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Evidence to Care: Mobilizing Childhood Disability Research into Practice
Canadian Knowledge Mobilization Forum
Saskatoon, Saskatchewan June 9, 2014
Dr. Shauna Kingsnorth Evidence to Care Lead Clinical Study Investigator Assistant Professor (status), Department of Occupational Science and Occupational Therapy, University of Toronto Holland Bloorview Kids Rehabilitation Hospital [email protected]
Healthcare in Ontario: Ministry of Health and Long-Term Care
• Provincial governing body for healthcare services
• Patient-focused, results-driven, integrated and sustainable, publicly funded
• Provide strategic direction on provincial priorities; establish sustainable funding models, legislation, monitoring, reporting, and policies
MOHLTC. (2013). http://www.health.gov.on.ca/en/common/ministry
Legislation: What is ECFAA?
The Excellent Care for All Act (ECFAA), which came into law in June of 2010, puts Ontario patients first and helps define quality for the
health care sector, by reinforcing shared responsibility for quality of care, building and supporting boards’ capability to oversee the delivery of high quality of care, and ensuring
health care organizations make information on their commitment to quality publicly available
MOHLTC. (2012). http://www.health.gov.on.ca/en/public/programs/ecfa
What is the aim of ECFAA?
•To ensure that:
–Best practices information is supported by available scientific evidence
–This information is translated into materials for employees and persons providing services within the health care organization
–The use of these materials is monitored through user-based surveys and standards of care
Ontario Government. (2010). http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_10e14_e.htm
ECFAA as a Social Innovation
•Places the patient at the centre of care
•Creates an enduring organizational focus on quality and continuous improvement
•As a regulatory systems driver, ECFAA creates conditions to support, enable and compel quality improvement
Quality
improvement
for better
outcomes
6
Holland Bloorview Kids Rehabilitation Hospital
Discovering Evidence Use at Holland Bloorview
Indicator Audit
Validated Tool
Best practices?
Focus Groups
7
To what extent is current research
evidence being used in clinical
practice?
Results: How evidence-friendly are we?
0
10
20
30
40
50
60
70
1 2 3 4 5 6 7
Anchored Scale (-/+)
Perc
en
t fr
eq
uen
cy
8
Waste of time Fundamental!
Mode
• Solid understanding of evidence-informed best practice
• Strong appreciation of value and need
• Very positive attitudes
Results: Is it easy is it to access?
•Described as limited and self-directed
–Research Librarian fundamental for direct access
–Conference attendance key learning vehicle
–Collaborative research partnerships not optimized
–No systematic organizational push/pull processes
9
Conclusions: Enablers and Barriers to Use
•Resource drivers – Individual skill
– Organizational capacity
•Evidence enablers – Quality and fit
– Availability
•Professional drivers – Colleges and associations (i.e., regulated roles)
– Colleagues
10
ECFAA at Holland Bloorview
Evidence to Care
Evidence Informed
Best Practice
Excellent Care for All Act
(ECFAA)
Health Quality Ontario
Evidence to Care (EtC): A Catalyst for Knowledge Translation
"The collaborative and systematic review, assessment, identification, aggregation, and practical application of high-quality disability and rehabilitation research by key stakeholders for the purpose of improving the lives of individuals with disabilities.”
12
NCDDR. (2005). http://www.ncddr.org/knowledge_trans_over.html
What is Evidence to Care?
•Our vision is to promote the best available research evidence to inform care in childhood disability
•A bridge between research and clinical care and policy
13
What is Evidence to Care?
