kt cohort seminars sep20 2006

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Knowledge Translation Cohort: 

Knowledge Translation Cohort Introduction to CHPSTP Overview of KT Cohort Model Review of KT Theories and Methods KT Strategies in Canada Next Steps

Introduction to CHPSTP: 

Introduction to CHPSTP CIHR Health Informatics PhD/postdoc Strategic Training Program (CHPSTP) 6-yr funding 2002-08, 8 partners: UVic, UofC, McMaster, UofT, Waterloo, McGill, Sherbrooke, Dalhousie Aim: Increase research capacity in HI Objectives: Offer research/education experience not available locally Strengthen collaboration in education/research Build virtual HI community Assume leadership/facilitation role in Canada 2x Cohorts, 60+ trainees/fellows, 15+ mentors/collaborators Virtual seminars, annual workshops, publications, funding for conferences/presentations

Overview of KT Cohort Model: 

Overview of KT Cohort Model KT cohort: 1-yr, Sep06-May07 Aim: Foster best practices in HI thru KT to improve health system Virtual seminars (tentative schedule) Online forums: moderated, 2-wks/topic, summary Conferences: paper, $1500, confirm by Dec06, attend by Jun07 Outputs: training plan with timeline, paper or project

Review of KT Theories and Methods: 

Review of KT Theories and Methods Systematic review of literature on KT Grimshaw 2001, Changing provider behavior Lavis 2003, How can research organizations more effectively transfer knowledge to decision makers? Greenhalgh 2004, diffusion of innovations in service orgns Fleuren 2004, Determinants of innovations in healthcare orgns Graham 2004, Innovations in KT and continuity of care

Grimshaw 2001, Changing Provider Behavior: 

Grimshaw 2001, Changing Provider Behavior 41 reviews between 1966-1998 15 on broad strategies/behaviors, e.g. CME, guidelines, primary care programs, doctor-nurse collaboration 14 on specific behaviors, e.g. preventive care, prescribing, referrals, test ordering, EOL care 15 on specific interventions, e.g. printed educational material, outreach visits, opinion leaders, audit/feedback, reminders, CDS, feedback on cost, mass media, CQI Promising approaches Educational outreach (for prescribing) and reminders Multifaceted interventions targeting different barriers to change Variable success with audit/feedback, opinion leaders

Lavis 2003, Effective Transfer .. Decision Makers: 

Lavis 2003, Effective Transfer .. Decision Makers Five questions as organizing framework What should be transferred to decision maker (message) To whom should knowledge be transferred (audience) By whom should knowledge be transferred (messenger) How should knowledge be transferred (process, infrastructure) With what effect should knowledge be transferred (evaluation) Suggested improvements Develop actionable messages for decision makers Develop knowledge uptake and knowledge transfer skills Evaluate impact of KT activities Research funders help with individualized feedback, conducting evaluation, KT requirements

Greenhalgh 2004, Diffusion of Innovations : 

Greenhalgh 2004, Diffusion of Innovations 13 research traditions e.g. rural/medical sociology, communication, marketing, development, health promotion, EBM, organizational determinants/process/context, inter-organization, knowledge utilization, complexity Range of conceptual and theoretical bases 6 categories of findings Innovation, adoption/assimilation process, communication and influence, inner context, outer context, implementation process Conceptual model on diffusion, dissemination and implementation of innovations in health service delivery organizations


Range of conceptual and theoretical bases


Conceptual model of diffusion, dissemination and sustainability of innovations in health service organization

Fleuren 2004, Determinants of Innovations : 

Fleuren 2004, Determinants of Innovations Literature review andamp; Delphi study, 57 studies, 50 determinants Facilitating determinants in andgt;5 studies Organization: support other professionals, self-efficacy, ownership Innovation: relevance for patient Impeding determinants in andgt;5 studies Socio-political: negative patient cooperation/discomfort, innovation not fit with regulations/legislation Organization: poor collaboration, high staff turnover, incomplete staff capacity, little support of professionals/supervisors/management, limited knowledge/skills, low self-efficacy, negative ownership Innovation: unclear procedures, incompatible, not appealing, no added value, high risk, few resources, no reimbursement, lack time


