1 / 45

Knowledge Translation in Healthcare: Moving from Evidence to Practice (2013, 2nd Edition)

This book provides comprehensive insights into knowledge translation in healthcare, including the K2A cycle, knowledge synthesis, tailoring knowledge, implementing interventions, and evaluating outcomes.

riverascott
Download Presentation

Knowledge Translation in Healthcare: Moving from Evidence to Practice (2013, 2nd Edition)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Have Got a for Knowledge Translation in Health Care: Moving from Evidence to Practice (2013, 2nd edition)Ian D Graham, PhD, FCAHSProfessor, Epidemiology and Community Medicine, UOttawaSenior Scientist, OHRI October 9, 2014 KT Canada

  2. Disclosures • Originator of the K2A cycle • Editor of KT in Healthcare • All royalties go to KT Canada STIHR for student fellowships (V1 royalties went into CIHR fund for students) • Sharon is making me do this!

  3. Session Objectives Understand the K2A Cycle KT in Health Care, what’s included, what new Anything else?

  4. The Warning Signs and Symptoms Eye rolling Sighing Involuntary utterances OMG HML JKMN Hyperventilating Fainting More common among physicians and males What is it?

  5. TAS Theory Averse Syndrome FAS Framework Averse Syndrome

  6. Knowledge Inquiry Tailoring Knowledge Synthesis Products/ Tools Monitor Knowledge Use Select, Tailor, Implement Interventions from: Graham et al: Lost in Knowledge Translation: Time for a Map? Evaluate Outcomes KNOWLEDGE CREATION Assess Barriers/ Supports to Knowledge Use Sustain Knowledge Use Adapt Knowledge to Local Context Identify Problem Identify, Review, Select Knowledge

  7. use the knowledge to action cycle to improve implementation and uptake of research How to move research knowledge into practice?

  8. Chapter format Key learning points Background Evidence Future research Summary References

  9. Section 1: Introduction Chapter 1.1 Intro to KT; What it is and what it isn’t (Straus, Tetroe, Graham) Chapter 1.2 Integrated KT (Bowen, Graham) (new)

  10. Knowledge Inquiry studies using all types of study designs primary research needs to be targeted to fill the known gaps in our knowledge base primary research needs to be solutions-based need data on effectiveness/impact of practices and hence methods of evaluation Knowledge Inquiry Tailoring Knowledge Synthesis Products/ Tools

  11. Synthesis need for synthesis to determine what we already know (or should know if we were to summarize the existing knowledge) can take the form of systematic reviews, meta analyses, realist reviews, etc. need to determine where there is a strong evidence base and move that evidence into action Chapter 2.0: Introduction: the K in KT: Knowledge Creation (Straus) Chapter 2.1: Knowledge Synthesis (Tricco, Tetzlaff, Moher) Knowledge Inquiry Tailoring Knowledge Synthesis Products/ Tools

  12. Knowledge Products/Tools Algorithms Decision rules Decision aids Guidelines Chapter 2.2: Knowledge translation tools (Brouwers, Stacey, O’Connor) Chapter 2,3 Searching for research findings and the KT literature (McKibbon, Lokker) Chapter 2..4: Knowledge Dissemination: End of Grant KT (Graham, Tetroe, Gagnon) (new) Knowledge Inquiry Tailoring Knowledge Synthesis Products/ Tools

  13. Monitor Knowledge Use Select, Tailor, Implement Interventions Evaluate Outcomes Section 3: the Action cycle Chapter 3.0: Introduction (Straus) Assess Barriers/ Supports to Knowledge Use Sustain Knowledge Use Start here Adapt Knowledge to Local Context Identify Problem Identify, Review, Select Knowledge

  14. EITHER Start with problem/issue concern and look for research to solve the problem How to determine if and what research is needed? from an individual and a systems perspective Who should identify the need for research? Does the research question address an issue of relevance to the end user? Are all the relevant stakeholders involved? Monitor Knowledge Use KNOWLEDGE CREATION Knowledge Inquiry Synthesis Products/ Tools Identify Problem Identify, Review, Select Knowledge Tailoring Knowledge Identify Problem Identify, Review, Select Knowledge Select, Tailor, Implement Interventions Evaluate Outcomes Assess supports/ Barriers to Knowledge Use Sustain Knowledge Use Adapt Knowledge to Local Context

