Dissemination and Implementation Update - PCORI

Dissemination and Implementation Update

Anne C. Beal, MD, MPH, Deputy Executive Director and Chief Officer for Engagement PCORI Board of Governors Meeting Washington, DC September 23, 2013

Overview

1. Dissemination for Implementation of Clinical Comparative Effectiveness Research at PCORI

2. Results and lessons learned from PCORI’s Roundtable of Multiple Stakeholders in Dissemination for Implementation on July 29, 2013

3. Next Steps

4. Appendix: 1. Roundtable details 2. Roundtable participants 3. Request for Proposal (released August 30, 2013)

Board of Governors Meeting September 2013 2

Questions for the Board

What is the appropriate relationship between dissemination activities and implementation activities? Are we on the right path in thinking that we should emphasize dissemination, making information available and usable to those who are implementing?


PCORI Board of Governors Meeting, September 2013 4

Dissemination for Implementation of Clinical Comparative Effectiveness Research at PCORI

Dissemination Efforts Start with Patient and Stakeholder Engagement in Research


Research Peer Review Disseminate Implement Impact

The Continuum of PCORI’s

Efforts in Dissemination for

Implementation beginning with the

Active Portfolio Management Cycle

Making the case for addressing the gap between information, its use, and health outcomes

Knowledge + Practice


PCORI’s Action Plan for Dissemination for Implementation targets the gap between information and its use in delivery and decision making for clinicians, patients, and caregivers.

Current Knowledge and Practice

New Investments in Knowledge

Dissemination Efforts to Promote Implementation

Optimal Healthcare Practice

Establishing a PCORI Action Plan for Dissemination to Promote Implementation

PCORI’s Action Plan for Dissemination for Implementation is being established:

To guide the organization in disseminating the research findings of funded research conducted in the national program areas

To speed implementation by actively facilitating how PCORI’s research findings can be used by healthcare decision makers

To evaluate how the effect of the dissemination of such findings reduces practice variation and disparities in health care


DISSEMINATION IMPLEMENTATION ►

Clinicians frequently use general Internet searches and colleagues to obtain information to diagnose and treat patients How often do you use the following sources to obtain information to diagnose, treat and care for patients?


40%

38%

34%

20%

18%

4%

31%

28%

28%

40%

35%

13%

0% 20% 40% 60% 80% 100%

General internet search engines

Online subscription services

Colleagues

Online free services

Peer reviewed literature

Cochrane Database or other systematicreviews

Daily A few times per week

6%

27%

34%

32%

2%

11%

26%

60%

0% 20% 40% 60% 80% 100%

Other source

Family or friends

Doctor or healthcare provider

Internet

Chronic Disease Patients Rare Disease Patients

Patients use the Internet as first source of health information The most recent time you looked for information about health or medical topics, where did you go first?

*p <0.05


Patients use a variety of Internet sources In the past 12 months, which of the following internet sources have you used to get information about health or medical topics?


42%

54%

47%

45%

37%

36%

34%

37%

0% 20% 40% 60% 80% 100%

Website for disease focusedgroup

Website for government healthagency

Website for health plan

Patient online community


*p <0.05

*

*

*

Patients’ trust in Internet is low compared to other sources How much do you trust information about health or medical topics from each of the following?


23%

21%

20%

23%

24%

41%

69%

12%

13%

13%

15%

20%

40%

76%

0% 20% 40% 60% 80% 100%

Online patient communities

Family or friends

Internet

Your health plan

Government health agencies

Disease focused groups

Doctor

% “A lot” of trust


*p <0.05

*

*

* *

►

Potential Mechanisms for Dissemination to Promote Implementation

Engage major patient organizations Establish partnerships with specialty organizations; Build working relationships with health plans; Develop partnerships with health systems; Connect thru the National Patient-Centered Clinical Research Network; Publish findings in key journals; and Explore use of web services, social media, apps, etc.


