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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