evidence to care: mobilizing childhood disability research into practice

Evidence to Care: Mobilizing Childhood Disability Research into Practice

Canadian Knowledge Mobilization Forum

Saskatoon, Saskatchewan June 9, 2014

Dr. Shauna Kingsnorth Evidence to Care Lead Clinical Study Investigator Assistant Professor (status), Department of Occupational Science and Occupational Therapy, University of Toronto Holland Bloorview Kids Rehabilitation Hospital [email protected]

Healthcare in Ontario: Ministry of Health and Long-Term Care

• Provincial governing body for healthcare services

• Patient-focused, results-driven, integrated and sustainable, publicly funded

• Provide strategic direction on provincial priorities; establish sustainable funding models, legislation, monitoring, reporting, and policies

MOHLTC. (2013). http://www.health.gov.on.ca/en/common/ministry

Legislation: What is ECFAA?

The Excellent Care for All Act (ECFAA), which came into law in June of 2010, puts Ontario patients first and helps define quality for the

health care sector, by reinforcing shared responsibility for quality of care, building and supporting boards’ capability to oversee the delivery of high quality of care, and ensuring

health care organizations make information on their commitment to quality publicly available

MOHLTC. (2012). http://www.health.gov.on.ca/en/public/programs/ecfa

What is the aim of ECFAA?

•To ensure that:

–Best practices information is supported by available scientific evidence

–This information is translated into materials for employees and persons providing services within the health care organization

–The use of these materials is monitored through user-based surveys and standards of care

Ontario Government. (2010). http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_10e14_e.htm

ECFAA as a Social Innovation

•Places the patient at the centre of care

•Creates an enduring organizational focus on quality and continuous improvement

•As a regulatory systems driver, ECFAA creates conditions to support, enable and compel quality improvement

Quality

improvement

for better

outcomes

6

Holland Bloorview Kids Rehabilitation Hospital

Discovering Evidence Use at Holland Bloorview

Indicator Audit

Validated Tool

Best practices?

Focus Groups

7

To what extent is current research

evidence being used in clinical

practice?

Results: How evidence-friendly are we?

0

10

20

30

40

50

60

70

1 2 3 4 5 6 7

Anchored Scale (-/+)

Perc

en

t fr

eq

uen

cy

8

Waste of time Fundamental!

Mode

• Solid understanding of evidence-informed best practice

• Strong appreciation of value and need

• Very positive attitudes

Results: Is it easy is it to access?

•Described as limited and self-directed

–Research Librarian fundamental for direct access

–Conference attendance key learning vehicle

–Collaborative research partnerships not optimized

–No systematic organizational push/pull processes

9

Conclusions: Enablers and Barriers to Use

•Resource drivers – Individual skill

– Organizational capacity

•Evidence enablers – Quality and fit

– Availability

•Professional drivers – Colleges and associations (i.e., regulated roles)

– Colleagues

10

ECFAA at Holland Bloorview

Evidence to Care

Evidence Informed

Best Practice

Excellent Care for All Act

(ECFAA)

Health Quality Ontario

Evidence to Care (EtC): A Catalyst for Knowledge Translation

"The collaborative and systematic review, assessment, identification, aggregation, and practical application of high-quality disability and rehabilitation research by key stakeholders for the purpose of improving the lives of individuals with disabilities.”

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NCDDR. (2005). http://www.ncddr.org/knowledge_trans_over.html

What is Evidence to Care?

•Our vision is to promote the best available research evidence to inform care in childhood disability

•A bridge between research and clinical care and policy

13

What is Evidence to Care?