DISSEMINATION IMPLEMENTATION ►

AHRQ and PCORI’s Role in Dissemination and Implementation

AHRQ shall disseminate the research findings that are published by PCORI Sec. 937(a)(1) Create informational tools that organize and disseminate research findings for physicians, health care providers, patients, payers, and policy makers Sec. 937(a)(1) Develop a publicly available resource database that collects and contains government-funded evidence and research Sec. 937(a)(1)


Authorizing Legislation

The purpose of the institute is to assist patients, clinicians, purchasers, and policy-makers in making informed health decisions by advancing the quality and relevance of evidence…and the dissemination of research findings with respect to the relative health outcomes, clinical effectiveness, and appropriateness of the medical treatments, services, and items described in subsection (a)(2)(B).

Success for PCORI and AHRQ = Impact on practice and patient outcomes

Agency for Healthcare Research

and Quality (AHRQ)

Patient-Centered Outcomes Research Institute (PCORI)


Results and Lessons Learned From PCORI’s Roundtable of Multiple Stakeholders in

Dissemination for Implementation

Developing the PCORI Dissemination for Implementation Action Plan


Process for Developing PCORI’s Action Plan for Dissemination for Implementation

Incorporate learning from workshop and develop PCORI’s Action Plan

for Dissemination & Implementation

Host D & I Roundtable

Convene experts at D & I Roundtable to receive input which

will inform RFP

Conduct Phone Calls

Collect preliminary information from roundtable participants

Release Consortia RFP

Award Consortia RFP Host D&I Workshop & Activate Public Input

FINAL: PCORI D&I Action Plan

JULY 2013

Using input from the roundtable, develop and release consortia RFP

Award consortia RFP to finalist Convene D & I Workshop to hear results of project(s)

RFP

AUGUST 2013

OCTOBER 2013 FEBRUARY 2014 FEBRUARY 2014

Overview of the Roundtable Agenda Establishing PCORI’s Action Plan for Dissemination and Implementation

1

2

3

4

5

6

Welcome and Introductions

Brian Mittman - Overview of D&I Frameworks

Jean Slutsky - Overview of AHRQ’s D&I Efforts

Roundtable Discussion - Part 1

Roundtable Discussion - Part 2

Public Comment Period

7 Next Steps and Adjourn

Break

Break


Roundtable Results


3.4 Million Twitter Reach

28 Panelists Including BoG and MC Members: Gail Hunt, Bob Jesse, Sharon Levine, Brian Mittman, and Jean Slutsky

323 Webinar Participants

5.7 Hours of Discussion

Stakeholder Groups Attendance Total

Multi-Stakeholder

7 Clinician/Provider 4 Patient/Caregiver 5 Purchasers/Payors 6 QI/Implementation Advocacy, Support, Professional Organizations, Industry 6 Research and Policy

28 Roundtable Participants



Discussion Questions: Share Experience

1

2

3

Given your personal experience in dissemination and implementation, what are the lessons learned, barriers, and successful facilitators in dissemination and implementation?

What strategies can PCORI use to build on or complement AHRQ’s current work in dissemination and implementation?

What key elements would you like to see in PCORI's blueprint to help your organization with implementing research findings?


Discussion Questions: Help Formulate RFP

4

5

6

What is the best approach to develop a framework for implementing results of comparative effectiveness research (CER)?

Which already existing frameworks would you recommend be reviewed for developing PCORI’s blueprint for dissemination and implementation?

What would you include in the scope of work for the request for proposal (RFP)? What are the key abilities we should seek among applicants interested in developing a framework in response to the request for proposal (RFP)?

Six Key Lessons Learned

1. Consortia. Effectively managing dissemination to speed implementation will require the involvement of key groups: patients, providers, consumers, media, journal publishers, opinion leaders, community and public health workers, government agencies, and health-data consortiums.

2. Framework. Build on a variety of already existing frameworks and agree on a generalizable model which supports PCORI’s mission.

3. Readiness. Include a preliminary plan for assessing readiness for the people and organizations affected by new knowledge

4. Tailor Messages. Consider tailored message to different audiences through trusted channels; include a focus on underserved populations.

5. Leverage Partnerships. Disseminate in coordination (not in isolation) with other organizations through the engagement efforts.

