Indian Health Service: Translation of Knowledge into Action

1. Indian Health Service: Translation of Knowledge into Action Theresa Cullen, MD, MS Indian Health Service Chief Information Officer

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

3. Knowledge translation in the IHS • IHS Health Care • Examples • The Special Diabetes Program for Indians • iCARE • What Works • What Doesn’t • The Future

4. Indian Health Service:A True Health Care System • IHS is principal federal health care provider for 1.9M Indian people • Unique gov’t to gov’t relationships, Tribal Communities • National & regional coordination, local autonomy • Blend of clinical, family, community, population & public health approach

5. Models Within the Indian Health Service SDPI Competitive Grant Program • Special Diabetes Community-directed programs • Each grant program sets its own priorities and objectives • Some local evaluation is conducted but a national collective evaluation is required • “Best practices” approach • iCARE • Allows local facilities to evaluate health data set to identify priorities • Develop appropriate health reminders on the fly • Facilitates clinical quality tracking of patient, family, community and population

6. What Works SDPI Competitive Grant Program • Attention to Culture • Crafting the message • Local as well as regional and national epidemiologic surveillance data inform program planning • Identification of appropriate stakeholders • Involving stakeholders from the beginning in the priorities, requirements, development and implementation • Ensuring that appropriate IT and support tools are integrated into the health care delivery model • Integrated system change & rapid-cycle PDSAs

7. What Doesn’t Work? SDPI Competitive Grant Program • Failure to redesign delivery model to ensure an integrated approach to participation • Limiting access to data • Failure to share results in a timely and frequent manner with providers as well as patients and community • Inadequate resources

8. What Are the Roadblocks? How are they overcome? SDPI Competitive Grant Program • What innovation to select? • Work with community to identify assets, skills and importance • IT support • Development of appropriate IT tools that are available from the beginning of the innovation implementation • Evaluation results are on the fly and passive • Inadequate resources • Planning for creative resourcing for sustenance

9. What Are the Persistent Roadblocks? SDPI Competitive Grant Program • Changes in evidence based practice • Access to appropriate interventions in vulnerable populations • Appropriate assessment tools for interim outcome measures • Resources

10. Conclusions- What Matters? SDPI Competitive Grant Program • Access to information for all stakeholders • Appropriate tools for implementation and assessment • Adequate Resources • Attitude

11. The IHS Knowledge Translation Wish List SDPI Competitive Grant Program • Now: End-of-study KT activity for every relevant RCT to ask “what does this mean in the real world and how will we get there?” • Future: Integrative KT to include “real world” program personnel in the planning, design & evaluation of all relevant research studies • Other agencies: more outreach, communication, collaboration

12. Indian Health Service www.ihs.gov