Knowledge Translation: Closing the Evidence-to-Practice Gap

Lang, Eddy; Wyer, Peter C.; Haynes, R. Brian

doi:10.1016/j.annemergmed.2006.08.022

Cited by 249 publications

(202 citation statements)

References 42 publications

Supporting

Mentioning

198

Contrasting

Unclassified

Order By: Relevance

“…6 Within EM there is significant variation in test-ordering rates, [7][8][9][10] and there has been a tremendous increase in utilization of advanced imaging despite little evidence to suggest associated improvement in patient outcomes. [11][12][13][14][15] The etiology of this increase is likely multifactorial and may include malpractice fear, 16,17 desire for diagnostic certainty, 18 lack of or inconsistent clinical decision instruments, [18][19][20] poor adoption of such decision instruments, 21,22 inadequate training in evidenced-based medicine, 23,24 slow knowledge translation, 25 perverse financial incentives, 26 requests of consulting and referring physicians, 27,28 and increased practice intensity and overall complexity of emergency care. 28,29 Regardless of etiology, there has been a strong push within EM to counter this behavior to provide high-value, costconscious care.…”

mentioning

confidence: 99%

Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging

Kanzaria

Hoffman

Probst

et al. 2015

Academic Emergency Medicine

170

146

View full text Add to dashboard Cite

Objectives: The objective was to determine emergency physician (EP) perceptions regarding 1) the extent to which they order medically unnecessary advanced diagnostic imaging, 2) factors that contribute to this behavior, and 3) proposed solutions for curbing this practice.Methods: As part of a larger study to engage physicians in the delivery of high-value health care, two multispecialty focus groups were conducted to explore the topic of decision-making around resource utilization, after which qualitative analysis was used to generate survey questions. The survey was extensively pilot-tested and refined for emergency medicine (EM) to focus on advanced diagnostic imaging (i.e., computed tomography [CT] or magnetic resonance imaging [MRI]). The survey was then administered to a national, purposive sample of EPs and EM trainees. Simple descriptive statistics to summarize physician responses are presented.Results: In this study, 478 EPs were approached, of whom 435 (91%) completed the survey; 68% of respondents were board-certified, and roughly half worked in academic emergency departments (EDs). Over 85% of respondents believe too many diagnostic tests are ordered in their own EDs, and 97% said at least some (mean = 22%) of the advanced imaging studies they personally order are medically unnecessary. The main perceived contributors were fear of missing a low-probability diagnosis and fear of litigation. Solutions most commonly felt to be "extremely" or "very" helpful for reducing unnecessary imaging included malpractice reform (79%), increased patient involvement through education (70%) and shared decision-making (56%), feedback to physicians on test-ordering metrics (55%), and improved education of physicians on diagnostic testing (50%). Conclusions:Overordering of advanced imaging may be a systemic problem, as many EPs believe a substantial proportion of such studies, including some they personally order, are medically unnecessary. Respondents cited multiple complex factors with several potential high-yield solutions that must be addressed simultaneously to curb overimaging.ACADEMIC EMERGENCY MEDICINE 2015;22:390-398

show abstract

mentioning

confidence: 99%

Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging

Kanzaria

Hoffman

Probst

et al. 2015

Academic Emergency Medicine

170

146

View full text Add to dashboard Cite

show abstract

“…According to this effect, the scientific community pays disproportionate attention to the ideas of already-established scientists [5], [6], making it difficult for competing alternatives to gain attention [7]. These biases slow down the recognition and adoption of important new ideas, resulting in significant time delay in translating new research into new technologies and medical therapies [8], [9]. Yet, examples in which one theory, methodology, or line of inquiry overtakes an established one abound.…”

Section: Introductionmentioning

confidence: 99%

“…In comparison, both baseline methods identify irrelevant challengers, including those dealing with the top quark (papers (b)6-8), calculations of electronic structure of bulk materials (papers (c)1-3), quantum computing (papers (c)4, 7) and high energy physics ((b)2, (c) 5,8,9). d) Quantitative Analysis: We validate quantitatively that the proposed method identifies more relevant challengers than baseline by performing PACS number analysis of the challengers for the ten most-cited papers in the APS dataset.…”

