Transcript Slide 1

Translating Research into
Policy & Practice
KNOWLEDGE INTO ACTION
DAVE MURDAY
CENTER FOR HEALTH SERVICES & POLICY RESEARCH
Health Disparities
Racial and ethnic minorities continue to carry an
unequal share of disease burden and deaths for
various health conditions in South Carolina
 Death rates among minorities for both cancer
and heart disease are nearly 1.5 times that of
whites.
 Racial and ethnic minorities are more than 3
times more likely to die of diabetes and are 2
times more likely to die of stroke than whites.
DHEC Healthy People Living in Healthy Communities (2008)
RAND/McGlynn 2003 Study
RAND/McGlynn 2003 Study
RAND/McGlynn 2003 Study
RAND/McGlynn 2003 Study
 Overall, participants received about half of
the recommended processes involved in care.
 Deficits in processes involved in primary and
secondary preventive care are also associated
with preventable deaths.
 The gap between what we know works and
what is actually done is substantial enough to
warrant attention.
Knowledge Into Action
 Quality – health care that is effective,
efficient, up-to-date, and timely.
 Providing the right care, at the right time, for
the right person, in the right way.
 Up to two decades may pass before research
findings become part of routine clinical
practice, if ever.
Institute of Medicine (2003)
 “Unequal Treatment: Confronting Racial and
Ethnic Disparities in Health Care”
 Racial and ethnic minorities tend to receive a
lower quality of healthcare than nonminorities, even when access-related factors,
such as patients’ insurance status and
income, are controlled.
Institute of Medicine (2003)
 As in the case of studies of cardiovascular
disease, evidence suggests that disparities in
cancer care are associated with higher death
rates among minorities.
Klonoff (2009)
 Despite almost 30 years of recognition that
there exist real differences in the treatment
being provided to patients based on their
ethnicity or racial group, there is still little
understanding of the factors that underlie
these differences.
Klonoff (2009)
 While some evidence suggests that the gaps
are narrowing, other data suggest that
differences still exist for very serious
procedures and treatments, and that these
differences could contribute to differential
mortality and morbidity.
Knowledge Into Action
 Three stories:
 Clemson Extension
 Popular Mechanics Article
 Flossing teeth
American Heart Association
Knowledge Into Action
 Three Initiatives
 AHRQ: Translating Research Into Practice
(TRIP)
 NIH Roadmap: Centers for Clinical &
Translational Research
 Canadian Institute of Health Research:
Knowledge Translation (KT)
AHRQ Framework
AHRQ TRIP: Barriers
 Competing priorities
 Lack of buy-in
 Don’t believe change is necessary
 Don’t believe intervention is effective
 Lack skills, resources needed to implement
 Aspects of intervention were unacceptable
locally
Other Barriers
 Physician level – not knowing guidelines
exist, disagreeing with content, blame
patient
 Patient level – beliefs, time, trust, financial
limitations
 System level – patient volume, resource
constraints, not having right information at
right place and time
 Clinical inertia
Strategies
 Performance gap assessment
 Continuing education
 Academic detailing/educational outreach
 Audit and feedback
 Decision support/alerts/reminders
 Opinion leaders/change champions
 Continuous quality improvement
AHRQ TRIP
 Knowledge into action is linear:
 Scientific discovery
 Synthesis
 Dissemination
 Develop guidelines/best practices/treatment
protocols
 Implementation of performance indicators
 Quality improvement
Clinical and Translational
Science Award (CTSA) Consortium
 Led by the National Center for Research
Resources (NIH/NCRR), this national network
of medical research institutions is working
together to accelerate the process of turning
laboratory discoveries into treatments for
patients, to engage communities in clinical
research efforts, and to train the next
generation of clinical and translational
researchers.
