Ottawa Model Research Articles

Using Standardized Insulin Orders to Improve Patient Safety in a Tertiary Care Centre

To standardize insulin prescribing practices for inpatients, improve management of hypoglycemia, reduce reliance on sliding scales, increase use of basal-bolus insulin and improve patient safety. Patients with diabetes were admitted to 2 pilot inpatient units followed by corporate spread to all insulin-treated patients on noncritical care units in a Canadian tertiary care multicampus teaching hospital. Standardized preprinted insulin and hypoglycemia management orders, decision support tools and multidisciplinary education strategies were developed, tested and implemented by way of the Model for Improvement and The Ottawa Model for Research Process. Clinical and balance measures were evaluated through statistical process control. Patient safety was improved through a reduction in hypoglycemia and decreased dependence on correctional scales. Utilization of the preprinted orders approached the target of 70% at the end of the test period and was sustained at 89% corporately 3 years post-implementation. The implementation of a standardized, preprinted insulin order set facilitates best practices for insulin therapy, improves patient safety and is highly supported by treating practitioners. The utilization of formal quality-improvement methodology promoted efficiency, enhanced sustainability, increased support among clinicians and senior administrators, and was effective in instituting sustained practice change in a complex care centre.

Implementation of a Smoking Cessation Pilot Project within the Department of Radiation Oncology at the Stronach Regional Cancer Centre

The process proposed for the Stronach Regional Cancer Centre Smoking Cessation Pilot Project is to create a continuum of supportive and inter-professional care through the patient’s treatment journey from initial consult through to post-treatment follow-up. Similar to the Ottawa Model for Smoking Cessation, the smoking status of each patient is identified and documented through a universal electronic tobacco assessment tool. Next, based on willingness and/or readiness to quit, patients are provided with appropriate smoking cessation resources and strategies including information on Nicotine Replacement Therapies.

Knowledge translation in physical therapy: from theory to practice

Purpose: Knowledge translation (KT) has emerged as a concept that can lead to a greater utilization of evidence-based research in systems of care. Despite a rise in KT research, the literature on KT in relation to physical therapy practice is scarce. This article provides physical therapists (PTs) with recommendations that can support the effective implementation of new knowledge and scientific evidence in clinical practice. Method: Recommendations are grounded in the Ottawa Model of Research Use and in the literature in KT in the health professions. Results: A well-established KT process, which is supported by a planning model, is essential to guide the implementation of scientific evidence. Consensus among all stakeholders about what evidence will be implemented must be reached. Context-related barriers and facilitators should be assessed and tailored active and multi-component interventions should be considered. Participation from individuals in intermediary positions (e.g. opinion leaders) supports implementation of KT interventions. Monitoring of the process and assessment of intended outcomes should be performed in order to assess the success of the implementation. Conclusion: Five major recommendations grounded in the Ottawa model are provided that can assist PTs with the complex task of implementing new knowledge in their clinical practice.Implications for RehabilitationIn order to support EBP, knowledge translation interventions can be used to support best practice.Implementation of new knowledge should be guided by a framework or a conceptual model.Consensus on the evidence must be reached and assessment of context-related factors should be done prior to the implementation of any KT intervention.Intervention strategies should be active, multi-component and include individuals with intermediary positions that can facilitate the KT process.

Use of a community of practice (CoP) platform as a model in regional quality improvements in cancer surgery: The Ottawa model.

68 Background: The Ottawa CoP model for developing multidisciplinary practitioner networks and integrating them with organizational processes was established in 2007 as a platform improving access to quality cancer surgery in one of the health regions (population 1,276,370) of Ontario, Canada. The three inter-disciplinary CoP collaboratives in breast, colorectal, and prostate cancer involve 230 care providers from 9 hospitals performing over 2,000 cancer surgeries per year. Objectives: 1) to address lack of coordination and standardization of care, 2) develop a regional platform for quality initiatives, and 3) bridge the gap between academic and community hospitals. Methods: Using the model, an academic tertiary care hospital and eight community hospitals partnered to support a regional quality improvement initiative that combines 1) educational outreach with audit and feedback to address variations in practice and 2) a unique platform for knowledge generation and innovation. Regional interdisciplinary teams developed a set of regional quality indicators (18) linked to mutually agreed standards and pathways. Regional registry was established to provide data feedback on performance against both provincial and regional standards. Best practices, innovations, and implementation progress are reviewed through sustained interactions between CoP members. Patient and care provider surveys are conducted. Results: The development and implementation of regional care standards and clinical pathways for three disease sites in 9 hospitals. Regional pathway compliance ranged 65-94%. Other significant improvements include: rectal cancer surgery centralization (80-90% per annum), increase in use of sentinel lymph node biopsies in breast cancer surgery (60-77% per annum) and a decreased positive prostate cancer surgical margin rate form 45% to 22%. Compliance with provincial guidelines for colon cancer surgery improved (20% increase 2006/2007 vs. 2010/2011). Increase in patient access to high-quality cancer surgery closer to home. Conclusions: Participation in the regional CoPs is associated with quality improvements at the system, patient, and professional levels.

