Transcript Teaching to Advance Knowledge to Action

PTNow.org: Teaching to Advance
Knowledge to Action
The Problem
Too Much Information, Too Little Time:
Evidence-Practice Gap
Evenson AE, Sanson-Fisher R, D’Este C, Fitzgerald M. Trends in publications regarding
evidence-practice gaps: a literature review. Implementation Sci. 2010;5:11.
Knowledge Translation (KT)
• Gaps between knowledge
– Patients, health care providers, and policy-makers
• KT uses high-quality knowledge in processes of decision
making
• Moving knowledge into action involves applying research
to patient care
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Assists clinicians in best practice
Reduces unwanted variability
Improves outcomes for patients
Is efficient and cost effective
Straus SE, Tetroe J, Graham I. Defining knowledge translation. CMAJ. 2009;181(34):165-168.
The Gap Between Evidence and Decision Making
• 12-17 year gap
from bench to
bedside
Research
Knowledge
• KT fills the gap
between
knowledge and
practice
• Also called
Knowledge to
Action (K2A)
K2A
Practice
Action
Green LW. Making research relevant: if it is an evidence-based
practice, where’s the practice-based evidence? Fam Pract.
2008;25(suppl 1):i20‐24
http://extra.upmc.com/100108/8.html
Mycustomer.com
Why Does the Gap Exist?
• Knowledge creation and dissemination are not enough
to ensure use in the field
• Interventions not described in ways that can be
replicated
• Too much information, too little time
• Lack of skills and confidence in critical appraisal
• Inadequate analysis and resources aimed at eliminating
barriers
Glasziou P, Meats E, Heneghan C, Shepperd S. What is missing from descriptions of
treatments in trials and reviews? BMJ. 2008;336:1472–1474.
Evenson AE, Sanson-Fisher R, D’Este C, Fitzgerald M. Trends in publications regarding
evidence-practice gaps: a literature review. Implementation Sci. 2010;5:11.
Knowledge Synthesis
• Have to begin with
knowledge
• Primary literature
consumption is not feasible
on a large scale for
impacting clinical behaviors
• An internist must read 34
primary literature articles
daily to stay current in the
field
• Synthesis documents are
excellent resources
Straus Defining Knowledge Translation
CMAJ August 4, 2009 vol. 181 no. 3-4
Clinical
Practice
Guidelines
PTNow
Systematic
Reviews
Stroke
Engine
Synthesis Documents
Clinical Practice Guidelines
(CPGs): Statements that
include recommendations
intended to optimize patient
care that are informed by
systematic review of
evidence and assessment of
benefits and harms of
alternative care options
Cochrane Reviews
APTA and Section EDGE
documents
PTNow in a Nutshell
Multi-Tool for Practitioners
• Translation tool
Translating research to practice
• Implementation tool
Assist in implementing evidence to care
• Collaboration tool
Sharing information when evidence is
lacking
Examination
• Translate to the
practitioner
• Don’t just tell me what
to do—give me the
resources
What to Do With All This Information
• Need trigger that results
in team wanting to
“change” practice or
implement something
new
– Question in practice arises
– Evidence for something is
created or found
– There is a gap between the
new information and the
current practice pattern
Adapt Knowledge to Local Context
• What needs to be adjusted to fit into your practice
setting and area?
– Example: Guidelines may span care for a condition
from acute through chronic—you need to edit to
match just acute care components for your
inpatient hospital setting
Graham ID, Logan J, Harrison MB, et al. Lost in translation: time for a map?
J Contin Educ Health Prof. 2006;26(1):13-24.
Fall Risk/Prevention Program
Who Should Be Screened for Fall Risk?
http://www.cdc.gov/homeandrecreationalsafety/Falls/steadi/index.html
• Previous falls (RR=1.9 - 6.6)
• Balance impairments (RR=1.2 2.4)
• Decreased muscle strength
(RR=2.2 - 2.6)
• Vision impairment (RR=1.5 - 2.3)
• >4 medications or psychoactive
medications (RR=1.1 - 2.4)
• Gait impairment (RR=1.2 - 2.2)
Fall Risk: 8% risk for 1 factor
78% risk for 4 or more factors
Fall Risk Factors
• Depression
• Dizziness or orthostatic
hypotension
• Functional limitations or
limitations in activities of daily
living (ADL)
• Disabilities
• Age > 80 years old
• Female
• Low body mass index
• Urinary incontinence
• Cognitive impairment
• Arthritis
• Diabetes
• Pain
Perform Physiologic,
Impairment and
Performance Measures
Implement
comprehensive training
Clinical Sustainability
Audit and FB
Celebrate
Accountability
Outcome
Clinical
Champions