Shachak, A. et al.:Collaborative Knowledge Translation: Application of a Wiki Model for Primary Care Practitioners

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Collaborative Knowledge Translation:

Application of a Wiki Model for Primary Care Practitioners

Aviv Shachak, Steve Hockema, Jamie Meuser, Lena Salach, Tupper Bean, Noah

Ivers, Mike Evans

Presentation wiki

http://cep-kt.pbwiki.com/

Knowledge Translation (KT)

From: Lang et al., 2007

The nature of knowledge and criticism of EBM

• Knowledge is created through interaction• Knowledge is actionable• Expertise and tacit knowledge• The practice to research gap• Evidence is constantly changing• Difficult to implement EBM at the point of

care

From: Baumbusch et al., 2008

A better model…

Another step forward• Crossing traditional role boundaries:

collaboration in the creation and dissemination of knowledge

• Interprofessional • Wikis are ideal for this purpose:

- online EBM resources are becoming the preferred option for answering clinical questions;- Creating an on-line community;- Multi- (or inter-)professional community, transcends traditional borders;- Constant updating

Centre for Effective Practice• Focus: clinical care gaps in primary acre• NFP: close gaps by developing relevant,

evidence-based interventions• Identify barriers to optimal practice &

produce practical solutions • Relevant regardless of clinical setting,

training or background

Family Practice Sourcebook• Best selling textbook for primary care• Reference tool for residents and primary

care providers (MDs, nurses, pharms, etc.)• Covers current approaches and

controversies in the prevention and treatment

• Evidence based but short shelf life• DFCM at U of T lead contributor: + 194

faculty, residents, and medical students contributed

Collaborative Learning Tool(COLT)

• Apply 2.0 models to facilitate knowledge translation by connecting researchers and health care practitioners (MDs, nurses, pharms)

• Allows practitioners to participate in the synthesis of evidence and engage in an on-going discussion

• Updated continuously, thereby fostering the faster creation and dissemination of knowledge.

COLT• Offer the Sourcebook via a modified wiki

to primary care practitioners • Content managed by a University led team

(independent)• Endorsed by professional colleges and

bodies• Provide current, valid, and relevant

resources (tools, videos, patient info, etc.)

Key Differences• Sustainable financial model (Gov’t and

NGO support, CME, publishing, etc.)• Users are authenticated and must give

credentials • Final decisions for revisions rest with

“clinical editors” to ensure balance, evidence, validity, etc.

• Consistent language, style and formatting will be maintained by a professional editor to ensure consistent voice, readability, etc.

To Date….• Development server hosting source wiki

software (Mediawiki) • Beta site/concept pages established• Finalizing the edit/access/approval

framework and work flow• Focus groups, demonstrations, and

qualitative testing have taken place • Identified a variety of operational and

technical issues and will inform the further development

• Establishing appropriate partnerships/funding agreements

The list of subject areas follows the table of content from the Sourcebook for continuity and quick access.

Current Version

A page demonstrating a subject area: Women’s Gynecology – Endometriosis. A detailed table of contents for the subject area appears for the user to quickly see what is available (e.g., physician tools, tips and tricks, patient tools, videos, etc.)

Current Version

Proposed Version

Benefits • Unlike standard textbooks that only are

updated with each new edition, this will be constantly updated to reflect new research and local realities for best practice; – Encourage an active role for professionals in reviewing and

sharing information; – Promote and disseminate proven KT tools to encourage best

practices, with rapid feedback and revision aimed at making them better

– Support interaction in different time scales (20 sec/20 min/2 hrs)

• Comprehensive resource for all health practitioners engaged in primary care and will support interprofessional care

Benefits• Develop a greater sense of interaction and

community among members of the primary care community

• Positive effect on the healthcare system through:– Fostering collaboration and engaging professionals in

reviewing and sharing information – Improving access to current and relevant information,

resources and tools– Building the concept of interprofessional care into the

development of knowledge products (Guidelines, CME delivery etc.)

Potential COLT Partners

Founders

Potential Content

Supporters

Infrastructure

Quality management

Partnership InvolvementEach organization will participate in:

– Input into the design and structure;– Recruitment of content editors and champions;– Promotion and endorsement to potential funders, users, etc.;– Assistance in the recruitment of users;– Contribution to content and links of resources, applications,

functions– Research and evaluation (surveys, interviews, focus groups,

etc.)

Research and Evaluation• Research questions:

– How best practice resources are created and evolve collaboratively?

– Contributors’ and users’ perceptions of the wiki’s usefulness, ease of use, Credibility, and impact on behavior;

– Diffusion within the primary care community (e.g. rate of diffusion, barriers and enablers, adoption and post-adoption behavior)

Research and Evaluation• Mixed methods research:

- Discourse and content analysis, - Logfile analysis, - Key informant interviews- Focus groups,- Social network analysis,- Surveys

• Interdisciplinary team, involving researchers, knowledge creators, users and decision makers

Challenges

• Difficult to measure impact on clinical behavior and patient outcomes.

• Change is inherent (fluid environment)• Ethics