6. New Media. Be innovative and go to new venues, such as social media, non-usual suspect magazines/journals.


D&I Workgroup

Board of Governors Gail Hunt Bob Jesse Sharon Levine

Methodology Committee

Brian Mittman Jean Slutsky

Staff Anne Beal Orlando Gonzales Bill Silberg



Next Steps for Developing PCORI’s Action Plan for Dissemination for Implementation

Developing the PCORI Dissemination for Implementation Action Plan


Process for Developing PCORI’s Action Plan for Dissemination for Implementation

Incorporate learning from workshop and develop PCORI’s Action Plan for

Dissemination for Implementation

Host D&I Roundtable

Convene experts at D & I Roundtable to receive input which

will inform RFP

Conduct Phone Calls

Collect preliminary information from roundtable participants

Release Consortia RFP

Award Consortia RFP Host D&I Workshop and Activate Public Input

FINAL: PCORI D&I Action Plan

JULY 2013

Using input from the roundtable, develop and release consortia RFP

Award consortia RFP to finalist Convene D&I Workshop to hear results of project(s)

RFP

AUGUST 2013

NOVEMBER 2013 FEBRUARY 2014 MARCH 2014

Timetable for the RFP

KEY DATES RFP Released August 30, 2013 Deadline for Proposals October 25, 2013 Semifinalists Notified November 15, 2013 Semifinalists Interviews in Atlanta, Georgia November 20 or 21, 2013

Projected Award Date November 29, 2013 Dissemination for Implementation Workshop February, 2014

Final PCORI D&I Action Plan March, 2014



Discussion

Questions for the Board

What is the appropriate relationship between dissemination activities and implementation activities? Are we on the right path in thinking that we should emphasize dissemination, making information available and usable to those who are implementing?


Appendix

1. Roundtable details 2. Roundtable participants 3. RFP (Released August 30, 2013)



Appendix 1: Roundtable Details

Three Goals: PCORI’s Action Plan for Dissemination for Implementation

1. Gather opinions from experts on what PCORI’s Action Plan should encompass

2. Identify gaps where there is a need to develop new knowledge on best practices for dissemination and implementation

3. Grow consensus behind an approach to our work in dissemination and implementation


Recommendation for the development of the RFP


This work might be too big for one organization to know.

Craig Acomb Institute for Clinical Systems Improvement

Forming a Consortium of Multiple Stakeholders to Develop the Plan


Involving stakeholders in the RFP

RFP Winner

The RFP Recipient will involve multiple stakeholders as

sub-contractors

Journals and Publications

Patients

Vulnerable Populations

Health Systems

Health IT

Social and App Developers Mass Media

RFP

Clinicians Researchers

Payors: Employers and Health Plans

Given your personal experience in dissemination and implementation, what are the lessons learned, barriers, and facilitators in successful spread and uptake?

Include a focus on health literacy, disparities, and cultural differences Communications should include storytelling, case studies, and simple but comprehensive messages Tailor message to different audiences through trusted channels Involve stakeholders and patients from the beginning Leverage partnerships Develop readiness framework

Include guidelines and registries Be flexible and adaptable Include a focus on caregivers Assess political impact Understand the workflow to implement in hospital or clinical settings Develop apps Disseminate in coordination with other organizations, not in isolation Develop criteria and framework for measurement PCORI Board of Governors Meeting, September 2013 33

1

What strategies can PCORI use to build on or complement AHRQ’s current work in dissemination and implementation?

Leverage diverse stakeholders that have credibility and trust with audience Create communication tools and decision-support tools to access information Provide technical assistance for end-users and incorporate technology Spread information nationally Explore successful examples within media and social media (Wikipedia, WebMD, Women’s Day) Involve stakeholders early

Complement AHRQ’s work Leverage PPRNs and CCBRs as test bed for D&I efforts Communicate about what works well and what doesn’t work


2

“Engage early adopter partnerships in advance so that

information does not fall on deaf ears.”

What key elements would you like to see in PCORI’s Action Plan to help your organization with implementing research findings?

