To appreciate the concept of knowledge brokering To understand how - - PDF document
25/06/2014 Alison Hoens Physical Therapy Knowledge Broker, University of British Columbia Linda Li Associate Professor, University of British Columbia 1 To appreciate the concept of knowledge brokering To understand how knowledge
25/06/2014 1
Alison Hoens Physical Therapy Knowledge Broker, University of British Columbia Linda Li Associate Professor, University of British Columbia
1
To appreciate the concept of knowledge
brokering
To understand how knowledge brokering
adds value to knowledge translation activities
To understand how a knowledge broker can
enhance PT practice and research
2
25/06/2014 2
3 4
17 Years for 14% of research findings to be adopted Into practice (Westfall et al, 2007)
25/06/2014 3
5
CDC http://www.cdc.gov/violenceprevention/pdf/evidence_project_overview2013-a.pdf
Clinician Organization Profession / regulatory bodies Research funding agencies Patient
6
25/06/2014 4
Didactic sessions Educational resources Clinical pathways Audit and feedback Reminders Local opinion leaders Decision aids &computer decision support typically change clinical practice by ~10%
Straus SE et al. 2009; Boaz et al. 2011
7
Previous Current Single study Synthesis Individual Collective Consulting Partnership Simple Complex A-contextual Contextual Transfer Engagement
8
Modified from B Riley. Closing the Know Do Gap. KT Forum BC May 23 2014
25/06/2014 5
9
broceur - small trader brocheor - wine retailer
Intermediary Bridge Boundary spanner Catalyst Facilitator Translator The human force that makes knowledge transfer (the
movement of knowledge from one place or group of people to another)
more effective and is distinct in aiming to bring people together for mutual advantage
CHSRF 2003
10
25/06/2014 6
Alberta Heritage Foundation for Medical Research, 2004
11
Not just moving but transforming knowledge
"Brokered knowledge is knowledge made more robust, more accountable, more usable; knowledge that 'serves locally' at a given time; knowledge that has been de- and reassembled“
Real value = creating relationships
12
25/06/2014 7
Expanding our understanding of K*. A concept paper emerging from the K* conference held in Hamilton, Ontario, Canada, April 2012
13
(1) to make evidence more accessible and tailored (knowledge management) (2) to facilitate mutual learning (linkage and exchange) (3) to develop skills and capacity for EIP (capacity building)
Robeson et al, 2008; Chew et al, 2013
14
25/06/2014 8 Essential characteristics:
knowledge, skills and credibility in all worlds extensive network of key stakeholders ability to facilitate reciprocal understanding ability to discern potential new linkages
15
The University Dept of PT
Research & Practice PHCRI Research & Practice
VCHRI
16
Professional Association PABC Established May 2009
25/06/2014 9 Research Support
Incorporate Implementation Science & KT principles
Develop Practice Resources
Decision-making tools Toolkits
Develop Capacity for EIP
Webinars Develop resources for enhancing EIP skills
17
12 projects 200 clinicians, researchers & decision makers 8 grants totalling ~$1,200,000 14 publications Development of 11 practice resources 13 webinars
18
25/06/2014 10
Researcher Push User Pull Linkage and Exchange
Lavis et al. 2003
19
Monitor Knowledge Use Sustain Knowledge Use Evaluate Outcomes Adapt Knowledge to Local Context Assess Barriers to Knowledge Use Select, Tailor, Implement Interventions Identify Problem Identify, Review, Select Knowledge Products/ Tools Synthesis Knowledge Inquiry
KNOWLEDGE CREATION
Graham 2006
20
25/06/2014 11
Engage stakeholders ‘Translate’ for local audience Transparent reporting of information, including
limitations
25/06/2014 12
23
Given that PTs are primary care practitioners Cspine trauma may be life threatening
Xrays are associated with long-term health risk xrays contribute to health care costs It is therefore critical that PTs identify the most appropriate patients, with
potentially serious injuries, and refer them to a GP or to ER for imaging & appropriate medical management
24
25/06/2014 13
The Team
– 1 researcher – 1 student – 4 expert clinicians
+3 for implementation phase
The Goals
25
Lay foundation Team members (initially & at implementation) Roles Establish process Format & framework Synchronous with KT principles (KT course) Facilitate discussions Secure participation of stakeholders Funders, private sector partner Access resources Supports MSc position for evaluation Ensure ‘on track’
26
25/06/2014 14
PABC members who were also members of the
Orthopaedic or Sport Physiotherapy Divisions of the CPA (N=889)
Online survey conducted January 28 – May 15, 2013. 467/889 completed the survey (52%) 41% had heard of the Canadian C-Spine Rule
27
Hypothetical cases Case 1: X-ray not indicated but 43% would
have recommended an X-ray
Case 2: 95 % correctly identified that X-ray
indicated, however, the reasons were in conflict with the Csp Rule
28
25/06/2014 15
1.
