The Knowledge To Action (K2A) Cycle:Providing a Framework for Implementation

Ian Graham, PhD, FCAHSAugust 6, 2014TEACH, NYAM

Session objectivesLearn about the K2A Cycle (see Chapter 3.7a, p.249)Be able to identify and discriminate action phases of the K2A cycle

Disclosures/contextKnowledge Translation in Healthcare (2009, 2nd edition 2013, co-editor) (do not receive royalties) Evaluating the Impact of Implementing Evidence-based Practice (2010, co-editor). Co-originator: Ottawa Model of Research Use (OMRU)Practice Guideline Evaluation and Adaptation Cycle (PGEAC)Can-Implement ADAPTE processKnowledge to Action (K2A) CycleQueens University Roadmap for Knowledge Implementation (QuRKI)

Founding memberInternational ADAPTE Collaboration

No relationships with the bio-pharma industry

So what is knowledge translation?

Its all in the nameKnowledge to action (KTA)Knowledge Translation (KT)Knowledge Exchange (KE)Research Use/UtilizationKnowledge Transfer (KT) ImplementationKnowledge mobilization

So what is KT?It comprises:the practice of knowledge translation/implementation:Closing the gap between what we know and what we do (the reducing the know-do gap)Making users aware of knowledge and facilitating their use of it to improve health and health care systemsTransforming evidence into practice (moving knowledge into action)

&

Research/science: KT science/implementation science (studying the determinants of knowledge use and effective methods of promoting the uptake of knowledge)doing research in a collaborative fashion (iKT)

Just a bit of theory

Warning signs and symptomsEye rollingSighingInvoluntary utterancesOMGHMLJKMNHyperventilatingFaintingAffects people of all agesMore common in men and physicians

Does anyone suffer from TAS? or FAS?

TAS? Theory Averse Syndrome Framework Averse Syndrome FAS ?

Types of models/theories of changeChange theories/models fall into two basic kindsClassical - models that describe change, but were not specifically designed to cause change (normative)Planned models that are intended to be used to guide or cause changerefer to deliberately engineering change that occurs in groups that vary in size and setting. those who use planned change theories/models may work with individuals, but their objective is to alter ways of doing things in social systems. help change agents control variables that increase or decrease the likelihood of the occurrence of change.

K2A Cycle Framework: A Planned Action Modelbased on a concept analysis of 31 planned action theories

was developed to help make sense of the black box known as knowledge translation or implementation

offers a holistic view of the phenomenon by integrating the concepts of knowledge creation and application or action

Graham ID et al. Lost in knowledge translation: time for a map. JCEPH 2006, (1):13-24

The K2A frameworkThe framework takes a systems perspective:

knowledge producers and users are situated within a social system or systems that are responsive and adaptive, although not always in predictable ways.

the K2A process is considered iterative, dynamic, and complex, with the boundaries between the knowledge creation and action components are fluid and permeable.

The K2A frameworkfalls within the social constructivist paradigm which privileges social interaction and adaptation of research/evidence and takes local evidence, context and culture into account

designed to be used by a broad range of audiences

MonitorKnowledgeUseSustainKnowledgeUseEvaluateOutcomesAdaptKnowledgeto Local ContextAssess Barriers/Supports to Knowledge UseSelect, Tailor,ImplementInterventionsIdentify Problem

Identify, Review,Select KnowledgeStart hereApplication cycle

KNOWLEDGE CREATION

MonitorKnowledgeUseSustainKnowledgeUseEvaluateOutcomesAdaptKnowledgeto Local ContextAssess Barriers/Supports to Knowledge UseSelect, Tailor,ImplementInterventionsIdentify Problem

Identify, Review,Select KnowledgeKNOWLEDGE CREATION

The 2013 version of the K2A Cycle

Alternate ways of using the K2A Cyclepush researchpull researchlinkage and exchange (or integrated Knowledge Translation)

PushPush: Researchers, push research/syntheses/guidelines to knowledge-users

MonitorKnowledgeUseSustainKnowledgeUseEvaluateOutcomesAdaptKnowledgeto Local ContextAssessBarriers to Knowledge UseSelect, Tailor,ImplementInterventionsPullPull: Knowledge-users pull research/syntheses/guidelines that they need for their practice/policy decisions

