CHRSP: Context is critical Pablo Navarro, Senior Research Officer - - PowerPoint PPT Presentation

Contextualized Health Research Synthesis Program

CHRSP:

Context is critical

Pablo Navarro, Senior Research Officer

Newfoundland & Labrador Centre for Applied Health Research CADTH 2013 Symposium | May 5-7, 2013

Today’s Presentation

• 1. About NLCAHR & CHRSP
• 2. Evidence in Context:
• 3. Hyperbaric Oxygen Therapy for

Non-Healing Wounds: a CHRSP project example

• 4. Findings > Contextualization
• 6. Dissemination & Follow Up
• 7. Concluding comments

Established in 1999 by the provincial government, Memorial University and the Eastern Health regional health authority:

 to build research capacity  to address priority research needs in NL  to encourage evidence-informed health decisions

About

“How can we

get scientific evidence used more frequently and more effectively by the healthcare system?”

“How can we find

and use the best scientific evidence as one input among many into decision making?”

…for researchers …for the healthcare system:

The challenge…

The CHRSP Partnership:

CHRSP About

• 1. What

works?

• 2. What will

work here?

CHRSP in a nutshell

• Integrated KTE:
• System leaders identify issues of importance
• Issues formulated as a researchable question shaped to NL
• Prioritize and categorize research questions
• Engage decision makers throughout
• Effective knowledge transfer & exchange:
• Multiple report formats
• Emphasis on implications for decision makers
• Facilitate post-project engagement among stakeholders

CHRSP tailors its synthesis to the context of Newfoundland & Labrador at all stages of the project

• 3. CHRSP interprets

findings in context.

• 2. CHRSP identifies

contextual factors. Patient populations Site of service and/or service design Health human resources Organization and delivery

• f services

Other System Factors Economics Politics

Labrador Grenfell Health Central Health Eastern Health

• 1. Topics of

relevance Contextual factors may effect

• utcomes and/or cost effectiveness

Contextual Factors: 

More about context here: www.nlcahr.mun.ca/research/ chrsp/

Contextualization Overview

Integrated KTE: beginning, middle and end

• f project, consultations

with partners/stakeholders

DHCS Western Health

NLCAHR

Eastern Health Central Health

Labrador Grenfell Health

Contextualization Methodology

a contextualization example Hyperbaric Oxygen Therapy for Difficult Wound Healing in Newfoundland & Labrador

CHRSP Health System Partner: Eastern Health CHRSP External Specialist: CADTH (Rhonda Boudreau, Research Officer; Kristen Moulton, Research Assistant; Sarah McGill, Information Specialist) CHRSP Team: Dr. Ken LeDez, Chair of the Discipline of Anesthesia, Memorial University Faculty of Medicine and Director of MEDICOR, Norma Baker, COO, Adult Acute Care for Eastern Health (now retired), Cathy Burke, Regional Director, Cardiac/Critical Care Program, Eastern Health, and Mary Bursey, Associate Professor in the School of Nursing at Memorial University.

HBOT in NL

• Located at Health Sciences Centre
• 1982: MEDICOR (MUN) for research

and emergencies

• Transferred to Eastern Health in 2010
• Multi-chamber facility (original)
• Two mono-chambers (at transfer)
• Broadened focus to include non-

emergency conditions

CHRSP HBOT Project Background

Belief that a significant number of patients may be suitable candidates for HBOT but are currently not receiving treatment

CHRSP HBOT Project

Focus on non-healing wounds:

• Diabetic foot ulcers
• Delayed radiation-induced

injuries

• Severe burns
• Skin grafts/flaps
• Post-transplantation

revascularization

CHRSP HBOT Project

Partner with CADTH for Knowledge Synthesis

• 1. What

works?

CHRSP Findings

• HBOT is clinically effective and cost

effective (societal perspective) for non- healing diabetic foot ulcers.

• HBOT is clinically effective for some

delayed radiation-induced injuries.

• If referred appropriately and in a

timely manner.

CHRSP Findings

• Insufficient evidence to support or

contradict HBOT for other studied conditions.

• Lack of evidence means

future research will have significant impact on evidence base.

CHRSP Findings

• Overall cost-effectiveness of HBOT

(when clinically effective) increases with increased use of the facility.

• 1. What

works?

• 2. What will

work here?

Contextualization: Patient Level

• Geography & costs:

challenges to completing full course of therapy for patients from far away*

Contextualization: Site of Service

• Location: distant from

related clinical sections of hospital

Contextualization: Human Resources

• Training and

safety: shortage of nurses and respiratory therapists

Contextualization: Organization

• Appropriate

referrals*

• Wound care

management integration*

Contextualization: Economic

• Remuneration
• Overtime

Contextualization: Political

• Public expectations



Dissemination

• Report (3 formats)

Dissemination

• End of event, bring people together
• Communications
• Follow up

Decisions & Actions

• Diabetes implications

communicated to NLMA and others

• Additional HBOT

physician positions created and filled

• Payment system adapted
• Credentials system in

process

Distinguishing features of CHRSP

• focus on questions identified by system not the researchers
• use both local and external expertise
• build teams that combine researchers and decision makers
• contextualize
• work quickly
• communicate effectively

Does CHRSP work?

• topic selection complex but workable
• each side has learned how to work together
• contextualization is feasible and helpful
• leading external experts fairly easy to recruit
• teams work well together
• the results have been produced fairly quickly
• the results have actually been used:
• dialysis decision template
• Youth Residential Treatment planning
• Single-use Medical Devices policy
• considerations for development of PET
• patient handling protocols in Eastern Health

It does.

www.nlcahr.mun.ca/research/chrsp/

• Web: www.nlcahr.mun.ca
• Phone: (709) 777-6993
• Email: nlcahr@mun.ca
• Location: 95 Bonaventure Avenue, Suite 300

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