Position Holland Bloorview as a ‘go to’ hub for:

• Systematic reviews • Clinical practice guidelines • Evidence-informed best practices

CIHR. (2014). http://www.cihr-irsc.gc.ca/e/39033.html

Aligning Evidence with the Pillars

• Accelerate Knowledge • Provide expertise in best practices in the field of

knowledge translation • Hold events that promote and showcase using

evidence to enhance care • Support BRI grant requests through suggesting

creative knowledge translation strategies

• Lead the System • Identify gaps in evidence-informed best practice in

childhood disability • Generate systematic reviews and clinical practice

guidelines to meet our needs • Raise Holland Bloorview’s knowledge translation

Aligning Evidence with the Pillars

• Transform Care • Identify, appraise and communicate research

evidence • Develop and implement clinical practice

guidelines • Evaluate changes in care related to evidence use

• Inspire our People • Develop a strategy that enhances staff’s ability to

use evidence • Create opportunities for researchers and

clinicians (and families where possible) to work together to solve issues using evidence

• Promote evidence use in all programs throughout the organization

Funding

• Foundation

• Partnership with MOHLTC

• Grant funding

EtC in Action: Energy in the System

●Success contingent on inter-professional cooperation

●Partnerships and key enablers:

− Academic health science centre

− Commitment to research

− Collaborative structures

− Senior management engagement

− Change champions

− Expertise

Progression of the Model: In Practice

19

Organizational partners

EtC Steering Committee

Core Staff

Associates

Teaching & Learning Institute

Hospital CEO

Lead

Collaborative Practice Leaders

Bloorview Research Institute

VPs

Knowledge Brokers(2)

Research Librarian

Senior Directors Knowledge Translation

Specialist (2)

Scientists & Clinicians

Directors

Administrative Assistant

Communications & Public Affairs

EtC Lead

Research Assistant

Family & Youth Leaders

Organizational Impact

•Embedding KT Competencies in:

–Research Curriculum

–KT Consultations

–HR Interview Questions

–Investigator Performance Appraisal

–Key Performance Indicator Reporting

–Grant application process

EtC in Action: Best Practice Projects

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Phase 2: Evidence appraisal

Phase 3: Product develop and tailoring to

context

Phase 4: Dissemination, Implementation

& Evaluation

Integrated Knowledge Translation Strategy

Phase 1: Identify Priority

Area


Chronic Pain and Cerebral Palsy Project

Develop and implement a best practice recommendation for the assessment of chronic pain among paediatric outpatients with cerebral

palsy

Cerebral Palsy Chronic Pain Toolbox

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Multi-phase approach identified:

• Registered Nurses Association of Ontario (RNAO) Best Practice Guideline (BPG) for Pain Assessment Recommendations6

• Cerebral Palsy specific care

and practice points • 7 pain interference tools

Knowledge Translation Activities

- Printed Educational Materials

- Champions

- Educational Meetings (e.g. workshops, huddles)

- Audit and Feedback

- Reminders

Chronic Pain and Cerebral Palsy Implementation: Knowledge Translation Strategies


Children with Medical Complexity Project

Engage in a best practice project to develop a compendium of evidence informed resources for

children with medical complexity

Children with Medical Complexity Project

Identifying

Best Practice:

How are best practices

advanced

when the evidence

doesn't exist?

Scoping Review of the Evidence

Stakeholder Engagement for Product

Development

Leading Practices Scan

Engaging

Families

is Critical!

Early Learnings

• Emerging field of KT

– Advancing a model of 'on the ground' learning

• Building skills while building products

– Big investment short-term long-term pay offs

• 'Evidence-informed Practice' vs.

'Practice-informed Evidence '

– Medical advance, technology and societal attitudes are changing

– Disability research is not simple or easy

• Early wins to foster culture of change

Social Innovation

Social innovation is a process of change emerging from the creative re-combination of existing assets, the aim of which is to achieve socially recognized goals in a new way - Ezio Manzini (2014)

Evidence to Care bridges the gap

between research and clinical practice to create a world of

possibility for kids with disability

Evidence to Care acts as a bridge between

research and clinical care and policy.

Our vision

is to promote the

best available research

evidence

to inform care in childhood

disability.

Find us on the web at:

www.hollandbloorview.ca/TeachingLearning/EvidencetoCare

Thank you!

Evidence to Care