Dissemination and Implementation Update
Anne C. Beal, MD, MPH, Deputy Executive Director and Chief Officer for Engagement PCORI Board of Governors Meeting Washington, DC September 23, 2013
Overview
1. Dissemination for Implementation of Clinical Comparative Effectiveness Research at PCORI
2. Results and lessons learned from PCORI’s Roundtable of Multiple Stakeholders in Dissemination for Implementation on July 29, 2013
3. Next Steps
4. Appendix: 1. Roundtable details 2. Roundtable participants 3. Request for Proposal (released August 30, 2013)
Board of Governors Meeting September 2013 2
Questions for the Board
What is the appropriate relationship between dissemination activities and implementation activities? Are we on the right path in thinking that we should emphasize dissemination, making information available and usable to those who are implementing?
Board of Governors Meeting September 2013 3
PCORI Board of Governors Meeting, September 2013 4
Dissemination for Implementation of Clinical Comparative Effectiveness Research at PCORI
Dissemination Efforts Start with Patient and Stakeholder Engagement in Research
Board of Governors Meeting September 2013 5
Research Peer Review Disseminate Implement Impact
The Continuum of PCORI’s
Efforts in Dissemination for
Implementation beginning with the
Active Portfolio Management Cycle
Making the case for addressing the gap between information, its use, and health outcomes
Knowledge + Practice
Board of Governors Meeting September 2013 6
PCORI’s Action Plan for Dissemination for Implementation targets the gap between information and its use in delivery and decision making for clinicians, patients, and caregivers.
Current Knowledge and Practice
New Investments in Knowledge
Dissemination Efforts to Promote Implementation
Optimal Healthcare Practice
Establishing a PCORI Action Plan for Dissemination to Promote Implementation
PCORI’s Action Plan for Dissemination for Implementation is being established:
To guide the organization in disseminating the research findings of funded research conducted in the national program areas
To speed implementation by actively facilitating how PCORI’s research findings can be used by healthcare decision makers
To evaluate how the effect of the dissemination of such findings reduces practice variation and disparities in health care
Board of Governors Meeting September 2013 7
DISSEMINATION IMPLEMENTATION ►
Clinicians frequently use general Internet searches and colleagues to obtain information to diagnose and treat patients How often do you use the following sources to obtain information to diagnose, treat and care for patients?
Board of Governors Meeting September 2013 8
40%
38%
34%
20%
18%
4%
31%
28%
28%
40%
35%
13%
0% 20% 40% 60% 80% 100%
General internet search engines
Online subscription services
Colleagues
Online free services
Peer reviewed literature
Cochrane Database or other systematicreviews
Daily A few times per week
6%
27%
34%
32%
2%
11%
26%
60%
0% 20% 40% 60% 80% 100%
Other source
Family or friends
Doctor or healthcare provider
Internet
Chronic Disease Patients Rare Disease Patients
Patients use the Internet as first source of health information The most recent time you looked for information about health or medical topics, where did you go first?
*p <0.05
Board of Governors Meeting September 2013 9
Patients use a variety of Internet sources In the past 12 months, which of the following internet sources have you used to get information about health or medical topics?
Board of Governors Meeting September 2013 10
42%
54%
47%
45%
37%
36%
34%
37%
0% 20% 40% 60% 80% 100%
Website for disease focusedgroup
Website for government healthagency
Website for health plan
Patient online community
Chronic Disease Patients Rare Disease Patients
*p <0.05
*
*
*
Patients’ trust in Internet is low compared to other sources How much do you trust information about health or medical topics from each of the following?
Board of Governors Meeting September 2013 11
23%
21%
20%
23%
24%
41%
69%
12%
13%
13%
15%
20%
40%
76%
0% 20% 40% 60% 80% 100%
Online patient communities
Family or friends
Internet
Your health plan
Government health agencies
Disease focused groups
Doctor
% “A lot” of trust
Chronic Disease Patients Rare Disease Patients
*p <0.05
*
*
* *
►
Potential Mechanisms for Dissemination to Promote Implementation
Engage major patient organizations Establish partnerships with specialty organizations; Build working relationships with health plans; Develop partnerships with health systems; Connect thru the National Patient-Centered Clinical Research Network; Publish findings in key journals; and Explore use of web services, social media, apps, etc.
