TRIP

From Clinicaltools.com

Contents 1 Translating Research Into Practice and the Diffusion of Innovations - Using the Internet 2 Notes 2.1 Diffusion of Innovations 2.2 Notes on APS Podcast on Translational Research Based in Clinics 2.3 Notes from AHRQ on TRIP 2.4 Other Research on Translating Research Into Practice

Translating Research Into Practice and the Diffusion of Innovations - Using the Internet

We will employ the latest information on how best to address the challenge of translating research into practice as well as apply concepts from Rogers' Diffusion of Innovations theory. These two concepts are relevant to two aspects of the Pain and Addiction project:

1. We want to use the Internet to support the use of evidence-based practice in pain and addiction medicine by the target audience
2. We want to use a technological innovation, an online simulated, standardized patient learning experience, to support this use of evidence-based practices.

Notes

Diffusion of Innovations

The theory first put forth in Rogers book Diffusion of Innovations (1962) describes how new ideas and technology are spread over time. The spread tends to start with "early adopters" and continue to secondary and tertiary levels, etc. Adoption also spreads laterally at each level when people who are known and respected adopt the change. Attitude toward the new idea is key to its adoption. Adoption takes place in stages: knowledge, attitude, decision, implementation, and confirmation.

Reference

Rogers, Everett M. (2003). Diffusion of Innovations, Fifth Edition. New York, NY: Free Press. ISBN 0-7432-2209-1.

Notes on APS Podcast on Translational Research Based in Clinics

Evidence-Based Pain Management Practices for Older Adults in Multiple Practice Settings: The Challenge and Translation by Marita Titler and presented by Emily Griffin at the 2008 APS meeting focused on translational research in pain management for adults in a hospital setting. Her translation strategies are based on TRIP (translating research into practice) and Rogers' Diffusion of Innovations theory.

Ideas from Titler's presentation can be adapted to an online setting.

• Quick reference guidelines are important - she used 6 of them
• Learner should be required to set a goal and action plan as part of the learning process
• Printable posters to hang in clinic reminding the clinical staff of the practice goal
• Monthly review of goal and action plan
• Support for change should be ongoing. We could develop a followup course and send invitations after a specified time.
• To sustain a practice change, reminders are needed (option of email followup reminder)
• Focus groups of providers discussing how to implement guidelines and trouble shoot were an important component of her TRIP process. Discussion boards targeted to this purpose could serve a similar function.
• "Academic detailing" (comparing the individual to others). We could do this with a questionnaire. Feedback would say you're doing well here and here, but you're below the average PCP here and here in terms of following guidelines. (Alternatively, we could provide an instant comparison to peer responses on quiz questions within the course as in Casebeer,et al. (2002))
• Incorporate the elements of "Local opinion leaders" (sits in background, trouble shoots, has expertise) and change champions (project leader, role model) via expert forum, our participation in discussions, other ideas.
• Tailoring to the group is important. Our tags on resources that mark resources for specific specialties or professional groups is one way to achieve this. We might consider a “special issues for nurses” section.
• Include something specifically for senior leaders - chief nurses, chief medical officers
• Encourage change in documentation system to require documentation of ongoing patient management steps (the biggest problem area)
• Other concepts not as easy to implement online: monthly teleconferences, train the trainers, audits and feedback.
• Need to identify target areas for reminders and alerts

Casebeer, Allison, Spettell

Notes from AHRQ on TRIP

From the AHRQ TRIP website:

"A key to TRIP-II is the presence of partnerships between researchers and health care organizations such as:

• Integrated service delivery systems.
• Practice-based networks.
• Academic health centers.
• Managed care organizations."

Relevant Trip-II Project:

An Internet Intervention To Increase Chlamydia Screening. Tests Internet-based learning modules designed to increase primary care physician screening of at-risk female patients and decrease incidence of pelvic inflammatory disease. Principal Investigator: Jeroan Allison, University of Alabama, Birmingham, AL. Partnering organization: U.S. Quality Algorithms.

Abstract based on this research: Casebeer L, Allison J, Spettell CM. Designing tailored Web-based instruction to improve practicing physicians' chlamydial screening rates. "four tailored Web-based modules for primary care physicians with the goal of improving rates of screening for chlamydia. Each module includes: (1) individual office chlamydial screening rates; (2) interactive cases with real-time comparison of answers with those of peers; (3) a toolbox of office support materials, including patient education materials and guideline summaries; and (4) real-time tailoring of the Web pages based on physicians' interactions with module." They measure readiness and barriers to change. Unique interactive features included providing "individual office feedback on performance", comparison of responses with peers, evaluation of readiness to change and tailored training based on their readiness. Their program is also "linked in an automated fashion to administrative data files." Note: Item 2 is "academic detailing."

Other Research on Translating Research Into Practice

A followup article to the Casebeer study by Allison JJ et al. (2005), Multicomponent Internet continuing medical education to promote chlamydia screening, provided objective data on practice patterns. Four case-based learning modules were tailored based on behavior change theory. The rest of the intervention was office-level feedback on chlamydia screening rates. With an outcome measure of HEDI chlamydia screening rates, an attenuated decline in screening rates was observed in intervention offices in comparison to comparison offices.

Other relevant articles already described in our research proposals: Fordis et al., (2005), Casebeer et al, 2003'

Green, LA, et al. 2005. Translation of Research Into Practice: Why We Can’t "Just Do It"Discusses strategies based on the cognitive processes required to translate knowledge into practice: 1) structured case-level feedback; 2) practice in context; 3) deliberative practice when procedural knowledge is being refined. Each of these strategies is implemented at a specific phase of skill development.

Vollmar et al. 2006 An e-learning platform for guideline implementation--evidence- and case-based knowledge translation via the Internet. Supports the effectiveness of interactive online case-based CME in facilitating guideline implementation.