KT Knowledge Transfer

Collection of articles on KT is available here.

The LEAP Program: Quality Improvement Training to Address Team Readiness Gaps Identified by Implementation Science Findings.
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L. J. Damschroder, N. R. Yankey, C. H. Robinson, et al.
J Gen Intern Med 2020 Sep 8
Integrating evidence-based innovations (EBIs) into sustained use is challenging; most implementations in health systems fail. Increasing frontline teams’ quality improvement (QI) capability may increase the implementation readiness and success of EBI implementation. OBJECTIVES: Develop a QI training program (“Learn. Engage. Act. Process.” (LEAP)) and evaluate its impact on frontline obesity treatment teams to improve treatment delivered within the Veterans Health Administration (VHA). DESIGN: This was a pre-post evaluation of the LEAP program. MOVE! coordinators (N = 68) were invited to participate in LEAP; 24 were randomly assigned to four starting times. MOVE! coordinators formed teams to work on improvement aims. Pre-post surveys assessed team organizational readiness for implementing change and self-rated QI skills. Program satisfaction, assignment completion, and aim achievement were also evaluated. PARTICIPANTS: VHA facility-based MOVE! teams. INTERVENTIONS: LEAP is a 21-week QI training program. Core components include audit and feedback reports, structured curriculum, coaching and learning community, and online platform. MAIN MEASURES: Organizational readiness for implementing change (ORIC); self-rated QI skills before and after LEAP; assignment completion and aim achievement; program satisfaction. KEY RESULTS: Seventeen of 24 randomized teams participated in LEAP. Participants’ self-ratings across six categories of QI skills increased after completing LEAP (p< 0.0001). The ORIC measure showed no statistically significant change overall; the change efficacy subscale marginally improved (p < 0.08), and the change commitment subscale remained the same (p = 0.66). Depending on the assignment, 35 to 100% of teams completed the assignment. Nine teams achieved their aim. Most team members were satisfied or very satisfied (81-89%) with the LEAP components, 74% intended to continue using QI methods, and 81% planned to continue improvement work. CONCLUSIONS: LEAP is scalable and does not require travel or time away from clinical responsibilities. While QI skills improved among participating teams and most completed the work, they struggled to do so amid competing clinical priorities.

A scoping review of strategies for financing the implementation of evidence-based practices in behavioral health systems: State of the literature and future directions.
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Alex R. Dopp, Marie-Rachelle Narcisse, Peter Mundey, et al.
Implementation Research and Practice 2020 01/01; 2020/09;1:2633489520939980
Increased availability of evidence-based practices (EBPs) is essential to alleviating the negative public health and societal effects of behavioral health problems. A major challenge to implementing and sustaining EBPs broadly is the limited and fragmented nature of available funding.Method:We conducted a scoping review that assessed the current state of evidence on EBP financing strategies for behavioral health based on recent literature (i.e., post-Affordable Care Act). We defined financing strategies as techniques that secure and direct financial resources to support EBP implementation. This article introduces a conceptualization of financing strategies and then presents a compilation of identified strategies, following established reporting guidelines for the implementation strategies. We also describe the reported level of use for each financing strategy in the research literature.Results:Of 23 financing strategies, 13 were reported as being used within behavioral health services, 4 had potential for use, 5 had conceptual use only, and 1 was potentially contraindicated. Examples of strategies reported being used include increased fee-for-service reimbursement, grants, cost sharing, and pay-for-success contracts. No strategies had been evaluated in ways that allowed for strong conclusions about their impact on EBP implementation outcomes.Conclusion:The existing literature on EBP financing strategies in behavioral health raises far more questions than answers. Therefore, we propose a research agenda that will help better understand these financing strategies. We also discuss the implications of our findings for behavioral health professionals, system leaders, and policymakers who want to develop robust, sustainable financing for EBP implementation in behavioral health systems.Plain language abstract:Organizations that treat behavioral health problems (mental health and substance use) often seek to adopt and use evidence-based practices (EBPs). A challenge to adopting EBPs broadly is the limited funding available, often from various sources that are poorly coordinated with one another. To help organizations plan effectively to adopt EBPs, we conducted a review of recent evidence (i.e., since the passage of the 2010 Affordable Care Act) on strategies for financing EBP adoption in behavioral health systems. We present definitions of 23 identified strategies and describe each strategy?s reported (in the research literature) level of use to fund EBP adoption in behavioral health services. Of the 23 financing strategies, 13 strategies had evidence of use, 4 had potential for use, 5 had conceptual use only, and 1 was potentially contraindicated. Examples of strategies with evidence of use include increased fee-for-service reimbursement, grants, cost sharing, and pay-for-success contracts. This comprehensive list of EBP financing strategies may help guide decision-making by behavioral health professionals, system leaders, and policymakers. The article also presents a research agenda for building on the current research literature by (1) advancing methods to evaluate financing strategies? effects, (2) partnering with stakeholders and decision-makers to examine promising financing strategies, (3) focusing on strategies and service systems with the greatest needs, (4) improving methods to guide the selection of financing strategies, and (5) paying greater attention to sustainable long-term financing of EBPs.

