Knowledge Translation Across Health Disciplines: Lessons on Successful Engagement and Meaningful Impact. An SWG Led Panel

Knowledge Translation Across Health Disciplines: Lessons on Successful Engagement and Meaningful Impact. An SWG Led Panel

Completing the Cycle: From Evidence to Action to Evidence Scott Mitchell, Director, Knowledge Transfer, CMHA Ontario CAHSPR, May 27, 2015 Knowledge Translation across Disciplines: Lessons on Successful Engagement and Meaningful Impact

EVIDENCE Collaborate Adapt Implement ACTION Evaluate EVIDENCE

Project funded by the Ontario Ministry of Health and Long Term Care through the Healthy Communities Fund

The best predictor of research use is early and continued involvement of relevant decision makers. Caplan 1979; Huberman 1994; Landry, Amara, and Lamari 2001; Lavis et al. 2002; Lomas et al. 2003; Rich 1991; Weiss 1997; Wingens 1990

NEXT STEPS Orientation Video Facilitator s Guide

For more information, visit llttf.ca

Scott Mitchell Director, Knowledge Transfer Canadian Mental Health Association, Ontario 416 977 5580 x4136 smitchell@ontario.cmha.ca

Ariella Lang RN, PhD Nurse Researcher VON Canada May 27, 2015

Background Service Gap for Bereavement Care VON Canada: National Home & Community Care Organization Program of Research

Research evidence informs VON s home care practice and in turn, VON s practice informs research.

VON staff; front-line, managers, directors, and VPs are team members on each and every project! Strong and strategic links with decision- and policymakers, both as co-investigator and collaborators from the inception of the projects Partnering stakeholders include: citizen engagement groups, provincial ministries, regional health authorities, national healthcare stakeholders (i.e., Canadian Patient Safety Institute, Accreditation Canada, Conference Board of Canada)

Current bereavement care focuses on those who present with complications rather than on primary prevention and health promotion interventions. Addressing the needs of the bereaved in an upstream, preventative, and health promoting manner calls for a shift in the way care providers interact with individuals and families surrounding the death of their loved one.

Nurses and other healthcare providers capturing and creating opportunities to be with and support individuals / families in their experiences of grief and mourning regardless of the type of loss or where the death occurs.

PURPOSE: Create a comprehensive and up to date representation of primary bereavement care. Create opportunities for nurses and other care providers to reflect on, challenge, and evaluate their practices with the bereaved surrounding loss. Provide a springboard for organizations to build, expand, and focus their competence in supporting primary bereavement care with families.

Development of evidence-informed guideline (Canadian Nurses Foundation 2005-2007) Stakeholder review (GRISSIQ 2010-2011) Knowledge-to-Action Grant (CIHR 2011-2014) Joanna Briggs Institute systematic review to update guideline (RRISIQ 2013-2014) CIHR March 2015 Realist Evaluation (submitted) 39

Purpose: To increase organizational and practitioner uptake and application of an evidence-informed primary bereavement care guideline through a researcher knowledge - user partnership.

Research Questions 1) What is the process of translating evidenceinformed recommendations from the guideline into action? 2) How does a researcher-knowledge-user partnership influence the translation of the guideline? 3) What are the impacts at multiple levels of the system of this knowledge-to-action approach?

Method Integration of an organizational change initiative and research study Organizational change supported by several multi-stakeholder meetings as well as two large collaborative forums Multiple data sources observations document reviews series of individual interviews focus groups

Engaging Listening Partnering Collaborating Tailoring Communicating Are there any concerns and pitfalls for young health policy researchers to avoid? SEE ABOVE

CAHSPR Conference Montreal, Quebec May 27, 2015

Context High MUHC rates of C-Difficile and VRE Accreditation results & feedback: Poor compliance with hand hygiene policies Inappropriate glove use Increased risk for patients and increased costs - C. Difficile : $10,000 /case - Length of Stay prolongation = 10 days - 30 day mortality = 15 % - VRE Blood Stream Infection : $60,000 / case $150K grant to interprofessional team (Nsg, Inf. C & Housekeeping)

CSI Objectives Objective # 1 Objective # 2 Objective # 3 Reduce C-Difficile & VRE rates by 50% on six high risk units, within 12 months. Build organizational capacity in quality improvement & prevention of infections. Improve inter-departmental teamwork & engage patients in quality improvement activities. Objective # 4 Further validate the TCAB spread & sustainability strategies.

