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Implementation Central

 

CAHE’s Dr Saravana Kumar has been awarded the prestigious national Fellowship:
Improving the management of whiplash-associated disorders

Visit the Implementation Central website dedicated to this project: www.implementationcentral.com

 

iCentral Updates from CAHE's newsletters: Dr Saravana Kumar provides a monthly summary of Implementation Central's updates in the CAHE newsletter

 

The National Health and Medical Research Council (NHMRC) has presented CAHE’s Dr Saravana Kumar with the National Institute for Clinical Studies (NICS) Fellowship, co-sponsored by TRACsa: Trauma and Injury Recovery and the Motor Accident Commission of South Australia (MAC)

Dr Saravana Kumar, Research Fellow and Lecturer, Centre for Allied Health Evidence, University of South Australia, will utilise this fellowship to address the internationally recognised issue of improving the management of people with whiplash-associated disorders by physiotherapists and chiropractors.

Each year in South Australia, these disorders account for 45% of the 6,000 Compulsory Third Party (CTP) claims and a third of costs, which is more than $120 million. Internationally, whiplash-associated disorders contribute to approximately 42% of all CTP claims and this figure continues to increase. People suffering from whiplash-associated disorders (WAD) are currently offered a range of costly treatment and rehabilitation options, but despite this many patients remain in constant pain and develop long-term complaints.

Over the next two-year implementation period Dr Kumar aims to improve patient outcomes by implementing TRACsa’s new Clinical guidelines for best practice management of acute and chronic whiplash-associated disorders. In order to achieve this Dr. Kumar will be working with physiotherapists, chiropractors and consumers. The ultimate goal of the fellowship project is to address the broadening gap between evidence and current practice in the management of WAD.

As part of his project, Dr Kumar will assess current practice in the management of WAD and will provide a multi-dimensional strategy to support guideline implementation by physiotherapists and chiropractors. Recognising the growing and important role of consumers, this research will provide consumers with TRACsa’s ‘guide for injured people’ to assist their understanding of WAD and available treatment options.

TRACsa: Trauma and Injury Recovery is focused on better treatment and recovery for people injured on the road or at work. The Motor Accident Commission (MAC) is SA’s Compulsory Third Party insurer and provides $360 million each year in compensation to road crash victims. The National Institute of Clinical Studies (NICS) is part of the National Health and Medical Research Council (NHMRC), Australia's leading funding body for health and medical research. NICS role within the NHMRC is to improve health care by getting the best available health and medical research into everyday practice.
 

iCentral Updates from CAHE's newsletters:

 

CAHE Newsletter Edition 52: May to June 2009

CAHE Newsletter Edition 51: March to April 2009

CAHE Newsletter Edition 50: January to February 2009

CAHE Newsletter Edition 49: November to December 2008

CAHE Newsletter Edition 48: September to October 2008

CAHE Newsletter Edition 47: July to August 2008

 

 

iCentral Update:  CAHE Newsletter Edition 52: May to June 2009

An update on the Fellowship

May and June 2009 have been very busy for implementation central! CAHE researcher, Luke Perraton and I have recruited 20 physiotherapy and 20 chiropractic practices spread across Adelaide. A number of physiotherapists and chiropractors from these practices have agreed to participate in the implementation central research project. As part of this phase of the project, Luke and I have been travelling to meet, and collect data, from physiotherapists and chiropractors at the participating practices. This has taken us from Murray Bridge to McLaren Vale and provides us with the unique opportunity to meet with physiotherapists and chiropractors in their clinical working environment. Luke and I will be continuing this process till end of July, by which time this phase of research will be completed. It is anticipated that the next phase of research, during which participating physiotherapists and chiropractors will be invited to attend a one-day workshop in Adelaide, will commence in August/September 2009.

While we have been busy with data collection for the Fellowship, there have also been ongoing updates on the iCentral website. Did you know, since January 2009, there have been more than 400 visits to this website by people from 20 different countries! From end of this month, we plan to upload quick, concise lectures and corresponding podcasts on this website which will outline common issues and topics related to evidence implementation. We have also been creating a bibliography of relevant publications for evidence implementation and this will be available on the iCentral website soon.

Finally, as this Fellowship aims to implement a guideline, thanks to Motor Accident Commission, iCentral will soon host the full WAD guideline developed by the Motor Accident Commission. All supporting materials for these guidelines (such as the consumer resource) will also be available on the website. An accompanying audio file will also be included which will provide an overview of this guideline, and how it will play an integral role in this Fellowship. Visit the iCentral website.