Mobile health and new apps Create common standards, terms, and definitions Include a focus on underserved populations Provide technical assistance to implementers Determine ROI construct and financial incentives Learn from and build relationships with successful efforts, such as CTSA Provide training and education Work closely with evaluator

Develop a sustainable communication action plan: Scale and sustainability Focus on where the field is going Customized and personalized Understand how different groups digest information Develop communication readiness tools and user-friendly tools


3

“Skate to where the puck is going to be.”

What is the best approach to develop a framework for implementing results of comparative effectiveness research (CER)?

Identify best methods to disseminate evidence Partner with key stakeholders Convene conferences to ensure alignment and coordination with other groups Don’t consider proposal unless it addresses disparities Use crowd-sourcing to identify gaps and conduct environmental scan Use targeted, frequent communications with storytelling

Leverage trusted spokespersons (ex. Angelina Jolie and Oprah) “Consider 7-11 rule” Patients may reject CER, but PCORI must still build trust Advanced apps and technology Include a focus on shared decision-making and caregivers SOW should be completed by single organization with communications skills and experience


4

Which already existing frameworks would you recommend be reviewed for developing PCORI’s Action Plan for dissemination and implementation?

Leverage existing frameworks (ex. Porter’s 5 Forces, Pestel model, Social cognitive theory, elaboration models, social inoculation model) Review successful quality improvement and standards efforts currently underway Facilitate registries across specializations Create safe places to fail Leverage opinion-leaders Review cultural and technical aspects such as webinars

Look at learning communities (ex. regional extension centers, ONC, AHRQ exchanges, RWJF “Aligning Forces”) Explore non-health models Understand why bad ideas stick


5

“Frameworks need to be simple,

credible, emotional, and include aspects

of storytelling”

What would you include in the scope of work for the request for proposal (RFP)? What are the key abilities we should seek among applicants interested in developing a framework in response to the request for proposal (RFP)?

Engage multiple and credible stakeholders to complete the SOW Include an effective testing site to measure strategies in real-time Focus on underrepresented populations Bridge the digital divide Effective communications, branding, and behavioral patterns/changes Include a focus on speed of adoption Measure ROI

Consider audience segmentation and analysis Explore the benefits and limitations of social media Include broad stakeholder engagement to gather feedback Include ability customize frameworks to communicate preferences, outcomes, risk and benefits


6

“One size doesn’t fit all”


Appendix 2: Roundtable Participants


Craig Acomb, Institute for Clinical Systems Improvement Hilda Bastian, National Center for Biotechnology Information Kathleen Blake, American Medical Association

Panelists

Don Goldmann, Institute for Health Improvement Jennifer Graff, National Pharmaceutical Council Matthew Holland, WebMD

Barbara Edson, American Hospital Association Kevin Fahey, America's Health Insurance Plans Tejal Gandhi, National Patient Safety Foundation


Gail Hunt, National Alliance for Caregiving Bob Jesse, US Department of Veterans Affairs Norm Kahn, Council of Medical Specialty Societies Christine Laine, American College of Physicians and International Committee of Medical Journal Editors Sharon Levine, Kaiser Permanente Sarah Lock, AARP Renee Mentnech, Centers for Medicare and Medicaid Services Brian Mittman, US Department of Veterans Affairs Doris Peter, Consumer Reports

No Photo Available


Michelle Proser, National Association of Community Health Centers Pamela Rich, National Business Group on Health Kate Ryan, Consumers United for Evidence-based Healthcare and National Women's Health Network Bruce Seeman, Agency for Healthcare Research and Quality Lisa Simpson, AcademyHealth Jamie Skipper, US Department of Health and Human Services/Office of the National Coordinator Jean Slutsky, Agency for Healthcare Research and Quality Roger Snow, Medicaid Medical Directors Learning Network Darius Tandon, Johns Hopkins University

No Photo Available


Daniel Wolfson, ABIM Foundation

Ayodola Anise, Senior Program Associate Anne Beal, Deputy Executive Director and Chief Officer for Engagement Orlando Gonzales, Chief of Staff for Engagement

Joe Selby, Executive Director

PCORI Staff


Appendix 3: RFP seeking a contractor to develop an action plan for the dissemination and implementation (“D&I”) of comparative effectiveness research (CER) findings, as well as the process for evaluating those efforts. (Released August 30, 2013)

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