Bridging the Gap Between Research and Practice: Building an Enterprise Knowledge Translation System to Optimize Military Healthcare

Transcription

1 Bridging the Gap Between Research and Practice: Building an Enterprise Knowledge Translation System to Optimize Military Healthcare Copyright 2018 by Engility. Permission granted to INCOSE to publish and use. Aaron Sawyer, PhD, PMP Program Manager and Technical Fellow INCOSE SE in Health Care Conference 2018 April 2018

2 Systems Engineering + Knowledge Translation Systems Engineering (SE) provides the mechanism to develop a consistent systemof-systems approach for Knowledge Translation (KT) KT is a standardized yet adaptable process that aims to identify and bridge the gaps between medical research and clinical practice 2

3 What s the Problem? It takes 17 years to turn 14 percent of original research to the benefit of patient care. David Chambers, National Cancer Institute In the Military Health System (MHS), the pattern is the same: KT processes are variable and inefficient Many solutions lack a demonstrable return on investment Data on system performance are often absent or inadequate 3

4 Meet the Military Health System The Military Health System (MHS) is a global organization serving 9.4 million beneficiaries, including active duty Service members, retirees, and dependents Care environments range from traditional hospitals to ships and aircraft to austere field environments and humanitarian missions TRICARE also provides funding for private sector purchased care 4

5 A Complex and Changing System The Department of Defense (DOD) funds research, builds and buys solutions, trains and equips providers, and employs and insures the patient population MHS is composed of a web of interrelated systems operated by the Defense Health Agency (DHA) and military Service branches (Army, Air Force, Navy/Marine Corps) MHS is changing rapidly: o o o DHA will begin managing all military hospitals in October 2018 MHS GENESIS combines more than 50 data systems and is being rolled out as a centralized electronic health records (EHR) system Calls for increased integration and modernization across DoD and the Department of Veterans Affairs are abundant 5

6 SE +KT SE approaches provide a way to break down complexity and overlay KT best practices across MHS s fragmented systems to drive integration and efficiency that will get evidence-based tools to providers faster, thereby shrinking the research-to-practice gap. 6

7 Conceptual Approach to Systems Integration CURRENT STATE FUTURE STATE Fragmented Systems Systems Integration Integrated System of Systems 7

8 KT Model 1.0: Component-Level Integration Generalizable Knowledge Translation Activities Over Time Needs and Gaps Identification KTSC 1.3 Identify Gaps & Prioritize External Evidence Review Required? (Model Decision 1) Yes No 2.8 Review KTPP Recommendations Decision to Translate? (Model Decision 2) No Yes Periodic Updates to KTSC Start/Finish Point Process Step Legend KTSC SRC Service Lead Site Leadership Strategic Analysis Solution Material Development Dissemination Implementation Center & Site Leadership, KTWG Service Representative(s) SRC 2.1 KTPP Submission & Screening 2.2 Peer Review Evaluation 2.3 Formulate Analytic Framework & Key Questions 2.4 Perform External Evidence Review 2.5 Review KTPP & Validate Needs 2.7 Prioritize KTPP & Submit with Recommendations 2.6 Complete KT BCA Element 3-5 Planning Begins Inform Submitter KTPP not Recommended No 3.1 Plan & Develop Solution Material 4.1a Complete Stakeholder List & Create Audience Profile Output: Finalized Solution Material Yes Solution Material Ready for Review? 3.2 Solution Material User Feedback 4.2 Update Environmental Scan 3.3 Complete Quality Review No Adjust as Needed Dissemination Plan Approved? 4.3 Develop Dissemination Plan Yes BCA - KT - KTPP - KTSC - KTWG - SRC - 5.2b Establish & Train Implementation Team 5.2a Build Site Capacity Provide Ongoing Support Decision Point Optional Steps Critical Hand-off No Yes No Disseminate? Adjust as Needed 4.4 Pilot Dissemination Plan KTWG 4.5 Execute Dissemination Plan Organization Leadership PH/TBI KT Work Group(s) Acronyms Implementation Plan Approved? 5.3 Refine Generic Implementation Plan Yes 5.4 Execute Implementation Plan Adjust as Needed Evaluation Sub-process Exists Feedback Loop Ongoing Evaluation 4.1b Site Selection 5.1 Develop Generic Implementation Plan & Training Package Evaluate Dissemination Activities Evaluation and Monitoring PH KT Work Group TBI KT Work Group 1.1 Monitor Emerging Knowledge, Practices & Needs 1.2a Analyze Needs 1.2b Analyze Solutions 8