 

iCentral Update:  CAHE Newsletter Edition 51: March/April 2009

Implementation Science: new developments everyday

As yet another year gallops away from us with astonishing speed, Implementation Central website has been undergoing regular updates to ensure it is up to date with emerging evidence on evidence implementation and knowledge transfer. As implementation science is a relatively new field of science, each day brings new knowledge about evidence implementation and knowledge transfer and it is vitally important that this emerging knowledge is shared with key stakeholders in this field.

One of the significant changes to the website has been the “Resources” section. As the website evolved it became clear that the resources section needs to be better organised with additional content including:

Another change to the website is the addition of “upcoming events”. This has been created to feature conferences or events where I have been invited to present about evidence implementation and knowledge transfer. An overview of the conference, including location and dates are provided, along with the link to the conference’s website. In recent times, in most instances, after the completion of the conference, presentations from the conferences are hosted on these websites for wider dissemination. Therefore, these websites can be a useful portal to access up to date information on a range of topics.

I urge you to visit the updated website and provide me with any feedback. To aid in this process, the updated website features a “feedback form”. As this website has been created to facilitate access to evidence implementation and knowledge transfer resources for all stakeholders, your feedback is important and will drive future updates. I look forward to hearing from you soon!  Visit Dr Saravana Kumar’s website: www.implementationcentral.com  
 

iCentral Update:  CAHE Newsletter Edition 50: January/February 2009

An introduction to Knowledge Transfer Clearinghouse

It is increasingly recognised that evidence implementation and knowledge transfer (KT) is a science in its own merit. Recognising this, around the world, there are increasingly dedicated resources targeted towards achieving successful knowledge transfer. Some of these resources include Implementation Science (a scientific journal dedicated towards publishing scholarly works in the field of evidence implementation), NHMRC NICS (an organisation dedicated towards knowledge transfer and implementing evidence into everyday clinical practice), The Cochrane Effective Practice and Organisation of Care Group (EPOC) (an organisation which produces systematic reviews of interventions designed to improve health professional practice) and finally Implementation Central (the website which was created as part of this Fellowship).
Recently, I came across another fantastic resource dedicated to knowledge transfer. This is a website titled “KT Clearinghouse” was developed in association with KT Canada, the Knowledge Translation Program of the Li Ka Shing Knowledge Institute at St. Michael’s Hospital, the University of Toronto and the KT Branch of the Canadian Institutes of Health Research. This comprehensive website is intended to provide stakeholders of evidence implementation and knowledge transfer access to, and information on, various aspects of KT. The website provides an overview of models and theories of KT, tools and resources for KT and access points of knowledge inquiry and knowledge synthesis.

The home page of the website presents an interactive Knowledge-to-Action cycle which provides a step by step approach to implementing evidence into clinical practice. Each step in the cycle is further detailed with an individual webpage outlining key processes underpinning each step. The website also provides access to KT Canada seminar series conducted by prominent researchers in KT and evidence implementation. For anyone interested in KT and evidence implementation, this website is compulsory viewing and I hope you find it as useful as I did. Happy browsing! Visit Dr Saravana Kumar’s website: www.implementationcentral.com
 

iCentral Update:  CAHE Newsletter Edition 49: November/December 2008

The Hitchhiker’s Guide to Implementation Science

As the silly season is upon us, it must also be the high season for conferences. In the last month or so, I attended three conferences and one symposium here in Adelaide. They were:

• The National Forum on Safety and Quality in Health Care
• 2008 Annual Scientific Meeting Australian National Members Society International Society for Prosthetics and Orthotics
• Australasian Symposium on Neck Pain 2008 and
• Better Choices Better Health

At first look all these conferences may seem distinctly different, catering for different audiences, with uniquely different messages. And my roles at these conferences also varied, ranging from standing next to a poster and grinning widely, to being part of an expert panel, to chairing sessions and presenting multiple papers. While I thoroughly enjoyed each conference
I was left wondering what I took away from attending these distinctively different conferences and symposium.

Other than the obvious fact that all these were health-related conferences, they also shared a common message. These conferences and the symposium presented cutting edge information on techniques, tools and ways in which quality health service could be provided to consumers of health care.

However, from my perspective, the central theme arising from these conferences and the symposium was the “so what”? As stakeholders of health care, we are routinely confronted with new knowledge, be it for a new technique or new research evidence about an intervention. The question is: what do we do with this knowledge?

