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Knowledge TranslationKnowledge TranslationTradução do conhecimentoTradução do conhecimento(Perdoar má tradução)(Perdoar má tradução)
Eddy Lang, MD, CFPC (EM), CSPQ
SMBD-Jewish General Hospital, McGill University,
Montreal, Canada
3º Workshop de Prática Clínica Baseada em Evidências
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Declaração de conflito de interesses
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Rio de Janeiro
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Brasiliophilia
Gilberto Gil Gal Costa Caetano Veloso Feijoada Suco de Pina Caipirinhia
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Objectives
Sensitize you to the gap (fosso) between research and practice
Introduce the field of Knowledge Translation (Tradução do conhecimento)
Prepare for the “Olympiade de Implentação” (não piade)
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Question 1
Based on your observations of care provided in the private hospital system, how commonly do patients who suffer a stroke (Acidente vascular
cerebral) receive most evidence-based secondary prevention therapies?
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Choices
0 – 20% of the time
20 – 50% of the time
50 – 90% of the time
> 90% of the time
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Question 2
Based on your observation of clinical practice in the private hospitals, how commonly do otherwise healthy patients with a diagnosis of bronchitis receive a prescription for antibiotics?
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Choices
0 – 20% of them
20 – 50% of them
50 – 90% of them
> 90% of them
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Question 3
Based on your observation of clinical practice in private hospitals what percentage of low-risk head trauma patients undergo CT head?
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Choices
0 – 20% of them
20 – 50% of them
50 – 90% of them
> 90% of them
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The research to practice gap
Not a new problem 263 years before citrus juice was
introduced into the British Navy Thrombolysis in MI
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Is this a problem? IOM: Crossing the Quality Chasm
“ between the health care that we now have and the health care that we could have lies not just a gap, but a chasm”
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Rita-Mangione et al. The Quality of Ambulatory Care Delivered to Children in the United States. Oct. 2007
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Mangione-Smith R et al. N Engl J Med 2007;357:1515-1523
Adherence to Quality Indicators, According to Clinical Area
Children received:
• 67.6% for acute medical• 53.4% for chronic medical• 40.7% for preventative
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The gap between research and practice
Why does it exist?Por que?
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Cabana et al. JAMA 2002
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Studies
Systematic reviews and syntheses
Synopses and Critically Appraised Topics
Systems
1. Research synthesis
guidelines, EBM journals
2. Bedside
EBM
4. Decision aids, patient education and compliance
aids
3. Clinical CQI
Evidence PracticeApplication
Summaries
Lang and Wyer 2007
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Available evidence
Evidence that gets incorporated
into practice
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When was the last time you changed practice or were able to develop a
program that changed the delivery of healthcare?
How?
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Knowledge Translation
“Knowledge translation (KT) is the effective and timelyincorporation of evidence-based information into the practicesof health professionals in such a way as to effect optimalhealth care outcomes and maximize the potential of the healthsystem.”
(Modified from the Canadian Institutes for HealthResearch definition – 2001).
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KT principles
Overcoming barriers to evidence uptake is complex
Every gap and setting have a signature set of obstacles
Achieving KT is like fitting a key into a lock A chave e uma fechadura
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KT Interventions – 6 domains
Education (academic detailing) CDSS / reminders Audit / feedback Physician champion development Administrative intervention Financial incentives / disincentives
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How can we improve KT?
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Common Tasks
Systematic review of 31 KT theories / models
Identifying the landscape for changeNature of the problemThe need for changeChange agents – who?Target audienceBarriers and facilitators
Graham ID. AEM. November 2007
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Common Tasks Developing a tailored intervention
Review evidenceAdapt to local realtiesLink project to stakeholders (thought
leaders, early adopters) Implement (pilot / roll-out)Evaluation plan (process / outcomes)Maintain / sustainDisseminate results of implementation
Graham ID. AEM. November 2007
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Key Lessons for Success
LeadershipChampionBuy-in by local leaders
PlanningProject managementMarketingSense of urgency
Grol, Eccles and Wensing: Improving Patient CareBerwick: Disseminating Innovation, JAMA 2003
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Key Lessons for Success
ImplementationDefine objective and outcome
measuresPrepare to adapt
SupportShowcasing others’ successSharing wisdomCommunities of Practice
Grol, Eccles and Wensing: Improving Patient CareBerwick: Disseminating Innovation, JAMA 2003
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Establishing local priorities and championing local initiatives
(todo implementação es local)
Determining priorities
Where are the greatest gaps?
Understanding barriers and facilitators
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Olympiade de Implementação
Rationale 2-3 volunteers from each group Develop KT program to share with us
tomorrow 10-minute presentation (Português) Judges
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Hint
Use Chapter 22.7 as your guide
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Specific tasks
Choose an important gap between research and practice i.e. HTA report not being followed
Describe a KT program for closing that gap efficiently, effectively and in a sustainable manner
Points for topic, context, assessing barriers, implementation strategies, methods.
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Conclusions
In Rio we are looking at how to get the evidence straight and make decisions for each patient
We also need to think about how to implement strong evidence (getting it to the patient) so that more of our patients can benefit using Knowledge Translation approaches
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