The rule is too rigid
2.
Doctors may believe that this is not the PT’s role or within physiotherapy scope of practice
3.
a) I am afraid I may miss serious injuries
3.
b) I think clinical judgement is as good or better
5.
I may forget the details
29
Laminated flow sheet (85%) Resource on PABC website (55%) Course/webinar (40%) Email reminders (25%) Ability to contact knowledgeable
colleague (18%)
30
25/06/2014 16
31
Barrier Targeted intervention Evaluation
Feel unsure of what is best management (Knowledge gap) Involve clinicians in providing input Structured interviews - knowledge Feel incompetent in using tool (Self efficacy gap) Provide & record webinars re how to use toolkit (case histories) Structured interviews – confidence Feel there is limited added value in using tool (Attitude gap) Develop video with champions using the tool Structured interviews – attitude Feel there is not enough time to use tool (Attitude gap) App Structured interviews – attitude
Laminated sheets Video
Demo with ‘respected clinician’
Webinar Template of letters to GP QxMD Calculator Social media campaign Next step: evaluation
32
25/06/2014 17
33 34
25/06/2014 18
https://www.mediafire.com/?0q4 b7xa5ikwk51y
36
25/06/2014 19
Primary Stakeholder impacted: GPs Initial awareness Template of letter for individual PTs/clinics to send
to GPs re the initiative
Template of letter for individual PTs/clinics to send
to GPs when referring a patient back for imaging
Information for PTs re how to use the letter and
strategies to enhance the relationship
37
Curriculum: Incorporating into
Pre-licensure training Continuing education
38
25/06/2014 20
Monitor Knowledge Use Sustain Knowledge Use Evaluate Outcomes Adapt Knowledge to Local Context Assess Barriers to Knowledge Use Select, Tailor, Implement Interventions Identify Problem Identify, Review, Select Knowledge Products/ Tools Synthesis Knowledge Inquiry
KNOWLEDGE CREATION
Graham 2006
39
SuPRA: Does PT coaching + a wearable digital
tracking system improve physical activity in people with knee osteoarthritis
KB connected researchers with Physiotherapy
Association of BC to develop:
The project idea The study procedure The KT plan
40
25/06/2014 21
IMPAKT-HiP: What is the relationship of FAI,
physical activity and hip osteoarthritis?
KB output: Plain language summary Press releases Facebook, Twitter Community forums – English-speaking,
Cantonese/Mandarin speaking and Indigenous communities
41 42
25/06/2014 22
Limited certified training No regulation No template No established funding structure No established evaluation criteria Undefined scope Paucity of additional training Lack of a clear career pathway
Chew et al. 2013; Lightowler & Knight 2013
43
Seek partners to develop KB positions
Undertake KT training CIHR Knowledge Translation Canada Summer Institute Sick Kids Scientist Knowledge Translation Training Workshop Foundations of KT course NIH Training Institute on Dissemination and Implementation
Research in Health
44
25/06/2014 23
Knowledge translation in healthcare: Moving
from evidence to practice (Straus et al)
Sick Kids KT Plan Template
45 46