Diabetes Clinical Indicator Database: Advancing Chronic Disease Management in Diabetes Education

predetermined questions were constructed using the Ottawa Model of Research Use, to identify perceived gaps and barriers in postpartum care. The session was audio taped, transcribed and opinions thematically analyzed. Results: Participants’ responses revealed themes on the organization of health services: receipt of conflicting messages; the challenge of competingpriorities;apprehensionaboutpostpartumdiabetes testing; lack of ongoing support; difficulty applying knowledge to sustain behaviour change. Needs identified: child-friendly environments and skill based resources. Patient's recommendations: merge community and health services with follow-up testing, restructure services as a group support format and face-to-face contact was important. Implications and Conclusions: Future development of services should engage community resources in planning, development and implementation. Women with young children require care that is child friendly, flexible and optimizes the use of their limited time to support their own behaviour change and long-term health. Funded in part by the Public Health Agency of Canada.

Examining sustainability in a hospital setting: Case of smoking cessation

BackgroundThe Ottawa Model of Smoking Cessation (OMSC) is a hospital-based smoking cessation program that is expanding across Canada. While the short-term effectiveness of hospital cessation programs has been documented, less is known about long-term sustainability. The purpose of this exploratory study was to understand how hospitals using the OMSC were addressing sustainability and determine if there were critical factors or issues that should be addressed as the program expanded.MethodsSix hospitals that differed on OMSC program activities (identify and document smokers, advise quitting, provide medication, and offer follow-up) were intentionally selected, and two key informants per hospital were interviewed using a semi-structured interview guide. Key informants were asked to reflect on the initial decision to implement the OMSC, the current implementation process, and perceived sustainability of the program. Qualitative analysis of the interview transcripts was conducted and themes related to problem definition, stakeholder influence, and program features emerged.ResultsSustainability was operationalized as higher performance of OMSC activities than at baseline. Factors identified in the literature as important for sustainability, such as program design, differences in implementation, organizational characteristics, and the community environment did not explain differences in program sustainability. Instead, key informants identified factors that reflected the interaction between how the health problem was defined by stakeholders, how priorities and concerns were addressed, features of the program itself, and fit within the hospital context and resources as being influential to the sustainability of the program.ConclusionsApplying a sustainability model to a hospital smoking cessation program allowed for an examination of how decisions made during implementation may impact sustainability. Examining these factors during implementation may provide insight into issues affecting program sustainability, and foster development of a sustainability plan. Based on this study, we suggest that sustainability plans should focus on enhancing interactions between the health problem, program features, and stakeholder influence.

017 Randomized trial of an automated telephone follow-up system for smoking cessation in smokers with CHD

Smokers with CHD benefit from cessation counseling in hospital only if it continues after discharge. A randomized controlled trial was conducted to determine if continuous abstinence from smoking would be higher 26 and 52 weeks after discharge in smokers who received interactive voice-response (IVR) mediated telephone follow-up and triage to nurse counseling compared to those receiving standard care. A total of 440 smokers (≥ 5 cigarettes/d) hospitalized with CHD at the University of Ottawa Heart Institute were randomized to either standard care (SC) or IVR. Standard care included: in-hospital nurse counseling; nicotine replacement therapy (NRT) during hospitalization; and a recommendation for ongoing NRT following discharge. Participants in the IVR group received standard care and also received automated telephone calls 3, 14, 30, 60, 90, 120, 150 and 180 days after discharge. During the call, the IVR system posed a series of questions concerning smoking status, confidence in staying smoke-free, and use of cessation medications. If the patient identified that they had resumed smoking or indicated that their confidence in remaining smoke-free was low, they were contacted by a nurse-counselor who provided additional assistance. The primary outcome was self-reported continuous abstinence 26 and 52 weeks after hospital discharge. Four hundred and one participants were eligible for inclusion in the analysis. Continuous abstinence was significantly higher in the IVR compared to the SC group at 26 weeks (38.7% vs. 29.5%; adjusted OR = 1.58; 95% CI, 1.04-2.42; P= 0.034). There was also a trend for higher continuous abstinence at 52 weeks favouring the IVR group (35.6% vs. 28.6%; adjusted OR = 1.45; 95% CI, 0.94-2.22; P= 0.093). IVR-mediated telephone follow-up and triage to nurse counseling lead to statistically and clinically significant increases in abstinence after discharge among smokers hospitalized with CHD. IVR offers an efficient way to direct limited hospital resources to smokers in need of ongoing support after discharge; the approach used in this study is a fundamental component of the Ottawa Model for Smoking Cessation.