Board of Governors Meeting September 2013 12
DISSEMINATION IMPLEMENTATION ►
AHRQ and PCORI’s Role in Dissemination and Implementation
AHRQ shall disseminate the research findings that are published by PCORI Sec. 937(a)(1) Create informational tools that organize and disseminate research findings for physicians, health care providers, patients, payers, and policy makers Sec. 937(a)(1) Develop a publicly available resource database that collects and contains government-funded evidence and research Sec. 937(a)(1)
Board of Governors Meeting September 2013 13
Authorizing Legislation
The purpose of the institute is to assist patients, clinicians, purchasers, and policy-makers in making informed health decisions by advancing the quality and relevance of evidence…and the dissemination of research findings with respect to the relative health outcomes, clinical effectiveness, and appropriateness of the medical treatments, services, and items described in subsection (a)(2)(B).
Success for PCORI and AHRQ = Impact on practice and patient outcomes
Agency for Healthcare Research
and Quality (AHRQ)
Patient-Centered Outcomes Research Institute (PCORI)
Board of Governors Meeting September 2013 14
Results and Lessons Learned From PCORI’s Roundtable of Multiple Stakeholders in
Dissemination for Implementation
Developing the PCORI Dissemination for Implementation Action Plan
Board of Governors Meeting September 2013 15
Process for Developing PCORI’s Action Plan for Dissemination for Implementation
Incorporate learning from workshop and develop PCORI’s Action Plan
for Dissemination & Implementation
Host D & I Roundtable
Convene experts at D & I Roundtable to receive input which
will inform RFP
Conduct Phone Calls
Collect preliminary information from roundtable participants
Release Consortia RFP
Award Consortia RFP Host D&I Workshop & Activate Public Input
FINAL: PCORI D&I Action Plan
JULY 2013
Using input from the roundtable, develop and release consortia RFP
Award consortia RFP to finalist Convene D & I Workshop to hear results of project(s)
RFP
AUGUST 2013
OCTOBER 2013 FEBRUARY 2014 FEBRUARY 2014
Overview of the Roundtable Agenda Establishing PCORI’s Action Plan for Dissemination and Implementation
1
2
3
4
5
6
Welcome and Introductions
Brian Mittman - Overview of D&I Frameworks
Jean Slutsky - Overview of AHRQ’s D&I Efforts
Roundtable Discussion - Part 1
Roundtable Discussion - Part 2
Public Comment Period
7 Next Steps and Adjourn
Break
Break
Board of Governors Meeting September 2013 16
Roundtable Results
Board of Governors Meeting September 2013 17
3.4 Million Twitter Reach
28 Panelists Including BoG and MC Members: Gail Hunt, Bob Jesse, Sharon Levine, Brian Mittman, and Jean Slutsky
323 Webinar Participants
5.7 Hours of Discussion
Stakeholder Groups Attendance Total
Multi-Stakeholder
7 Clinician/Provider 4 Patient/Caregiver 5 Purchasers/Payors 6 QI/Implementation Advocacy, Support, Professional Organizations, Industry 6 Research and Policy
Board of Governors Meeting September 2013 19
Discussion Questions: Share Experience
1
2
3
Given your personal experience in dissemination and implementation, what are the lessons learned, barriers, and successful facilitators in dissemination and implementation?
What strategies can PCORI use to build on or complement AHRQ’s current work in dissemination and implementation?
What key elements would you like to see in PCORI's blueprint to help your organization with implementing research findings?
Board of Governors Meeting September 2013 20
Discussion Questions: Help Formulate RFP
4
5
6
What is the best approach to develop a framework for implementing results of comparative effectiveness research (CER)?
Which already existing frameworks would you recommend be reviewed for developing PCORI’s blueprint for dissemination and implementation?
What would you include in the scope of work for the request for proposal (RFP)? What are the key abilities we should seek among applicants interested in developing a framework in response to the request for proposal (RFP)?
Six Key Lessons Learned
1. Consortia. Effectively managing dissemination to speed implementation will require the involvement of key groups: patients, providers, consumers, media, journal publishers, opinion leaders, community and public health workers, government agencies, and health-data consortiums.
2. Framework. Build on a variety of already existing frameworks and agree on a generalizable model which supports PCORI’s mission.
3. Readiness. Include a preliminary plan for assessing readiness for the people and organizations affected by new knowledge
4. Tailor Messages. Consider tailored message to different audiences through trusted channels; include a focus on underserved populations.
5. Leverage Partnerships. Disseminate in coordination (not in isolation) with other organizations through the engagement efforts.
