Karen M. Emmons, Ph.D. Vice President for Research, Kaiser Permanente

Transcription

1 Dissemination & Implementation of Evidence-Based Strategies IOM Committee, Ovarian Cancer State of the Science, April 7, 2015 Karen M. Emmons, Ph.D. Vice President for Research, Kaiser Permanente

2 Assumptions: - Focus is on providers and patients - Looking at dissemination of current knowledge, towards implementation of future evidence-based practices

3 What Is It? Dissemination: Targeted distribution of information or intervention materials to a specific audience Implementation: The use of strategies to adopt and integrate EBIs and change practice patterns in specific settings 3 April 10, Kaiser Foundation Health Plan, Inc. For internal use only.

4 Spread of Innovations Greenhalgh, Robert, Macfarlane, Bate, Kyriakidou, April 10, Kaiser Foundation Health Plan, Inc. For internal use only.

5 Dissemination Targeted distribution of information or intervention materials to a specific audience Outgrowth of work in diffusion or how innovations spread We know that: Dissemination of scientific evidence does not occur spontaneously Passive approaches are largely ineffective Single source messages are less effective than multiple source/level approaches The process of dissemination needs to be tailored for different audiences 5 April 10, Kaiser Foundation Health Plan, Inc. For internal use only.

6 Strategies for Dissemination To Providers Reach strategies: Journal articles, social/mass media, national quality campaigns Motivation strategies: Knowledge Brokers, champions, social/professional networks Ability strategies: Academic detailing, skills-building interventions AHRQ (2012) review found little evidence for differential impact Multicomponent and active strategies are best 6 April 10, Kaiser Foundation Health Plan, Inc. For internal use only.

7 Strategies for Dissemination To Patients Reach strategies: Mail, , phone; social/mass media, national campaigns Motivation strategies: providers, trusted others, champions, social networks Ability strategies: Skills-building interventions, role models, efficacy AHRQ (2012) review found little evidence for differential impact, including multicomponent strategies 7 April 10, Kaiser Foundation Health Plan, Inc. For internal use only.

8 Key Strategies for Communication with Patients Washing Chicken Spreads Salmonella Pathogen Estimated annual illnesses Estimated annual hospitalizations Estimated annual deaths Salmonella spp., nontyphoidal 1,000,000 19, Don t Wash Your Chicken! Narratives are better than statistics Tailoring and targeting may be helpful Communications tied to actions that can be taken are most effective 8 April 10, Kaiser Foundation Health Plan, Inc. For internal use only.

9 Use and Quality of Health Content on Social Media 58% of US adults have a smart phone (90% cell phone) 87% of adults use internet; 68% through mobile devices Pew Research Center, Updates, April 10, Kaiser Foundation Health Plan, Inc. For internal use only.

10 Use and Quality of Health Content on Social Media 58% of US adults have a smart phone (90% cell phone) 87% of adults use internet; 68% through mobile devices ~ 2 B tweets/week; 150M users Misunderstanding- 6% of anti-biotic-related tweets (Scanfeld, 2010); inaccuracies in 8% of concussion-related tweets (Sullivan, 2012) Only 14% of Twitter-delivered smoking cessation programs had guidelines consistent content (Prochaska, 2012) Pew Research Center, Updates, April 10, Kaiser Foundation Health Plan, Inc. For internal use only.

11 Centrality of the patient doctor encounter between social and professional/provider networks 11 April 10, 2015 Griffiths, 2011 Cave, Kaiser Foundation Boardman, Health Plan, Ren, Inc. Pawlikowska, For internal use only. Ball, Clarke, Cohen, 2012

12 Implementation Using the disseminated information The use of strategies to adopt and integrate EBIs and change practice patterns in specific settings We know that: Guideline dissemination is insufficient Relationships are important Health systems are continuously adapting Implementation requires top-down AND bottom-up strategies 12 April 10, Kaiser Foundation Health Plan, Inc. For internal use only.

13 Resources and possibilities for agents contributions to implementation processes (May, 2013) Contribution Capability Capacity (Social-structural resources available to agents) (Possibilities presented by the complex intervention) Contribution (What agents do to implement a complex intervention) Potential (Socialcognitive resources available To agents)

14 KP The Hypertension Control Story Transformative impact of asking: WHO: Creation of HT registry WHAT: Reduced variation in BP measurements HOW: Use of non-physician providers Sim, et al, April 10, Kaiser Foundation Health Plan, Inc. For internal use only.

15 Conceptual Model of Implementation Research (Proctor, et al, 2010) Intervention Strategies Implementation Strategies Outcomes Evidence- Based Practices Systems Environment Organizational Group / Learning Supervision Individual Providers / Consumers Implementation Outcomes Feasibility Fidelity Penetration Acceptability Sustainability Uptake Costs Service Outcomes* Efficiency Safety Effectiveness Equity Patient- Centeredness Timeliness Client Outcomes Satisfaction Function Symptomotology *IOM Standards of Care Implementation Research Methods 15 April 10, Kaiser Foundation Health Plan, Inc. For internal use only.

16 Blueprint of Effective Strategies in the Dissemination and Implementation of Evidence-Based Practices through a National Quality Campaign Strategy 1 Highlight evidence base and relative simplicity of recommended practices Strategy 2 Strategy 3 Strategy 4 Strategy 5 Strategy 6 Strategy 7 Strategy 8 Align the campaign with the strategic goals of the adopting organizations Increase recruitment by integrating opinion leaders into the enrollment process and employing a nodal organizational structure Form a coalition of credible campaign sponsors Generate a threshold of participating organizations that maximizes network exchanges Develop practical implementation tools and guides for key stakeholder groups Create networks to foster learning opportunities Incorporate monitoring and evaluation of milestones and goals Yuan, et al. (2010). Commonwealth Fund

17 When has an issue arrived? Ovarian Cancer Prevention What is ready for dissemination? To whom? What is ready for implementation in practice? Risk factors for ovarian cancer Family history Inherited risk HRT Talc Weight and height Protective factors for ovarian cancer Oral contraceptives Tubal ligation Breastfeeding Risk-reducing salpingooophorectomy