Better Improvement Research Resources download from: http://homepage.mac.com/johnovr/FileSharing2.html 1 John Øvretveit, Director of Research, Professor, Karolinska Medical Management Centre Sweden and Professor of Health Management, Faculty of Medicine, Bergen University 03/22/22
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Recognition of AHRQ & researchersYou are making a difference…
Just some achievements : Shojania ed 2001 700 page review of safety interventions
Quality and safety indicators
Culture survey
Team STEPS & other tools
Innovations exchange
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Achievements
Notable research funded by AHRQ:
Closing the quality gap series http://www.ahrq.gov/clinic/epc/qgapfact.htm
Henriksen K, Battles JB, Marks ES, Lewin DI, editors. Advances in patient safety: from research to implementation. Vol. 1, Vol2. Vol 3 implement Vol4 AHRQ Publication No. 05-0021-1. Rockville, MD: Agency for Healthcare Research and Quality; Feb. 2005.
Shown excellence, but now challenges# 1: Is it effective? (for many types of QSI)
# 2: Why?: causal model
# 3: Who cares anyway? - More useful to research users
# 3a: How to implement it?
# 3b: Researcher-user interaction: use knowledge translation res/K to shape question and enable users to use
= Exciting opportunity for research innovation
But silos6
My subject interventions to providers/organisations, not patientsevaluating non-standardisable complex interventions and implementation
strategies
Not Treatments: BBs after AMI (beta-blockers after myo cardial infarc tion)
But Intervention to get BBs given appropriately (eg Education,
guidelines, CDS, audit) Intervention to spread CDM eg Breakthrough collaborative RRT (or CRM) Development programme to lead improvement P4P for QS Accreditation: benefits for costs compared to alt?
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Distinguish
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INTERVENTION
Seed
IMPLEMENTATION STRATEGIESPlanting
CONTEXT
Soil and climate
Clinical QSI (eg prescribe BBs)
EducationGuidelinesAudit and feedbackAcademic detailing
Result: Innovation content – three shared rehabilitation units with common decision making forum
Planning Establishment Further actions and types of coordination created
Combined client/patient care planning system Development of systemsprocedures and sub structures>>>>>>>>>>>>
One management group with representatives from the county council and municipal care
Context factors help and hinder implementation at different timesGovernment policy helps planning
L3: Theory essential - of intervention pathway to outcomes
To decide which data to gather To provide explanations to test To give implementers to help them adapt.
(Program theory Weiss 1972, 1997 Rog&Fournier 1997; Logic Model Wholey 1979; Theory-driven evaluation Chen 1990, Sidani & Braden 1998; realist evaluation Henry et al 1998, Pawson & Tilley 1997; Theories Grol et al 2007)
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L4: Action evaluation learning cycle
Feedback findings during implementation + and – for science
Assess effect of researcher on implementation and results
Helps develop intervention during the implementation journey
Increases cooperation and access to data
Partnership, but distinct roles
Study how implementers use knowledge and help use more
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#4 Challenge: use – faster, wider
Demand? - Real men don’t need research
Supply? - Real researchers don’t write exec summaries Make sure unusable and ”throw over the fence”
delivery
Closing the research/practice gap
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Translation in QSI HSR
Evidence>Test>Package User>Adapt>Implement/Adjust
Development Translation 1 Implementation Translation 2
(intervention development and testing) (adoption/ spread)
What is the intervention?
Where do you draw the boundary?
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#4 Resolutions – our experience Use KT/KM literature – what works? Content: accessibility and relevance
Service implications; many examples; 3:20:Appx reports; ghost writers and mediator authors;
Engage emotionally: patient describes experience or video
Process: interact with users at each stage Structure: forums, networks, joint appointments,
brokers
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Summary
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Challenge Resolutions
Decision makers information needs
Their hierarachy of evidence
Proof of efficacy RCT/CT priceless...For all else, strengthen observational studiesParrallel process evaluationReporting