  15. OR Become aware of current research/systematic review/guideline and assess whether current practice is in keeping with it Is it high quality evidence? If using a guideline, does it adhere to the AGREE and IOM quality criteria? Monitor Knowledge Use KNOWLEDGE CREATION Knowledge Inquiry Synthesis Products/ Tools Identify Problem Identify, Review, Select Knowledge Tailoring Knowledge Identify Problem Identify, Review, Select Knowledge Select, Tailor, Implement Interventions Evaluate Outcomes Assess supports/ Barriers to Knowledge Use Sustain Knowledge Use Adapt Knowledge to Local Context

  16. Know-do gap • Chapter 3: Identifying knowledge to action gaps (Kitson, Straus)

  17. To apply knowledge, one needs to contextualize or adapt it for local use e.g. ADAPTE Collaboration (for guideline adaptation); CAN-IMPLEMENT How might the guideline need to be adapted for local use? What are the specific contextual variables that need to be taken into account for the context in which you are working? Chapter 3.2: Adapting knowledge to local context (Harrison, Graham, Fervers, van den Hoek) Monitor Knowledge Use Select, Tailor, Implement Interventions KNOWLEDGE CREATION Evaluate outcomes Knowledge Inquiry Assess supports/ Barriers to Knowledge Use Synthesis Sustain Knowledge Use Products/ Tools Adapt Knowledge to Local Context Identify Problem Identify, Review, Select Knowledge Tailoring Knowledge Adapt Knowledge to Local Context

  18. Assess barriers and supports related to: the innovation the potential adopters the practice setting What might be the individual (patient or provider), organizational and team barriers to uptake of best practice? What might be the individual, organizational and team supports to uptake of best practice? Chapter 3.3a: Barriers and facilitators: strategies for identification and measurement (Legare, Zhang) Chapter 3.3b: Mapping KT interventions to barriers and facilitators (Colquhoun, Grimshaw, Wensign) (new) Monitor Knowledge Use Select, Tailor, Implement Interventions KNOWLEDGE CREATION Evaluate outcomes Knowledge Inquiry Assess supports/ barriers to Knowledge Use Synthesis Sustain Knowledge Use Products/ Tools Adapt Knowledge to Local Context Identify Problem Identify, Review, Select Knowledge Tailoring Knowledge Assess barriers/ supports to knowledge use

  19. Tailor interventions as much as possible, based on the barriers and supports identified, select or tailor interventions to move knowledge to practice Consider the context in which you are trying to implement change – what interventions are more or less likely to be effective? Chapter 3.4a: Developing and selection KT interventions (Wensign, Bosch, Grol) Chapter 3.4b: Formal educational interventions (Davis, Davis, Johnson) Chapter 3.4c: Linkage and exchange (Salsberg, Macaulay) (newish) Chapter 3.4d: Audit and feedback interventions (Foy, Eccles) Chapter 3.4e: Informatics interventions (Gupta, McKibbon) Monitor Knowledge Use Select, Tailor, Implement Interventions Select, Tailor, Implement Interventions KNOWLEDGE CREATION Evaluate outcomes Knowledge Inquiry Assess supports barriers to Knowledge Use Synthesis Sustain Knowledge Use Products/ Tools Adapt Knowledge to Local Context Identify Problem Identify, Review, Select Knowledge Tailoring Knowledge

  20. Selecting KT interventions con’td • Chapter 3.4 f: Patient-directed and patient mediated KT interventions (Stacey, Hill) (new) • Chapter 3.4g: Organizational interventions (Ferlie) • Chapter 3.4h: Shared decision making (Legare, Zhang) • Chapter 3.4i: Financial incentive interventions (Flodgren, Eccles, Scott, Sheppard) (new)

  21. Instrumental (behaviour): guideline adherence, use/adoption of innovation Conceptual (knowledge & attitudes & intentions), Symbolic knowledge use identify appropriate indicators of use of the innovation identify the level(s) (system, team, practitioner, patient) where you need to measure the knowledge use Monitor Knowledge Use Select, Tailor, Implement Interventions KNOWLEDGE CREATION Evaluate outcomes Knowledge Inquiry Assess supports/ barriers to Knowledge Use Synthesis Sustain Knowledge Use Products/ Tools Adapt Knowledge to Local Context Identify Problem Identify, Review, Select Knowledge Tailoring Knowledge Monitor Knowledge Use

