Health Researchwith an Impact
Ian D Graham PhDVice President, Knowledge Translation
and Public OutreachCanadian Institutes of Health Research
New Brunswick Health Research FoundationOfficial Launch and 1st Annual Conference
October 4th 2009
Health Researchwith an Impact
• Doesn’t all health research have an impact?• Knowledge Translation as a mechanism for impact• Commonalities in our approaches to health research • KT infrastructure for achieving impact
Doesn’t all health research have an impact?
• Consistent evidence of failure to translate research findings into clinical practice• 30-45% patients do not get treatments of proven
effectiveness• 20–25% patients get care that is not needed or
potentially harmful (McGlynn et al, 2003; Grol R, 2001; Schuster, McGlynn, Brook, 1998;)
• Cancer outcomes could be improved by 30% with optimum application of what is currently known
• 10% reduction in cancer mortality with widespread use of available therapies
(CSCC 2001; Ford et al, 1990)
Knowledge Translation as a mechanism for impact
Knowledge Translation is part of our mandate
Context: CIHR Mandate
(4h) promoting the dissemination of knowledge and the application of health research to improve the health of Canadians
(4i) encouraging innovation, facilitating the commercialization of health research in Canada and promoting economic development through health research
(5f) communicate with the public, governments, the Canadian and international communities, voluntary organizations and the private sector on issues pertaining to health or health research
(KT research and practice)
Research outputs Research impacts
Knowledge Translation is the bridge between discovery and impact
It’s is about making a difference
What is Knowledge Translation?
KT is a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system.
This process takes place within a complex system of interactions between researchers and knowledge users which may vary in intensity, complexity and level of engagement depending on the nature of the research and the findings as well as the needs of the particular knowledge user.
Knowledge synthesis
Ethically sound application of knowledge
Dissemination
Knowledge exchange
What is Knowledge Translation? The contextualization and integration of research findings of individual research studies within the larger body of knowledge on the topic. Synthesis is a family of methodologies for determining what is known in a given area or field and what the knowledge gaps are.
The iterative process by which knowledge is actually considered, put into practice or used to improve health and the health system. KT activities must be consistent with ethical principles and norms, social values as well as legal and other regulatory frameworks
Refers to the interaction between the knowledge user and the researcher resulting in mutual learning, it encompasses the concept of collaborative or participatory, action oriented research where researchers and knowledge users work together as partners to conduct research to solve knowledge users’ problems (Integrated KT).
Involves identifying the appropriate audience for the research findings, and tailoring the message and medium to the audience.
What is Knowledge Translation?
Knowledge translation is about:
• Making users aware of knowledge and facilitating their use of it to improve health and health care systems
• Closing the gap between what we know and what we do (reducing the know-do gap)
• Moving knowledge into action
Knowledge translation research research (KT Science) is about:
• Studying the determinants of knowledge use and effective methods of promoting the uptake of knowledge
At CIHR we consider two broad categories of KT
End of grant KT
Integrated KT
The researcher develops and implements a plan for making knowledge users aware of the knowledge generated through a research project
The researcher engages potential knowledge users as partners in the research process. This requires a collaborative or participatory approach to research that is action oriented and is solutions and impactimpact focused.
What is end of grant KT?
A broad spectrum of activities including:
DiffusionDiffusion• Conference presentations• Peer reviewed publications (Open access policy-
Jan 1, 2008)• Non-peer reviewed publications• Website postings
What is end of grant KT?
DisseminationDissemination (activities that tailor the message and medium to a specific audience)
• End of grant report to funders• Summary/briefings to stakeholders• Educational sessions with patients, practitioners and/or
policy makers• Engaging knowledge users in developing & executing
dissemination/implementation plan• Tools creation • Media engagement• Use of knowledge brokers
What is end of grant KT?
ApplicationApplication* (moving research into practice in cases where the strength of evidence is sufficient)
• Understanding the context/environment where research is to be applied
• Identifying barriers to the uptake of the research findings• Adapting knowledge, tailoring messages and interventions
to promote uptake• Evaluating the implementation process and outcomes • Working within a conceptual framework
*NB knowledge application is often a fundamental component of integrated KT as well
What is integrated KT?
• a way of doing research• collaborative, participatory, action-oriented, community
based research, co-production of knowledge, mode 2 research
• involves engaging and integrating knowledge users into the research process
• Knowledge users can be:– Policy- and decision-makers from the community to
the federal level, researchers, the public, industry, clinicians, the media
– Investigators from different disciplines, teams, countries
Knowledge users and researchers (knowledge creators) work together to:shape the research questions interpret the study findings and craft messaging
around them move the research results into practice
In our view – this is the minimum requirement for conducting integrated KT
What is integrated KT?
In addition, knowledge users and researchers (knowledge creators) can work together to:
shape the research questionsdecide on the methodologyhelp with data collection and tools development interpret the study findings and craft messaging
around themmove the research results into practicewidespread dissemination and application
What is integrated KT?
