New Brunswick Health Research Foundation Official Launch and 1 st Annual Conference

1. Health Researchwith an ImpactIan D Graham PhDVice President, Knowledge Translationand Public OutreachCanadian Institutes of Health Research New Brunswick Health Research Foundation Official Launch and 1st Annual Conference October 4th 2009

2. Health Researchwith an Impact • Doesn’t all health research have an impact? • Knowledge Translation as a mechanism for impact • Commonalities in our approaches to health research • KT infrastructure for achieving impact

3. Doesn’t all health research have an impact? • Consistent evidence of failure to translate research findings into clinical practice • 30-45% patients do not get treatments of proven effectiveness • 20–25% patients get care that is not needed or potentially harmful (McGlynn et al, 2003; Grol R, 2001; Schuster, McGlynn, Brook, 1998;) • Cancer outcomes could be improved by 30% with optimum application of what is currently known • 10% reduction in cancer mortality with widespread use of available therapies (CSCC 2001; Ford et al, 1990)

4. Knowledge Translation as a mechanism for impact

5. Knowledge Translation is part of our mandate

6. Context: CIHR Mandate (4h) promoting the dissemination of knowledge and the application of health research to improve the health of Canadians (4i) encouraging innovation, facilitating the commercialization of health research in Canada and promoting economic development through health research (5f) communicate with the public, governments, the Canadian and international communities, voluntary organizations and the private sector on issues pertaining to health or health research

7. Knowledge Translation is the bridge between discovery and impact (KT research and practice) Research outputs Research impacts It’s is about making a difference

8. What is Knowledge Translation? KT is a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system. This process takes place within a complex system of interactions between researchers and knowledge users which may vary in intensity, complexity and level of engagement depending on the nature of the research and the findings as well as the needs of the particular knowledge user.

9. What is Knowledge Translation? Ethically sound application of knowledge • The contextualization and integration of research findings of individual research studies within the larger body of knowledge on the topic. • Synthesis is a family of methodologies for determining what is known in a given area or field and what the knowledge gaps are. Knowledge synthesis • Involves identifying the appropriate audience for the research findings, and tailoring the message and medium to the audience. Dissemination • Refers to the interaction between the knowledge user and the researcher resulting in mutual learning, it encompasses the concept of collaborative or participatory, action oriented research where researchers and knowledge users work together as partners to conduct research to solve knowledge users’ problems (Integrated KT). Knowledge exchange • The iterative process by which knowledge is actually considered, put into practice or used to improve health and the health system. • KT activities must be consistent with ethical principles and norms, social values as well as legal and other regulatory frameworks

10. What is Knowledge Translation? Knowledge translation is about: • Making users aware of knowledge and facilitating their use of it to improve health and health care systems • Closing the gap between what we know and what we do (reducing the know-do gap) • Moving knowledge into action Knowledge translation research (KT Science) is about: • Studying the determinants of knowledge use and effective methods of promoting the uptake of knowledge

11. At CIHR we consider two broad categories of KT The researcher develops and implements a plan for making knowledge users aware of the knowledge generated through a research project End of grant KT The researcher engages potential knowledge users as partners in the research process. This requires a collaborative or participatory approach to research that is action oriented and is solutions and impact focused. Integrated KT

12. What is end of grant KT? A broad spectrum of activities including: Diffusion • Conference presentations • Peer reviewed publications (Open access policy- Jan 1, 2008) • Non-peer reviewed publications • Website postings

13. What is end of grant KT? Dissemination (activities that tailor the message and medium to a specific audience) • End of grant report to funders • Summary/briefings to stakeholders • Educational sessions with patients, practitioners and/or policy makers • Engaging knowledge users in developing & executing dissemination/implementation plan • Tools creation • Media engagement • Use of knowledge brokers

14. What is end of grant KT? Application* (moving research into practice in cases where the strength of evidence is sufficient) • Understanding the context/environment where research is to be applied • Identifying barriers to the uptake of the research findings • Adapting knowledge, tailoring messages and interventions to promote uptake • Evaluating the implementation process and outcomes • Working within a conceptual framework *NB knowledge application is often a fundamental component of integrated KT as well

15. What is integrated KT? • a way of doing research • collaborative, participatory, action-oriented, community based research, co-production of knowledge, mode 2 research • involves engaging and integrating knowledge users into the research process • Knowledge users can be: • Policy- and decision-makers from the community to the federal level, researchers, the public, industry, clinicians, the media • Investigators from different disciplines, teams, countries

