NICE McDonald FINAL1 by wuyunqing


									Hartford Geriatric Social Work
   Leadership Conference

    November 4 – 7, 2008
       Chantilly, VA

               1                 1
National Initiative for the Care of the
Initiative nationale pour le soin des personnes

   NICE: Context and Background
   Goals of NICE
   Knowledge Transfer Model
   Knowledge Transfer Practice
   Evaluating Knowledge Transfer
   Lessons Learned
   Implications for Others

                       3            3
NICE: Context & Background
     Unprecedented growth in number and proportion of
      elderly in Canada
           2006, 4.3 million seniors, 13.7% of population1
           2036, 9.8 million seniors; 24.5% of population1
           2001 Census 7.2 % of older population belong to a visible
     Shortage of professionals and students specializing
      in the care of the elderly
     Gaps in interdisciplinary care of the elderly
     Gaps in evidence-based care of the elderly
1.   Statistics Canada (2007). Ottawa, ON: Statistics Canada, 2007, p. 5.
2. Ibid., p. 23; A. Bélanger and É. Caron Malenfant, Population Projections of Visible Minority Groups, Canada, Provinces and Regions: 2001 – 2017, Ottawa,
     ON: Statistics Canada, 2005.

                                                                            4                                                                            4
Gaps in evidence-based care of the elderly

   30 to 45 percent of patients are not receiving
    care based on scientific evidence
                        Graham et al., 2006
   2 percent of social work research makes its
    way into direct practice
                         Saini, 2007

                          5                          5
NICE: A short history…
   Funded through Networks of Centres of Excellence
    – New Initiative Grant
   One of only 5 “New Initiative” networks funded
   Incorporated non-profit, 2006
   Housed at Institute for Life Course and Aging,
    University of Toronto
   One of only 3 networks awarded International
    Partnership Initiative Grant & IDRC (2007)
       Established International Collaboration for the Care of the
        Elderly (ICCE)
   Over 300 members
       Diverse disciplines and professions

                                   6                                  6
International Collaboration for the Care of
the Elderly (ICCE)
   Only NCE-NI to be awarded additional funding
    through International Partnership Initiative of NCE
    and International Development and Research
    Centre (IDRC)
   New partnerships with researchers and
    organizations in:
       Australia       China
       England         Germany
       India           Israel
       Scotland        South Africa
       Switzerland

                              7                           7
ICCE: Context and Goals
   Global aging
     Economy of scale in world-wide knowledge on the care of

       the elderly
   Canada‟s growing older population
     Collaborate with countries with longer histories of meeting
       the challenges of an aging population
   Canada‟s growing ethnically-diverse older population
     Collaborate with countries with experience in the cultural
       issues of aging
   Critical shortage of geriatric/gerontological professionals
     Forum for interdisciplinary collaboration and training

                                 8                                  8
NICE: Network Goals
   Networking and Knowledge Transfer
   Introduce evidence-based research into
       Develop and disseminate interdisciplinary, team-
        based tools that are user-friendly
   Improve training for current practitioners in
    the field
   Improve education in geriatrics/gerontology
   Attract and retain new students to the field
   Effect positive policy changes

                              9                            9
   Central Committees                   International
     Knowledge Identification
     Program Development
                                             Policy, Planning and
       Researcher Training
       Curriculum
                                             ICCE Advisory
       Professional                     Theme Teams
         Development                         Caregiving
     Communications
                                             Dementia
   Advisory Committees                      Elder Abuse
     Business Advisory
                                             End-of-Life
     Seniors Advisory
                                             Mental Health

                                 10                                  10
Knowledge Transfer
   Knowledge transfer is used according to the
    CIHR as “…the exchange, synthesis and
    ethically sound application of knowledge within a
    complex system of interactions among
    researchers and users.”
                             CIHR, 2006
   Knowledge translation usually refers to the
    scientific study of the methods for closing the
    knowledge-to-practice gap.”
                             Davis, 2007

                           11                       11
The OMRU Model

             12   12
   OMRU a framework for knowledge transfer

   RE-AIM a framework for translational

   RE-AIM is a framework for doing research in
    a way to make it more easily transferred
    which is what we try to do after the fact

                        13                    13
OMRU                                 RE-AIM
   Practice environment             Reach
   Potential adopters
   Evidence-based innovation        Efficacy
   Outcome evaluations
   Practice environment             Adoption
   Potential adopters
   Adoption and use
   Barrier management               Implementation
   Transfer strategies
   Adoption and use                 Maintenance

                                14                    14
NICE “Theme Teams”
   Caregiving, dementia care, elder abuse, end-
    of-life issues, mental health
   Action towards interdisciplinary care: Forging
    unique links
       Interdisciplinary teams
         Medicine, nursing, social work, and others

       Bridging research and practice
   Develop user-friendly tools using evidence-
    based research, translate into practice
       Easily accessible tools (pocket tools)

                               15                      15
Theme Team Tools
                   Caregiving Theme Team
                   “Respect All” Poster
                     Designed for staff in long-
                      term care facilities
                     Placed on facility walls for
                      easy visibility
                     Suggestions are based upon
                      research evidence
                     Distributed through Canadian
                      Gerontological Nursing
                     Format & use are being

               16                             16
Theme Team Tools
   Caregiving Theme Team
   “Caring Calendar”
     Designed for family members