198 Identification of smoking status among hospitalized cardiac patients: Are we doing enough to promote smoking cessation?

Smoking has adverse prognostic consequences in patients with established coronary artery disease (CAD), including greater subsequent rates of non-fatal myocardial infarctions, recurrent coronary events, restenosis and all-cause mortality. Smoking cessation is the most effective lifestyle modification in the management of patients with CAD. Clearly, patient smoking status should be screened systematically in inpatient cardiac settings, and smoking patients should be offered evidence-based cessation therapies. This study investigated cardiac outpatients' recall of: (1) being asked about their smoking status, and (2) among smokers, their recall of being offered treatment while hospitalized. In this cross-sectional substudy, 155 consenting CAD outpatients referred to 1 of 5 Ontario cardiac rehabilitation (CR) programs were provided a self-report survey at their first CR intake visit. Patients were asked to report their current smoking status, whether they recalled being asked about their smoking status while in-hospital, whether they were offered treatment, and the nature of treatment offered. A descriptive examination was performed. Of all participants, 9 (5.8%) reported they had never smoked. 126 (81.8%) reported they had quit smoking (24.62 ± 13.87 years). Finally, 19 (12.3%) reported being current smokers (Mean = 13.78 ± 10.67 cigarettes/day for 33.8 ± 12.80 years). Of all participants, 25 (16.2%) reported not being asked in hospital whether or not they smoked. This did not differ by time since hospital discharge (mean 10.54 ± 14.18, median 6, weeks P = 0.641). Of cardiac patients that currently smoked, 2 (10.5%) did not recall being asked if they smoked. When asked whether a healthcare provider offered them treatment or counseling to assist them in smoking cessation, overall 41 (26.6%) responded affirmatively. Of the current smokers, 11 (57.9%) reported being offered treatment. Specifically, 5 (50%) were offered nicotine replacement therapy, 4 (40%) were offered counselling, and 1 (10%) was offered Champix. Approximately 1/6 of cardiac patients do not recall being asked about their smoking status while hospitalized, with a slightly higher rate of recall among smokers (10%). Moreover, approximately 40% of smoking cardiac patients do not recall being offered smoking cessation treatment or counseling by a healthcare provider. These findings may be explained by patient recall failure, however clearly we should be striving to achieve universal screening of all smoking cardiac patients, and application of evidence-based strategies to promote cessation, such as the Ottawa Model for Smoking Cessation.

Barriers and facilitators to the dissemination of DECISION+, a continuing medical education program for optimizing decisions about antibiotics for acute respiratory infections in primary care: A study protocol

BackgroundIn North America, acute respiratory infections are the main reason for doctors' visits in primary care. Family physicians and their patients overuse antibiotics for treating acute respiratory infections. In a pilot clustered randomized trial, we showed that DECISION+, a continuing medical education program in shared decision making, has the potential to reduce the overuse of antibiotics for treating acute respiratory infections. DECISION+ learning activities consisted of three interactive sessions of three hours each, reminders at the point of care, and feedback to doctors on their agreement with patients about comfort with the decision whether to use antibiotics. The objective of this study is to identify the barriers and facilitators to physicians' participation in DECISION+ with the goal of disseminating DECISION+ on a larger scale.Methods/designThis descriptive study will use mixed methods and retrospective and prospective components. All analyses will be based on an adapted version of the Ottawa Model of Research Use. First, we will use qualitative methods to analyze the following retrospective data from the pilot study: the logbooks of eight research assistants, the transcriptions of 15 training sessions, and 27 participant evaluations of the DECISION+ training sessions. Second, we will collect prospective data in semi-structured focus groups composed of family physicians to identify barriers and facilitators to the dissemination of a future training program similar to DECISION+. All 39 family physicians exposed to DECISION+ during the pilot project will be eligible to participate. We will use a self-administered questionnaire based on Azjen's Theory of Planned Behaviour to assess participants' intention to take part in future training programs similar to DECISION+.DiscussionBarriers and facilitators identified in this project will guide modifications to DECISION+, a continuing medical education program in shared decision making regarding the use of antibiotics in acute respiratory infections, to facilitate its dissemination in primary care on a large scale. Our results should help continuing medical educators develop a continuing medical education program in shared decision making for other clinically relevant topics. This will help optimize clinical decisions in primary care.