9 KT Model 1.0: Core Elements Element 1: Needs and Gaps Assessment uses a systematic process to actively monitor research developments, clinical best practices and operational requirements in order to identify and prioritize evolving needs, emerging solutions and current gaps. Element 2: Strategic Analysis begins with the submission and review of proposed ideas, solutions or innovations that address identified gaps. A business case is built using available evidence, expert opinions, and cost and feasibility estimates. Element 3: Solution Material Development describes how materials are developed, refined and approved to support translation of the knowledge solution identified in the Strategic Analysis process. Element 4: Dissemination involves sharing of the solution with target audiences through planned strategies, including defining target audiences, selecting communication channels, environmental scans, and customization of materials. Element 5: Implementation seeks to integrate a solution into operational practice to produce individual and organizational behavior change required to achieve ultimate outcomes. Planning is phased to allow piloting, refinement, and scaling. Evaluation and Monitoring of the effectiveness and impact of the model, processes and knowledge solution occur throughout and include feedback loops to ensure continuous improvement. 9

10 KT Model 2.0: Enterprise-Level Integration Key Features and Benefits Builds on well-supported KT and project management best practices encompassed in KT Model 1.0 Research to Practice Integration (RPI) Operational Activity Model (OV-5b) Incorporates SE best practices and multidimensional views through use of Cameo Systems Modeler TM Based on DoD Architecture Framework v2.02 for seamless integration and interoperability with existing technologies and systems Breaks down organizational complexity into generalizable model that can be tailored for specific use cases (e.g., specific solutions, system components, or clinical target areas) Champions and stakeholder input will be gathered from across the KT lifecycle to ensure accuracy and completeness 10

11 3 Establish relationships with champions 5 Pilot and scale to full operational capability The Road Ahead INPUT 1 Build on existing KT framework and MHS structures OUTPUT Well-defined, datadriven system of systems to enable research-practice integration 2 Apply SE expertise and techniques to develop system model 4 Socialize, refine, and operationalize model 11

12 Ultimate Outcomes: Quadruple Aim Better Care Better Health Lower Cost Increased Readiness Robust KT will enhance the quality of care by moving more research-based solutions to the field faster Providers adopting evidenced-based practices and tools will improve health outcomes for their patients Efficiency will increase by defining pathways, aligning needs with expenditures, and continuously evaluating outcomes The latest tools and open communication between researchers and practitioners produce a ready medical force (providers) and a medically ready force (patients) 12

13 Progress to Date and Lessons Learned Key Accomplishments Developed and tested a generalizable KT model within one segment of MHS Secured buy-in from 30+ MHS R&D units on structure for advanced planning embedded within research funding process Supported several projects related to mobile health technology, behavioral health, and traumatic brain injury applied KT best practices for segments of the KT lifecycle Engaged a team of systems engineers to detail a comprehensive enterprise organizational model for research-practice integration now being socialized across MHS Lessons Learned Communication is a key to success, to manage expectations, clarify terminology, identify resources and expertise needed, and find a balance between the ideal and reality A flexible structure is needed to allow for changes of plans and priorities, while also permitting novel frameworks Champions must be engaged at multiple levels (leadership, collaborating organizations, sites) to advance implementation of new practices and overcome barriers 13

14 Contact Us Our Website: www. Contact Information: Aaron Sawyer, PhD, PMP Program Manager, Defense and Security Group Technical Fellow

15 Thank you for attending! Share your experiences at #HWGSEC 15

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