Integrated Knowledge TranslationiKT: Researchers and knowledge-users work together to define and refine research questions and to put it into practice

K2A Cycle: an illustrationCommunity care of venous leg ulcersCollaborative interdisciplinary approachCo-PI Dr. Margaret Harrison, Queens University8 year program of research and implementation

A community-researcher alliance to improve chronic wound careCIHR KT Casebook, (Graham et al, 2006)http://www.cihr-irsc.gc.ca/e/30669.html

Pick the targeted issue carefully

To result in an action, the knowledge being translated needs to be relevant, appropriate, applicable, timely and reasonable to the needs of the intended users

*Campbell B. Applying knowledge to generate action: A community-based knowledge translation framework. JCEHP 30(1):65-71, 2010

Venous Leg UlcersPopulation with Leg Ulcers in particular:Common, costly, complexChronic, recurringDebilitating, isolating condition80% care reported to be community-based

A Picture is Worth a 1,000 Words

iKTiKT approach to project

KNOWLEDGE CREATIONUse of external and local evidence woven throughout all phases of the project

EITHER Start with problem/issue concern and look for research to solve the problemWhat is the magnitude of the problem?How do you know?Are all the relevant stakeholders involved in determining the problem?Identify Problem

Identify, Review,Select KnowledgeMonitorKnowledgeUseSustainKnowledgeUseEvaluateOutcomesAdaptKnowledgeto Local ContextAssess supports/Barriers to Knowledge UseSelect, Tailor,ImplementInterventions

ORBecome aware of current research/systematic review/guideline and assess whether current practice is in keeping with itHow to determine if and what knowledge How to determine if and what knowledge is needed?from an individual, team, unit and systems perspectiveDoes the evidence address an issue of relevance to the end user?Is it high quality evidence?If using a guideline, does it adhere to the AGREE and IOM quality criteria?

Identify Problem

Identify, Review,Select KnowledgeMonitorKnowledgeUseSustainKnowledgeUseEvaluateOutcomesAdaptKnowledgeto Local ContextAssess supports/Barriers to Knowledge UseSelect, Tailor,ImplementInterventions

ExampleHomecare authority identified wounds as issue (growing supply budget) and engaged researchers

Issue clarification requires local evidence to provide baseline and planning info at regional levelPopulation prevalence and profile studiesKnowledge, attitudes, practice (KAP surveys of providers)Environmental scan of expendituresGap analysis of current vs best practice

Identify Problem

Identify, Review,Select Knowledge

Products/ ToolsSynthesisKnowledge InquiryTailoring KnowledgeKNOWLEDGE CREATIONMonitorKnowledgeUseSustainKnowledgeUseEvaluateOutcomesAdaptKnowledgeto Local ContextAssessBarriers to Knowledge UseSelect, Tailor,ImplementInterventions

Knowledge inquiryProducts/ToolsSynthesisKnowledge InquiryTailoring KnowledgeExample:Regional prevalence study: 2 phased approach:1- case finding2- detailed clinical assessmentsIn homecare- admin database (supplies)Surveys of:family physicianspodiatristsLTC facilitiesAdvertisements in 15 local and community papers for self-referral

531 individuals identified with active LU, estimated 836 for region

Harrison MB, Graham ID, Friedberg E, Lorimer K, Vandelvelde-Coke S. Assessing the population with leg and foot ulcers. CN 1001, 97 (2): 18-23

Knowledge inquiryProducts/ToolsSynthesisKnowledge InquiryTailoring KnowledgeProfile studies:- 107 confirmed VLU cases from prevalence study Phase II (clinical assessment)Sociodemographic characteristicsCircumstances of livingHealth historyLeg ulcer historyHealth care providers seen

66 clients receiving care in 1 month at 1 agency (chart audit)Audit tool based on recommendations from 3 practice guidelines

Lorimer K, Harrison MB, Graham ID, Friedberg E. Venous leg ulcer care: How evidence-based is nursing practice? Wound Care 2003:30:132-42Lorimer K, Harrison MB, Graham ID, Friedberg E. Assessing venous ulcer population characteristics and practice in a home care community. OstomyWound Management. 2003:49(5):32-43

Knowledge inquiry

Products/ToolsSynthesisKnowledge InquiryTailoring KnowledgeKnowledge Attitudes, Practice (KAP) surveys: faxback survey of 425 family physicians in Ottawa-Carleton, 214 returned questionnaires (61% response rate)

all visiting nurses at 3 nursing agencies (n=170), paper based survey with return envelop and $1 scratch lottery ticket, 124 surveys returned (73% response rate).