6. New Media. Be innovative and go to new venues, such as social media, non-usual suspect magazines/journals.
Board of Governors Meeting September 2013 21
D&I Workgroup
Board of Governors Gail Hunt Bob Jesse Sharon Levine
Methodology Committee
Brian Mittman Jean Slutsky
Staff Anne Beal Orlando Gonzales Bill Silberg
Board of Governors Meeting September 2013 22
PCORI Board of Governors Meeting, September 2013 23
Next Steps for Developing PCORI’s Action Plan for Dissemination for Implementation
Developing the PCORI Dissemination for Implementation Action Plan
Board of Governors Meeting September 2013 24
Process for Developing PCORI’s Action Plan for Dissemination for Implementation
Incorporate learning from workshop and develop PCORI’s Action Plan for
Dissemination for Implementation
Host D&I Roundtable
Convene experts at D & I Roundtable to receive input which
will inform RFP
Conduct Phone Calls
Collect preliminary information from roundtable participants
Release Consortia RFP
Award Consortia RFP Host D&I Workshop and Activate Public Input
FINAL: PCORI D&I Action Plan
JULY 2013
Using input from the roundtable, develop and release consortia RFP
Award consortia RFP to finalist Convene D&I Workshop to hear results of project(s)
RFP
AUGUST 2013
NOVEMBER 2013 FEBRUARY 2014 MARCH 2014
Timetable for the RFP
KEY DATES RFP Released August 30, 2013 Deadline for Proposals October 25, 2013 Semifinalists Notified November 15, 2013 Semifinalists Interviews in Atlanta, Georgia November 20 or 21, 2013
Projected Award Date November 29, 2013 Dissemination for Implementation Workshop February, 2014
Final PCORI D&I Action Plan March, 2014
Board of Governors Meeting September 2013 25
Questions for the Board
What is the appropriate relationship between dissemination activities and implementation activities? Are we on the right path in thinking that we should emphasize dissemination, making information available and usable to those who are implementing?
Board of Governors Meeting September 2013 27
Appendix
1. Roundtable details 2. Roundtable participants 3. RFP (Released August 30, 2013)
PCORI Board of Governors Meeting, September 2013 28
Three Goals: PCORI’s Action Plan for Dissemination for Implementation
1. Gather opinions from experts on what PCORI’s Action Plan should encompass
2. Identify gaps where there is a need to develop new knowledge on best practices for dissemination and implementation
3. Grow consensus behind an approach to our work in dissemination and implementation
PCORI Board of Governors Meeting, September 2013 30
Recommendation for the development of the RFP
PCORI Board of Governors Meeting, September 2013 31
This work might be too big for one organization to know.
Craig Acomb Institute for Clinical Systems Improvement
Forming a Consortium of Multiple Stakeholders to Develop the Plan
PCORI Board of Governors Meeting, September 2013 32
Involving stakeholders in the RFP
RFP Winner
The RFP Recipient will involve multiple stakeholders as
sub-contractors
Journals and Publications
Patients
Vulnerable Populations
Health Systems
Health IT
Social and App Developers Mass Media
RFP
Clinicians Researchers
Payors: Employers and Health Plans
Given your personal experience in dissemination and implementation, what are the lessons learned, barriers, and facilitators in successful spread and uptake?
Include a focus on health literacy, disparities, and cultural differences Communications should include storytelling, case studies, and simple but comprehensive messages Tailor message to different audiences through trusted channels Involve stakeholders and patients from the beginning Leverage partnerships Develop readiness framework
Include guidelines and registries Be flexible and adaptable Include a focus on caregivers Assess political impact Understand the workflow to implement in hospital or clinical settings Develop apps Disseminate in coordination with other organizations, not in isolation Develop criteria and framework for measurement PCORI Board of Governors Meeting, September 2013 33
1
What strategies can PCORI use to build on or complement AHRQ’s current work in dissemination and implementation?
Leverage diverse stakeholders that have credibility and trust with audience Create communication tools and decision-support tools to access information Provide technical assistance for end-users and incorporate technology Spread information nationally Explore successful examples within media and social media (Wikipedia, WebMD, Women’s Day) Involve stakeholders early
Complement AHRQ’s work Leverage PPRNs and CCBRs as test bed for D&I efforts Communicate about what works well and what doesn’t work
PCORI Board of Governors Meeting, September 2013 34
2
“Engage early adopter partnerships in advance so that
information does not fall on deaf ears.”
What key elements would you like to see in PCORI’s Action Plan to help your organization with implementing research findings?