Transforming Care at the Bedside program is the basis Protected release time, one day per week for 5 staff Structured Modules & workshops Facilitator support weekly Teams brainstormed what to change Support from other services NHS Sustainability model

Timeline: Workshops, Tools, Bundled Interventions Timeline October 2013 Nov - Dec 2013 Workshop Nov. 7 th January 2014 Workshop January 7 th Feb- March 2014 Workshop March 26 th April-June 2014 Workshop June 19 th July - Dec 2014 Orient n Sessions with staff Module 1: Learning PDSA Module 2: 5S Waste Walk 5S Waste Walk 5S Waste Walk Sustain & Spread Best Practices to other adult units Learning to use the audits tools Hand Hygiene Equipment Disinfectio n Routine Additional Precaution s

Outcom emeasur e Process Measure Indicator Rates of C-difficile & VRE Work satisfaction & team effectiveness Staff perception of collaboration & impacts (interviews pre and post) Hand hygiene audits Audits of other Precautions Routine precautions: appropriate glove use Additional precautions Equipment Cleaning and Disinfection audits Routine cleaning Discharge cleaning Target 50% reduction Improved survey scores knowledge/s kill 80% >95 % 80% 100%

Bundle 1: Hand Hygiene S9W: computers have hand-washing reminders as screensavers (and are updated

undle 2: Equipment Disinfection Aha! VRE on the bladder scanner

undle 3: Proper Isolation Techniques

VRE CASES C-Difficile CASES MGH 15 50% 62% RVH 6 Med 40% 31% RVH 10 Med 2% 6% RVH Ross 3 55% 6% RVH S8E 39% 40% RVH S9W 27% 85% OVERALL 26% 25%

Overall VRE cases (6 units combined): 26% decrease 2013 = 436 2014 = 322 Decrease = 26% TCAB INDICS - VRE Cases - 2013-2014 Period 9-2014-2015 Period 9 P9 P10 P11 P12 P13 P1 P2 P3 P4 P5 P6 P7 P8 P9

erall C Difficile cases (6 units combined): 25% decrease 013 = 136 014 = 102 ecrease = 25% TCAB INDICS - CDAD Cases - 2013-2014 Period 9-2014-2015 Period 9 P9 P10 P11 P12 P13 P1 P2 P3 P4 P5 P6 P7 P8 P9 13 6 13 17 9 15 6 12 8 7 7 9 7 7

arly Comparison of VRE Cases & Rates for CSI Units: Clear Downward trend = Improvement VRE YEARLY COMPARISON FOR CSI-TCAB UNITS 140.00 120.00 100.00 80.00 60.00 Rate per 10,000 pt. days 40.00 20.00

arly Comparison of C Difficile Cases & Rates for CSI Units: Clear Downward trend = Improvement CDAD YEARLY COMPARISON FOR CSI-TCAB UNITS 35.00 30.00 25.00 20.00 15.00 10.00 Rate per 10,000 pt. days 5.00

pread & Sustainability Plan (2015) tandardization of clear role responsibilities within ing ew Room Discharge Cleaning model etter learning methods developed (e-learning/interactive ons) uild organizational capacity for large scale auditing

. Inter-departmental collaboration. Weekly protected release time & facilitator support. Real-time data. What s measured matters.. Distributed leadership and fully owned countability, as staff being involved in ALL changes decisions. Involvement of senior leaders. Demonstrated return on investments (ROI) in 10 onths Cost avoidance: $340,000 = 34 less C-diff cases Improved access to care: 340 more bed days available for