Graham ID, Harrison MB, Shafey M, Keast D. Knowledge and attitudes regarding care of leg ulcers. Canadian Family Physician, 2003 49:896-902Graham ID, Harrison MB, Moffat C, Franks P. :eg ucler care: nursing attitudes and knowledge. Canadian Nurse 2001 97(3):19-24.

Knowledge inquiry

Products/ToolsSynthesisKnowledge InquiryTailoring KnowledgeExpenditure review: Descriptive survey conducted over 4 week period192 clients2270 care visits mean treatment time 26 min, mean travel time 17 min$80.62 (supplies $21.06) per visitcost per client $397 (SD =381)6% of homecare clients consuming 20% of supply budget

Estimate: 192 clients costing 1.3M per year

Friedberg E, Harrison M, Graham ID.. Current home care expenditures for persons with leg ulcers. Wound Care 2002, 29:186-92

The local evidenceRegional prevalence & profile study Prevalence: 1.8/1000 population (> 25 years)3/4 were > 65 yearsMajority independently mobile 60% had 4 or more co-morbid conditions Recurrent - 64% had a recurrent venous ulcerLongstanding - 60% had ulcer > 6 months, 1/3 >1 year40% had 2 or more ulcersEnvironmental scan, expenditures Average 19 different nurses saw any one client in month40% received daily or twice a day visits4 week costing estimated 192 cases $1.26 million nursing & supply expenditures(Harrison, et al 2001; Lorimer, et al 2003; Nemeth, et al 2003, 2004; Friedberg, et al 2002)

What should be best practice for (VLU management)?Review of published (Pubmed) and grey literature (accessible via the internet) to identify:Evidence on assessment and management of venous leg ulcershigh level evidence from numerous RCTs, Cochrane Systematic Reviewnumerous international Clinical Practice Guidelines available of variable quality (appraised using AGREE instrument)

Identify Problem

Identify, Review,Select Knowledge

Products/ ToolsSynthesisKnowledge InquiryTailoring KnowledgeKNOWLEDGE CREATIONMonitorKnowledgeUseSustainKnowledgeUseEvaluateOutcomesAdaptKnowledgeto Local ContextAssessBarriers to Knowledge UseSelect, Tailor,ImplementInterventions

Gap analysis of best practice vs current practice (Know do Gap)Identify Problem

Identify, Review,Select Knowledge

Products/ ToolsSynthesisKnowledge InquiryTailoring KnowledgeKNOWLEDGE CREATIONMonitorKnowledgeUseSustainKnowledgeUseEvaluateOutcomesAdaptKnowledgeto Local ContextAssessBarriers to Knowledge UseSelect, Tailor,ImplementInterventions

Best practice recommendationsPre guideline adoption(n = 66)n (%)Identification of Ulcer Etiology 35 (53)ABPI prior to initiating compression 21 (47)Serial Ulcer measurement recorded 7 (11)Compression bandage initiated for venous ulcers44 (66)Pain Assessment Documented10 (15)

AdaptKnowledge to Local ContextPractice Guidelines Evaluation and Adaptation Cycle (Graham et al 1999; Graham et al 2005)Adapt/contextualize knowledge to be implemented to contextExample

