Dissemination & Implementation of Evidence-Based Strategies
Karen M. Emmons, Ph.D. Vice President for Research, Kaiser Permanente
IOM Committee, Ovarian Cancer State of the Science,
April 7, 2015
Assumptions:
- Focus is on providers and patients
- Looking at dissemination of current knowledge, towards
implementation of future evidence-based practices
What Is It?
Dissemination: Targeted distribution of information or intervention materials to a specific audience
Implementation: The use of strategies to adopt and integrate EBIs and change practice patterns in specific settings
3 | © 2011 Kaiser Foundation Health Plan, Inc. For internal use only. April 10, 2015
Spread of Innovations
Greenhalgh, Robert, Macfarlane, Bate, Kyriakidou, 2004
4 | © 2011 Kaiser Foundation Health Plan, Inc. For internal use only. April 10, 2015
Targeted distribution of information or intervention materials to a specific audience
Outgrowth of work in diffusion– or how innovations spread
We know that:
– Dissemination of scientific evidence does not occur spontaneously
– Passive approaches are largely ineffective
– Single source messages are less effective than multiple source/level approaches
– The process of dissemination needs to be tailored for different audiences
5 | © 2011 Kaiser Foundation Health Plan, Inc. For internal use only. April 10, 2015
Dissemination
Strategies for Dissemination
Reach strategies: Journal articles, social/mass media, national quality campaigns
Motivation strategies: “Knowledge Brokers”, champions, social/professional networks
Ability strategies: Academic detailing, skills-building interventions
AHRQ (2012) review found little evidence for differential impact
– Multicomponent and active strategies are best
6 | © 2011 Kaiser Foundation Health Plan, Inc. For internal use only. April 10, 2015
To Providers
Strategies for Dissemination
To Patients
7 | © 2011 Kaiser Foundation Health Plan, Inc. For internal use only. April 10, 2015
Reach strategies: Mail, email, phone;
social/mass media, national campaigns
Motivation strategies: providers, trusted others, champions, social networks
Ability strategies: Skills-building interventions, role models, efficacy
AHRQ (2012) review found little evidence for differential impact, including
multicomponent strategies
Key Strategies for Communication with Patients
Narratives are better than statistics
Tailoring and targeting may be helpful
Communications tied to actions that can be taken are most effective
8 | © 2011 Kaiser Foundation Health Plan, Inc. For internal use only. April 10, 2015
Pathogen Estimated
annual
illnesses
Estimated
annual
hospitalizations
Estimated
annual
deaths
Salmonella
spp.,
nontyphoidal
1,000,000 19,000 380
Washing Chicken Spreads Salmonella
Don’t Wash Your Chicken!
Use and Quality of Health Content on Social Media
58% of US adults have a smart phone (90% cell phone)
87% of adults use internet; 68% through mobile devices
Pew Research Center, Updates, 2012-2014
9 | © 2011 Kaiser Foundation Health Plan, Inc. For internal use only. April 10, 2015
Use and Quality of Health Content on Social Media
58% of US adults have a smart phone (90% cell phone)
87% of adults use internet; 68% through mobile devices
~ 2 B tweets/week; 150M users
10 | © 2011 Kaiser Foundation Health Plan, Inc. For internal use only. April 10, 2015
– Misunderstanding- 6% of anti-biotic-related tweets (Scanfeld,
2010); inaccuracies in 8% of concussion-related tweets (Sullivan, 2012)
– Only 14% of Twitter-delivered smoking cessation programs had guidelines consistent content (Prochaska, 2012)
Pew Research Center, Updates, 2012-2014
11 | © 2011 Kaiser Foundation Health Plan, Inc. For internal use only. April 10, 2015 Griffiths, Cave, Boardman, Ren, Pawlikowska, Ball, Clarke, Cohen, 2012
Centrality of the patient – doctor encounter between social and professional/provider networks
Implementation– Using the disseminated information
The use of strategies to adopt and integrate EBIs and change practice patterns in specific settings
We know that:
– Guideline dissemination is insufficient
– Relationships are important
– Health systems are continuously adapting
– Implementation requires top-down AND bottom-up strategies
12 | © 2011 Kaiser Foundation Health Plan, Inc. For internal use only. April 10, 2015
Resources and possibilities for agents’
contributions to implementation processes (May, 2013)
Contribution
Capability
(Possibilities
presented by
the complex
intervention)
Potential
(Social-
cognitive
resources
available
To agents)
Capacity
(Social-structural
resources
available
to agents)
Contribution
(What agents
do to
implement a
complex
intervention)
KP– The Hypertension Control Story
14 | © 2011 Kaiser Foundation Health Plan, Inc. For internal use only. April 10, 2015
Transformative impact of asking:
– WHO: Creation of HT registry
– WHAT: Reduced variation in BP measurements
– HOW: Use of non-physician providers
Sim, et al, 2014
15 | © 2011 Kaiser Foundation Health Plan, Inc. For internal use only. April 10, 2015
Conceptual Model of Implementation Research (Proctor, et al, 2010)
Intervention
Strategies
Implementation
Strategies
Outcomes
Evidence-
Based
Practices
Service
Outcomes*
Efficiency
Safety
Effectiveness
Equity
Patient-
Centeredness
Timeliness
Client
Outcomes
Satisfaction
Function
Symptomotology
*IOM Standards of Care
Implementation Research Methods
Systems Environment
Organizational
Group / Learning
Supervision
Individual
Providers / Consumers
Implementation
Outcomes
Feasibility
Fidelity
Penetration
Acceptability
Sustainability
Uptake
Costs
Blueprint of Effective Strategies in the Dissemination and Implementation of Evidence-Based Practices through a National Quality Campaign
Strategy 1 Highlight evidence base and relative simplicity of recommended practices
Strategy 2 Align the campaign with the strategic goals of the adopting organizations
Strategy 3 Increase recruitment by integrating opinion leaders into the enrollment process and employing a nodal organizational structure
Strategy 4 Form a coalition of credible campaign sponsors
Strategy 5 Generate a threshold of participating organizations that maximizes network exchanges
Strategy 6 Develop practical implementation tools and guides for key stakeholder groups
Strategy 7 Create networks to foster learning opportunities
Strategy 8 Incorporate monitoring and evaluation of milestones and goals
Yuan, et al. (2010). Commonwealth Fund
When has an issue “arrived?”
Risk factors for ovarian
cancer
• Family history
• Inherited risk
• HRT
• Talc
• Weight and height
Protective factors for
ovarian cancer
• Oral contraceptives
• Tubal ligation
• Breastfeeding
• Risk-reducing salpingo-
oophorectomy
Ovarian Cancer Prevention
What is ready for dissemination? To whom?
What is ready for implementation in practice?