     Formatted with consideration

      of behaviour changes
     One evidence based support

      strategy per month
     URL linked to original

     Distributed through

      Alzheimer Canada
     Format & use are being


                                 17   17
Theme Team Tools
   Elder Abuse Theme Team
   Elder Abuse Suspicion Index
   Developed by Dr. Mark Yaffe,
    McGill University
   Tool to screen for potential
    cases of elder abuse
   Adapting for use with different
    health practitioners
   Adapting for use in different
    countries (Israel, England)

                                  18   18
Theme Team Tools
                       Elder Abuse Theme Team
                       Developed by Drs. Myrna
                        Reis and Daphne Nahmiash
                       Caregiver Abuse Screen
                        (CASE) and Indicators of
                        Abuse Screen (IOA)
                       CASE: Screen caregivers
                        for potential signs of abuse
                       IOA: Training practitioners
                        to recognize the signs of
                        potential elder abuse

               19                                  19
Theme Team Tools
   Elder Abuse Theme Team
   In Hand (En Main)
   Developed by Dr. Marie
    Beaulieu, University of
    Sherbrooke (Quebec)
   A framework to guide health
    care professionals in
    decision-making around
    suspected/confirmed cases
    of elder abuse
   Original devised in French,
    being translated/adapted for
    use with English audiences

                                   20   20
Theme Team Tools
                   End-of-Life Theme Team
                   “Capacity & Consent” Tool
                   Quick reference tool to
                    help health practitioners in
                    understanding law and
                    respecting seniors‟ rights
                   First tool geared to Ontario
                       Additional tools in
                        development for other
                        provinces and territories

               21                                   21
Theme Team Tools
   End-of-Life Theme Team
   “What to Expect” Brochure
       Includes sections that describe
           Physical Changes
           Pain Control and Opiate Use
           Advance Care Planning and
            Substitute Health Care Decision-
       Written for friends and family
        members of the dying person in a
        respectful and matter-of-fact tone
           Could also comfort the dying
       Will be placed in palliative care
        facilities across the country

                                            22   22
Theme Team Tools
                       Mental Health Theme Team
                       Depression Assessment
                       Based on guidelines of the
                        Canadian Coalition for
                        Seniors Mental Health
                       Tool for family physicians
                        and teams to increase
                        screening of older patients
                        for symptoms of depression

               23                                 23
Knowledge Transfer Events
   Goal is to hold forums in various regions of
    the country to distribute tools, set up
    evaluation process and receive feedback
    about their use.
   Each region has a “champion” and a student
   This phase has just commenced

                         24                        24
Evaluating Tools/Knowledge Transfer
   Evaluations planned/started
   Using a case study approach
   Provide in-depth understanding of tool process
       How tool was selected for development
       How tool was developed
       Context of tool development (social, cultural, political)
       Stakeholder & user‟s feedback on its use
       Feedback on what worked/did not work
   Potential for application of RE-AIM framework

                                    25                              25
Lessons Learned
   The Challenges of
   The Challenges of
    Knowledge Transfer
   The Challenges of
    Working in Teams

                         26   26
Networks: Thinking Outside of the Box
   Model currently in Canada is the research
    network which has KT as an add-on
   Transfer is NOT research
       But…it can be the subject of research
   Members have a very difficult time moving
    away from research to KT
   Members are suspect because they don‟t do
   How do you get academic or practice credit
    for knowledge transfer?

                              27                 27
28   28
   What kind of network?
       3 types models at minimum:
         Communities of Practice (individuals who are self-
            organizing, non hierarchical, informal)

           Knowledge Networks (formal groups of experts who work
            together on a common concern)

           Soft networks (lists of members usually in an electronic directory)
           Governance? Democracy or Dictatorship?
                                           - CHSRF, 2005

                                             29                                   29
30   30
Knowledge Transfer
   Only about 20 percent of knowledge transfer
    gets through1
   There are at least 20 theories available2
   There are at 15 models for transfer-OMRU3
   Members aren‟t sure what KT really is – which of
    the hundred definitions do you use?
   How do you actually engage in evaluation if not
    a research network?
1Zwarenstein,   2007; 2 Estabrooks et al.,2006; 3Santesso et al., 2006

                                                            31           31
Knowledge Transfer continued
   KISS principle

   Guidelines and tools that are simple and
    observable were more effectively

   KISS principle makes colleagues laugh

   1Davis,   D.A. and Taylor-Vaisey, A. (1997); Dawes, M. and Sampson, U. (2003).; Formoso, G., Marata,
    A., and Magrini, N. (2006); Grol, R. and Grimshaw, J. (2003).

                                                     32                                                    32
   What team?
   What kind of team?
   Old boys/girls networks
   Who has time to process?
   Teams grow too fast – require sub-teams

                        33                    33
34   34
    Four Ways to use RE-AIM

1.   Criteria for choosing research at the outset;
2.   A method for evaluating the effectiveness of
3.   It solves the „what next problem‟
4.   Easy to use in other countries

                          35                         35
NICE Knowledge Transfer
   Website
   NICENews
       Available online
   Workshops, Forums and Symposia
   Annual NICE Knowledge Exchange
       June 5 – 6, 2008: Toronto, Ontario

          The great aim of education is not knowledge
                           but action.
                       - Herbert Spencer

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