Knowledge Translation

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Knowledge Translation

Moving from Best Evidence to Best Practice

Ann McKibbon MLS PhD

Health Information Research Unit

McMaster University

Professor emeritum

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KT is

 Taking what we know and applying it…

 Behaviour change based on knowledge

 Getting research findings into practice

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Disclaimers

 I view KT as large

 Background is health sciences—all of what I have to say applies to all disciplines

 Retired for 4 years

 Learning is based on fun and interaction

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Goals today

 History of KT

 Want you to experience breadth of KT

 Types/forms/intensity of KT

 Searching for KT in research literature

 Example of 2 models of KT

 KT examples

 Tool (Sick Kids toolkit)

 Stretch yourself and have some fun

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Forms of KT

 KT has 2 forms:

 Research into KT to make it better

 Practical form to take what we know/discover and insure that we help make it happen

 Today: Practical

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Researcher Obligations

 Base your research on

 Important questions

 What we already know

 Existing gaps

 Do high quality, feasible-to-apply research

 Report findings in a timely and accurate manner

 Work to make sure your findings are applied

(translated)

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Why is KT important?

~55% of patients get less than adequate care

 30% to 40% not get what they should get

 20% to 25% get what…

 should not have

 they do not need

 McGlynn E. NEJM 2003.

 If optimal cancer care for adults…

 30% improvement in cancer outcomes

 10% reduction in cancer mortality

 Exercise likely better than meds in many situations

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Australia 2009-2010

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History

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Plotinus (Roman 205-207 AD)

“Knowledge, if it does not determine action is dead to us”

http://www.philosophyarchive.com

/index.php?title=Plotinus

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Arabic world--Avicenna

 “…the practice of

medicine is not the work which the physician

carries out but it is the branch of medical

knowledge, which when acquired, enables one to form an opinion upon

which to base the proper plan of treatment”

 980 to 1037

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James Lind Vitamin C 1747

Published 1753 applied 1795 (50% mortality)

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Louis Pasteur

“To him who devotes his life to science, nothing can

give more happiness than increasing the number of discoveries, but his cup of joy is full when the results of his studies immediately find practical applications.”

Quoted by René J. Dubos in Louis Pasteur, Free Lance of Science

http://www.whonamedit.com/doctor.cfm/2994.html

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Definition

Canadian Institute for Health Research

“the exchange, synthesis, and ethically-sound application of knowledge – with a complex system of interactions among researchers and users – to accelerate the capture of the benefits of research for [the people we serve]

through improved health, more effective

services and products, and a strengthened

health care system.”

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Definition

find your own working definition Harnessing our evidence

Knowledge to action

Behavioural change (based on knowledge)

KT is not a “one size fits all” kind of thing

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Failures of KT

Still need some more KT

Successes of KT

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Failures of KT

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Failures of KT

 Childhood immunizations and autism

 Immunization in some populations

 Obesity

 Physical activity

 Opioid crisis

 Smoking outside North America

 Climate change

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Still needs some more KT

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Still needs some more KT

 Smoking in North America

 Antibiotics for viral infections

 Flu vaccinations for health professionals

 Hand washing

 Fast food restaurants’ menu choices

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Successes of KT

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Successes of KT

 Seatbelts

 Motorcycle helmets in Canada

 Infant and toddler car seats

 Breast feeding in North America

 Sprinkles (iron)

 Anything Apple

 Pharmaceutical industry

 Advertising industry

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Question

What proportion of research dollars are spent on knowledge generation vs translation?

 100:1 generation vs translation

 10:1 generation vs translation

 1:1 generation vs translation

 1:10 generation vs translation

 1:100 generation vs translation

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Answer

What proportion of research dollars are spent on knowledge generation vs translation?

 100:1 generation vs translation

 10:1 generation vs translation

 1:1 generation vs translation

 1:10 generation vs translation

 1:100 generation vs translation

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Searching challenges

 Multiple names

 Not everyone who does KT labels it as such

 Do a lot of seeking

 Seek out help from librarian

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KT Terms

 Applied health research

 Capacity building

 Complex interventions

 Complexity science

 Complexity studies

 Co-optation

 Diffusion of innovations

 Diffusion(s)

 Dissemination

 Evidence based practice

 Getting knowledge into practice

 Implementation

 Implementation research

 Implementation science

http://whatiskt.wikispaces.com /

 Information dissemination and utilization

 Innovation adaptation

 Innovation adoption

 Innovation diffusion

 Knowledge communication

 Knowledge cycle

 Knowledge dissemination

 Knowledge exchange

 Knowledge management

 Knowledge mobilization (mobilisation)

 Knowledge transfer

 Knowledge translation

 Knowledge transformation

 Knowledge uptake

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KT Terms

 Knowledge utiliz(s)ation

 Linkage and exchange

 Organizational change

 Outcomes effectiveness research

 Policy research

 Popularization (popularisation) of research

 Research into action

 Research into practice

 Research mediation

 Research transfer

 Research transformation

 Research translation

 Research utiliz(s)ation

 Sociology of knowledge

 Technology transfer

 Third mission

 Translation(al) research

 Translation(al) science

 Transmission

 Utilization (utilisation)