Interprofessional collaborative practice within cancer teams: Translating evidence into action. A mixed methods study protocol.

BackgroundA regional integrated cancer network has implemented a program (educational workshops, reflective and mentoring activities) designed to support the uptake of evidence-informed interprofessional collaborative practices (referred to in this text as EIPCP) within cancer teams. This research project, which relates to the Registered Nurses' Association of Ontario (RNAO) Best Practice Guidelines and other sources of research evidence, represents a unique opportunity to learn more about the factors and processes involved in the translation of evidence-based recommendations into professional practices. The planned study seeks to address context-specific challenges and the concerns of nurses and other stakeholders regarding the uptake of evidence-based recommendations to effectively promote and support interprofessional collaborative practices.AimThis study aims to examine the uptake of evidence-based recommendations from best practice guidelines intended to enhance interprofessional collaborative practices within cancer teams.DesignThe planned study constitutes a practical trial, defined as a trial designed to provide comprehensive information that is grounded in real-world healthcare dynamics. An exploratory mixed methods study design will be used. It will involve collecting quantitative data to assess professionals' knowledge and attitudes, as well as practice environment factors associated with effective uptake of evidence-based recommendations. Semi-structured interviews will be conducted concurrently with care providers to gather qualitative data for describing the processes involved in the translation of evidence into action from both the users' (n = 12) and providers' (n = 24) perspectives. The Graham et al. Ottawa Model of Research Use will serve to construct operational definitions of concepts, and to establish the initial coding labels to be used in the thematic analysis of the qualitative data. Quantitative and qualitative results will be merged during interpretation to provide complementary perspectives of interrelated contextual factors that enhance the uptake of EIPCP and changes in professional practices.DiscussionThe information obtained from the study will produce new knowledge on the interventions and sources of support most conducive to the uptake of evidence and building of capacity to sustain new interprofessional collaborative practice patterns. It will provide new information on strategies for overcoming barriers to evidence-informed interventions. The findings will also pinpoint critical determinants of 'what works and why' taking into account the interplay between evidence, operational, relational micro-processes of care, uniqueness of patients' needs and preferences, and the local context.

If you build it, they still may not come: outcomes and process of implementing a community-based integrated knowledge translation mapping innovation

BackgroundMaps and mapping tools through geographic information systems (GIS) are highly valuable for turning data into useful information that can help inform decision-making and knowledge translation (KT) activities. However, there are several challenges involved in incorporating GIS applications into the decision-making process. We highlight the challenges and opportunities encountered in implementing a mapping innovation as a KT strategy within the non-profit (public) health sector, reflecting on the processes and outcomes related to our KT innovations.MethodsA case study design, whereby the case is defined as the data analyst and manager dyad (a two-person team) in selected Ontario Early Year Centres (OEYCs), was used. Working with these paired individuals, we provided a series of interventions followed by one-on-one visits to ensure that our interventions were individually tailored to personal and local decision-making needs. Data analysis was conducted through a variety of qualitative assessments, including field notes, interview data, and maps created by participants. Data collection and data analysis have been guided by the Ottawa Model of Research Use (OMRU) conceptual framework.ResultsDespite our efforts to remove all barriers associated with our KT innovation (maps), our results demonstrate that both individual level and systemic barriers pose significant challenges for participants. While we cannot claim a causal association between our project and increased mapping by participants, participants did report a moderate increase in the use of maps in their organization. Specifically, maps were being used in decision-making forums as a way to allocate resources, confirm tacit knowledge about community needs, make financially-sensitive decisions more transparent, evaluate programs, and work with community partners.ConclusionsThis project highlights the role that maps can play and the importance of communicating the importance of maps as a decision support tool. Further, it represents an integrated knowledge project in the community setting, calling to question the applicability of traditional KT approaches when community values, minimal resources, and partners play a large role in decision making. The study also takes a unique perspective--where research producers and users work as dyad-pairs in the same organization--that has been under-explored to date in KT studies.

