1. A Model for Translating Research into Practice in the United States - Mexico Border Region Howard J. Eng, MS, DrPH Director, Southwest Border Rural Health Research Center Rural Health Office Mel and Enid Zuckerman College of Public Health The University of Arizona United States - Mexico Border Center of Excellence Consortium Arizona State Conference April 30, 2009

2. Presentation Overview  Translational Research Overview of Translational Research Overview of Translational Research Examples of Translational Research Models Examples of Translational Research Models  U.S.-Mexico Border  A Model for Translating Research into Practice in the U.S. –Mexico Border Region

3. Translation Research © 2010 College of Medicine

4. Translational Research  Apply scientific discoveries to health professional practice  Include basic, clinical, epidemiological, health services, intervention/evaluation, etc…  Implement into community health and medical professional practice  Reduce or delay the incidence, morbidity, and mortality of acute and chronic diseases  Can use different models to apply research results into health professional practices

5. Translational Research Models  Universities Johns Hopkins’ Quality and Safety Research Group’s Translating Evidence into Practice Model Johns Hopkins’ Quality and Safety Research Group’s Translating Evidence into Practice Model  Health Professional Associations American Heart Association’s Improving Evidence-Based Medicine Model American Heart Association’s Improving Evidence-Based Medicine Model  Federal Health Agencies National Cancer Institute’s Translational Research Model National Cancer Institute’s Translational Research Model National Center for Chronic Disease Prevention and Health Promotion’s Translational Research Model National Center for Chronic Disease Prevention and Health Promotion’s Translational Research Model Agency for Healthcare Research and Quality Knowledge Transfer Framework Agency for Healthcare Research and Quality Knowledge Transfer Framework

6. U.S.-Mexico Border © 2010 College of Medicine

7. The United States – Mexico border extends for 1,952 miles (3,141 kilometers), stretching from the Gulf of Mexico to the Pacific Ocean. The1983 La Paz Agreement defined the border area as the land within 100 km (62.5 miles) on either side of the international boundary. U.S.-Mexico Border Source: PAHO/WHO Health in the Americas 2007

8. U.S.-Mexico Border States

9. Arizona-Sonora Border Cochise County Border = 87 miles Santa Cruz County Border = 60 miles Pima County Border = 133 miles (Tohono O’odham Nation = 80 miles) Yuma County Border = 97 miles Total Border = 377 miles *** *

10. Agency for Healthcare Research and Quality Knowledge Transfer Framework © 2010 College of Medicine

11. Agency for Healthcare Research and Quality Knowledge Transfer Framework Source: Nieva VF, et al. From Science to Service: A Framework for the Transfer of Patient Safety Research into Practice, Advances in Patient Safety, Vol 2. p.441-453

12. Agency for Healthcare Research and Quality Knowledge Transfer Framework Knowledge Creators (Researchers)  Universities  Government Agencies  Research Institutions  Private Companies  Health Care Providers Physician Offices Physician Group Practices Community Health Centers Clinics Hospitals Long Term Facilities Pharmacies Public Health Departments

13. Agency for Healthcare Research and Quality Knowledge Transfer Framework Research Types (Innovation)  New Drugs  New Medical Devices  New Health Technologies  New / Modified Diagnostic Procedures  New / Modified Treatment Protocols  New / Modified Surgical Procedures  New / Modified Health Programs  Changes in the Delivery of Care  New Health Care Delivery Systems

14. Agency for Healthcare Research and Quality Knowledge Transfer Framework Distillation of Knowledge  Who does the distillation? Researchers Expert Panels Professional and Policy Associations Federal Health Agencies  How is it distillated? Evidence Summaries / Syntheses Papers Consensus Processes for Decision Making Criteria Selection Effectiveness comparisons Cost benefit analysis Evidence need for the change Transportability to real life conditions Acceptance by practitioners and patients Adoptability by the health care system

15. Agency for Healthcare Research and Quality Knowledge Transfer Framework Diffusion and Dissemination  Creation of Dissemination Partners  Determination of the Targeted Health Professions  Diffusion and Dissemination Methods Academic and professional journals Professional newsletters Professional conferences Professional associations Websites Fact sheets Workshops / Webcasts Professional continue education presentations

16. Agency for Healthcare Research and Quality Knowledge Transfer Framework Adoption and Implementation  Review New Innovation(s) Processes Treatments Programs  Decision Levels (PRN) Health Care System Health Facility Practitioner  Implementation Notification of new innovation change(s) Adjusting to any cultural needs of border patients Training of the health care team Pilot testing the new Innovation Overcoming the barriers to change Evaluating the innovation implementation

17. Agency for Healthcare Research and Quality Knowledge Transfer Framework Institutionalization  Successfully adopted Practitioner Level Facility Level Health Care System Level  Approval by external organizations Regulatory Agencies Credentialing Agencies

18. Agency for Healthcare Research and Quality Knowledge Transfer Framework Source: Nieva VF, et al. From Science to Service: A Framework for the Transfer of Patient Safety Research into Practice, Advances in Patient Safety, Vol 2. p.441-453 Feedback to Decision Maker on Adoption* *Note: Conference participants recommended adding a feedback loop to the Framework to provide the decision makers information on the adoption level.

19. Questions? Thank You! © 2010 College of Medicine

20. Contact Information Howard J. Eng, MS, DrPH Director Southwest Border Rural Health Research Center Rural Health Office Mel and Enid Zuckerman College of Public Health P.O. Box 245177 1295 N. Martin Ave. Tucson, Arizona 85724 hjeng@email.arizona.edu (520) 626-5840