By requiring both researchers and knowledge users to be part of the research team, integrated KT requires merit merit review:review:
• Both knowledge users and researchers on the review panel
• Each proposal scored on impact/relevance as well as scientific merit
• Panellists often need orientation materials explaining the process as well as worksheets to apply the criteria
• Both “types” of panel members have a voice
Review implications of integrated KT
Health research with an impact means avoiding waste:
• Avoiding waste????• Chalmers and Glaziou1: “Within specific health
problems there is little research on the extent to which questions addressed by researchers match questions of relevance to patients and clinicians.
• e.g. the research priorities of patients with osteoarthritis of the knee favoured more rigorous evaluation of physiotherapy and surgery – 9% wanted more research on drugs, yet 80% of RCTs of patients with this condition were on drugs
Iain Chalmers, Glaziou,P. Avoidable waste in the production and reporting of research evidence. The Lancet 2009 374 86-89.
Having an impact means closing the gap between
evidence and actionSome general KT principles:
1. Researchers need to do the rightright research
need for synthesis to determine what we already know (or should know if we were to summarize the existing knowledge)
Paul Ewald*: “We have in hand most of the information we need to facilitate a new golden age of medicine. And what we don’t have in hand we can get fairly readily by wise investment in targeted research and intervention.”
*From John Brockman. “What is Your Dangerous Idea”
Some general KT principles for achieving impact:
1. Researchers need to do the rightright research need for synthesis to determine what we
already know (or should know if we were to summarize the existing knowledge)
need to determine where there is a strong evidence base and move that evidence into action
today's health problems are complex and interdisciplinary and require mixed methods to solve
primary research needs to be targeted to fill the known gaps in our knowledge base
primary research needs to be solutions-based
Some general KT principles for achieving impact :
2. The rightright people need to be involved from the beginning
need applied, collaborative, interdisciplinary research (in other words: integrated KT)
users of the research need to be helping to set the research agenda and define the research questions to ensure relevance and greater likelihood of uptake of the results when they become available
Some general KT principles for achieving impact :
3. Knowledge-users need to make the research right right for their own context
research is not used like a can opener knowledge-users need to adapt, contextualize
and take ownership of knowledge for local use as research producers, this means you need to
help them sufficiently understand your work so that they are able to put it to use
Achieving impact:closing the gap between
evidence and action
How to close the gap between evidence and action: shift attention from individual adopters to the
organizational and environmental context for change
set targets for change monitor uptake of the research and evaluate the
health and system outcomes/impact keep it simple focus on a few important targets, practical
indicators
How do we measure impact at CIHR?
Types of impact
Impact writ large: Impact framework – adapted from/by the CAHS
Impact at the level of an individual study - included in merit review of integrated knowledge translation grants
Impact writ large: the CIHR Impact Framework
• Advancing Knowledge – discoveries/breakthroughs, contributions to the scientific
literature.• Building Capacity
– development and enhancement of research skills in individuals and teams.
• Informing Decision-Making (knowledge use)– impacts of research in the areas of science, public, clinical
and managerial decision-making, practice and policy.• Health & Health System Impacts
– advances in prevention, diagnosis, treatment and palliation as well as advances in the way the system functions.
• Economic Impacts– commercialization of discoveries; direct cost savings; and
human capital gains.
Impact at the level of an individual study: Merit Review
Research question: To what extent does the research question respond to an important need identified by the knowledge-user(s) on the research team
Research approach: To what extent are the knowledge-user team members meaningfully engaged where appropriate (e.g. in defining the research questions, informing the research plan, interpreting the findings, informing the end-of-grant KT plan)?
Impact at the level of an individual study: Merit Review
Feasibility: To what extent are the knowledge-users on the team committed to applying the findings when they become available and is their application achievable in the particular practice, program and/or policy context?
• To what extent does the researcher-knowledge-user team have the necessary expertise and track record to deliver on the project’s objective(s), including the objectives of the end-of-grant KT plan?
Impact at the level of an individual study: Merit Review
Outcomes: To what extent will the project have a substantive and sustainable impact on health outcomes, practice, programs and/or policy in the study context?
• To what extent will the project’s findings be transferable to other practice, programs and/or policy contexts?
• To what extent is the evaluation plan appropriate to assess the project’s impact?