Knowledge translation in the context of community based primary health care France Légaré MD, PhD, (F) CCFP 2015 CAHSPR Knowledge Translation Across Health Disciplines: Lessons on Successful Engagement and Meaningful Impact. An SWG-Led Panel

iversité Laval, Ville de Québec

What is KT/Implementation? KT/Implementation is about: Making users aware of knowledge and facilitating their use of it to improve health and health care systems Implementing change into practice KT/Implementation research (KT Science) is about: Studying the determinants and outcomes of knowledge use and effective methods of promoting the uptake of knowledge

In the context of CBPHC Range of conditions presented Uncertainty associated with diverse screening and treatment options High incidence of collaboration among diverse professionals from the health and social care sectors

The Grey Zone of Decision Making 11% 3% 7% Beneficial Likely to be ineffective 50% 5% Trade offs Unlikely to be beneficial Likely to be beneficial 24% Unknown effectiveness About 3000 treatments

hared Decision Making (SDM) uilds on relationships ecognizes that a decision is required ighlights best evidence about risks and enefits of each option (including status quo) s explicit about the probabilistic nature of vidence akes into account the patient s values and references (patient specific) ostered by decision aids and training

SDM = KT intervention

Inform Decision Aids = KT tools Provide facts: Condition, options, benefits, harms Communicate probabilities Clarify values Patient experience Ask which benefits/harms matters most Facilitate communication Support a process Guide in steps in deliberation/communication Worksheets, list of questions

How do they compare? Standard knowledge information tool Patient decision aids cus Knowledge Decision decision point + a process to decision t the listic nature of e +/ + +/ + provider Knowledge broker Decision broker es of interest Knowledge Decision Behaviour Change in individuals from behaviors that are presumed to be detrimental to health, to behaviors that are presumed to be conducive to health Knowledge Values congruence Quality Decision Decisional conflict Improving the decision making process so that decisions can lead to a choice that is informed by the best evidence and in line with what

Quality decision Choice Is congruent With the best available evidence and informed patient values International Patient Decision Aids Standards 2006 & 2013

Impact of SDM

Randomized (FPTUs, n=12) 6 FPTUs assigned to intervention group 5 FPTUs recruited 151 of 189 eligible FPs and 239 patients 6 FPTUs assigned to control group 4 FPTUs recruited 99 of 144 eligible FPs and 210 patients Clusters analyzed 5 FPTUs; 182 eligible patients consulting 88 FPs Clusters analyzed 4 FPTUs; 171 eligible patients consulting 63 FPs DECISION+2 Clusters analyzed 5 FPTUs; from 216 patients, 181 eligible consulting 77 FPs Clusters analyzed 4 FPTUs; from 213 patients, 178 eligible consulting 72 FPs

CME: Online self-tutorial and workshop Estimate the diagnostic probabilities of acute respiratory infections (ARI) Describe therapeutic options available for treating ARIs and describe their risks and benefits Use effective communication strategies to share risks and benefits of the options Identify the patients values and preferences, consider their opinions and involve them in the decision Use decision aids

Values and Preferences at matters most to you and Charlie? creasing his chance by a little relieve his symptoms more pidly, or avoiding side effects and recovering without antibiotics? Are there other things that are important to you that would make you decide to give Charlie antibiotics or not?

Results

Results 50 45 40 30 20 10 0 36 27 24 21 18 13 13 4 0 1 2 3 4 5 Z=3.9; p<0.001 1. I made the decision alone 2. I made the decision but considered the opinion of my doctor 3. My doctor and I decided equally 4. My doctor made the decision but considered my opinion 5. My doctor made the decision alone

Knowledge to Action Cycle DM ME Decision quality AB use Decision aids CBPHC

Tips for young KT researchers interested in CBPHC?

Primary care PBRN