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Canadian Knowledge Mobilization Forum 2012 - June 20, 2012

TEAM-beta: Treatment and Evidence Algorithmic Mapping – a platform for an efficient decision support tool for clinicians, researchers and funders. Dalton Wolfe 1 , Jane Hsieh 2 , Jennifer Hunter 2 , Amanda Khan 1 , Saagar Walia 1 & the Spinal Cord Injury Knowledge Mobilization Network

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Canadian Knowledge Mobilization Forum 2012 - June 20, 2012

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  1. TEAM-beta: Treatment and Evidence Algorithmic Mapping – a platform for an efficient decision support tool for clinicians, researchers and funders Dalton Wolfe1, Jane Hsieh2, Jennifer Hunter2, Amanda Khan1, Saagar Walia1 & the Spinal Cord Injury Knowledge Mobilization Network 1: Parkwood Hospital, Lawson Health Research Institute 2: Ontario Neurotrauma Foundation Canadian Knowledge Mobilization Forum 2012 - June 20, 2012

  2. Outline • Objective: to describe the rationale and early concept development behind TEAMbeta (clinical decision making support tool) • Problem Identification: Too Much Information, Not Enough Knowledge (Is Practice Evidence-Informed?) • Solution: TEAMbeta, a map to information that is clinically relevant  Knowledge  Action • Initial Features and Methods

  3. A Vast Sea of Information: But is it Being Used in Practice (i.e. Behaviour Change)? • Challenges for Knowledge Users • Ever increasing volume and complexity • Access hindered by multiple barriers (competing demands, cost, feasibility) • Application hampered by inertia and inability to apply appropriately • What to do??? (Information  Knowledge  Action

  4. Spinal Cord Injury Rehabilitation Evidence (SCIRE): Knowledge Product Canadian collaboration between scientists and clinicians www.scireproject.com Expert synthesis  evidence statements

  5. SCIRE: Knowledge Product Platform Standards of Care Standards of Care (Informing SCI KMN, etc.) Outcome Measure Standardization (Outcome Measure Toolkit) Clinical Practice Development (e.g., Canadian Physical Activity / Pressure Ulcer Guidelines Knowledge Translation Case Studies (Modeling Evidence  Practice) TEAMbeta Outcome Measurement “How-to” Videos SCI-U (eLearning modules directed to the person with SCI = self-management) Research / Care Priorities Consensus Priority Setting Activities (base on Gap Analysis, strengths, etc.)

  6. SCIRE: Influencing Decision-Making Typical approaches to consensus-seeking activities do not place decision making in the context of practice Ultimate goal … To influence practice so as to improve outcomes

  7. Our Challenge How do we get information to users in a way they will use it? Goal: to enhance decision making and influence practice (action) by … Clinicians Researchers Funders / Policy makers / Administrators

  8. Our Solution: TEAMbeta • An algorithm to guide decision making that is consistent with the clinical situation (for pain management in persons with SCI) • Assessment • Diagnosis • Treatment • Each node represents links to further information

  9. Applying the Solution to the Real World • Identifying implementation targets for the Spinal Cord Injury Knowledge Mobilization Network (SCI KMN) • The SCI KMN is 6 Canadian rehab centres applying the principles of Implementation Science for best practice adoption Parkwood Hospital - London, ON Glenrose Hospital – Edmonton, AB Foothills Hospital – Calgary, AB IRDPQ – Québec City, QC IRGLM– Montreal, QC Toronto Rehab - Toronto, ON

  10. Delphi: Selecting Practices as Targets for Implementation • Successive rounds of considering practice options and voting • Participants voted according to set criteria DRAFT Canadian Practice Guidelines on Pressure Ulcers 48 Practices 1. ASSESSMENT: Conduct a comprehensive, systematic assessment of risk factors 2. EDUCATION: Provide structured pressure ulcer prevention education Best Practices 1……………...12 Best Practices 1……………...23 Round 2 Round 3 Round 1 • Before: this was done by reviewing long lists of information about evidence behind practice options • After TEAMbeta: this information will be provided in a clinically relevant way

  11. Methods: Building the Content, Defining the Specs • Pain Advisory Team (PAT) • 8 subject matter experts (variety of clinical perspectives) • Facilitated through collaboration platform (SharePoint) • Specification and Features Advisory Team (SFAT) • 4 subject matter experts (2 IT, 2 clinical) • Core Development Team (CDT) • Data abstraction from CPGs, systematic reviews, meta-analyses, etc. • Iterative prototyping with IT partner

  12. TEAMbeta Features • The map will parallel the structure of the International SCI Pain (ISCIP) classification system, which first identifies pain sub-types and highlights associated treatment options • Web-based (platform independent) software system • Interactivity enabled by zoom and pan functions

  13. TEAMbeta Features … • Overall shape and colour of treatment option will reflect a class of treatment • Illustrative icons link to underlying information (i.e. active/greyed-out = info available/not) • Icon colour-coding will illustrate status at-a-glance associated with the underlying information Gabapentin Tricyclic …

  14. TEAMbeta Features • By clicking on the appropriate icon, it will take you to the underlying information ?????? How-to Guidelines Gabapentin Evidence • There is level 1 evidence that Gabapentin and pregabalin improve neuropathic pain post SCI. • There is level 4 evidence that the anticonvulsant Gabapentin is more effective when SCI pain is <6 months than >6 months. • Source: SCIRE; This evidence is based on these articles

  15. Enabling the Delphi Process … • Icons to initiate voting and view past results • Enable culling over successive rounds Gabapentin Tricyclic …

  16. Lots of ideas – Long-term Development Gabapentin • Use gaming concepts (i.e., motivational rewards, competition, etc.). • Community of practice • Ideas emerging from PAT / SFAT Evidenc How-to Guidelines How-to Method of Administration: Oral Recommended Dose: cc mg bid Contraindications: safm dsein sdfdsoe dfs ssfs. Source: www.drquacky .com Congratulations!! You have completed the quest to examine and apply 5 “How-To” sections for pain treatments. You will receive 5 gold bars …

  17. Key Concept • Decision-making  Practice Change (Action) will be aided by placing information in an appropriate context. Comments?

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