PTNow.org: Teaching to Advance Knowledge to Action

The Problem Too Much Information, Too Little Time: Evidence-Practice Gap Evenson AE, Sanson-Fisher R, D’Este C, Fitzgerald M. Trends in publications regarding evidence-practice gaps: a literature review. Implementation Sci. 2010;5:11.

Knowledge Translation (KT) Gaps between knowledge – Patients, health care providers, and policy-makers KT uses high-quality knowledge in processes of decision making Moving knowledge into action involves applying research to patient care – Assists clinicians in best practice – Reduces unwanted variability – Improves outcomes for patients – Is efficient and cost effective Straus SE, Tetroe J, Graham I. Defining knowledge translation. CMAJ. 2009;181(3- 4):

The Gap Between Evidence and Decision Making year gap from bench to bedside KT fills the gap between knowledge and practice Also called Knowledge to Action (K2A) Mycustomer.com Research Practice K2A Knowledge Action Green LW. Making research relevant: if it is an evidence-based practice, where’s the practice-based evidence? Fam Pract. 2008;25(suppl 1):i20‐24

Why Does the Gap Exist? Knowledge creation and dissemination are not enough to ensure use in the field Interventions not described in ways that can be replicated Too much information, too little time Lack of skills and confidence in critical appraisal Inadequate analysis and resources aimed at eliminating barriers Glasziou P, Meats E, Heneghan C, Shepperd S. What is missing from descriptions of treatments in trials and reviews? BMJ. 2008;336:1472–1474. Evenson AE, Sanson-Fisher R, D’Este C, Fitzgerald M. Trends in publications regarding evidence-practice gaps: a literature review. Implementation Sci. 2010;5:11.

Knowledge Synthesis Have to begin with knowledge Primary literature consumption is not feasible on a large scale for impacting clinical behaviors An internist must read 34 primary literature articles daily to stay current in the field Synthesis documents are excellent resources Straus Defining Knowledge Translation CMAJ August 4, 2009 vol. 181 no. 3-4 Clinical Practice Guidelines Systematic Reviews PTNow Stroke Engine

Synthesis Documents Clinical Practice Guidelines (CPGs): Statements that include recommendations intended to optimize patient care that are informed by systematic review of evidence and assessment of benefits and harms of alternative care options Cochrane Reviews APTA and Section EDGE documents

PTNow in a Nutshell

Multi-Tool for Practitioners Translation tool Translating research to practice Implementation tool Assist in implementing evidence to care Collaboration tool Sharing information when evidence is lacking

Examination Translate to the practitioner Don’t just tell me what to do—give me the resources

What to Do With All This Information Need trigger that results in team wanting to “change” practice or implement something new – Question in practice arises – Evidence for something is created or found – There is a gap between the new information and the current practice pattern

Adapt Knowledge to Local Context What needs to be adjusted to fit into your practice setting and area? – Example: Guidelines may span care for a condition from acute through chronic — you need to edit to match just acute care components for your inpatient hospital setting Graham ID, Logan J, Harrison MB, et al. Lost in translation: time for a map? J Contin Educ Health Prof. 2006;26(1):13-24.

Fall Risk/Prevention Program

Who Should Be Screened for Fall Risk?

Fall Risk Factors Previous falls (RR= ) Balance impairments (RR= ) Decreased muscle strength (RR= ) Vision impairment (RR= ) >4 medications or psychoactive medications (RR= ) Gait impairment (RR= ) Depression Dizziness or orthostatic hypotension Functional limitations or limitations in activities of daily living (ADL) Disabilities Age > 80 years old Female Low body mass index Urinary incontinence Cognitive impairment Arthritis Diabetes Pain Fall Risk: 8% risk for 1 factor 78% risk for 4 or more factors

Perform Physiologic, Impairment and Performance Measures

Implement comprehensive training

Clinical Sustainability Audit and FBCelebrateAccountabilityOutcome Clinical Champions