Commonalities in our approaches to health research
Commonalities in our approaches to health research
Translation to the Broad Community• We believe in effective mechanisms for linkage between researchers
and users of health research to enhance the relevance and value of publicly funded research
Capacity Building• We will strive to build a strong and stable infrastructure to strengthen
health research capacity in New Brunswick Leveraging• We are committed to using provincial health research funds to provide
a platform that ensures the successful acquisition of additional research funds from public and private sector, both national and international
Culture of Innovation • We believe in fostering a culture of innovation by engaging health
researchers in the excitement of discovery, and by supporting the creation, growth, and maturation of new discoveries and technologies with market potential at all stages of the innovation pipeline
CIHR’s Health Research RoadmapCIHR’s Health Research Roadmap
Four main Strategic Directions:
1. Invest in world class excellence
2. Address health and health system research priorities (considered within the light of the S&T and STIC
sub-priorities)
3. Accelerate the capture of health and economic benefits of health research
4. Achieve organizational excellence, foster ethics and demonstrate impact
CIHR’s Health Research RoadmapCIHR’s Health Research Roadmap
Strategic Direction 3: Accelerate the capture of health and economic benefits of health research
• Reaping socio-economic benefits from research through KT and partnerships
• Enhancing the application of research and its evaluation
Accelerate the capture of healthAccelerate the capture of health and economic benefits of health research and economic benefits of health research
Reaping socio-economic benefits from research through KT and partnerships
1. Facilitate and strengthen partnerships between researchers and knowledge users and between CIHR and a variety of organizations to achieve impact
2. Support evidence-informed policy making to improve health and the health system at both the provincial and federal levels.
3. Facilitate innovation and commercialization
4. Implement citizen engagement and public outreach initiatives
Accelerate the capture of healthAccelerate the capture of health and economic benefits of health research and economic benefits of health research
Enhancing the application of research and its evaluation
5. Advance the application of research and its evaluation
6. Build capacity of both researchers and knowledge users to engage in KT
7. Increase the number of researchers to advance the science of KT
KT infrastructure for achieving impact
KT Funding OpportunitiesSynthesis • CIHR funds the Canadian Cochrane Network and Centre
• Knowledge Synthesis FO• Operating grants competition - reviewed by KTR panel
Integrated KT • Knowledge Synthesis FO• Knowledge to Action FO• Partnerships for Health System Improvement FO• Meeting, Planning and Dissemination grant – KT Events to develop collaborative relationships and grant proposals
End of Grant KT • Meeting, Planning and Dissemination grant – KT Supplement to disseminate results• Allowable expense as part of a grant application
Commercialization • Proof of Principle FO• CIHR/SME FO• Science to Business FO
Science of KT
Training
• Operating grants competition - KTR Panel
• Doctoral, Fellowship, New Investigators Awards • Health Research Communications Award, Journalism Award
Our funding opportu
nities a
re driven by o
ur operatio
nal defin
ition of K
T
KT Funding Opportunities:many serve multiple functions
Synthesis
Science of KT
Commercialization
End of Grant KT
Integrated KT
KT Awards (New Investigator, Fellowships, Doctoral) Strategic Training Initiative in Health Research (STIHR)
Operating grants Canadian Cochrane
Evidence on TapKnowledge Synthesis
Partnerships in Health System Improvement (PHSI) KT Awards (Prizes)
Knowledge to ActionKT Supplement Grants
Meeting, Planning and Dissemination Proof of Principle (POP)
SME/CIHRScience to Business
Knowledge Synthesis Grant
Supports teams of researchers and decision-makers to produce knowledge syntheses ($100 000 per year) and scoping reviews ($50 000 per year), that respond to the information needs of knowledge-users in all areas of health. Partners can, but are not required to make in-kind or cash contributions.
Partnerships for Health Systems Improvement Supports teams of researchers and decision-makers
interested in conducting applied health research useful to health system managers and or policy-makers. CIHR pays up to $400 000 over 3 years, with an additional 20 to 30% required from partners.
Knowledge to Action Grant
Supports teams engaged in knowledge translation (KT) at the community, regional, provincial or federal level by funding KT and implementation activities of researchers and decision-makers/knowledge-users.
CIHR pays up to $100 000 per year for one or two years. Partners can, but are not required to make in-kind or cash contributions.
Meetings, Planning and Dissemination Meetings, Planning and Dissemination GrantsGrants
• provide support for meetings, planning and/or dissemination activities consistent with the mandate of CIHR and relevant to CIHR Institutes, Initiatives, or Branches.
• Competition Dates– 3 competitions/year. – Applications due: Oct 1, Feb 1, June 1– Decision/funding dates: Jan 1, May 1, Sept 1
• Term and amounts– 1 year, non-renewable grants– Maximum grant value is $15,000
Meetings Planning and Dissemination Grant:
KT Supplement
• Up to $40 000 for KT activities at the end of a CIHR grant when it is appropriate to disseminate the results of the research beyond the traditional scientific community and using methods supplementary to and in addition to publication in peer-reviewed journals.
• Offered three times a year: October 1, February 1 and June 1
amount
More KT Funding Opportunities
• Training and Personnel Awards• Knowledge Translation priority awards:
– New Investigator Award– Fellowship Award – Doctoral Research Award
• Health Research Communications Award
My question is:Are we making an
impact?
Bottom line: we all want to make an impactBottom line: we all want to make an impact
Thank you
For more information, visit our web page:http://www.cihr-irsc.gc.ca/e/29418.html http://www.cihr-irsc.gc.ca/f/29418.html