Mobile health and new apps Create common standards, terms, and definitions Include a focus on underserved populations Provide technical assistance to implementers Determine ROI construct and financial incentives Learn from and build relationships with successful efforts, such as CTSA Provide training and education Work closely with evaluator
Develop a sustainable communication action plan: Scale and sustainability Focus on where the field is going Customized and personalized Understand how different groups digest information Develop communication readiness tools and user-friendly tools
PCORI Board of Governors Meeting, September 2013 35
3
“Skate to where the puck is going to be.”
What is the best approach to develop a framework for implementing results of comparative effectiveness research (CER)?
Identify best methods to disseminate evidence Partner with key stakeholders Convene conferences to ensure alignment and coordination with other groups Don’t consider proposal unless it addresses disparities Use crowd-sourcing to identify gaps and conduct environmental scan Use targeted, frequent communications with storytelling
Leverage trusted spokespersons (ex. Angelina Jolie and Oprah) “Consider 7-11 rule” Patients may reject CER, but PCORI must still build trust Advanced apps and technology Include a focus on shared decision-making and caregivers SOW should be completed by single organization with communications skills and experience
PCORI Board of Governors Meeting, September 2013 36
4
Which already existing frameworks would you recommend be reviewed for developing PCORI’s Action Plan for dissemination and implementation?
Leverage existing frameworks (ex. Porter’s 5 Forces, Pestel model, Social cognitive theory, elaboration models, social inoculation model) Review successful quality improvement and standards efforts currently underway Facilitate registries across specializations Create safe places to fail Leverage opinion-leaders Review cultural and technical aspects such as webinars
Look at learning communities (ex. regional extension centers, ONC, AHRQ exchanges, RWJF “Aligning Forces”) Explore non-health models Understand why bad ideas stick
PCORI Board of Governors Meeting, September 2013 37
5
“Frameworks need to be simple,
credible, emotional, and include aspects
of storytelling”
What would you include in the scope of work for the request for proposal (RFP)? What are the key abilities we should seek among applicants interested in developing a framework in response to the request for proposal (RFP)?
Engage multiple and credible stakeholders to complete the SOW Include an effective testing site to measure strategies in real-time Focus on underrepresented populations Bridge the digital divide Effective communications, branding, and behavioral patterns/changes Include a focus on speed of adoption Measure ROI
Consider audience segmentation and analysis Explore the benefits and limitations of social media Include broad stakeholder engagement to gather feedback Include ability customize frameworks to communicate preferences, outcomes, risk and benefits
PCORI Board of Governors Meeting, September 2013 38
6
“One size doesn’t fit all”
PCORI Board of Governors Meeting, September 2013 40
Craig Acomb, Institute for Clinical Systems Improvement Hilda Bastian, National Center for Biotechnology Information Kathleen Blake, American Medical Association
Panelists
Don Goldmann, Institute for Health Improvement Jennifer Graff, National Pharmaceutical Council Matthew Holland, WebMD
Barbara Edson, American Hospital Association Kevin Fahey, America's Health Insurance Plans Tejal Gandhi, National Patient Safety Foundation
PCORI Board of Governors Meeting, September 2013 41
Gail Hunt, National Alliance for Caregiving Bob Jesse, US Department of Veterans Affairs Norm Kahn, Council of Medical Specialty Societies Christine Laine, American College of Physicians and International Committee of Medical Journal Editors Sharon Levine, Kaiser Permanente Sarah Lock, AARP Renee Mentnech, Centers for Medicare and Medicaid Services Brian Mittman, US Department of Veterans Affairs Doris Peter, Consumer Reports
No Photo Available
PCORI Board of Governors Meeting, September 2013 42
Michelle Proser, National Association of Community Health Centers Pamela Rich, National Business Group on Health Kate Ryan, Consumers United for Evidence-based Healthcare and National Women's Health Network Bruce Seeman, Agency for Healthcare Research and Quality Lisa Simpson, AcademyHealth Jamie Skipper, US Department of Health and Human Services/Office of the National Coordinator Jean Slutsky, Agency for Healthcare Research and Quality Roger Snow, Medicaid Medical Directors Learning Network Darius Tandon, Johns Hopkins University
No Photo Available
PCORI Board of Governors Meeting, September 2013 43
Daniel Wolfson, ABIM Foundation
Ayodola Anise, Senior Program Associate Anne Beal, Deputy Executive Director and Chief Officer for Engagement Orlando Gonzales, Chief of Staff for Engagement
Joe Selby, Executive Director
PCORI Staff
Top Related