dissemination & implementation of evidence-based strategies/media/files/activity...

Dissemination & Implementation of Evidence-Based Strategies

Karen M. Emmons, Ph.D. Vice President for Research, Kaiser Permanente

IOM Committee, Ovarian Cancer State of the Science,

April 7, 2015

Assumptions:

- Focus is on providers and patients

- Looking at dissemination of current knowledge, towards

implementation of future evidence-based practices

What Is It?

Dissemination: Targeted distribution of information or intervention materials to a specific audience

Implementation: The use of strategies to adopt and integrate EBIs and change practice patterns in specific settings

3 | © 2011 Kaiser Foundation Health Plan, Inc. For internal use only. April 10, 2015

Spread of Innovations

Greenhalgh, Robert, Macfarlane, Bate, Kyriakidou, 2004


Targeted distribution of information or intervention materials to a specific audience

Outgrowth of work in diffusion– or how innovations spread

We know that:

– Dissemination of scientific evidence does not occur spontaneously

– Passive approaches are largely ineffective

– Single source messages are less effective than multiple source/level approaches

– The process of dissemination needs to be tailored for different audiences


Dissemination

Strategies for Dissemination

Reach strategies: Journal articles, social/mass media, national quality campaigns

Motivation strategies: “Knowledge Brokers”, champions, social/professional networks

Ability strategies: Academic detailing, skills-building interventions

AHRQ (2012) review found little evidence for differential impact

– Multicomponent and active strategies are best


To Providers

Strategies for Dissemination

To Patients


Reach strategies: Mail, email, phone;

social/mass media, national campaigns

Motivation strategies: providers, trusted others, champions, social networks

Ability strategies: Skills-building interventions, role models, efficacy

AHRQ (2012) review found little evidence for differential impact, including

multicomponent strategies

Key Strategies for Communication with Patients

Narratives are better than statistics

Tailoring and targeting may be helpful

Communications tied to actions that can be taken are most effective


Pathogen Estimated

annual

illnesses

Estimated

annual

hospitalizations

Estimated

annual

deaths

Salmonella

spp.,

nontyphoidal

1,000,000 19,000 380

Washing Chicken Spreads Salmonella

Don’t Wash Your Chicken!

Use and Quality of Health Content on Social Media

58% of US adults have a smart phone (90% cell phone)

87% of adults use internet; 68% through mobile devices

Pew Research Center, Updates, 2012-2014


Use and Quality of Health Content on Social Media

58% of US adults have a smart phone (90% cell phone)

87% of adults use internet; 68% through mobile devices

~ 2 B tweets/week; 150M users


– Misunderstanding- 6% of anti-biotic-related tweets (Scanfeld,

2010); inaccuracies in 8% of concussion-related tweets (Sullivan, 2012)

– Only 14% of Twitter-delivered smoking cessation programs had guidelines consistent content (Prochaska, 2012)

Pew Research Center, Updates, 2012-2014

11 | © 2011 Kaiser Foundation Health Plan, Inc. For internal use only. April 10, 2015 Griffiths, Cave, Boardman, Ren, Pawlikowska, Ball, Clarke, Cohen, 2012

Centrality of the patient – doctor encounter between social and professional/provider networks

Implementation– Using the disseminated information

The use of strategies to adopt and integrate EBIs and change practice patterns in specific settings

We know that:

– Guideline dissemination is insufficient

– Relationships are important

– Health systems are continuously adapting

– Implementation requires top-down AND bottom-up strategies


Resources and possibilities for agents’

contributions to implementation processes (May, 2013)

Contribution

Capability

(Possibilities

presented by

the complex

intervention)

Potential

(Social-

cognitive

resources

available

To agents)

Capacity

(Social-structural

resources

available

to agents)

Contribution

(What agents

do to

implement a

complex

intervention)

KP– The Hypertension Control Story


Transformative impact of asking:

– WHO: Creation of HT registry

– WHAT: Reduced variation in BP measurements

– HOW: Use of non-physician providers

Sim, et al, 2014


Conceptual Model of Implementation Research (Proctor, et al, 2010)

Intervention

Strategies

Implementation

Strategies

Outcomes

Evidence-

Based

Practices

Service

Outcomes*

Efficiency

Safety

Effectiveness

Equity

Patient-

Centeredness

Timeliness

Client

Outcomes

Satisfaction

Function

Symptomotology

*IOM Standards of Care

Implementation Research Methods

Systems Environment

Organizational

Group / Learning

Supervision

Individual

Providers / Consumers

Implementation

Outcomes

Feasibility

Fidelity

Penetration

Acceptability

Sustainability

Uptake

Costs

Blueprint of Effective Strategies in the Dissemination and Implementation of Evidence-Based Practices through a National Quality Campaign

Strategy 1 Highlight evidence base and relative simplicity of recommended practices

Strategy 2 Align the campaign with the strategic goals of the adopting organizations

Strategy 3 Increase recruitment by integrating opinion leaders into the enrollment process and employing a nodal organizational structure

Strategy 4 Form a coalition of credible campaign sponsors

Strategy 5 Generate a threshold of participating organizations that maximizes network exchanges

Strategy 6 Develop practical implementation tools and guides for key stakeholder groups

Strategy 7 Create networks to foster learning opportunities

Strategy 8 Incorporate monitoring and evaluation of milestones and goals

Yuan, et al. (2010). Commonwealth Fund

When has an issue “arrived?”

Risk factors for ovarian

cancer

• Family history

• Inherited risk

• HRT

• Talc

• Weight and height

Protective factors for

ovarian cancer

• Oral contraceptives

• Tubal ligation

• Breastfeeding

• Risk-reducing salpingo-

oophorectomy

Ovarian Cancer Prevention

What is ready for dissemination? To whom?

What is ready for implementation in practice?

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