Knowledge Transfer

Knowledge Transfer Moving from Best Evidence to Best Practice Ann McKibbon, MLS PhD Connie Schardt, MLIS AHIP McMaster University/Duke University MLA 2008

Housekeeping • Who we are • Washrooms • Heat, light, and sound • Break • Interactive as possible • Fun is linked to learning • Only stupid question is the one not asked

Agenda • Who are you and your expectations • What is KT? • Models of KT • Break

Louis Pasteur “To him who devotes his life to science, nothing can give more happiness than increasing the number of discoveries, but his cup of joy is full when the results of his studies immediately find practical applications.”

KT definition Canadian Institute for Health Research “the exchange, synthesis, and ethically-sound application of knowledge – with a complex system of interactions among researchers and users – to accelerate the capture of the befits of research for [the people we serve] through improved health, more effective services and products, and a strengthened health care system.”

KT definition: short one Getting research into practice

Translational Research NIH says from “bench to bedside” Others say just from basic ideas (bench) to be ready for bedside use Today use the definition from bench to proof of new knowledge Knowledge Translation Knowledge is ready for use—the controlled trials have been done. How do we get clinical people to modify their behavior and actions? Today use the definition of existing knowledge to appropriate use Two aspects of K Transfer

Think Think—about an innovation that you adopted and what made you adopt

Applied health research Capacity building Complex interventions Complexity science Complexity studies Co-optation Diffusion of innovations Diffusion(s) Dissemination Evidence based practice Getting knowledge into practice Implementation Implementation research Implementation science Information dissemination and utilization Innovation adaptation Innovation adoption Innovation diffusion Knowledge communication Knowledge cycle Knowledge dissemination Knowledge exchange Knowledge management Knowledge mobilization (mobilisation) Knowledge transfer Knowledge translation Knowledge transformation Knowledge uptake KT Terms

Knowledge utiliz(s)ation Linkage and exchange Organizational change Outcomes effectiveness research (Titler) Policy research Popularization (popularisation) of research Research into action Research into practice Research mediation Research transfer Research transformation Research translation Research utiliz(s)ation Sociology of knowledge Technology transfer Third mission Translation(al) research Translation(al) science Transmission Utilization (utilisation) Knowledge to action Knowledge development and application Knowledge diffusion Applied dissemination Effective dissemination Research implementation KT Terms

Research Utilization 141 USA 35 Canada 30 UK 8 Australia 7 Sweden 3 Finland 3 Ireland 2 Denmark 2 Netherlands 1 Greece 1 India 1 Iran 1 Italy 1 Korea 1 Norway 1 Spain 1 Taiwan 1 Tanzania Diffusion 371 USA 86 UK 46 Canada 21 Australia 16 Netherlands 10 France 8 Sweden 7 Denmark 7 Germany 5 Greece 4 Italy 4 Japan 4 Norway 3 Brazil 3 France 3 Ireland 3 Israel International view of KT Knowledge Translation 51 Canada 6 UK 6 USA 3 Australia 3 Africa 3 France 3 South Africa 2 Germany 2 Switzerland 1 Mexico 1 Norway 1 Thailand

Disciplinarity of KT • Pharmaceutical industry • Nurses • Medicine • Public health • Engineering (Technology transfer) • Management studies (change management) • Advertising and marketing • Cognitive science…

Individual people Individual health professionals Groups of care givers Hospitals Local areas such as municipalities, cities States and provinces Nations Single Multiple groups Individuals Managers or decision makers Policy makers Regional National International Levels of KT

Why is KT important? ~55% of patients get less than adequate care • 30% to 40% not get what they should get • 20% to 25% get what… • should not have • they do not need • If optimum cancer care for adults… • 30% improvement in cancer outcomes • 10% reduction in cancer mortality

Implement existing knowledge? Develop new knowledge? Conundrum

Aspirin 23% reduction in strokes Only 58% take aspirin 9600 more stokes/100k population at risk Clopidogrel & Ticlopidine Must be 74% better than aspirin to match non-compliance data Tested in 22,976 patients Only 10% to 12% better than aspirin Aspirin vsClopidogrel and Ticolopdine

Simvastatin or pravastatin vsnew & improved statins 5-year coronary artery disease mortality • Simvastatin and pravastatin 24% decrease • Only 33% of patients who need them get them • New statins would have to be 3 times as potent at 72% reduction in mortality to achieve the same results as compliance with known statins • Best we can get yet is rosuvastatin 26% better than simvastatin

KT in Informatics Nick Gaunt: “Health informatics, in common with other applications of informatics, has no shortage of innovation but nevertheless has a history of failed implementations. Why is it that so many good ideas and informatics developments fail when it comes to widespread deployment?” …Reflections and Realities: How much Impact has our Health/Medical Informatics Research had on our Health Care Systems” Conference. June 2005. University of Victoria.

