Implementing AHRQ ’ s Tools in the Field: Successes and Lessons Learned

1. Implementing AHRQ’s Tools in the Field: Successes and Lessons Learned Bonnie Ohri Deputy Director, Operations/Marketing and Implementation Office of Communications and Knowledge Transfer Agency for Healthcare Research and Quality Bethesda, MD – September 20, 2011

2. Implementing Knowledge in the Field • Cheryl Thompson: Partnership development • Barbara Kass: Technical assistance/training • Margie Shofer: Learning networks • Discussion Putting The ‘KT’ In OCKT

3. Putting Knowledge Where People Are • Increasing quality, safety, and access • Improving outcomes • Enhancing efficiency and effectiveness • Disseminating messages

4. The OCKT Marketing & Implementation Continuum Media Marketing Knowledge Transfer

5. Knowledge Transfer (KT) is More Than Marketing • KT Implementation is: • An interactive process • An interchange of knowledge • KT implementation is not: • A one-time discrete event • Simply dissemination

6. System Transformation Drives Need for KT • Goal: • An outcome oriented, inclusive health care system • Strategy to achieve: • Move research into practice • Need: • Increased awareness, outreach • Primary challenge: • Use of the right tools to reach target audiences

7. Effective KT Improves Knowledge Use • Enhances awareness • Increases knowledge • Ensures implementation of tools • Identifies successes and barriers • Provides feedback to the Agency

8. Feedback/Follow Up Are Critical in KT

9. Implementing Knowledge in the Field • Cheryl Thompson: Partnership development • Barbara Kass: Technical assistance/training • Margie Shofer: Learning networks • Discussion Putting The ‘KT’ In OCKT

10. What is Partnership?

11. Why Do We Do Partnership Development? • Connection to Real World • Share of Common Interests • Support in Shared Goals • Wider Spread/ Further Dissemination/ Greater Implementation • Greater Awareness Raising/ More Informed Thinking/ Broader Behavior Change

12. Partnership Development in FIVE Steps

13. Partnership Development in FIVE Steps • Getting a foot in the door • Watch • Do Homework • Why are we a good match? • How might we work together? • Practice your pitch Show off your assets!

14. Partnership Development in FIVE Steps • Mutual interests identified and shown • Partner shows familiarity with AHRQ Portfolios/Work • Partner asks valuable, on-target and engaging questions There may be something here!

15. Partnership Development in FIVE Steps • Partner exhibits attribute and behaviors from #2 • Requests/Accepts orders of publications and tools to share with colleagues/members or patients • Partner acknowledges your relationship publically (eNews, journal, blog…) • Talks about doing more together Only you’re still doing most of the calling

16. Partnership Development in FIVE Steps • Partner exhibits attributes and behaviors of #2 and most of #3 • Partner begins to suggest ways to collaborate: • Speaker for an event/annual meeting • Offer to post special announcements • Co-host/sponsor Web conferences • Offer names of other potential leads for outreach and dissemination • Partner willing to carry some of the burden/develop and sign an agreement

17. Partnership Development in FIVE Steps • We’ve passed #2, some of #3, all of #4 • Partners report or we can track measurable change in: • Behavior/process of organization/ staff/ patients • Health conditions/ outcomes of patients • Can capture meaningful case studies

18. Lessons We’ve Learned About Partnership Development

19. Partnership Lessons Learned 1. Bigger is not always Better

20. Partnership Lessons Learned • Slow and Steady Wins the Race

21. Partnership Lessons Learned • Listen, Engage, Connect • Individualized Attention vs. Cattle Calls • Think Creatively

22. Partnership Lessons Learned • Primary Care Doctor Not the ONLY Target

23. Partnership Lessons Learned • Identify: • Connectors, Mavens, Salesmen/women • M. Gladwell, The Tipping Point

24. Partnership Lessons Learned • Mindful of Cultural Appropriateness • Race • Ethnicity • Urban • Rural • Low Socio-Economic Status (SES) • Health Literacy Levels

25. Partnership Lessons Learned • Manage Your Partners • Keep Partners Engaged • Balancing Act • Juggling Act • Forging/Forming Unusual Parings • Make Every Partner Feel Important

26. Partnership Principles • Enjoy Your Work

27. Implementing Knowledge in the Field • Cheryl Thompson: Partnership development • Barbara Kass: Technical assistance/training • Margie Shofer: Learning networks • Discussion Putting The ‘KT’ In OCKT

28. What is Technical Assistance and Training? • Technical Assistance • Subject matter experts • AHRQ staff and consultants • Training • Correct usage of tools, research, and products • Impact • Feedback – how can we improve?

