NYAMTEACH

Tutorial Curriculum

Level III: Knowledge Translation

Tutorial #2: Adapt Knowledge to Local Context

Objectives:

By the end of this session, participants are expect to

  • Identify strategies for identifying evidence sources, including, but not limited to practice guidelines
  • Identify strategies to adapt evidence sources to their local context(s)
  • Apply appraisal criteria to evaluate published clinical practice guidelines: i.e. the AGREE II tool
  • Review frameworks for adapting clinical practice guidelines to local contexts: i.e. ADAPTE, Can-Implement

Activities:

These are suggested activities that will help facilitate group discussion and collaboration. Select those that fit the needs of your group. Make appropriate use of the attached worksheets

  • Process
  • Divide into small groups to select evidence source(s). The groups can consist of individuals from the same institutions working on the same project
  • Search for evidence source(s). See web resources below
  • Appraise the evidence source(s) & select one to implement
  • Identify local resources that can support the dissemination & uptake of evidence source(s)
  • Formulate a clinical pathway based on the adapted recommendation
  • Contents/Materials
  • Worksheet – Select evidence source(s)
  • Worksheet or online AGREE II tool – Appraise the evidence source(s)
  • Worksheet – Environmentalscan
  • Table 3.3.1 (pp. 77-79)– ADAPTE

Preparatory Work

  • Assigned reading:
  • KT text Chapter 3.3, pp. 73-
  • Harrison MB, Legare F, Graham ID, Fervers B Adapting clinical practice guidelines to local context and assessing barriers to their use. CMAJ 2010;182:E78-E84

Work Assignment for Next Session

-[INSERT]

References:

  • Sharon E Straus, Jacqueline Tetroe and Ian Graham. Knowledge Translation in Healthcare Moving from Evidence to Practice. Wiley Blackwell.
  • Harrison MB, Legare F, Graham ID, Fervers B Adapting clinical practice guidelines to local context and assessing barriers to their use. CMAJ 2010;182:E78-E84

Identify, Review, Select Knowledge

  1. Outline your strategies for identifying an appropriate evidence sources (e.g. clinical practice guideline) that can inform your KT problem? What online resources would you use? Hint: Refer to Table 2.4.1 (pp. 50-52)
  1. What criteria would you apply to determine which among two or more competing guidelines should be used? What factors should be taken into account when considering specific recommendations? In particular, how do the following concepts relate to the guidelines you located?
  1. Validity
  1. Reliability
  1. Applicability
  1. Feasibility
  1. Clinical utility

Worksheet

Critical Appraisal Checklist for a Practice Guideline

Adapted from AGREE Framework

Note: Options to divide the seminar group into two, then regroup to discuss; Or pair-share, then each pair reports to larger group
Screening Questions
  1. Is the overall objective of the guideline clearly described?
/ Answers
  1. Is the health question covered by the guideline clearly described? Consider:
  2. Who is the target population of the guideline (patients, public)?
  3. What are management options?
  4. What are the possible outcomes?
  5. Who are the target users of the guideline ?

Detailed Questions
  1. Stakeholder Involvement
  2. Did the guideline development group include individuals from all relevant professional groups?
/ Answers
  1. Were the views and preferences of the target population sought, and if so, were they associated with each of the outcomes?

  1. Rigor of Development
  2. Were systematic methods used to search for evidence?

  1. Did the guideline developers assess the strengths and limitations of the body of evidence?

  1. Did the guideline developers clearly describe their methods for formulating recommendations?
Consider:
•Is there an explicit link between the recommendations and the supporting evidence?
•Did the guideline developers take health benefits, side effects and risks into account when formulating the recommendations?
Results
  1. What are they key recommendations? Are they clear and specific?
/ Answers
  1. What is the strength of the key recommendations?

Applicability
  1. Do the recommendations make sense in your practice setting?
/ Answers
  1. Are there any facilitators or barriers to the guideline’s application?

/

ref AGREE L. Falzon & P Wyer 7/11/11 2

Worksheet

Environmental Scan

  1. What is already occurring in your institution with respect to aspects of this project?
  1. What is the training or job requirement related to activities associated with this project (e.g. Residents are required to carry out a research project before graduation.)? What’s the cost of not doing this?
  1. Is there an EMR system at your institution? What are the capabilities of the system? For implementing practice guidelines? For gathering evaluation data?
  1. What guidelines are already in existence related to your KT project? What is the quality of these guidelines?
  1. What are the reward structures related to KT implementation at your institution?
  1. What methods would you use for performing an environmental scan of current practice? What are their strengths & weaknesses?

Note: Divide seminar group into smaller groups, w each taking an instrument

  1. Survey?
  1. Structured interviews?Random vs. key informants?
  1. Focus group?
  1. Observation? Walk-through?
  1. Chart audit?
  1. Others?
  1. How would you document existing gaps in care? And to whom would you present the results?

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