 Knowledge to action

 Knowledge development and application

 Knowledge diffusion

 Applied dissemination

 Effective dissemination

 Research implementation

 Quality improvement/assurance

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Disciplinarity of KT

 Pharmaceutical industry

 Public health

 Nursing

 Psychology

 Medicine

 Engineering (technology transfer)

 Management studies (change management)

 Advertising and marketing

 Cognitive science

 Education

 Parenting

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KT has 3 audiences

 Individuals

 Decision makers

 Policy people

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End of grant KT Integrated KT

 Do you do your KT work within the study frame or after the end of your project?

 Benefits and more work for Integrated KT—

more bonus points for CIHR and other

funding too

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3 Approaches/Intensities of KT

1. Diffusion

1. Let it happen

2. Dissemination

1. Help it happen

3. Application

1. Make it happen

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1. Diffusion—let KT happen

 Everett Rogers—Diffusion Model

 Malcolm Gladwell—Tipping Point

 Sociological approach to changing behaviours

 Populations in social networks

 Think cell phones, tablets, Netflixs

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Rogers Diffusion of Innovation Model

http://www.utwente.nl/cw/theorieenoverzicht/Theory%20clusters/Communication%20and

%20Information%20Technology/Diffusion_of_Innovations_Theory.doc

/

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http://investeddevelopment.com/about/

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Diffusion in health care, etc

 Netflix

 Hormone replacement after Women’s Health Initiative publication (fastest I have ever seen)

 Cholesterol lowering agents (slower)

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2. Help it happen (passive)

 Conference attendance, posters, presentations

 Publish papers in usual journals

 Do rounds at your institution

 Newsletters for professional associations

 Press releases

 Continuing education/other educational

events

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3. Make it happen —most effective

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Example: Bone fractures

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http://www.webmd.com/osteoporosis/ss/slideshow-osteoporosis-overview

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Improved Osteoporosis Care in Ontario Long Term Care Facilities

Kennedy CC, Ioannidis G, Giangregorio LM, Adachi JD,

Thabane L, Morin SN, Crilly RG, Marr S, Josse RG, Lohfeld L, Pickard LE, King S, van der Horst ML, Campbell G, Stroud J, Dolovich L, Sawka AM, Jain R, Nash L, Papaioannou A.

Successful knowledge translation intervention in long-term care: final results from the vitamin D and

osteoporosis study (ViDOS) pilot cluster

randomized controlled trial. Trials. 2015 May

12;16:214. 20 authors from many domains

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Improved Osteoporosis Care in Ontario Long Term Care Facilities

McMaster

Medicine, CE&B, Family Medicine

St Peters Hospital, Hamilton Health Sciences University of Waterloo

Western University University of Toronto

St. Mikes, Medicine McGill

Medical Pharmacies Group

Osteoporosis Canada

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Improved Osteoporosis Care in Ontario Long Term Care Facilities

Osteoporosis expert Geriatrician

Pharmacist Researchers

qualitative and quantitative Statistician

Kinesiologist

Long term care health professionals and staff Patient advocate group member

Industry representative

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Steps to get Intervention Right

 Systematic reviews (theirs and others)

 Summaries of the evidence

 Collected and reviewed existing local data

 Compared evidence with performance data

 Involved almost everyone in planning including LTC people

 Pilot tested

 Multiple interventions

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Steps of the Intervention

 Professional Advisory Committee each LTC facility

 3 educational sessions, 1 every 6 months

 Learning modules, key messages, evidence, group discussions

 Expert opinion leader/study coordinator at each site

 DVD 10 minutes on prevention

 Audit and Feedback—each LTC site and all individuals

 Reminders, point of care tools on prescribing

 Treatment alerts, checklists, X-ray stamp with “please rule out…

 Action planning at each site

 Internal champion at each site

 Osteoporosis LTC website for champions, etc

 Toolkit of tools including all training materials* (all groups)

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Results

CONCLUSIONS: “Our KT intervention significantly improved the prescribing of vitamin D and calcium and is a model that could potentially be applied to other ^areas

requiring quality improvement.”

…no differences in fracture rates

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Capability = physical and psychological Opportunity = social and physical

Motivation = automatic and reflective

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C = capability M = motivation O = opportunity

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Mapping of interventions to BCW

https://static-content.springer.com/esm/art%3A10.1186%2F1748-

5908-6-42/MediaObjects/13012_2011_352_MOESM8_ESM.PDF

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Attributes of a good KT person

 Team player with many connections across and within disciplines

 Comfortable with complex problems

 Creative, capable of out-of-the-box thinking

 Patient

 Somewhat lacking in ego

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 Don’t forget to use the Sick Kids template for

planning….

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Disinformation/Fake News

 35 deaths in Europe in 2015-16 from measles

 Ebola spread based on information that people feared the motives of quarantines