ANZMUSC: Promoting effective transfer of research outcomes into - - PowerPoint PPT Presentation

Trusted evidence. Informed decisions. Better health.

ANZMUSC: Promoting effective transfer of research outcomes into health policy and practice

Disclosure of interests

Director of Australasian Cochrane Centre Employee Monash University Funding from NHMRC, Cochrane, ACSQHC and DHA Physiotherapist in private practice

Research translation in the CRE

Furthering the science of research translation for MSK conditions Perform implementation trials to evaluate what works to change practice Implement CCS for hip fracture and knee OA Develop living systematic reviews and living guidelines Effectively disseminate and translate the results of the CRE External advisory board Clinician researchers Annual national meeting Training opportunities in KTE Media and communications plan including range of outputs (policy briefs, consumer summaries, forums)

A common language for research translation

• Ensuring stakeholders* are aware of and use research

evidence to inform their health and healthcare decision- making

• Ensuring research is informed by current available

evidence and the experiences and information needs of stakeholders

Grimshaw et al, Implement Sci 2012

*stakeholders include:

• healthcare professionals
• consumers of health care (i.e. patients,

family members, carers)

• policy makers
• educators
• research funders
• researchers

Research translation in the CRE

Furthering the science of research translation for MSK conditions Perform implementation trials to evaluate what works to change practice Implement CCS for hip fracture and knee OA Develop living systematic reviews and living guidelines Effectively disseminate and translate the results of the CRE External advisory board Clinician researchers Annual national meeting Training opportunities in KTE Media and communications plan including range of outputs (policy briefs, consumer summaries, forums)

Linked data repositories Living evidence services Living guidance Decision support systems Learning healthcare systems Health 'big data'

Health Practice

Hypotheses Prioritisation

Primary research

Publication

Systematic review

Publication

Guidance

Knowledge translation

Living systematic review

Ellio% JH, Turner T, Clavisi O, Thomas J, et al. (2014) PLoS Med 11(2): e1001603.

An evidence ecosystem

Ellio% JH, Turner T, Clavisi O, Thomas J, et al. (2014) PLoS Med 11(2): e1001603.

Linked data repositories Living evidence services Living guidance Decision support systems Learning healthcare systems Health 'big data'

Health Practice

Hypotheses Prioritisation

Primary research

Publication

Systematic review

Publication

Guidance

Knowledge translation

Living systematic review

An new evidence ecosystem

Ellio% JH, Turner T, Clavisi O, Thomas J, et al. (2014) PLoS Med 11(2): e1001603.

The reality

• The problem: systematic review production is inefficient

and resource intensive

Time from study to systematic review

Shojania et al, Ann Intern Med. 2007;147(4):224-233.

Survival of systematic review accuracy

Australian Guidelines: challenges

1. Inefficiency 2. Poor quality 3. Lack of capacity 4. Lack of investment in information technology 5. Inaccessibility 6. Obsolescence

Better informed health care through better clinical guidelines: NHMRC Draft Discussion Paper, November 2015

Our response: Project Transform

People + Process + Technology converge

PEOPLE TECHNOLOGY PROCESS

Cochrane Crowd crowd.cochrane.org

Cochrane Crowd crowd.cochrane.org

911,442

classifications

3,485

contributors

28,000+

RCTs/q-RCTs

“What have you done? I got distracted by almost all the studies, wanting to read the whole articles. I just gave my husband snack food for tea as I don't have time to cook.” Charry, Medical Doctor, Australia

“There goes my social life. I'm hooked.” Kate, NGO worker, UK

Pilot evaluation

A backlog of 25,000 records Over 15,655 were deemed very unlikely to be RCTs by the machine. It was right for 99.9% of those 15,655

What is a Living Systematic Review?

“Systematic reviews which are continually updated, incorporating relevant new information as it becomes available”

What are LSR methods?

• Continuously updated
• Active, ongoing evidence surveillance
• Updates provided whenever new evidence, data or

information is identified

• Explicit, transparent, predefined decisions about:

– How frequently new evidence is sought and screened; – When and how new evidence is incorporated into the review; – What thresholds cause the review to cease being ‘living ’

• No difference in core methods
• Can be applied to any review type

How do LSRs differ from other reviews?

Feature LSR Frequently updated SR Rapid Review Explicit methods for ‘when’ and ‘how’ of updating ü X X Continuous evidence surveillance ü ? X New evidence rapidly incorporated ü X X Standard SR methods ü ü X

When should I do an LSR?

• The review question is a priority for decision making
• There is likely to be a high volume of emerging research
• There is capacity to maintain ongoing workflows

ANZMUSC research translation example

Trials: arthroscopy self- management and exercise

Evidence practice gap Living systematic review Living Guideline CCS Implementation trials

• Consumer support

tools

• Models of care
• Implementation

plans