Knowledge Translation Cohort: Knowledge Translation Cohort
Introduction to CHPSTP
Overview of KT Cohort Model
Review of KT Theories and Methods
KT Strategies in Canada
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
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
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)
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 Slide8: Range of conceptual and theoretical bases Slide9: 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 Slide11: 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
Slide13: 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: 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