness in the Management of a Hypothetical Typical Patient With Acute Low Back Pain Results.  Use of interventions with strong or moderate evidence of effectiveness: 68%.  Use interventions for which research evidence was limited or absent. 90%
    37. 37. Physical Therapists’ Use of Interventions With High Evidence of Effectiveness in the Management of a Hypothetical Typical Patient With Acute Low Back Pain Discussion and Conclusion.  Although most (not really!) therapists use interventions with high evidence of effectiveness, much of their patient time is spent on interventions that are not well reported in the literature.  Christine Mikhail et al. Physical Therapy . Volume 85 . Number 11 . November 2005
    38. 38. Knowledge Application (Action Cycle) includes: 1 • Identifying the problem (Audit of Low Back Pain LBP care) 2 • Measure Magnitude and Determine the Root-Cause 3 • Pass to your KT Team 4 • Find (& Appraise) the Evidence 5 • Assess barriers and facilitators to knowledge use. 6 • Adapting knowledge to local context 7 • Selecting and implementing interventions (TOOLS) 8 • Monitoring knowledge use: Process & Outcome (LBP Monitor) 9 • Sustaining knowledge use: Re-audit, Update, Certify/Accredit
    39. 39. An Audit Cycle
    40. 40. KT for LBP: Implementation Tools Implementation Tools • Education, Back Pain Clinical Pathway, Checklists System Redesign • LBP Team, LBP Monitor, • Electronic H&P, Order Set
    41. 41. Examples of Clinical Pathways
    42. 42. KT in Summary Getting research into practice Is a Complex but Achievable Task Collective Effort Organizational and Individual Responsibilities Patient Right
    43. 43. E B Lessons from experienced guideline implementers: Attend to many factors and use multiple strategies. Journal of Quality Improvement 2000; 26(4):171-188. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. BMJ 1998;317:465-468. Evidence-based implementation of evidence-based medicine. Jt Comm J Qual Improv. 1999;25(10):503-13. Translating guidelines into practice: A systematic review of theoretical concepts, practical experience and research evidence in the adoption of clinical practice guidelines. CAN MED ASSOC J, 1997; 157 (4)409-416. A guide to the development, implementation and evaluation of clinical practice guidelines. National Health and Medical Research Council. Commonwealth of Australia 1999. Integrated care pathways. BMJ 1998;316:133-137. Using checklists and reminders in clinical pathways to improve hospital inpatient care. MJA 2004; 181 (8): 428-431. M

    ×