Rebecca L Craik, PT, PhD, FAPTA Professor & Chair Arcadia University
RESEARCH PRACTICE TRANSLATION
Health Care Delivery Payors P Burgeoning Cost Health Disparities Unwanted mortality & morbidity Dissatisfied Clinicians & Consumers Who to cover? What to cover? Profit Scientists New exciting discoveries Inadequate funding Need to translate science Clinicians How does evidence best guide practice? g outcome with inadequate q g Maximizing funding Strategies to keep informed Educators Integrating knowledge & skills to prepare students Bloated curriculum New methods of pedagogy practice
Translation & Accountability Other health care professionals International issue Academicians Parents Teachers
Centre for Use of Research & Evidence in Education (CUREE) Our mission centres on promoting the use of evidence by building bridges between academic research and professional practice. http://www.curee paccts.com/
Belgian physiotherapists Lack of autonomy & authority to decide patient treatments Lack of evidence Inaccessible and inapplicable scientific evidence Patient expectations Lack of motivation to use EBP Physio Theory Practice 2009;Oct 25: 476 88
The step between dissemination & implementation is NOT easy Where is the best evidence? ( >500,000 articles/yr) What is the GOLD STANDARD? Who do I believe? How long is the information valid?
Implementation Science SEVEN approaches to accept free access to online evidence based source BMJ Clinical Evidence Letter Questionnaire and usage Online tutorial Pamphlet CEUs $500 prize to attend any medical conference Combination 10% acceptance rate Buchan et al Implementation Science 2009;4:68
We need to find more effective ways of motivating to take part Buchan et al Implementation Science 2009;4:68
Focused Research on Efficient, Secure Physicians Health Care (www.fresh thinking.org) Health Insurance Executives Health Policy Experts Business Leaders Hospital Administrators i t Economists Ann Int Med 2009; 150(7):493 495
Eight Recommendations Replace current fee for service payment system encourage and reward innovation in the efficient delivery of quality care. invest in the development of outcome measures to guide payment. Establish a securely funded, independent agency to sponsor and evaluate research on the comparative effectiveness of drugs, devices, and other medical interventions. i Develop a health information technology infrastructure with national standards of interoperability to promote data exchange. Create a national health database with the participation of all payers, delivery systems, and others who own health care data. Agree on methods to make de identified information from this dtb database on clinical i l interventions, ti patient t outcomes, and costs available to researchers.
Three bodies of literature Dissemination Theory & Research Conscious efforts to spread ideas Utilization Theory & Research Diffusion Theory & Research Natural history of the spread of ideas Green et al Annual Rev Pub Health 2009;30:151 174
Pipeline The figure that was used in the oral presentation illustrated the traditional production and transfer of and knowledge from research to practice. I will describe it but it would be much better if you look at the figure in the following publication: Green LW, Fam Pract 2008; 25 (Supp 1):i20 24 Imagine a pipeline this image assumes that the peer review processes assure quality research is delivered d to the clinician i i and policy makers. The time to get through this pipeline has been assumed to take 17 years. The process is linear and specific steps include peer review grants, publication priorities and peer review, research synthesis, Guidelines for evidence based practice and, finally, practice. The healthpolicy maker, clinician, consumer are not involved in generating the ideas.
Green LW, Ottoson JM, Garcia, C, Hiatt RA. Diffusion Theory and Knowledge Dissemination, Utilization, and Integration in Public Health. The AnnualReview of PublicHealth. 2009;30:151 174. 174. In contrast to the trickle down pipeline in the previous slide, this slide in the presentation illustrated a framework that begins with social determinants and context t influencing i community health the end users are involved at the beginning of the process. Dissemination is more than giving gthe end user research results the product must meet the needs of the end user. Multiple stakeholders must be involved in generating the question, determining answer, and implementing the change. The information gained is shared with multiple stakeholders who then proceed. The source of this is an excellent paper which I encourage you to read.
Look for the Principles My setting is different
Principles Research Community Encourage discovery (T 1 ) Other methods to conduct research Framework for Dissemination & Utilization Dissemination Utilization Clinical Community Culture of collaboration Models for successful utilization Beyond low back pain using the example
We have a lot of work to do and no time to waste.