25/06/2014 Alison Hoens Physical Therapy Knowledge Broker, University of British Columbia Linda Li Associate Professor, University of British Columbia 1 � To appreciate the concept of knowledge brokering � To understand how knowledge brokering adds value to knowledge translation activities � To understand how a knowledge broker can enhance PT practice and research 2 1
25/06/2014 3 17 Years for 14% of research findings to be adopted Into practice (Westfall et al, 2007) 4 2
25/06/2014 CDC http://www.cdc.gov/violenceprevention/pdf/evidence_project_overview2013-a.pdf 5 Profession / regulatory bodies Research Organization funding agencies EIP Clinician Patient 6 3
25/06/2014 � Didactic sessions � Educational resources � Clinical pathways � Audit and feedback � Reminders � Local opinion leaders � Decision aids &computer decision support � typically change clinical practice by ~10% � Straus SE et al. 2009; Boaz et al. 2011 7 Previous Current Single study Synthesis Individual Collective Consulting Partnership Simple Complex A-contextual Contextual Transfer Engagement Modified from B Riley. Closing the Know Do Gap. KT Forum BC May 23 2014 8 4
25/06/2014 Broker broceur - small trader brocheor - wine retailer 9 � Intermediary � Bridge � Boundary spanner � Catalyst � Facilitator � Translator � The human force that makes knowledge transfer ( the movement of knowledge from one place or group of people to another ) more effective and is distinct in aiming to bring people together for mutual advantage � CHSRF 2003 10 5
25/06/2014 � Knows people who should be at the table � Arbitrator � Lobbyist or marketer � Alberta Heritage Foundation for Medical Research, 2004 11 � Not just moving but transforming knowledge "Brokered knowledge is knowledge made more robust, more accountable, more usable; knowledge that 'serves locally' at a given time; knowledge that has been de- and reassembled“ � Real value = creating relationships � Meyer M 2010 12 6
25/06/2014 Expanding our understanding of K*. A concept paper emerging from the K* conference held in Hamilton, Ontario, Canada, April 2012 13 (1) to make evidence more accessible and tailored ( knowledge management ) (2) to facilitate mutual learning ( linkage and exchange ) (3) to develop skills and capacity for EIP ( capacity building ) � Robeson et al, 2008; Chew et al, 2013 14 7
25/06/2014 � Essential characteristics: � knowledge, skills and credibility in all worlds � extensive network of key stakeholders � ability to facilitate reciprocal understanding � ability to discern potential new linkages � Meagher L & LyallC, 2013; Sebba J 2013 15 The Research Research Professional & Practice & Practice University Association Dept of PABC PHCRI VCHRI PT Established May 2009 16 8
25/06/2014 Develop Research Develop Practice Support Capacity for EIP Resources Webinars Decision-making Incorporate tools Develop Implementation resources for Science enhancing EIP Toolkits skills & KT principles 17 � 12 projects � 200 clinicians, researchers & decision makers � 8 grants totalling ~$1,200,000 � 14 publications � Development of 11 practice resources � 13 webinars 18 9
25/06/2014 � Researcher Push � User Pull � Linkage and Exchange Lavis et al. 2003 19 Monitor Knowledge Use Select, Tailor, Implement Interventions KNOWLEDGE CREATION Evaluate Outcomes Knowledge Assess Inquiry Barriers to Knowledge Use Synthesis Sustain Knowledge Products/ Use Tools Adapt Knowledge to Local Context Identify Problem Identify, Review, Graham 2006 Select Knowledge 20 10
25/06/2014 � Engage stakeholders � ‘Translate’ for local audience � Transparent reporting of information, including limitations 11
25/06/2014 23 � Given that � PTs are primary care practitioners � Cspine trauma may be life threatening or life altering � Xrays are associated with long-term health risk � xrays contribute to health care costs � It is therefore critical that � PTs identify the most appropriate patients , with potentially serious injuries, and refer them to a GP or to ER for imaging & appropriate medical management 24 12
