Context is critical...Contextualization Overview. Integrated KTE: beginning, middle and end of...

Contextualized Health Research Synthesis Program

CHRSP:Context is critical

Pablo Navarro, Senior Research OfficerNewfoundland & Labrador Centre for Applied Health Research

CADTH 2013 Symposium | May 5-7, 2013

Today’s Presentation

1. About NLCAHR & CHRSP2. Evidence in Context:3. Hyperbaric Oxygen Therapy for

Non-Healing Wounds: a CHRSP project example

4. Findings > Contextualization6. Dissemination & Follow Up7. Concluding comments

Established in 1999 by the provincial government, Memorial University and the Eastern Health regional health authority:

to build research capacity to address priority research needs in NL to encourage evidence-informed health decisions

About

“How can we

get scientific evidence used more frequently and

more effectively by the

healthcare system?”

“How can we findand use the best

scientific evidenceas one input among many

into decision making?”

…for researchers

…for the healthcare system:

The challenge…

The CHRSP Partnership:

CHRSP About

1. What works?

2. What willwork here?

CHRSP in a nutshell• Integrated KTE:

o System leaders identify issues of importance

o Issues formulated as a researchable question shaped to NL

o Prioritize and categorize research questions

o Engage decision makers throughout

• Effective knowledge transfer & exchange:

oMultiple report formats

o Emphasis on implications for decision makers

o Facilitate post-project engagement among stakeholders

CHRSP tailors its synthesis to the context of Newfoundland & Labrador at all stages of the project

3. CHRSP interprets findings in context.

2. CHRSP identifies contextual factors.

Patient populations

Site of serviceand/or service design

Health human resources

Organization and delivery of services

Other System Factors

Economics

Politics

Labrador Grenfell Health

CentralHealth

EasternHealth

1. Topics of relevance

Contextual factors may effectoutcomes and/or cost effectiveness

Contextual Factors:

More about context here:www.nlcahr.mun.ca/research/chrsp/

Contextualization Overview

Integrated KTE: beginning, middle and end of project, consultations with partners/stakeholders

DHCSWestern Health

NLCAHREastern Health

Central Health

Labrador Grenfell Health

ContextualizationMethodology

a contextualization example Hyperbaric Oxygen Therapy for Difficult Wound Healing in Newfoundland & Labrador

CHRSP Health System Partner: Eastern HealthCHRSP External Specialist: CADTH (Rhonda Boudreau, Research Officer; Kristen Moulton, Research Assistant; Sarah McGill, Information Specialist)CHRSP Team: Dr. Ken LeDez, Chair of the Discipline of Anesthesia, Memorial University Faculty of Medicine and Director of MEDICOR, Norma Baker, COO, Adult Acute Care for Eastern Health (now retired), Cathy Burke, Regional Director, Cardiac/Critical Care Program, Eastern Health, and Mary Bursey, Associate Professor in the School of Nursing at Memorial University.

HBOT in NL

• Located at Health Sciences Centre

• 1982: MEDICOR (MUN) for research and emergencies

• Transferred to Eastern Health in 2010

• Multi-chamber facility (original)

• Two mono-chambers (at transfer)

• Broadened focus to include non-emergency conditions

CHRSP HBOT Project Background

Belief that a significant number of patients may be suitable candidates for HBOT but are currently not receiving treatment

CHRSP HBOT Project

Focus on non-healing wounds:• Diabetic foot ulcers

• Delayed radiation-induced injuries

• Severe burns

• Skin grafts/flaps

• Post-transplantation revascularization

CHRSP HBOT Project

Partner with CADTH for Knowledge Synthesis

1. What works?

CHRSP Findings• HBOT is clinically effective and cost

effective (societal perspective) for non-healing diabetic foot ulcers.

• HBOT is clinically effective for some delayed radiation-induced injuries.

• If referred appropriately and in a timely manner.

CHRSP Findings

• Insufficient evidence to support or contradict HBOT for other studied conditions.

• Lack of evidence means future research will have significant impact on evidence base.

CHRSP Findings

• Overall cost-effectiveness of HBOT (when clinically effective) increases with increased use of the facility.

1. What works?

2. What willwork here?

Contextualization: Patient Level

• Geography & costs: challenges to completing full course of therapy for patients from far away*

Contextualization: Site of Service

• Location: distant from related clinical sections of hospital

Contextualization: Human Resources

• Training and safety: shortage of nurses and respiratory therapists

Contextualization: Organization

• Appropriate referrals*

• Wound care management integration*

Contextualization: Economic

• Remuneration

• Overtime

Contextualization: Political

• Public expectations

Dissemination

• Report (3 formats)

Dissemination

• End of event, bring people together

• Communications

• Follow up

Decisions & Actions• Diabetes implications

communicated to NLMA and others

• Additional HBOT physician positions created and filled

• Payment system adapted• Credentials system in

process

Distinguishing features of CHRSP

• focus on questions identified by system not the researchers• use both local and external expertise• build teams that combine researchers and decision makers• contextualize• work quickly• communicate effectively

Does CHRSP work?

• topic selection complex but workableoeach side has learned how to work together

• contextualization is feasible and helpful• leading external experts fairly easy to recruit• teams work well together• the results have been produced fairly quickly• the results have actually been used:

odialysis decision templateoYouth Residential Treatment planningo Single-use Medical Devices policyo considerations for development of PETopatient handling protocols in Eastern Health

It does.

www.nlcahr.mun.ca/research/chrsp/

• Web: www.nlcahr.mun.ca

• Phone: (709) 777-6993

• Email: nlcahr@mun.ca

• Location: 95 Bonaventure Avenue, Suite 300

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