16. What is integrated KT? Knowledge users and researchers (knowledge creators) work together to: • shape the research questions • interpret the study findings and craft messaging around them • move the research results into practice In our view – this is the minimum requirement for conducting integrated KT

17. What is integrated KT? In addition, knowledge users and researchers (knowledge creators) can work together to: • shape the research questions • decide on the methodology • help with data collection and tools development • interpret the study findings and craft messaging around them • move the research results into practice • widespread dissemination and application

18. Review implications of integrated KT By requiring both researchers and knowledge users to be part of the research team, integrated KT requires merit review: • Both knowledge users and researchers on the review panel • Each proposal scored on impact/relevance as well as scientific merit • Panellists often need orientation materials explaining the process as well as worksheets to apply the criteria • Both “types” of panel members have a voice

19. Health research with an impact means avoiding waste: • Avoiding waste???? • Chalmers and Glaziou1: “Within specific health problems there is little research on the extent to which questions addressed by researchers match questions of relevance to patients and clinicians. • e.g. the research priorities of patients with osteoarthritis of the knee favoured more rigorous evaluation of physiotherapy and surgery – 9% wanted more research on drugs, yet 80% of RCTs of patients with this condition were on drugs Iain Chalmers, Glaziou,P. Avoidable waste in the production and reporting of research evidence. The Lancet 2009 374 86-89.

20. Having an impact means closing the gap between evidence and action Some general KT principles: • Researchers need to do the right research • need for synthesis to determine what we already know (or should know if we were to summarize the existing knowledge) • Paul Ewald*: “We have in hand most of the information we need to facilitate a new golden age of medicine. And what we don’t have in hand we can get fairly readily by wise investment in targeted research and intervention.” *From John Brockman. “What is Your Dangerous Idea”

21. Some general KT principles for achieving impact: • Researchers need to do the right research • need for synthesis to determine what we already know (or should know if we were to summarize the existing knowledge) • need to determine where there is a strong evidence base and move that evidence into action • today's health problems are complex and interdisciplinary and require mixed methods to solve • primary research needs to be targeted to fill the known gaps in our knowledge base • primary research needs to be solutions-based

22. Some general KT principles for achieving impact : • The right people need to be involved from the beginning • need applied, collaborative, interdisciplinary research (in other words: integrated KT) • users of the research need to be helping to set the research agenda and define the research questions to ensure relevance and greater likelihood of uptake of the results when they become available

23. Some general KT principles for achieving impact : • Knowledge-users need to make the research right for their own context • research is not used like a can opener • knowledge-users need to adapt, contextualize and take ownership of knowledge for local use • as research producers, this means you need to help them sufficiently understand your work so that they are able to put it to use

24. Achieving impact:closing the gap between evidence and action How to close the gap between evidence and action: • shift attention from individual adopters to the organizational and environmental context for change • set targets for change • monitor uptake of the research and evaluatethe health and system outcomes/impact • keep it simple • focus on a few important targets, practical indicators

25. How do we measure impact at CIHR?

26. Types of impact Impact writ large: Impact framework – adapted from/by the CAHS Impact at the level of an individual study - included in merit review of integrated knowledge translation grants

27. Impact writ large: the CIHR Impact Framework • Advancing Knowledge • discoveries/breakthroughs, contributions to the scientific literature. • Building Capacity • development and enhancement of research skills in individuals and teams. • Informing Decision-Making (knowledge use) • impacts of research in the areas of science, public, clinical and managerial decision-making, practice and policy. • Health & Health System Impacts • advances in prevention, diagnosis, treatment and palliation as well as advances in the way the system functions. • Economic Impacts • commercialization of discoveries; direct cost savings; and human capital gains.

28. Impact at the level of an individual study: Merit Review Research question: To what extent does the research question respond to an important need identified by the knowledge-user(s) on the research team Research approach: To what extent are the knowledge-user team members meaningfully engaged where appropriate (e.g. in defining the research questions, informing the research plan, interpreting the findings, informing the end-of-grant KT plan)?

29. Impact at the level of an individual study: Merit Review Feasibility: To what extent are the knowledge-users on the team committed to applying the findings when they become available and is their application achievable in the particular practice, program and/or policy context? • To what extent does the researcher-knowledge-user team have the necessary expertise and track record to deliver on the project’s objective(s), including the objectives of the end-of-grant KT plan?

30. Impact at the level of an individual study: Merit Review Outcomes: To what extent will the project have a substantive and sustainable impact on health outcomes, practice, programs and/or policy in the study context? • To what extent will the project’s findings be transferable to other practice, programs and/or policy contexts? • To what extent is the evaluation plan appropriate to assess the project’s impact?