Developing theory-informed knowledge translation strategies to facilitate the use of patient-reported outcome measures in interdisciplinary low back pain clinical practices in Quebec: mixed methods study.
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O. Eilayyan, R. Visca, D. Zidarov, P. Ware, A. Bussières and S. Ahmed.
BMC Health Serv Res 2020 Aug 25;20(1):789-020-05616-5
There is a growing interest among healthcare providers (HCPs) to use Patient Reported Outcome Measures (PROMs) in clinical care. PROMs can help improve patient-care provider communication and may be used to inform the need for interdisciplinary care for Low Back Pain (LBP). However, PROM implementation to support clinical decision-making is complex and requires knowledge translation (KT) interventions that will overcome barriers to using PROMs in interdisciplinary clinical settings. OBJECTIVES: to 1) identify potential barriers and enablers to using PROMs in primary care LBP clinical practice from the perspective of healthcare team members, and 2) develop a theory-based tailored KT intervention to facilitate the use of PROMs in interdisciplinary clinical practice. METHODS: We invited 25 HCPs working in an interdisciplinary team to complete a self-administered survey designed based on the Theoretical Domain Framework (TDF) to identify the barriers and enablers to using PROM scores in LBP clinical practice. The questionnaire consisted of 30 questions rated on a 5-point Likert scale (quantitative) and included open-ended questions (qualitative). Quantitative and qualitative data were analysed to estimate the frequency of barriers and enablers. Findings were then reviewed by a panel of four KT experts who mapped behaviour change techniques to barriers identified that informed the design of a KT intervention. RESULTS: Eighteen HCPs responded to the survey. Factors identified as likely to restrict the use of PROM scores included knowledge, skills, social/professional role and identity, goals, decision processes, beliefs about consequences, environmental context and resources, behavioural regulation, and social influence. A multi-component evidence-based KT intervention was proposed by the panel of experts to address these barriers: a training workshop; educational materials; and use of PROM score reports to HCPs that were all delivered by an opinion leader. CONCLUSION: The routine use of PROMs in clinical practice may optimize the quality of LBP care and improve patients’ outcomes. The proposed multi-component KT intervention is expected to be an effective strategy to increase HCPs’ ability to integrate PROMs into clinical decision-making and to engage patients in their care.

Mapping the community: use of research evidence in policy and practice.

Elizabeth Farley-Ripple, Kathryn Oliver and Annette Boaz.
Humanities and Social Sciences Communications 2020 09/07;7(1):83
The use of research evidence (URE) in policy and practice is relevant to many academic disciplines, as well as policy and practice domains. Although there has been increased attention to how such evidence is used, those engaged in scholarship and practice in this area face challenges in advancing the field. This paper attempts to “map the field” with the objective of provoking conversation about where we are and what we need to move forward. Utilizing survey data from scholars, practitioners, and funders connected to the study of the use of research evidence, we explore the extent to which URE work span traditional boundaries of research, practice, and policy, of different practice/policy fields, and of different disciplines. Descriptive and network analyses point to the boundary spanning and multidisciplinarity of this community, but also suggest exclusivity, as well as fragmentation among disciplines and literatures on which this work builds. We conclude with opportunities for to improve the connectedness, inclusiveness, relationship to policy and practice, and sustainability of URE scholarship.

Diffusion in Information-Seeking Networks: Testing the Interaction of Network Hierarchy and Fluidity with Agent-Based Modeling.
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Reed M. Reynolds.
2020 09/07:1-20
People need information to cope with the demands of life, yet, questions remain about the way social structures facilitate the spread of new information. This study applies agent-based modeling (ABM) to information-seeking behavior. The primary focus is the role of network structure in shaping the spread of information. The present study confirms and extends existing diffusion research by showing that in-degree hierarchy influences multiple diffusion outcomes; hierarchy determines the likely targets of information requests, but its effects are contingent on structural fluidity, the extent that information-seekers may deviate from typical network behavior. Consistent with prior research, more rigid hierarchies increase the potential for rapid diffusion but dramatically increase the risk of diffusion failure. However, the effects of hierarchy that enable rapid diffusion do not require extreme rigidity, but rather are enhanced by a moderately fluid network in which information requests deviate to an extent from the structurally defined channels. This study also analyzes the effects of initial conditions, and the distribution of information itself within networks. Methodological, theoretical, and pragmatic implications are discussed.