A method to audit and score implementation of knowledge translation (KT) interventions in large health regions \u2013 an observational pilot study using rectal cancer surgery in Ontario

Marko Simunovic,Nancy Baxter,Melissa Brouwers,Angela Coates,Craig Earle,Christine Fahim,Mary Ann O’Brien,David Urbach,Vanja Grubac

doi:10.1186/s12913-020-05353-9

Abstract

BackgroundAcross Ontario, since the year 2006 various knowledge translation (KT) interventions designed to improve the quality of rectal cancer surgery have been implemented by the provincial cancer agency or by individual researchers. Ontario is divided administratively into 14 health regions. We piloted a method to audit and score for each region of the province the KT interventions implemented to improve the quality of rectal cancer surgery.MethodsWe interviewed stakeholders to audit KT interventions used in respective regions over years 2006 to 2014. Results were summarized into narrative and visual forms. Using a modified Delphi approach, KT experts reviewed these data and then, for each region, scored implementation of KT interventions using a 20-item KT Signature Assessment Tool. Scores could range from 20 to 100 with higher scores commensurate with greater KT intervention implementation.ResultsThere were thirty interviews. KT experts produced scores for each region that were bimodally distributed, with an average score for 2 regions of 78 (range 73–83) and for 12 regions of 30.5 (range 22–38).ConclusionOur methods efficiently identified two groups with similar KT Signature scores. Two regions had relatively high scores reflecting numerous KT interventions and the use of sustained iterative approaches in addition to those encouraged by the provincial cancer agency, while 12 regions had relatively low scores reflecting minimal activities outside of those encouraged by the provincial cancer agency. These groupings will be used for future comparative quantitative analyses to help determine if higher KT signature scores correlate with improved measures for quality of rectal cancer surgery.

Highlights

Across Ontario, since the year 2006 various knowledge translation (KT) interventions designed to improve the quality of rectal cancer surgery have been implemented by the provincial cancer agency or by individual researchers
Stakeholders have suggested that KT intervention effectiveness may be enhanced through the use of ‘integrated knowledge translation’; the use of theory to plan, implement and evaluate any KT strategy; and, sustained iterative approaches that allow KT efforts to be modified as barriers to practice change are recognized [2,3,4,5]
Prior to this study we were aware that the two KT Signature I regions had published articles on the implementation of rectal cancer surgery KT interventions in addition to those championed by Cancer Care Ontario [13, 14]

Summary

Introduction

Across Ontario, since the year 2006 various knowledge translation (KT) interventions designed to improve the quality of rectal cancer surgery have been implemented by the provincial cancer agency or by individual researchers. Cancer Care Ontario, the governing body responsible for cancer care across the province, has used various KT interventions to improve the quality of care received by patients diagnosed with cancer, including patients undergoing rectal cancer surgery These include use of guidelines, communities of practice, diagnostic assessment programs, and multidisciplinary cancer conferences [7–12]. Cancer Care Ontario routinely reports on wait times for cancer surgery and occasionally executes limited audit and feedback to health region administrators (e.g., number of lymph nodes counted in pathology specimens) Of note, these interventions are delivered or encouraged in a top down manner; Cancer Care Ontario administrators have no mechanism to force surgeon engagement with any intervention, nor has there been an effort to evaluate the impact on patient care of these interventions

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