Applying knowledge to generate action: A community-based knowledge translation framework

Practical strategies are needed to translate research knowledge between researchers and users into action. For effective translation to occur, researchers and users should partner during the research process, recognizing the impact that knowledge, when translated into practice, will have on those most affected by that research. Participatory action research (PAR) was used to generate a rural community's knowledge of their children's health. The Ottawa Model of Research Use (OMRU), a knowledge translation framework, was used to guide the translation of that generative knowledge into action, and the more current knowledge-to-action (KTA) conceptual framework provided the rationale for the graphical depiction of engagement of a rural community in knowledge translation. The definitions, perspectives, best practices, and existing frameworks of knowledge translation are outlined. The foundational underpinnings and elements of PAR, the OMRU, and KTA are linked to form a conceptual framework for knowledge translation in a rural community context. Select strategies noted in OMRU to translate existing knowledge informed aspects of PAR to generate an action. Diverse yet complementary approaches could be used by health professionals to advance the theory, method, and research of knowledge translation and exchange, regardless of context. Knowledge needs to be relevant, appropriate, applicable, timely, and reasonable to influence change.

Smoking cessation for hospitalized smokers: An evaluation of the “Ottawa Model”

Interventions for hospitalized smokers can increase long-term smoking cessation rates. The Ottawa Model for Smoking Cessation (the "Ottawa Model") is an application of the "5 A's" approach to cessation, customized to the hospital setting. This study evaluated the impact of implementing the Ottawa Model in 9 hospitals in eastern Ontario. The RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) framework was used to evaluate the intervention. Trained outreach facilitators assisted 9 hospitals to implement the Ottawa Model; program delivery was then monitored over a 1-year period using administrative data and data from a follow-up database. A before-and-after study was conducted to gauge the effect of the Ottawa Model program on cessation rates 6 months after hospitalization. Self-reports of smoking cessation were biochemically confirmed in a random sample of patients, and all cessation rates were corrected for potential misreporting. Sixty-nine percent of the expected number of smokers received the Ottawa Model intervention. Controlling for hospital, the confirmed 6-month continuous abstinence rate was higher after, than before, introduction of the Ottawa Model (29.4% vs. 18.3%; odds ratio = 1.71, 95% CI = 1.11-2.64; Z = 2.43; I(2) = 0%; p = .02). The intervention was more likely to accomplish counseling for smokers than delivery of medications or postdischarge follow-up. Attitudinal, managerial, and environmental challenges to program implementation were identified. Trained outreach facilitators successfully implemented the Ottawa Model in 9 hospitals leading to significantly higher long-term cessation rates. The public health implications of systematic cessation programs for hospitalized smokers are profound.

Barriers and supports to implementation of MDI/spacer use in nine Canadian pediatric emergency departments: a qualitative study

BackgroundDespite recent research supporting the use of metered dose inhalers with spacer devices (MDI/spacers) in pediatric emergency departments (PEDs) for acute exacerbations of asthma, uptake of this practice has been slow. The objectives of this study were to determine the barriers and supports to implementing MDI/spacer research and to identify factors associated with early and late adoption of MDI/spacers in Canadian PEDs.MethodsUsing a comparative case study design, we classified nine tertiary care pediatric hospital PEDs based on their stage of implementation. Data were collected using focus group interviews with physicians, registered nurses (RNs), and respiratory therapists (RTs), and individual interviews with both patient care and medical directors at each site. Initial coding was based on the Ottawa Model of Research Use (OMRU) categories of elements known to influence the uptake of innovations.ResultsOne hundred and fifty healthcare professionals from nine different healthcare institutions participated in this study. Lack of leadership in the form of a research champion, a lack of consensus about the benefits of MDI/spacers among staff, perceived resistance from patients/parents, and perceived increased cost and workload associated with MDI/spacer use were the most prevalent barriers to the adoption of the MDI/spacer. Common strategies used by early-adopting sites included the active participation of all professional groups in the adoption process in addition to a well-planned and executed educational component for staff, patients, and families. Early adopter sites were also more likely to have the MDI/spacer included in a clinical protocol/pathway.ConclusionPotential barriers and supports to implementation have been identified that will help EDs adopt MDI/spacer use. Future interventions intended to increase MDI/spacer use in PEDs will need to be sensitive to the barriers identified in this study.