The adapted protocol

Ottawa-Carleton CCAC Leg Ulcer Care Protocol Reference Guide

A

C

C

B

A

B

Compression stockings (fitted) 1-3, 5, 6

Prevention of Recurrence: Client Education3, 4, 6

skin care, 1-3, 6 exercise, 1-4, 6, 7 elevation of legs 1, 2, 6, 7

Repeat ABPI 1, 2, 6

Review diagnosis, management and client adherence

with treatment; may require specialist referral and/or

biopsy 2-4

Refer for patch skin testing. 1-3, 6

Avoid products that commonly cause skin sensitivity

e.g. lanolin,1 topical antibiotics 1-3, 6

No routine bacteriological swab 1-3, 5, 6

Hydrocolloid or foam dressing 2

Pain management plan: 1, 3, 4, 6, 7

Compression, exercise, elevation and analgesia 1, 3, 4, 6, 7

Measure surface area serially over time. 1-3, 6

Wash ulcer with tap water or saline 1, 2, 4, 6

Simple non-adherent dressing 1-3, 6

Acceptable to client 1

Dressing appropriate to stage of healing and

amount of exudate. 4

Moist wound environment 4-7

C

2.1 Non-Venous or Mixed 1-3, 6, 7

ABPI between 0.5 and 0.8

OR

Unusual ulcer presentation

OR

Presence of other disease

Refer to the appropriate specialist1

A

B

A

C

Graduated, multilayer compression bandaging for the uncomplicated ulcer. High compression (35-40 mm Hg)

is more effective than low compression. 1- 7

Applied by trained practitioner 1-7

8. If ulcer is unhealed after 12 weeks of active treatment

7. If ulcer is associated with dermatitis

9. If ulcer has healed

6. If no sign of infection

1. Assessment

Clinical history, physical exam and lab testing to assess etiology and factors contributing to the leg ulcer1, 3, 4, 6, 7

Ankle Brachial Pressure Index (ABPI) to screen for arterial disease1-4, 6, 7

B

A

A

C

C

2.3 Venous

ABPI at least 0.8 6,7

Absence of arterial and other

non-venous disease

C

C

5. If ulcer is Painful

4.Wound Management

3. Management of Leg Ulcer

C

2.2 Arterial

ABPI less

than 0.5

Refer to

Vascular

surgeon 1-4, 6-8

A

C

B

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What might be the individual (patient or provider), organizational and team barriers to uptake of best practice?

What might be the individual, organizational and team supports to uptake of best practice?

Assess barriers/supports toknowledge use

To understand barriers and facilitators to adopting a recommendation consider the perspective of an end-user Why would I/we adopt this recommendation and how easily can I/we adapt it?

Does this recommendation make sense? (do I believe the evidence; does this align with what other respected sources are saying, does my experience support that this is the right thing to do? )If I change will it make an important difference to my patients well-being?How close is it to what I already do?Does it fit with how we do things around here?How disruptive will this be to my regular practice?Do I have the support I need in my practice or (in the system) to make this change?When I weigh the pros and cons of whether to adopt the new recommendation, which side wins?

What are the barriers/supports to uptake related to the innovation (best practice/guideline), adopters, practice setting/context?

The innovation/practice guideline/evidence

Development process

Attributes of the innovation

Credible developersall relevant stakeholdersinterdisciplinaryObjective & rigorous method Careful documentationExplicit & transparent processLocal involvementDevelopment Process

Relative advantage (useful)Low complexity (ease of use or do)Compatible (fits with current practice, norms/values)(Does not demand change in existing practice)Trialability (easy to try)Clear (not vague or non-specific)Evidence-based (Rogers 1995) (Grilli and Lomas, 1994) (Grol et al 1998) (Foy et al 2003)

Characteristics of the Innovation

Potential AdoptersAwarenessAttitudes/intentionKnowledge/SkillsConcerns(Squires et al. 2011; Graham, Logan, Harrison, Nimrod 2004)

Which of these adopter characteristics can be anticipated and addressed while trying to move research knowledge into practice?