29. Goals • Transfer knowledge • Develop partnerships among AHRQ stakeholders • Raise awareness • Ensure implementation

30. Summary of Two KT Projects • Outreach to Large Hospitals and Health Systems to Implement Project RED (Re-Engineered Discharge) - a hospital readmissions reduction initiative (2009-2012) • Outreach to Health Professional and Education Groups to Implement U.S. Preventive Services Task Force Recommendations (2009-2011)

31. Project RED: Overview • Ongoing AHRQ-funded project at Boston University Medical Center - Brian Jack, M.D. (P.I.) • Standardized methods to prevent readmissions • discharge planning • patient teaching • post discharge follow up Project RED Avatar ‘Louise’

32. Project RED: Methods • Developed training program • Curriculum • Preparation • Patient admission and education • Discharge and follow-up • Launch • Metrics • Technical assistance and training • Processes and components • Implementation • Evaluation of the impact

33. Project RED: Successes • Leadership and staff were engaged and supportive • New approaches for ensuring timely outpatient appointments • Actual implementation of the tool with feedback

34. Project RED: Challenges and Solutions • Slow initial response from hospitals • Solution: Collaboration and outreach through State hospital associations • Few resources to fill discharge advocate role or to purchase software • Solution: Divide the discharge advocate job among existing staff • Solution: Used AHRQ’s free tool to teach patients • Customized training • Solution: Adaptability

35. Overview: USPSTF Outreach • Increase awareness of recommendations among health professions educators and students • Curricula of graduate health professions education • Outreach to nursing and pharmacy clinicians and educators, faculty and student associations, priority populations • Presentations at national professional associations

36. USPSTF Outreach: Methods • Reaching out to Area Health Education Centers (AHECs) to recruit educators at graduate medical programs • Contacting national professional organizations for physicians, nurses, nurse practitioners, pharmacists, and physician assistants

37. USPSTF Outreach: Successes • Partnership with AHECs • 4-hour listening session National AHEC Organization (NAO) annual conference • Attended by 60 leaders from AHECs and schools of osteopathic medicine • Led to partnership with American Association of Colleges of Osteopathic Medicine (AACOM) • Identified over a dozen graduate medical programs already teaching USPSTF recommendations

38. USPSTF Outreach: Successes • Presentations to national professional organizations • Association for Prevention Teaching and Research • Society of Teachers of Family Medicine • Society of Osteopathic Medical Educators • American Association of Colleges of Osteopathic Medicine • American Osteopathic College of Occupational and Preventive Medicine • National Council of Asian and Pacific Islander Physicians • American Academy of Nurse Practitioners • American Academy of Physician Assistants • American Pharmacists Association

39. USPSTF Outreach: Successes • Web conferences • National Council of Asian Pacific Islander Physicians • American Academy of Nurse Practitioners • American Academy of Physician Assistants • American Pharmacists Association • Self-study slide deck

40. USPSTF Outreach: Challenges and Solutions • Role of AHECs misunderstood • Few AHECs influence medical school curricula • Role is managing preceptors and clinical rotations • Preceptors are too busy to create and teach prevention • Solution: provide technical assistance in developing materials • University of Colorado Health Sciences Center, School of Medicine • Southwestern Colorado AHEC

41. USPSTF Outreach: Challenges and Solutions • Changing curriculum is difficult • No time to prepare new course materials • Curriculum additions requires approval by medical school board • Solution: create new curriculum materials • Technical Assistance Document • “Understanding the Methods Used by the USPSTF” slide deck • “Putting Prevention into Practice” slide deck • Included expert advisory board recommendations • AHEC meets AACOM • Schools of Osteopathic Medicine

42. Implementing Knowledge in the Field • Cheryl Thompson: Partnership development • Barbara Kass: Technical assistance/training • Margie Shofer: Learning networks • Discussion Putting The ‘KT’ In OCKT

43. Learning Networks Some definitions… • Groups of people who share a concern, a set of problems or passion about a topic and who deepen their knowledge in this area by interacting on an ongoing basis • Set up for the primary purpose of increasing knowledge

44. Learning Network Characteristics • Domain • Creates common ground, inspires, guides • Community • Social structure for learning • Practice • Specific knowledge

45. Types • Practice-based • Task- based • Knowledge-based

46. Examples • High Reliability Organizations Learning Network • Quality Improvement Organizations Learning Network • Medicaid Medical Directors Learning Network

47. HRO Learning Network • Task-based: focused on operationalizing HRO concepts • 19 organizations from across U.S. • Operational for 1.5 years • Activities included in-person meetings, web conferences, member extranet

48. Successes and Challenges Successes Challenges Some members not engaged Those that were wanted to go to the next step- but could not agree what that step was • A core of very engaged members • Members very connected • Developed HRO Guide

49. Lessons Learned • Ownership • Degree of commitment • Learning network focus • Flexibility • Communication Methods

50. QIO Learning Network • Task-based: focused on implementing 2 AHRQ tools • QIOs in 16 State 243 providers • Two 1-year projects (2010-2011) • Activities included in-person meetings, QIO-specific technical assistance calls, national support calls, member extranet