There were lots of discussions across these forums on how best we can use new knowledge, if we employ it at all. It became clear that, as it stands, we do very little with new knowledge. Even if we do use this newly gained knowledge, it is questionable if we sustain its application. Why knowledge isn’t transferred into application, and what can be used to facilitate this transfer is the subject of much debate and research.

Maybe I am biased, but one of the key messages from these diverse conferences and symposium was applying and transferring new knowledge into practice, and how to sustain this. As another New Year dawns on us, addressing this gap could well be our New Year’s resolution (given that it is the festive season we will, for a moment, forget the well recognised intention-behaviour gap)! Visit Dr Saravana Kumar’s website: www.implementationcentral.com
 

iCentral Update:  CAHE Newsletter Edition 48: September/October 2008

I would like to dedicate this segment of iCentral to its bigger brother, the website Implementation Central: www.implementationcentral.com.

In late October 2008, Implementation Central went “live”, thanks to all the hard work of CAHE staff, especially Helen Walker. The Implementation Central website has been developed with the aim to provide access to resources specific to implementing evidence into clinical practice.

In its current form, www.implementationcentral.com provides an overview about my NHMRC-NICS-TRACsa-MAC Fellowship, including details about the Fellowship’s sponsors and host organisation. It also provides a brief overview about Whiplash Associated Disorders (WAD) and clinical guidelines in general. The section on clinical guidelines also provides access to a guideline appraisal tool, the AGREE instrument.

A separate section, Implementation Science, is dedicated to the emerging field of the science behind implementation. In this section evidence from seminal research on behaviour change, factors influencing behaviour change and implementation strategies are discussed.

A Resources section has also been created where direct links to agencies specialising in guideline development and implementation are provided. Each organisation’s link is supported by a brief description on the organisation’s mandate and tools available to support guideline development and implementation.

It is envisaged that there will be regular updates of Implementation Central. Future planned updates include lectures and pod casts on evidence implementation issues, online discussion forums, blogs and regular updating of resources specific to evidence implementation. Therefore, it is with great please I invite you to view Implementation Central.

As this website was created in response to a lack of dedicated evidence implementation resource, I invite you to provide me with any comments or feedback you may have regarding this website. I also encourage you to provide me with suggestions you may have on what, if any, additional resources you may require to facilitate uptake of evidence into clinical practice that can be achieved through this website. You can contact me via Saravana.kumar@unisa.edu.au
 

iCentral Update:  CAHE Newsletter Edition 47: July/August 2008

As part of my NHMRC-NICS TRACsa MAC Fellowship, I am in the process of developing a website which will house resources pertinent to implementation of evidence in clinical practice. This website will be called “Implementation Central”. Keeping this familiar theme, every CAHE newsletter will also feature an implementation specific corner, appropriately titled, “iCentral”. In this edition of iCentral, I want to discuss a recent publication that will be of interest to all allied health practitioners.

The publication is titled “Guideline implementation in allied health professions: a systematic review of the literature” by Sharron Hakkennes and Karen Dodd from LaTrobe University, Victoria (Hakkennes and Dodd 2008). This review identified fourteen studies, of varying methodological quality, utilising a variety of evidence dissemination and implementation strategies. The findings from this review suggest that there is no “one size fits all” and multi-dimensional, multi-faceted interventions were no more effective that single intervention strategies.

The findings of this review are not surprising as similar findings have been reported for medical professions. However, these findings do raise the issue of what is best practice in terms of evidence implementation? Well, I believe, there are key points to consider when discussing evidence implementation. Firstly, while there is insufficient evidence on what implementation strategies work best, there is ample evidence on strategies which do not work. There is good, high quality evidence which suggests that passive dissemination strategies do not work and hence should be avoided. Secondly, there is growing evidence which highlight the importance of considering models of behavior change, prior to evidence implementation. In the previous newsletter (Edition 46), I discussed research by Michie et al. (2005) which identified domains which could be used to explain resistance to, or implementation of, behavior change. Finally, local barriers may well require targeted, local intervention which assists as sustainable drivers of behavior change. What these local interventions are may very well be shaped and driven by local barriers, access to resources and scope and nature of the project.

1). Hakkennes S and Dodd, K 2008, “Guideline implementation in allied health professions: a systematic review of the literature”, Quality and Safety in Health Care, vol. 17, pp.296-300.
2) Michie, S, Johnston, M, Abraham, C, Lawton, R, Parker, D and Walker, A 2005, ‘Making psychological theory useful for implementing evidence based practice: a consensus approach’, Quality and Safety in Health Care, vol. 14, pp. 26-33.
 

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