31. Commonalities in our approaches to health research

32. Commonalities in our approaches to health research Translation to the Broad Community • We believe in effective mechanisms for linkage between researchers and users of health research to enhance the relevance and value of publicly funded research Capacity Building • We will strive to build a strong and stable infrastructure to strengthen health research capacity in New Brunswick Leveraging • We are committed to using provincial health research funds to provide a platform that ensures the successful acquisition of additional research funds from public and private sector, both national and international Culture of Innovation • We believe in fostering a culture of innovation by engaging health researchers in the excitement of discovery, and by supporting the creation, growth, and maturation of new discoveries and technologies with market potential at all stages of the innovation pipeline

33. CIHR’s Health Research Roadmap Four main Strategic Directions: • Invest in world class excellence • Address health and health system research priorities (considered within the light of the S&T and STIC sub-priorities) • Accelerate the capture of health and economic benefits of health research • Achieve organizational excellence, foster ethics and demonstrate impact

34. CIHR’s Health Research Roadmap Strategic Direction 3: Accelerate the capture of health and economic benefits of health research • Reaping socio-economic benefits from research through KT and partnerships • Enhancing the application of research and its evaluation

35. Accelerate the capture of health and economic benefits of health research Reaping socio-economic benefits from research through KT and partnerships • Facilitate and strengthen partnerships between researchers and knowledge users and between CIHR and a variety of organizations to achieve impact • Support evidence-informed policy making to improve health and the health system at both the provincial and federal levels. • Facilitate innovation and commercialization • Implement citizen engagement and public outreach initiatives

36. Accelerate the capture of health and economic benefits of health research Enhancing the application of research and its evaluation • Advance the application of research and its evaluation • Build capacity of both researchers and knowledge users to engage in KT • Increase the number of researchers to advance the science of KT

37. KT infrastructure for achieving impact

38. KT Funding Opportunities Our funding opportunities are driven by our operational definition of KT

39. KT Funding Opportunities:many serve multiple functions KT Awards (New Investigator, Fellowships, Doctoral) Strategic Training Initiative in Health Research (STIHR) Operating grants Canadian Cochrane Evidence on Tap Knowledge Synthesis Partnerships in Health System Improvement (PHSI) KT Awards (Prizes) Knowledge to Action KT Supplement Grants Meeting, Planning and Dissemination Proof of Principle (POP) SME/CIHR Science to Business Science of KT Synthesis IntegratedKT End of Grant KT Commercialization

40. Knowledge Synthesis Grant Supports teams of researchers and decision-makers to produce knowledge syntheses ($100 000 per year) and scoping reviews ($50 000 per year), that respond to the information needs of knowledge-users in all areas of health. Partners can, but are not required to make in-kind or cash contributions. Partnerships for Health Systems Improvement Supports teams of researchers and decision-makers interested in conducting applied health research useful to health system managers and or policy-makers. CIHR pays up to $400 000 over 3 years, with an additional 20 to 30% required from partners.

41. Knowledge to Action Grant Supports teams engaged in knowledge translation (KT) at the community, regional, provincial or federal level by funding KT and implementation activities of researchers and decision-makers/knowledge-users. CIHR pays up to $100 000 per year for one or two years. Partners can, but are not required to make in-kind or cash contributions.

42. Meetings, Planning and Dissemination Grants • provide support for meetings, planning and/or dissemination activities consistent with the mandate of CIHR and relevant to CIHR Institutes, Initiatives, or Branches. • Competition Dates • 3 competitions/year. • Applications due: Oct 1, Feb 1, June 1 • Decision/funding dates: Jan 1, May 1, Sept 1 • Term and amounts • 1 year, non-renewable grants • Maximum grant value is $15,000

43. Meetings Planning and Dissemination Grant: KT Supplement • Up to $40 000 for KT activities at the end of a CIHR grant when it is appropriate to disseminate the results of the research beyond the traditional scientific community and using methods supplementary to and in addition to publication in peer-reviewed journals. • Offered three times a year: October 1, February 1 and June 1 amount

44. More KT Funding Opportunities • Training and Personnel Awards • Knowledge Translation priority awards: • New Investigator Award • Fellowship Award • Doctoral Research Award • Health Research Communications Award

45. My question is: Are we making an impact? Bottom line: we all want to make an impact

46. For more information, visit our web page: http://www.cihr-irsc.gc.ca/e/29418.html http://www.cihr-irsc.gc.ca/f/29418.html ian.graham@cihr-irsc.gc.ca Thank you