Why can't we move research
into practice? Improving the
uptake of proven evidence.
Jill Hatchette, PhD
Consulting Scientist
IDR Team
Research Services
IWK Health Centre
First of all…..
• What are we talking about when
we say “uptake of proven
evidence”?
– Dissemination?
– Synthesis?
– Exchange?
– Application?
– Knowledge Translation?
Dissemination
• Dissemination involves identifying the
appropriate audience and tailoring the
message and medium to the audience.
• Dissemination activities include:
– summaries for stakeholders
– educational sessions with
• Patients
• Practitioners
• policy makers
– engaging knowledge users in developing and executing
• implementation plan,
• tools creation
• media engagement.
CIHR
Synthesis
• The contextualization and integration of
research findings of individual research studies
within the larger body of knowledge on the
topic.
• A synthesis must be
– reproducible and transparent in its methods.
• E.g. systematic review, follow the methods
developed by the Cochrane Collaboration, result
from a consensus conference or expert panel or
synthesize qualitative or quantitative results.
• Realist syntheses, narrative syntheses, metaanalyses, meta-syntheses and practice guidelines
are all forms of synthesis.
CIHR
Exchange
• The interaction between knowledge user
and researcher, resulting in mutual learning.
– collaborative problem-solving between
researchers and decision-makers that happens
through linkage and exchange.
– mutual learning through the process of planning,
producing, disseminating, and applying existing
or new research in decision-making.
CIHR; CFHI
Ethically sound application of
knowledge
• Activities for improved health consistent
with ethical principles and norms, social
values, as well as legal and other regulatory
bodies
• Application refers to the iterative process by
which knowledge is put into practice.
CIHR
Knowledge Translation
Dissemination
+
Synthesis
+
Exchange
+
Application
Implementation
Science….KT right? No….
• Implementation research is the scientific study
of methods to promote the systematic uptake
of proven clinical treatments, practices,
organizational, and management interventions
into routine practice, and hence to improve
health.
• Research on implementation addresses the
level to which health interventions can fit
within real-world public health and clinical
service systems.
http://www.implementationscience.com/about
http://www.fic.nih.gov/News/Events/implementation-science/Pages/faqs.aspx
What does implementation
science study?
• Comparisons of two evidence-based
interventions
• How to promote the use of evidence
based guidelines.
• How to adapt an intervention to a
different population
• How to scale-up effective interventions
• The effects of a quality improvement
program
Why do we need
implementation science?
• Why can’t we just do the KT and
be done?
• Research is an iterative process.
However, the reality is….
Implementation
Science
CIHR
• The NIH identifies similar areas of
“death”
• "Research-to-program “
– research evidence is not adequately or
appropriately considered and integrated
in the development of health outcomes.
• "Research-to-policy“
– research evidence is not adequately or
appropriately considered and integrated
in the development of health policy.
Why does implementation
fail?
• Short answer?
– We just don’t DO it.
• Preconditions not there
–
–
–
–
People
Attitudes
Training
Time
• Too costly
• Too difficult
• Just doesn’t fit
How is “implementation science” going to
make implementation actually happen?
• By changing the way we think about research,
who we do research with and how we actually
do research
• Implementation science is:
– A new way of thinking
– A new, but quickly developing field
• JAMA Pediatrics call for papers for Spring 2015
– Challenges:
• Current studies and existing research are small
• Dissemination remains somewhat localized
• Scientific methods are loose
• Implementation science is inherently
interdisciplinary/multidisciplinary
– Collaboration between researchers, implementers,
policymakers, the public
– Opportunities to learn from each other
– Challenges:
• Identifying methods of bringing people together
communicating in a meaningful way, developing
a common interest, goals and language.
• Identifying the expectations of researchers and
the expectations of those involved in the
implementation of new processes.
• Implementation science is not:
– Your typically scientifically rigorous research
– Opens up many opportunities to design research in
a context that is locally relevant
– Challenges
• Researchers and funders will need to appreciate the
value of findings from studies that are more loosely
controlled than the scientific norm.
• Implementation research will require a balance
between rigor and real world application
• MUST acknowledge that rigor ≠ quality.
• Scientific rigor must be balanced with a need to
conduct research that applies to real world settings.
• Researchers must be open to a range of methods
(qualitative/quantitative) and methods existing
outside their discipline.
TRIC funded
implementation science
Erna Snelgrove-Clarke, RN, PhD Staff Nurse, Birth Unit and PSCU, IWK Health
Centre and Assistant Professor, Dalhousie School of Nursing Jennifer West,
BScN, MHS Manager, IWK Health Centre, Birth Unit
A change in the approach to how women push when they are fully
dilated, or second Stage management, has the potential to increase vaginal
deliveries, decrease cesarean births, as well as, decrease the length of
Hospital stay for mothers
Isabel Smith, PhD Psychologist, Autism Research Centre, IWK Health Centre;
Associate Professor, Department of Pediatrics, Psychology and Neuroscience,
Dalhousie University Heather Osborne-Vincent, Manager, Rehabilitation Services
IWK Health Centre and Barbara Casey, Manager, Mental Health and Addictions
Program, IWK Health Centre.
Defining a health education partnership for earlier identification and assessment of
Autism Spectrum Disorders in school aged children.
Goal is to achieve a more efficient detection and more timely diagnosis of Autism
Spectrum Disorder to improve academic outcomes for children.
Dr. Graeme M. Rocker, Head, Division of Respirology, Capital
Health, Professor, Department of Medicine, Dalhousie
University Paula Bond, VP, Acute Care, Person Centered
Health, Capital Health
Expanding the INSPIRED COPD outreach program to the
Emergency Department: assessing feasibility, effieciencies
and outcomes
Karthik Tennankore, MD, FRCPC, Division of Nephrology,
Department of Medicine, Capital Health Cynthia Stockman, RN,
BScN, MN, Health Services Manager, Outpatient Nephrology,
Capital Health
The effectiveness of an online portal for the delivery of care to
home dialysis patients.
Resources
•
http://www.fic.nih.gov/News/Events/implementationscience/Pages/implementation-science-2010.aspx
•
http://www.implementationscience.com/
•
http://www.cihr-irsc.gc.ca/e/45669.html
•
http://www.iwk.nshealth.ca/research/iwk-research-fundcompetitions
•
http://www.cdha.nshealth.ca/discovery-innovation/qeii-fdntric-grants