Decision-making Policies, rules, lawsAvailable technologyPhysical layoutAvailability of evidenceWork pressureCurrent practice

Practice Environment/context

Structural Factors

Culture & belief systemsLeadershipPolitics & personalitiesPeer influence(Gifford, Davies, Edwards, Graham, 2006; Greenhalgh et al., 2004) Practice Environment/context Social Factors

Practice Environment/context Other FactorsPatient/Consumers/ClientsBehavior, attitudes, preferences, pressure

Economic ConsiderationsResources, remuneration, funding systems

Medical/Legal Issues

Other Organizational/System Factors

AssessBarriers to Knowledge Use

Approach to barriers assessment included:Example Knowledge, attitudes and practice (KAP) surveys of nurses and physicians (barriers to the guideline) Practitioner/policy maker feedback on adapted care protocol (barriers to the potential adopters) Discussions with providers and managers (barriers in the practice environment)

(Graham, Harrison, Friedberg et al. 2001; Graham, Harrison, Shafey et al. 2003)

Interviews using the theoretical domains framework

AssessBarriers to Knowledge UseExampleFindings: Knowledge deficits about effective treatment (compression bandaging) Lack of skills to assess for venous disease, bandage application Lack of equipment (ultrasound dopplers) Staffing system for community nursing agency Referral system (GP->home care; nurses->specialists) Remuneration system for nursing agencies Attitudes NOT an issue

Select/Tailor interventions as much as possible, based on the barriers and supports identified to move knowledge to practice

Consider the context in which you are trying to implement change what interventions are more or less likely to be effective?

Select, Tailor,ImplementInterventions

Creating an effective combination of strategies is both art and science.

The choice of KT interventions remains an art informed by science, meaning that practice-based experience and creativity are important in selecting KT interventions. We suggest that the use of a stepwise approach and structured methods helps take a comprehensive and balanced approach.

Wensing M, Bosch M, Grol R. Selecting, tailoring and implementing knowledge translation interventions in Strauss S, Tetroe J, Graham ID(editors) Knowledge Translation in Health Care: Moving from Evidence to Practice. 2013 p.150

Cochranes Effective Practice and Organization of Care review group source of synthesized info on effectiveness of KT interventionshttp://www.epoc.cochrane.org/en/index.htmlSRs of professional, organizational, financial & regulatory interventions

Rx for Change http://www.cadth.ca/en/resources/rx-for-change/database

Select, Tailor,ImplementInterventionsMonitorKnowledgeUseSustainKnowledgeUseEvaluateoutcomesAdaptKnowledgeto Local ContextAssess barriersbarriers to Knowledge UseSelect, Tailor,ImplementInterventions

Select, Tailor,ImplementInterventionsExample: Tailored implementation intervention Provider levelTraining for nurses (UK N18 course, doppler & bandaging training)

Practice setting level Redesigned service delivery for EB leg ulcer carededicated RN leg ulcer care teamhome and clinicequipmentreimbursement alterationsstanding medical orderschanges to process for referral to specialistsMonitorKnowledgeUse

Select, Tailor,ImplementInterventionsExampleDeveloped tools to facilitate use of the recommendations Protocol algorithm Assessment and documentation toolsMonitorKnowledgeUse

Instrumental (behaviour): guideline adherence, use/adoption of innovationConceptual (knowledge & attitudes & intentions),Symbolic/persuasive knowledge use

identify appropriate indicators of use of the innovation identify the level(s) (system, team, practitioner, patient) where you need to measure the knowledge useMonitorKnowledgeUse

MonitorKnowledgeUseExample

Recommendations Uptake

Parameters of EBCPGPre guideline adoption(n = 66)Post Guideline adoption(n = 238)n (%)n (%)Identification of Ulcer Etiology 35 (53)238 (100)ABPI prior to initiating compression 21 (47)227 (95)Serial Ulcer measurement recorded 7 (11)80(88)Compression bandage initiated for venous ulcers44 (66)148 (86)Pain Assessment Documented10 (15)215 (90)

Determine impact of using the guideline or uptake of the innovationPatient health outcomes (eg. relief of symptoms, mobility HRQoL)Provider outcomes (eg. satisfaction)System/organization outcomes (eg. Wait times, expenditures, readmissions)Unintended impacts

Identify outcomes/impacts to measure and methods for doing soDetermine your evaluation plan at the outset and in consultation with all stakeholdersEvaluateOutcomes

Pre-post Evaluation of Outcomes (Harrison, Graham, Lorimer et. al CMAJ 2005)

3 month healing rate: 23.1% 55.6% (p

SustainKnowledgeUseSustainability:

Anticipate sustainability issues from the beginning and build into Adaptation, KT interventions, Monitoring and Evaluation phasesExample:Leg ulcer service still available in Ottawa region Process used for developing and implementing best practice for other conditions (e.g. diabetic foot ulcers) Protocol was expanded to 3 other regions (still in use in 2) RCT of home vs clinic care (Harrison MB, Graham ID, et al. Nurse clinic versus home delivery of evidence-based community leg ulcer care: a randomized health services trial. BMC Health Services Research 2008, 8:2443) RCT of two compression technologies (Harrison MB, Vandenkerkhof EG, Hopman WM, Graham ID, et al. The Canadian Bandaging Trial: evidence-informed leg ulcer care and the effectiveness of two compression technologies. BMC Nurs 2011 10:20)

MonitorKnowledgeUseSustainKnowledgeUseEvaluateOutcomesAdaptKnowledgeto Local ContextAssessBarriers to Knowledge UseSelect, Tailor,ImplementInterventions

Take home messages (1)Closing the gap between best evidence and current practice (knowledge translation) is possible

Knowledge translation can lead to provision of effective and efficient care, and improved health outcomes

Choose your targeted change wisely

To maximize use of external evidence requires synthesizing and/or adaptation

Take home messages (2)Must generate and analyze local evidence about current situation and context

All research should be sufficiently rigorous & pragmatic, while meeting the needs of the project/implemenation process and timelines

The use of a framework (e.g. K2A Cycle) can be useful in guiding efforts and activities by providing the big picture (other planned action models exist)

Take home messages (3)

Understand barriers to implementation and select & tailor interventions accordingly

Evaluate use of knowledge and its impact to determine whether on track or need to revisit interventions

Plan for sustainability from the outset

Engaging knowledge-users from the start (iKT) is more likely to result in relevant research that is acted upon.

Change takes time, coordination, and sustained effort

I have been impressed with the urgency of doing.Knowing is not enough; we must apply.Being willing is not enough; we must do Leonardo da Vinci

Session objectivesLearn about the K2A CycleBe able to identify and discriminate action phases of the K2A cycle

Some Translation Resources

All royalties go into a fund for studentsChapters cover:Knowledge creationKnowledge-to-Action cycleTheories and Models of Knowledge-to-ActionKnowledge exchange/iKTEvaluation of Knowledge-to-Action

Presentations based on 2009 chapters available at:http://www.cihr-irsc.gc.ca/e/40618.html

KT in Health Care - Moving from Evidence to Practice

ktclearinghouse.ca

KT Clearinghouse

Any questions?I dont get it

Evaluate OutcomesMonitorKnowledgeUseExample

Stacey, 2007; www.ohri.ca/decisionaid *Just add slides from Cochrane review of implementation outcome slidesStacey, 2007; www.ohri.ca/decisionaid Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *23Studies and other articles have suggested that structural elements are important to consider. Decision-making refers to who makes the decisions related to practice. Does the decision making structure give nurses the authority to make practice decisions? Do existing policies support or hinder the new practice? If the change requires, is there sufficient working equipment available? Does the work layout hinder the change, do nurses now have to go out of their way to find a piece of equipment or to carry out the new practice.Do staff have access to updated evidence in a form that is meaningful to them? Do nurses have the time to learn and then carry out the new practice. How many other changes are being implemented concurrently to add to the work pressure?Are there sufficient funds to carry out the education of staff, the purchase of new equipment, to monitor and evaluate process and outcomes

Stacey, 2007; www.ohri.ca/decisionaid *27Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid We are following Wensings advice From KT in Health Care Moving from Evidence to PracticeStacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid Stacey, 2007; www.ohri.ca/decisionaid *Funded by CIHRProvides a large number of KT resources compiled in one place: - KT Canada: research network and training initiative - Knowledge Base: information repository and 'primer' course on doing KT - Centre for Evidence-Based Medicine: goal to help develop, disseminate, and evaluate resources that can be used to practise and teach EBM - list of KT tools: facilitate the practice or science of KT - Knowledge Translation Consultation Service: supports different clinical units at St. Michael's Hospital and researchers from the U. of T. to research, develop, implement and/or evaluate KT strategies - online community: connecting with other researchers Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid *Stacey, 2007; www.ohri.ca/decisionaid