Position Holland Bloorview as a ‘go to’ hub for:
• Systematic reviews • Clinical practice guidelines • Evidence-informed best practices
CIHR. (2014). http://www.cihr-irsc.gc.ca/e/39033.html
Aligning Evidence with the Pillars
• Accelerate Knowledge • Provide expertise in best practices in the field of
knowledge translation • Hold events that promote and showcase using
evidence to enhance care • Support BRI grant requests through suggesting
creative knowledge translation strategies
• Lead the System • Identify gaps in evidence-informed best practice in
childhood disability • Generate systematic reviews and clinical practice
guidelines to meet our needs • Raise Holland Bloorview’s knowledge translation
Aligning Evidence with the Pillars
• Transform Care • Identify, appraise and communicate research
evidence • Develop and implement clinical practice
guidelines • Evaluate changes in care related to evidence use
• Inspire our People • Develop a strategy that enhances staff’s ability to
use evidence • Create opportunities for researchers and
clinicians (and families where possible) to work together to solve issues using evidence
• Promote evidence use in all programs throughout the organization
Funding
• Foundation
• Partnership with MOHLTC
• Grant funding
EtC in Action: Energy in the System
●Success contingent on inter-professional cooperation
●Partnerships and key enablers:
− Academic health science centre
− Commitment to research
− Collaborative structures
− Senior management engagement
− Change champions
− Expertise
Progression of the Model: In Practice
19
Organizational partners
EtC Steering Committee
Core Staff
Associates
Teaching & Learning Institute
Hospital CEO
Lead
Collaborative Practice Leaders
Bloorview Research Institute
VPs
Knowledge Brokers(2)
Research Librarian
Senior Directors Knowledge Translation
Specialist (2)
Scientists & Clinicians
Directors
Administrative Assistant
Communications & Public Affairs
EtC Lead
Research Assistant
Family & Youth Leaders
Organizational Impact
•Embedding KT Competencies in:
–Research Curriculum
–KT Consultations
–HR Interview Questions
–Investigator Performance Appraisal
–Key Performance Indicator Reporting
–Grant application process
EtC in Action: Best Practice Projects
21
Phase 2: Evidence appraisal
Phase 3: Product develop and tailoring to
context
Phase 4: Dissemination, Implementation
& Evaluation
Integrated Knowledge Translation Strategy
Phase 1: Identify Priority
Area
EtC in Action: Best Practice Projects
Chronic Pain and Cerebral Palsy Project
Develop and implement a best practice recommendation for the assessment of chronic pain among paediatric outpatients with cerebral
palsy
Cerebral Palsy Chronic Pain Toolbox
23
Multi-phase approach identified:
• Registered Nurses Association of Ontario (RNAO) Best Practice Guideline (BPG) for Pain Assessment Recommendations6
• Cerebral Palsy specific care
and practice points • 7 pain interference tools
Knowledge Translation Activities
- Printed Educational Materials
- Champions
- Educational Meetings (e.g. workshops, huddles)
- Audit and Feedback
- Reminders
Chronic Pain and Cerebral Palsy Implementation: Knowledge Translation Strategies
EtC in Action: Best Practice Projects
Children with Medical Complexity Project
Engage in a best practice project to develop a compendium of evidence informed resources for
children with medical complexity
Children with Medical Complexity Project
Identifying
Best Practice:
How are best practices
advanced
when the evidence
doesn't exist?
Scoping Review of the Evidence
Stakeholder Engagement for Product
Development
Leading Practices Scan
Engaging
Families
is Critical!
Early Learnings
• Emerging field of KT
– Advancing a model of 'on the ground' learning
• Building skills while building products
– Big investment short-term long-term pay offs
• 'Evidence-informed Practice' vs.
'Practice-informed Evidence '
– Medical advance, technology and societal attitudes are changing
– Disability research is not simple or easy
• Early wins to foster culture of change
Social Innovation
Social innovation is a process of change emerging from the creative re-combination of existing assets, the aim of which is to achieve socially recognized goals in a new way - Ezio Manzini (2014)
Evidence to Care bridges the gap
between research and clinical practice to create a world of
possibility for kids with disability
Evidence to Care acts as a bridge between
research and clinical care and policy.
Our vision
is to promote the
best available research
evidence
to inform care in childhood
disability.
Find us on the web at:
www.hollandbloorview.ca/TeachingLearning/EvidencetoCare
Thank you!
Evidence to Care