25/06/2014 The Team – 1 researcher – 1 student – 4 expert clinicians +3 for implementation phase The Goals 1. Increase awareness 2. Increase adoption 25 � Lay foundation � Team members (initially & at implementation) � Roles � Establish process � Format & framework � Synchronous with KT principles (KT course) � Facilitate discussions � Secure participation of stakeholders � Funders, private sector partner � Access resources � Supports � MSc position for evaluation � Ensure ‘on track’ 26 13
25/06/2014 � PABC members who were also members of the Orthopaedic or Sport Physiotherapy Divisions of the CPA (N=889) � Online survey conducted January 28 – May 15, 2013. � 467/889 completed the survey (52%) � 41% had heard of the Canadian C-Spine Rule 27 � Hypothetical cases � Case 1: X-ray not indicated but 43% would have recommended an X-ray � Case 2: 95 % correctly identified that X-ray indicated, however, the reasons were in conflict with the Csp Rule 28 14
25/06/2014 The rule is too rigid 1. Doctors may believe that this is not the PT’s 2. role or within physiotherapy scope of practice a) I am afraid I may miss serious injuries 3. b) I think clinical judgement is as good or 3. better I may forget the details 5. 29 � Laminated flow sheet (85%) � Resource on PABC website (55%) � Course/webinar (40%) � Email reminders (25%) � Ability to contact knowledgeable colleague (18%) 30 15
25/06/2014 Barrier Targeted Evaluation intervention Feel unsure of what is Involve clinicians in Structured interviews - best management providing input knowledge (Knowledge gap) Feel incompetent in Provide & record Structured interviews – using tool webinars re how to use confidence ( Self efficacy gap) toolkit (case histories) Feel there is limited Develop video with Structured interviews – added value in using tool champions using the tool attitude (Attitude gap) Feel there is not enough App Structured interviews – time to use tool attitude (Attitude gap) 31 � Laminated sheets � Video � Demo with ‘respected clinician’ � Webinar � Template of letters to GP � QxMD Calculator � Social media campaign � Next step: evaluation 32 16
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25/06/2014 https://www.mediafire.com/?0q4 b7xa5ikwk51y Video 36 18
25/06/2014 � Primary Stakeholder impacted: GPs � Initial awareness � Template of letter for individual PTs/clinics to send to GPs re the initiative � Template of letter for individual PTs/clinics to send to GPs when referring a patient back for imaging � Information for PTs re how to use the letter and strategies to enhance the relationship 37 � Curriculum: � Incorporating into � Pre-licensure training � Continuing education - Sports Physiotherapy Division - Orthopaedic Specialization 38 19
25/06/2014 Monitor Knowledge Use Select, Tailor, Implement Interventions KNOWLEDGE CREATION Evaluate Outcomes Knowledge Assess Inquiry Barriers to Knowledge Use Synthesis Sustain Knowledge Products/ Use Tools Adapt Knowledge to Local Context Identify Problem Identify, Review, Graham 2006 Select Knowledge 39 � SuPRA: Does PT coaching + a wearable digital tracking system improve physical activity in people with knee osteoarthritis � KB connected researchers with Physiotherapy Association of BC to develop: � The project idea � The study procedure � The KT plan 40 20
25/06/2014 � IMPAKT-HiP : What is the relationship of FAI, physical activity and hip osteoarthritis? � KB output: � Plain language summary � Press releases � Facebook, Twitter � Community forums – English-speaking, Cantonese/Mandarin speaking and Indigenous communities 41 42 21
25/06/2014 � Limited certified training � No regulation � No template � No established funding structure � No established evaluation criteria � Undefined scope � Paucity of additional training � Lack of a clear career pathway � Chew et al. 2013; Lightowler & Knight 2013 43 � Seek partners to develop KB positions - practice, research, academic � Undertake KT training � CIHR Knowledge Translation Canada Summer Institute � Sick Kids Scientist Knowledge Translation Training Workshop � Foundations of KT course � NIH Training Institute on Dissemination and Implementation Research in Health 44 22
25/06/2014 � Knowledge translation in healthcare: Moving from evidence to practice (Straus et al) � Sick Kids KT Plan Template 45 Alison.hoens@ubc.ca lli@arthritisresearch.ca 46 23
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