Promoting Evidence-Based Dysphagia Assessment and Management by Nurses

The Ottawa Model of Research Use guided the Hospital Elder Life Program nursing staff at a community hospital in promoting dysphagia assessment and management. The effect of an educational program and educational outreach on nurses' knowledge retention and nurse-initiated speech language pathology (SLP) referrals were assessed. The sample consisted of 122 nurses. Repeated measures analysis of variance demonstrated significant differences among the pretest and posttests immediately after and at 2 and 6 months later (F[3,70] = 10.126, p < 0.001). Nurses were more likely to initiate SLP referrals after the program. Improving practice requires stakeholder engagement and multiple strategies to sustain change.

Overcoming Barriers to Cancer-Helpline Professionals Providing Decision Support for Callers: An Implementation Study

To evaluate the effect of an intervention on healthcare professionals' perceptions of barriers influencing their provision of decision support for callers facing cancer-related decisions. A pre- and post-test study guided by the Ottawa Model of Research Use. Australian statewide cancer call center that provides public access to information and supportive cancer services. 34 nurses, psychologists, and other allied healthcare professionals at the cancer call center. Participants completed baseline measures and, subsequently, were exposed to an intervention that included a decision support tutorial, coaching protocol, and skill-building workshop. Strategies were implemented to address organizational barriers. Perceived barriers and facilitators influencing provision of decision support, decision support knowledge, quality of decision support provided to standardized callers, and call length. Postintervention participants felt more prepared, confident in providing decision support, and aware of decision support resources. They had a stronger belief that providing decision support was within their role. Participants significantly improved their knowledge and provided higher-quality decision support to standardized callers without changing call length. The implementation intervention overcame several identified barriers that influenced call center professionals when providing decision support. Nurses and other helpline professionals have the potential to provide decision support designed to help callers understand cancer information, clarify their values associated with their options, and reduce decisional conflict. However, they require targeted education and organizational interventions to reduce their perceived barriers to providing decision support.

Mapping as a knowledge translation tool for Ontario Early Years Centres: views from data analysts and managers

BackgroundLocal Ontario Early Years Centres (OEYCs) collect timely and relevant local data, but knowledge translation is needed for the data to be useful. Maps represent an ideal tool to interpret local data. While geographic information system (GIS) technology is available, it is less clear what users require from this technology for evidence-informed program planning. We highlight initial challenges and opportunities encountered in implementing a mapping innovation (software and managerial decision-support) as a knowledge translation strategy.MethodsUsing focus groups, individual interviews and interactive software development events, we taped and transcribed verbatim our interactions with nine OEYCs in Ontario, Canada. Research participants were composed of data analysts and their managers. Deductive analysis of the data was based on the Ottawa Model of Research Use, focusing on the innovation (the mapping tool and maps), the potential adopters, and the environment.ResultsChallenges associated with the innovation included preconceived perceptions of a steep learning curve with GIS software. Challenges related to the potential adopters included conflicting ideas about tool integration into the organization and difficulty with map interpretation. Lack of funds, lack of availability of accurate data, and unrealistic reporting requirements represent environmental challenges.ConclusionDespite the clear need for mapping software and maps, there remain several challenges to their effective implementation. Some can be modified, while other challenges might require attention at the systemic level. Future research is needed to identify barriers and facilitators related to using mapping software and maps for decision-making by other users, and to subsequently develop mapping best practices guidelines to assist community-based agencies in circumventing some challenges, and support information equity across a region.

Correction: Using participatory design to develop (public) health decision support systems through GIS