Fleuren 2004, Determinants of Innovations

Graham 2004, Innovations in KT Continuity Care: 

Graham 2004, Innovations in KT Continuity Care 2 categories of KT theories/models Classical, descriptive e.g. diffusion, coordinated implementation Planned action, e.g. precede-proceed, social marketing, research into practice framework, rules for dissemination Ottawa model of research use Step1, getting started – identify authority to make changes Step2, clarifying innovation – what innovation andamp; implementation Step3, assessing innovation, potential adopters, practice environment for barriers and supports Step4, selecting/monitoring implementation interventions Step5, monitoring adoption Step6, evaluating outcomes


KT Strategies in Canada : 

KT Strategies in Canada CIHR KT Strategy 2004-2009 Exchange, synthesis and application of knowledge – within system of interactions among researchers/users – to accelerate capture of benefits of research thru improved health, more effective services/products, strengthened healthcare system Strategies/activities vary based on type of research and audience Develop systematic integrated approach to accelerate optimal use of best available evidence in health of Canadians Blueprint 2007 to advance research in health knowledge use across levels of decision making, develop/sustain individuals involved in exchange/use of knowledge, develop/sustain environments that enable/catalyze effective use of knowledge

KT Strategies in Canada …: 

KT Strategies in Canada … SSHRC Knowledge Mobilization Knowledge council in research, people and knowledge mobilization KM system, access to new data/findings, enable decision making on social, economic and cultural issues CHSRF Knowledge Transfer andamp; Exchange Web tour http://www.chsrf.ca/knowledge_transfer/index_e.php Landry R. KT Planning Tools for Stroke Research Teams Web tour http://kuuc.chair.ulaval.ca/ctci/ Canadian Strategy for Cancer Control, NCIC Working group on translational research andamp; knowledge integration Incorporation of knowledge into decisions, practices and policies of systems/organizations to inform decisions/outcomes

Next Steps: 

Next Steps What does KT have to do with HI and health IT? MOODLE discussion forum format Monday Sep25 to Sunday Oct9 midnight for postings Moderated by Francis Lau (UVic) and Karim Kesjavshee (McMaster) Login info to be distributed by Sep24 midnight Possible MOODLE topics 'What KT methods are effective in health IT implementation and use within the Canadian healthcare setting?' 'Can you suggest an effective KT method for health IT implementation and use that is evidence-based?' Next virtual seminar on Oct18 at 11am PST


References Best A, et al. The Language and Logic of Research Transfer: Finding Common Ground. NCIC Working Group on Translational Research andamp; Knowledge Integration, under review. CIHR. Knowledge Translation Strategy 2004-2009. http://www.cihr-irsc.gc.ca/e/26574.html. Fleuren M, et al. Determinants of innovation within healthcare organizations: Literature review and Delphi study. International J for Quality in Health Care 2004; 16(2):107-123. Graham ID et al. Translating research: Innovations in knowledge transfer and continuity of care. Canadian J Nursing Research 2004; 36(2):89-103. Greenlalgh T, et al. Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Quarterly 2004; 82(4):581-629. Grimshaw JM, et al. Changing provider behavior – An overview of systematic reviews of interventions. Medical Care 2001; 39(8) Suppl 2; pp II2-II45. Landry R. Two KT planning tools for stroke research teams. http://kuuc.chair.ulaval.ca/ctci. Lavis JN, et al. How can research organizations more effectively transfer research knowledge to decision makers? Milbank Quarterly 2003; 81(2): 221-248. SSHRC Strategic Plan 2006-2011. http://www.sshrc.ca/web/about/publications/strategic_plan_e.pdf

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