KT is about: • Making users aware of knowledge and facilitating their use of it • Closing the gap between what we know and what we do • Moving knowledge into action

KT Research is about: Studying • The determinates of knowledge use • Effective methods of processing and presenting information for good uptake • Effective methods of promoting the update of knowledge

Researcher Responsibility • Know and act upon what has gone on before (literature reviews, contact with colleagues) • Produce research that is • Important and needed • Of the highest quality possible • Ethical and moral • Insure that findings are “moved” along (communicated to those who need to know and then implemented)

Clinician Responsibility • Know and act upon what is current best care (literature reviews, contact with colleagues, continuing education) • Insure that research findings are “moved” into your practice in a timely manner (keeping up to date) • Feed back your experience and ideas to the health researchers

Question What proportion of research dollars are spent on knowledge generation vs translation? • 100:1 generation vs translation • 10:1 generation vs translation • 1:1 generation vs translation • 1:10 generation vs translation • 1:100 generation vs translation

Answer What proportion of research dollars are spent on knowledge generation vs translation? • 100:1 generation vs translation • 10:1 generation vs translation • 1:1 generation vs translation • 1:10 generation vs translation • 1:100 generation vs translation

Discovery and Production Ideas Lab/bench science Animal testing Early human Phase1 Middle human Phase 2 RCTs Phase 3 Post marketing Application and Implementation Aware Accepted Applicable Able Acted upon Agreed to Adhered to Knowledge Discovery and Application Processes

Discovery and Production Ideas 100,000 RCTs 100 Application and Implementation Aware 100% Adhered to 20% Knowledge Discovery and Application Processes

Application Process

Models

Several useful models of knowledge translation Rogers’ diffusion of innovation Weiss’ roadmaps Davis’ case for knowledge translation

Rogers’ diffusion of innovation • Innovation diffusion is an outgrowth of sociology • Diffusion research first looked at how agricultural innovations spread from farmer to farmer • For example, the process that Iowa farmers went through as they learned about and then adopted hybrid corn varieties was studied

Everett Rogers “Diffusion is the process by which an innovation is communicated through certain channels over time among members of a social system.”

Rogers’ diffusion of innovation • There are 2 important mechanisms that affect the adoption of an innovation • Relative Advantage • Diversity of Population

Rogers’ diffusion of innovation • There are 5 categories of system member innovativeness • Innovators • Early adopters • Early majority • Late majority • Laggards

Rogers’ diffusion of innovation • Several factors affects the diffusion of an innovation • Opinion Leaders • Communication • Homo/Heterophilous Groups

Rogers’ diffusion of innovation • Several factors affects the diffusion of an innovation • Trialability • Observability • Pace of innovation/reinvention • Norms, roles and social networks • Compatibility

Weiss’ roadmap to knowledge utilization • In the 70s social scientists were concerned about making their research useful for public policy makers • And policy makers were displaying concern about the usefulness of the social science research that government funds support

Weiss’ roadmap to knowledge utilization • Carol Weiss responded to this concern by setting out to understand what “using research” actually means • Through this exploration Weiss outlines 7 different meanings to knowledge utilization and the routes by which it occurs

Weiss’ roadmap to knowledge utilization • Knowledge-driven Model • Linear in process • New research findings lead to new applications and policies • A traditional research-development-diffusion approach • The existence of knowledge is seen to lead directly to its use

Weiss’ roadmap to knowledge utilization • Problem-Solving Model • Linear in process • Direct application of results to solve a problem that was previously identified by the “user” • The decision drives the application of research

Weiss’ roadmap to knowledge utilization • Interactive Model • Non-linear in process • Policy makers seek information from a variety of sources • The process of decision making and research to policy dynamics involves interconnectedness and multiple way exchanges

Weiss’ roadmap to knowledge utilization • Political Model • Constellations of interests or opinions predetermine the positions of policy makers • Opinions are hardened and decision-makers are not receptive to new evidence • Research is used as ammunition to support these predetermined positions

Weiss’ roadmap to knowledge utilization • Tactical Model • Research is not being used for its content • The fact that research is being done is used by policy makers when pressed to take action • Research becomes proof of the policy makers’ responsiveness

Weiss’ roadmap to knowledge utilization • Enlightenment Model • Perhaps the way in which social science research most frequently enters the policy arena • Not the findings that directly affect policy but the concepts and theoretical perspectives that social science research has engendered that permeate the policy making process

Weiss’ roadmap to knowledge utilization • Research as Part of the Intellectual Enterprise of the Society • Social science and policy interact influencing each other while being influenced by the larger fashions of social thought • It is often emerging policy interest in a social issue that leads to the allotment of research funding

Davis’ case for knowledge translation • KT both subsumes and broadens the concepts of CME and CPD • CME is primarily teacher driven which gives little attention to the concept of professional development • CPD is primarily learner driven which means that it can contribute only marginally to improving public health

Davis’ case for knowledge translation • The effects of CME and CPD have been extensively studied • The most passive educational activities are poor at changing behaviour • The most effective strategies tend to be more active (e.g., reminders), multiple, based on accurate assessment of need and aimed at overcoming barriers to change • These type of strategies are not the staple of most providers of CME and CPD

Davis’ case for knowledge translation • If education and persuasion of doctors cannot close the gap between evidence and practice, other strategies are needed • KT is an important tool • Includes groups other than doctors • Investigates issues more comprehensively than CME and CPD

Davis’ case for knowledge translation • KT is more effective at producing change than CME and CPD • KT focuses on health outcomes and changing behaviour so it is set in the site of practice • KT allows attention to be given to all possible participants in healthcare practices • KT builds on CME and CPD primarily by using evidence-based research

Davis’ case for knowledge translation • KT is more effective at producing change than CME and CPD • KT has a more holistic view since it reflects the considerations of both the practitioner-learner and the educations or clinical policy provider or healthcare system • KT can be enriched by people with training in informatics, patient education, organizational learning, social marketing, continuous quality improvement and many others

Davis’ case for knowledge translation • KT Model • Blend 2 existing KT models • Pathman’s model (from the perspective of the targeted consumer) marks progress from awareness, agreement, adoption, to adherence with evidence based practice • Green’s health promotion model (from the perspective of the effector arm, the healthcare or educational system)

Knowledge Transfer