Section: B Physicsmentioning

confidence: 99%

Identifying Transformative Scientific Research

Huang

Hsu²,

Lerman³

2013

2013 IEEE 13th International Conference on Data Mining

View full text Add to dashboard Cite

Abstract-Transformative research refers to research that shifts or disrupts established scientific paradigms. Notable examples include the discovery of high-temperature superconductivity that disrupted the theory established 30 years ago. Identifying potential transformative research early and accurately is important for funding agencies to maximize the impact of their investments. It also helps scientists identify and focus their attention on promising emerging works. This paper presents a datadriven approach where citation patterns of scientific papers are analyzed to quantify how much a potential challenger idea shifts an established paradigm. The key idea is that transformative research creates an observable disruption in the structure of "information cascades," chains of references that can be traced back to the papers establishing some scientific paradigm. Such a disruption is visible soon after the challenger's introduction. We define a disruption score to quantify the disruption and develop an algorithm to compute it from a large citation network. Experimental results show that our approach can successfully identify transformative scientific papers that disrupt established paradigms in Physics and Computer Science, regardless of whether the challenger paradigm is an instant hit or a classic whose contribution is formally recognized with a Nobel Prize decades later.

show abstract

“…19,20 Leaving aside any notational issues, such approaches depict KT as crucially important for improving health care as this is the process whereby research evidence comes to inform and impact health-care policy and practice and vice versa. 21 In the health-care setting, the notion of KT was given greater prominence among policy makers by the work of the Canadian Institutes for Health Research (CIHR). The World Health Organization subsequently adapted the CIHR's work and defined KT as 'the synthesis, exchange, and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and improving people's health' (p. 2).…”

Section: Chapter 2 Review Of Existing Literaturementioning

confidence: 99%

Networked innovation in the health sector: comparative qualitative study of the role of Collaborations for Leadership in Applied Health Research and Care in translating research into practice

Scarbrough

D'Andreta

Evans

et al. 2014

Health Services and Delivery Research

View full text Add to dashboard Cite

BackgroundCollaborations for Leadership in Applied Health Research and Care (CLAHRCs) were an initiative of the National Institute for Health Research in response to a new research and development strategy in the NHS: ‘Best Research for Best Health’. They were designed to address the ‘second gap in translation’ identified by the Cooksey review; namely, the need to improve health care in the UK by translating clinical research into practice more effectively. Nine CLAHRCs, each encompassing a university in partnership with local NHS bodies, were funded over the period 2008–13.AimsThe aim of this report is to provide an independent and theory-based evaluation of CLAHRCs as a new form of networked innovation in the health sector. This evaluation is based on an intensive research study involving three CLAHRCs in the UK and three international organisations (one in the USA and two in Canada). This study was carried out over two overlapping time phases so as to capture changes in the CLAHRCs over time. Networked innovation in the health sector is conceptualised as involving the translation of knowledge via informal social networks.MethodsA mix of research methods was used to help ensure the validity and generalisability of the study. These methods addressed the development of each CLAHRC over time, over multiple levels of analysis, and with particular reference to the translation of knowledge across the groups involved, and the quality of the informal underpinning network ties that supported such translation. Research methods, therefore, included a qualitative enquiry based on case studies and case analysis, cognitive mapping methods, and social network analysis.FindingsThrough our study, we found that each one of our samples of CLAHRCs appropriated the CLAHRC idea in a particular way, depending on their different interpretations or ‘visions’ of the CLAHRC’s role in knowledge translation (KT), and different operating models of how such visions could be achieved. These helped to shape the development of social networks (centralised vs. decentralised) and each CLAHRC’s approach to KT activity (‘bridging’ vs. ‘blurring’ the boundaries between professional groups). Through a comparative analysis, we develop an analytical model of the resultant capabilities which each case, including our international sites, developed for undertaking innovation, encompassing a combination of both ‘integrative capability’ (the ability to move back and forth between scientific evidence and practical application) and ‘relational capability’ (the ability of groups and organisations to work together). This extends previous models of KT by highlighting the effects of leadership and management, and the emergence of social network structures. We further highlight the implications of this analysis for policy and practice by discussing how network structures and boundary-spanning roles and activities can be tailored to different KT objectives.ConclusionsDifferent interpretations and enactments of the CLAHRC mission ultimately led to differing capabilities for KT among our studied initiatives. Further research could usefully explore how these different capabilities are produced, and how they may be more or less appropriate for particular national health-care settings, with a view to improving the design blueprint for future KT initiatives.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

show abstract

Knowledge Translation: Closing the Evidence-to-Practice Gap

Cited by 249 publications

References 42 publications

Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging

Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging

Identifying Transformative Scientific Research

Networked innovation in the health sector: comparative qualitative study of the role of Collaborations for Leadership in Applied Health Research and Care in translating research into practice

Contact Info

Product

Resources

About