Grant: Partnerships for Health System Improvement (PHSI)

<html> <body>Patients with cognitive impairments after a stroke are often <em>denied access to inpatient rehabilitation</em>,(1) despite evidence of its benefits to them.(2)&nbsp;These patients comprise up to 30% of stroke patients.(3)&nbsp;In the Toronto Stroke Networks (TSNs), the few patients with cognitive impairment admitted to inpatient stroke rehabilitation typically receive services based on outdated impairment-reduction models, rather than recommended function-based approaches.(4)&nbsp;These two issues, reduced access to rehabilitation and a knowledge-to-practice gap, both stem from a reported lack of skills and knowledge on the part of stroke rehabilitation teams to foster recovery in people with cognitive impairments.(4)&nbsp;To address these issues, we will implement and evaluate a multi-faceted, supported, integrated knowledge translation (KT) initiative, targeted specifically at the inter-professional application of Cognitive Orientation to daily Occupational Performance (CO-OP), (5)&nbsp;called CO-OP KT. CO-OP is an effective, cognitive strategy-based treatment approach aligned with Canadian Stroke Best Practice Recommendations for cognitive rehabilitation.(6)<br> <br> Lead knowledge user and decision maker, Ms. Linkewich, is a regional director within the TSNs. The TSNs consists of 3 of Ontario&rsquo;s 11 regional stroke networks devoted to implementation of evidence-based practice to improve outcomes for people with stroke.(7)&nbsp;Ms Linkewich has convened a knowledge user team of educators, management collaborators, and a community engagement specialist. They have been involved with all aspects of this project&rsquo;s design, beginning with identifying the problem and developing a plan to address it. Further, they have a track record of conducting and disseminating health system research,(1,8-13)&nbsp;and have integrated with a group of researchers, led by Dr. McEwen, who have expertise in the development and evaluation of complex interventions, cognitive impairment, health professional behaviour, and KT. <br> <br> The Knowledge to Action (KTA) frameworkdeveloped by Graham et al provides the foundation for this project.(14)&nbsp;It consists of a central knowledge creation cycle and a concurrent action cycle. Figure 1 depicts the KTA framework with content specific to the CO-OP KT project. In preparatory work, we conducted the first of the action phases, identifying issues and synthesizing knowledge to mitigate those issues. This project begins with adapting the knowledge to the local context and identifying barriers to knowledge uptake, and will continue with selecting, tailoring, and implementing KT intervention, monitoring and sustaining knowledge use and evaluating outcomes. Also informing the project are the inter-professional care (IPC) and inter-professional education (IPE) constructs. IPC promotes effective working relationships among health care providers from different disciplines and patients and enables optimal health outcomes by building on &ldquo;respect, trust, shared decision making and partnerships&rdquo;.(15)&nbsp;IPE emphasizes providers from multiple disciplines learning with, from, and about each other, and is interdependent with IPC. <br> <br> This project will advance knowledge about the degree to which an integrated KT initiative can change the health system (access), knowledge (team practice), and patient outcomes (functional improvement), &nbsp;as well as advancing knowledge about the sustainability of using existing infrastructure and partnerships with health and academic institutions to effect these changes.</body> </html>

Inst of Hlth Serv &amp; Policy Res~ $109,999~ $0~Knowledge Translation Branch~ $290,001~ $0~