BackgroundOrganizations that collect substantial data for decision-making purposes are often characterized as being 'data rich' but 'information poor'. Maps and mapping tools can be very useful for research transfer in converting locally collected data into information. Challenges involved in incorporating GIS applications into the decision-making process within the non-profit (public) health sector include a lack of financial resources for software acquisition and training for non-specialists to use such tools. This on-going project has two primary phases. This paper critically reflects on Phase 1: the participatory design (PD) process of developing a collaborative web-based GIS tool.MethodsA case study design is being used whereby the case is defined as the data analyst and manager dyad (a two person team) in selected Ontario Early Year Centres (OEYCs). Multiple cases are used to support the reliability of findings. With nine producer/user pair participants, the goal in Phase 1 was to identify barriers to map production, and through the participatory design process, develop a web-based GIS tool suited for data analysts and their managers. This study has been guided by the Ottawa Model of Research Use (OMRU) conceptual framework.ResultsDue to wide variations in OEYC structures, only some data analysts used mapping software and there was no consistency or standardization in the software being used. Consequently, very little sharing of maps and data occurred among data analysts. Using PD, this project developed a web-based mapping tool (EYEMAP) that was easy to use, protected proprietary data, and permit limited and controlled sharing between participants. By providing data analysts with training on its use, the project also ensured that data analysts would not break cartographic conventions (e.g. using a chloropleth map for count data). Interoperability was built into the web-based solution; that is, EYEMAP can read many different standard mapping file formats (e.g. ESRI, MapInfo, CSV).DiscussionBased on the evaluation of Phase 1, the PD process has served both as a facilitator and a barrier. In terms of successes, the PD process identified two key components that are important to users: increased data/map sharing functionality and interoperability. Some of the challenges affected developers and users; both individually and as a collective. From a development perspective, this project experienced difficulties in obtaining personnel skilled in web application development and GIS. For users, some data sharing barriers are beyond what a technological tool can address (e.g. third party data). Lastly, the PD process occurs in real time; both a strength and a limitation. Programmatic changes at the provincial level and staff turnover at the organizational level made it difficult to maintain buy-in as participants changed over time. The impacts of these successes and challenges will be evaluated more concretely at the end of Phase 2.ConclusionPD approaches, by their very nature, encourage buy-in to the development process, better addresses user-needs, and creates a sense of user-investment and ownership.

Adoption and sustainability of decision support for patients facing health decisions: an implementation case study in nursing

BackgroundEffective interventions prepare patients for making values-sensitive health decisions by helping them become informed and clarifying their values for each of the options. However, patient decision support interventions have not been widely implemented and little is known about effective models for delivering them to patients. The purpose of this study was to describe call centre nurses' adoption of a decision support protocol into practice following exposure to an implementation intervention and to identify factors influencing sustainable nursing practice changes.MethodsExploratory case study at a Canadian province-wide call centre guided by the Ottawa Model of Research Use. Data sources included a survey of nurses who participated in an implementation intervention (n = 31), 2 focus groups with nurses, interviews with 4 administrators, and a document review.ResultsTwenty-five of 31 nurses responded to the survey measuring adoption of decision support in practice. Of the 25 nurses, 11 had used the decision support protocol in their practice within one month of the intervention. Twenty-two of the 25 intended to use it within the next three months. Although some nurses found it challenging to begin using the protocol, most nurses reported that it: a) helped them recognize callers needing decision support; b) changed their approach to handling these calls; and c) was a positive enhancement to their practice. Strategies identified to promote sustainability of practice changes included integration of the decision support protocol in the call centre database, streamlining the patient decision aids for easier use via telephone, clarifying the administrative direction for the call centre's program, creating a call length guideline specific for these calls, incorporating decision support training in the staff development plan, and informing the public of this enhanced service.ConclusionAlthough most nurses adopted the decision support protocol for coaching callers facing values-sensitive decisions, to sustain practice changes, interventions are required to manage barriers in the practice environment and integrate decision support into the organization's policies, resources, and routine activities.

Knowledge translation in developing countries

There is increasing evidence that the application of knowledge in developing countries is failing. One reason is the woeful shortage of health workers, but as this is redressed, it is also crucial that we have an evidence base of what works to minimize the "know-do gap." The World Health Organization and other international organizations are actively building momentum to promote research to determine effective strategies for knowledge translation (KT). At this time, the evidence base for the effectiveness of those strategies is not definitive in developed countries and is relatively sparse in developing countries. It appears, however, that the effectiveness of these strategies is highly variable and dependent on the setting, and success hinges on whether the strategies have been tailored. A useful framework to provide direction for tailoring interventions is the Ottawa Model of Research Use (OMRU). Underlying OMRU is the principle that success rests with tailoring KT strategies to the salient barriers and supports found within the setting. The model recommends that barriers and supports found in the practice environment or as characteristics of potential adopters and the evidence-based innovation or research evidence be assessed and then the KT strategy tailored and executed. The model also recommends that whether the research has been applied and has resulted in improved health outcomes should be measured. Studies in developing countries, although few, illustrate that the OMRU approach may be a valid method of tackling the challenges of KT strategies to improve health care in developing countries.