  22. Determine impact of using the guideline or uptake of the innovation Patient health outcomes (eg. relief of symptoms, mobility HRQoL) Provider outcomes (eg. satisfaction) System/organization outcomes (eg. Wait times, expenditures, readmissions) Unintended impacts Identify outcomes/impacts to measure and methods for doing so Determine your evaluation plan at the outset and in consultation with all stakeholders Chapter 3.5: Monitoring knowledge use and evaluating outcomes (Straus, Tetroe, Bhattacharyya, Zwarenstein, Graham) Monitor Knowledge Use Select, Tailor, Implement Interventions KNOWLEDGE CREATION Evaluate Outcomes Knowledge Inquiry Assess supports barriers to Knowledge Use Synthesis Sustain Knowledge Use Products/ Tools Adapt Knowledge to Local Context Identify Problem Identify, Review, Select Knowledge Tailoring Knowledge Evaluate Outcomes

  23. Are interventions needed to sustain ongoing use of the innovation? Is there a role for quality improvement processes? What ongoing monitoring of use and impacts needed? How long are the skills/knowledge maintained? Consider sustainability issues at the beginning to optimize moving research knowledge into practice Chapter 3.6: Sustaining knowledge use (Davies and Edwards) Monitor Knowledge Use Select, Tailor, Implement Interventions KNOWLEDGE CREATION Evaluate Outcomes Knowledge Inquiry Assess supports Barriers to Knowledge Use Synthesis Sustain Knowledge Use Products/ Tools Adapt Knowledge to Local Context Identify Problem Identify, Review, Select Knowledge Tailoring Knowledge Sustain Knowledge Use

  24. Chapter 3.7: Case examples • Chapter 3.7a: Illustrating the knowledge to action cycle: an integrated knowledge translation research approach to wound care (Graham, Harrison) (new) • Chapter 3.7b: Tips on implementation (Ritchie) (new)

  25. Section 4: Theories and models of knowledge to action FAS & TAS Alert • Chapter 4.1: Planned action theories (Graham, Tetroe) • Chapter 4.2: Cognitive psychology theories of change in provider behavior (Hutchison, Estabrooks) • Chapter 4.3: Education theories (Hutchison, Estabrooks) • Chapter 4.4: Organizational theories (Denis, Lehoux) • Chapter 4.5: Quality improvement theories (Sales) (new)

  26. Section 5: Evaluation of knowledge to action • Chapter 5.1: Methodologies to evaluate effectiveness of knowledge translation interventions (Bhattacharyya, Zwarenstein) • Chapter 5.2: Economic evaluation of knowledge translation interventions (Quinn, Mitton, Ward) (new)

  27. Section 6: Ethics • Chapter 6.1: Ethics in the science lifecycle: broadening the scope of ethical analysis (Allen, Flamenbaum) (new) • Chapter 6.2: Ethical issues in Cluster-randomized trials in KT (Taljaard, Weijer, Grimshaw) (new)

  28. Chapters cover: Knowledge creation Knowledge-to-Action cycle Theories and Models of Knowledge-to-Action Knowledge exchange/iKT Evaluation of Knowledge-to-Action Available at: http://ca.wiley.com/WileyCDA/WileyTitle/productCd-1405181060,descCd-description.html Presentations based on chapters available at: http://www.cihr-irsc.gc.ca/e/40618.html KT in Health Care - Moving from Evidence to Practice: A KT Handbook

  29. ktclearinghouse.ca KT Clearinghouse

  30. Knowledge, if it does not determine action, is dead to us. Plotinus (Roman philosopher 205AD-270AD)

  31. Knowledge, if it does not determine action, is dead to us. Plotinus Moher (Roman philosopher 205AD-270AD)

  32. Take a Minute to Reflect on the Session’s Objectives Understand the K2A Cycle KT in Health Care, what’s included, what new

  33. Questions? I don’t get it

More Related