Knowledge Translation Tradução do conhecimento (Perdoar má tradução)

1. 3º Workshop dePrática Clínica Baseada em Evidências Knowledge TranslationTradução do conhecimento(Perdoar má tradução) Eddy Lang, MD, CFPC (EM), CSPQ SMBD-Jewish General Hospital, McGill University, Montreal, Canada

2. Declaração de conflito de interesses

3. Rio de Janeiro

6. Brasiliophilia • Gilberto Gil • Gal Costa • Caetano Veloso • Feijoada • Suco de Pina • Caipirinhia

7. Objectives • Sensitize you to the gap (fosso) between research and practice • Introduce the field of Knowledge Translation (Tradução do conhecimento) • Prepare for the “Olympiade de Implentação” (não piade)

8. Question 1 Based on your observations of care provided in the private hospital system, how commonly do patients who suffer a stroke (Acidente vascular cerebral) receive most evidence-based secondary prevention therapies?

9. Choices 0 – 20% of the time 20 – 50% of the time 50 – 90% of the time > 90% of the time

10. Question 2 Based on your observation of clinical practice in the private hospitals, how commonly do otherwise healthy patients with a diagnosis of bronchitis receive a prescription for antibiotics?

11. Choices 0 – 20% of them 20 – 50% of them 50 – 90% of them > 90% of them

12. Question 3 Based on your observation of clinical practice in private hospitals what percentage of low-risk head trauma patients undergo CT head?

13. Choices 0 – 20% of them 20 – 50% of them 50 – 90% of them > 90% of them

14. The research to practice gap • Not a new problem • 263 years before citrus juice was introduced into the British Navy • Thrombolysis in MI

15. Is this a problem? • IOM: Crossing the Quality Chasm “ between the health care that we now have and the health care that we could have lies not just a gap, but a chasm”

17. Rita-Mangione et al. The Quality of Ambulatory Care Delivered to Children in the United States. Oct. 2007

18. Adherence toQuality Indicators, According to Clinical Area • Children received: • 67.6% for acute medical • 53.4% for chronic medical • 40.7% for preventative Mangione-Smith R et al. N Engl J Med 2007;357:1515-1523

19. The gap between research and practice Why does it exist? Por que?

20. Cabana et al. JAMA 2002

21. 2. Bedside EBM 4. Decision aids, patient education and compliance aids Evidence Application Practice 3. Clinical CQI Systems Summaries 1. Research synthesis guidelines, EBM journals Synopses and Critically Appraised Topics Systematic reviews and syntheses Studies Lang and Wyer 2007

22. Evidence that gets incorporated into practice Available evidence

23. When was the last time you changed practice or were able to develop a program that changed the delivery of healthcare?How?

24. Knowledge Translation “Knowledge translation (KT) is the effective and timely incorporation of evidence-based information into the practices of health professionals in such a way as to effect optimal health care outcomes and maximize the potential of the health system.” (Modified from the Canadian Institutes for Health Research definition – 2001).

30. KT principles • Overcoming barriers to evidence uptake is complex • Every gap and setting have a signature set of obstacles • Achieving KT is like fitting a key into a lock • A chave e uma fechadura

31. KT Interventions – 6 domains • Education (academic detailing) • CDSS / reminders • Audit / feedback • Physician champion development • Administrative intervention • Financial incentives / disincentives

32. How can we improve KT?

33. Common Tasks • Systematic review of 31 KT theories / models • Identifying the landscape for change • Nature of the problem • The need for change • Change agents – who? • Target audience • Barriers and facilitators Graham ID. AEM. November 2007

34. Common Tasks • Developing a tailored intervention • Review evidence • Adapt to local realties • Link project to stakeholders (thought leaders, early adopters) • Implement (pilot / roll-out) • Evaluation plan (process / outcomes) • Maintain / sustain • Disseminate results of implementation Graham ID. AEM. November 2007

35. Key Lessons for Success • Leadership • Champion • Buy-in by local leaders • Planning • Project management • Marketing • Sense of urgency Grol, Eccles and Wensing: Improving Patient Care Berwick: Disseminating Innovation, JAMA 2003

36. Key Lessons for Success • Implementation • Define objective and outcome measures • Prepare to adapt • Support • Showcasing others’ success • Sharing wisdom • Communities of Practice Grol, Eccles and Wensing: Improving Patient Care Berwick: Disseminating Innovation, JAMA 2003

37. Establishing local priorities and championing local initiatives(todo implementação es local)Determining prioritiesWhere are the greatest gaps?Understanding barriers and facilitators

38. Olympiade de Implementação • Rationale • 2-3 volunteers from each group • Develop KT program to share with us tomorrow • 10-minute presentation (Português) • Judges

39. Hint • Use Chapter 22.7 as your guide

40. Specific tasks • Choose an important gap between research and practice i.e. HTA report not being followed • Describe a KT program for closing that gap efficiently, effectively and in a sustainable manner • Points for topic, context, assessing barriers, implementation strategies, methods.

41. Conclusions • In Rio we are looking at how to get the evidence straight and make decisions for each patient • We also need to think about how to implement strong evidence (getting it to the patient) so that more of our patients can benefit using Knowledge Translation approaches

42. Muito Obrigado