NIH CTSAs
 39 CTSA centers so far, 60 by 2012, MUSC
likely this year
 Accelerate the movement of scientific
findings into practice via translational
research
 Two types of translational research
 T1 (bench to bedside)
 T2 (bedside to community)
 Linear model
NIH CTSAs
 T1 translational research (ID new treatment)
 Basic science (bench science, animal studies)
 Pilot studies
 Efficacy trials (traditional clinical trials)
 T2 translational research
 Effectiveness trials (real world patients/settings)
 Dissemination research (conditions that support
or impede adoption of new interventions)
Institute of Medicine
 T1 - The transfer of new understandings of
disease mechanisms gained in the laboratory
into the development of new methods for
diagnosis, therapy, and prevention and their
first testing in humans.
 T2 - The translation of results from clinical
studies into everyday clinical practice and
health decision making.
NIH CTSAs
 CTSAs are more skewed toward T1
 Biomedical funding is more skewed toward
T1
 Grant mechanisms, academic incentives and
training all geared toward T1 research
 T2 struggles more with human behavior and
organizational inertia, resource constraints,
and the messiness of proving the
effectiveness under conditions that
investigators cannot fully control.
CIHR Knowledge Translation
 KT goes beyond dissemination and diffusion,
is an ongoing and iterative process that
requires the active participation of both
researchers and research users (policy,
practice)
 “Bringing decision makers who can use the
results of a particular piece of research into
its formulation and conduct is the best
predictor for seeing the findings applied”
CIHR Knowledge Translation
 Research can have an impact on:
 Agenda-setting,
 Policy formulation
 Implementation
 Evaluation
 Research findings must be translated into
information that is meaningful to
practitioners.
CIHR Knowledge Translation
 Push, to signify that researchers need to do a
better job of communicating their results to
the world of practice;
 Pull, to signify that practice organizations
need to become more evidence-based in
their policy making; and
 Exchange, to signify that, from the
beginning, research is designed to be
attentive to the needs of practice
CIHR Knowledge Translation
 KT involves an active exchange of information
between the researchers who create new knowledge
and those who use it.
 KT strategies and activities vary according to the
type of research to be translated (e.g., biomedical,
clinical, health services and policy or population and
public health) and the intended audience (e.g., other
researchers, front-line practitioners, health system
managers, policy-makers or the general public).
 Bringing users and creators of knowledge together
during all stages of the research cycle is fundamental
to successful KT.
Canadian KT Model
Two Stage Knowledge to Action
 Knowledge Creation Cycle
 Knowledge comes from many sources and includes
clinical and personal experience as well as research.
 Knowledge is sifted through filters, becoming more
distilled and more useful to stakeholders.
 It moves from inquiry (asking the right questions),
through synthesis (pulling together research and
information from other sources), to products
(delivering the right information in the right format).
 In the final phase, guidelines and decision aids are
designed and distributed to influence the behavior of
stakeholders.
Two Stage Knowledge to Action
 Action Cycle
 Identify a problem that needs addressing;
 Identify, review, and select knowledge relevant to the
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problem;
Adapt this knowledge to the local context;
Assess the barriers to using the knowledge;
Design transfer strategies to promote use of
knowledge;
Monitor knowledge diffusion throughout the user
group;
Evaluate the impact of the users’ application of the
knowledge; and
Sustain the ongoing use of knowledge by users.
Obama & Science of Change
 Time Magazine, April 2, 2009
 Consortium of Behavioral Scientists
 "A Record Turnout Is Expected."
 The most powerful motivator for hotel guests
to reuse towels, national-park visitors to stay
on marked trails and citizens to vote is the
suggestion that everyone is doing it.
Obama & Science of Change
 "People want to do what they think others
will do, the Obama campaign really got that.“
 "It was amazing to have these bullet points
telling us what to do and the science behind
it.”
 Obama is betting his presidency on our ability
to change our behavior. His top priorities —
the economy, health care and energy — all
depend on it.
Obama & Science of Change
 Basically, we need to make better choices —
about mortgages and credit cards, insurance
and retirement plans — so we won't need
bailouts down the road.
 The problem, as anyone with a sweet tooth,
an alcoholic relative or a maxed-out Visa card
knows, is that old habits die hard.
Obama & Science of Change
 We've got plenty of gurus, talk-show hosts
and celebrity spokespeople badgering us to
save energy, lose weight and live within our
means, but we're still addicted to oil, junk
food and debt.
 It's fair to ask whether we're even capable of
changing.