Contextualizing the Contextualizing the findings of a croup findings of a croup guideline knowledge guideline knowledge translation studytranslation study

Shannon Scott-Findlay, RN, PhD (c)Shannon Scott-Findlay, RN, PhD (c)Ian Graham, PhDIan Graham, PhDRena Pandya, MPHRena Pandya, MPHTerry Klassen, MSc, MDTerry Klassen, MSc, MDDavid Johnson, MDDavid Johnson, MD

AcknowledgementsAcknowledgements

Post-doctoral funding provided to Scott-Post-doctoral funding provided to Scott-Findlay by:Findlay by: Canadian Institutes of Health ResearchCanadian Institutes of Health Research and and the the Alberta Heritage Foundation for Medical Alberta Heritage Foundation for Medical

ResearchResearch

OVERALL OBJECTIVESOVERALL OBJECTIVES

To increase understanding of how a To increase understanding of how a croup CPG is transferred into practice in croup CPG is transferred into practice in the context of an implementation trial. the context of an implementation trial.

Recapping the cRCT TrialRecapping the cRCT Trial

ObjectivesObjectives determine which of the three knowledge determine which of the three knowledge

translation (KT) intervention strategies was translation (KT) intervention strategies was most effective at lowering the rate of hospital most effective at lowering the rate of hospital days per 1,000 disease episodes.days per 1,000 disease episodes.

determine which of the three dissemination determine which of the three dissemination strategies was most effective at increasing strategies was most effective at increasing the use of therapies (e.g., dexamethasone & the use of therapies (e.g., dexamethasone & epinephrine) of known benefit.epinephrine) of known benefit.

Recapping the Croup Recapping the Croup Trial (cont.)Trial (cont.)

The KT strategies that were compared were:The KT strategies that were compared were: a) mailing of printed CPG – (Standard); a) mailing of printed CPG – (Standard); b) CPG b) CPG plusplus a combination of interactive a combination of interactive

educational meetings, educational outreach visits educational meetings, educational outreach visits conducted by a self-selected local champion, and conducted by a self-selected local champion, and reminders, and reminders, and

c) a combination of mailing, interactive sessions, c) a combination of mailing, interactive sessions, outreach visits, reminders outreach visits, reminders plusplus identification of identification of local opinion leaders and establishment of local local opinion leaders and establishment of local consensus processesconsensus processes

PurposePurpose

better understand the determinants of the better understand the determinants of the use of the croup guidelines.use of the croup guidelines.

increase understanding of the process of increase understanding of the process of research transferresearch transfer

provide useful contextual information that provide useful contextual information that may inform the findings from the croup may inform the findings from the croup CPG cRCT. CPG cRCT.

Theoretical Framework: Theoretical Framework: Ottawa Model of Research Ottawa Model of Research UseUse

SamplingSampling

Purposeful samplingPurposeful sampling 12 hospitals chosen in equal numbers from 12 hospitals chosen in equal numbers from

each of the three arms,each of the three arms, Sampling based on:Sampling based on:

representation from both smaller and larger representation from both smaller and larger hospitals. hospitals.

representation from both poor and better performersrepresentation from both poor and better performers

‘‘Maximizing variation’Maximizing variation’

MethodsMethods

A qualitative case study research A qualitative case study research methodology (n=12) used to explore and methodology (n=12) used to explore and describe the process of research use that describe the process of research use that occurred during the Croup cRCT. occurred during the Croup cRCT.

Data collectionData collection

Personal or telephone interviews with key Personal or telephone interviews with key informants and/or focus groupsinformants and/or focus groups

Review of policy documents related to Review of policy documents related to institutional practices for treating croupinstitutional practices for treating croup

Completion of a brief questionnaire on Completion of a brief questionnaire on health care professionals’ perceptions of health care professionals’ perceptions of the guideline and practice settingthe guideline and practice setting

AnalysisAnalysis Data collection and analysis proceeded Data collection and analysis proceeded

concurrentlyconcurrently Constant comparative approach (Glaser & Constant comparative approach (Glaser &

Strauss)Strauss) Phases:Phases:

Coding Coding CategorizingCategorizing Developing themesDeveloping themes

FindingsFindings Passive dissemination is not as effective as Passive dissemination is not as effective as

more active strategiesmore active strategies Positive feedback about the guidelinePositive feedback about the guideline

Simple guideline – easy to followSimple guideline – easy to follow ““it works”it works” Guideline makes healthcare professionals’ work more Guideline makes healthcare professionals’ work more

predictable as well as increase certainty for the predictable as well as increase certainty for the parentsparents

Each hospital has different dynamics that Each hospital has different dynamics that shape how the CPG is implemented or notshape how the CPG is implemented or not

FindingsFindings

Focus on uni-disciplinary transfer is not Focus on uni-disciplinary transfer is not effectiveeffective

Nurses are important facilitators in Nurses are important facilitators in transferring informationtransferring information

The need for consistent “up keep” of The need for consistent “up keep” of educationeducation

FindingsFindings

BarriersBarriers nurses were not consistently involved in the nurses were not consistently involved in the

processprocess constant changes in staff compositionconstant changes in staff composition

FacilitatorFacilitator Standard ordersStandard orders CPG ‘works’ and is easy to useCPG ‘works’ and is easy to use

ConclusionsConclusions

Increased knowledge was developed Increased knowledge was developed about how a CPG was transferred or not about how a CPG was transferred or not into practiceinto practice

Acquired a deeper and richer Acquired a deeper and richer understanding of the barriers and understanding of the barriers and supports to the uptake of a croup clinical supports to the uptake of a croup clinical practice guidelinepractice guideline