Joe V. Selby MD MPH Division of Research Kaiser Permanente Northern CA Chair of Governing Board

1. Translating and Disseminating Clinical Research Findings into Practice in Integrated Delivery Systems Joe V. Selby MD MPH Division of Research Kaiser Permanente Northern CA Chair of Governing Board HMO Research Network

2. Disclosures Accelerating the Dissemination and Translation of Clinical Research into Practice The Following Faculty have No Relevant Financial Relationships with Commercial Interests Dr. Joe Selby Panel Discussion II: Integrating Dissemination into Existing Practice: Models used for Successful Translation

4. CTSI’s Community Engagement Program CO-DIRECTORS Kevin Grumbach MD, Chair Family & Community Medicine Joe Selby MD, Director KP Division of Research Community Academic Research Engagement (CARE) Community Clinicians (PBRN) Committee Integrated Delivery Systems Committee (i.e., KP DOR) Reach, Relevance And Dissemination Community Consultation Committee

5. Translational Research in Integrated Delivery Systems • Translation research within healthcare systems is a form of community-based participatory research, requiring alignment of research with perceived needs of systems, clinicians, patients • Translation research is a new discipline – and it’s much more than just interventions - understanding barriers and disparities in uptake and dissemination is crucial. • CTSA’s aim to increase collaborative translational research with integrated systems, PBRN’s and the community at large –including the “matchmaking” between external and internal researchers necessary for success.

6. What They’re Saying: “We all agreed at the end of the meeting that researchers and purchasers need more face to face time. There are so many things researchers could help purchasers with if the timelines could be more in sync with the timelines of purchasers (i.e., need to get stuff done yesterday)!”* • Summary from a Pacific Business Group on Health Conference, • circa 1998

7. Example: From Observational Findings to a System-level Translation Effort

10. Reasons Found for Invasive Cervical CA in Enrollees of 7 HMOs (n=833) Leyden et al JNCI2005

11. Reasons Found for Advanced Stage Breast CA in Enrollees of 7 HMOs (n=1347) Taplin et al JNCI2004

12. "Pathway to World Class Cancer Care“New Kaiser Permanente Northern CA Program - 2008 • Primary Prevention • Screening • Workup of Screen Positives • Initial Treatment • Post-treatment Surveillance • Palliative Care

13. Quotes from HMORN Translational Researchers I’m increasingly viewing effective translation research as akin to “soft power.” It doesn’t work to try to thrust our great research results down the throats of healthcare practitioners. Rather, translation entails understanding the nuances of local culture and values to influence behaviors or goals, and making it an attractive prospect to change how things are done. It entails the very same level of understanding of what’s going on at the local level and what might induce new ways of working. Our examples of effective translation suggest the need for an alchemy of good ideas, aligned with the needs of all stakeholders, brought into the fore at the “right” time (and probably at multiple points in time), and done so with trusting relationships and effective interpersonal communication skills. Sarah Greene, Group Health Cooperative

14. Quotes from HMORN Translational Researchers Successful Dissemination requires: 1. A line item in the budget 2. Clearly assigned accountability among employees who are responsible for the program 3. Serious upper and middle management support for the program; this means that management believes in the program/process and does not view it as a public relations effort that will quietly fade away. In our hotel study, we have a wide range of responses to our attempt to sustain the program. These range from total neglect to energetic embrace, with a fair amount of lukewarm pablum in the middle. Anything short of energetic embrace is doomed to gradual dismissal. Tom Vogt, Kaiser Permanente Hawaii

15. Conclusions • Present the “evidence” to systems/sites/ practitioners in terms of current burden of disease, effectiveness of therapy, cost-effectiveness? • Very helpful to have evidence of current deficiencies, undertreatment, inappropriate treatment in the population served by proposed intervention site(s). • Make certain that intervention’s goals are high priority for the system at this point in time. • Identify and include key internal collaborators (both operational and research) within the intervention system or setting. • Be clear that your support will be present for dissemination if the translational intervention proves to be effective?