Better pathways for people living with aphasia

Transcription

1 Better pathways for people living with aphasia Linda Worrall, Emma Thomas, Alexia Rohde, Miranda Rose, Leanne Togher and Alison Ferguson On behalf of the Australian NHMRC Centre for Clinical Research Excellence in Aphasia Rehabilitation NHMRC grant #569935

2 Terminology a pathway? A pathway is a tool that promotes organised and efficient patient care based on the best available evidence and guidelines. Other terms: Integrated care pathways Clinical pathways Patient journeys Care maps (Kwan et al., 2004)

3 Terminology Knowledge Translation (KT) is the process of improving the uptake of knowledge, or evidence, into practice - with the ultimate aim of improving clinical outcomes.

4 Aim To improve the overall patient journey for people with aphasia by developing a rehabilitation pathway within a knowledge transfer framework

5 Aims of this presentation 1. Present results of a systematic review of clinical guidelines in stroke and aphasia 2. Describe the Australian Aphasia Rehabilitation Pathway to date 3. Describe the translation of a complex system to a userfriendly web-based system

6 CCRE Aphasia KTE Plan Select / tailor / implement What interventions are successful in implementing guidelines / pathways? How can the Aphasia Pathway implementation be tailored to identified barriers and facilitators? Assess barriers / facilitators What are the barriers / facilitators in relation to the: i. Pathway itself (content / style) ii. Adopters (clinicians / managers) iii. Context / setting (e.g., public and private service contexts)? Adapt knowledge locally Will the Aphasia Pathway be implemented in original form? Will clinicians adapt it to their own contexts and how? How have they adapted currently available guidelines / pathways? What factors are key in deciding to adapt guidelines / pathways? Monitor knowledge use Is the Aphasia Pathway being used and how? If not, are there modifications to assist with re-implementation? KNOWLEDGE CREATION Filtering CCRE research knowledge into more synthesized, user-friendly forms. Knowledge Inquiry Individual CCRE research studies (Acute + rehab + community) Knowledge Synthesis Systematic Reviews (CCRE / others) Tools / Products Aphasia Pathway Identify clinical problem Do clinicians perceive a knowledge-action gap in aphasia practice? Is this gap observed? Identify, review, select knowledge Are clinicians aware of the Aphasia Pathway and do they believe it will fill that gap? How do they perceive guidelines / pathways? Are they using current stroke guidelines? What can we learn from these for our Pathway? Evaluate outcomes of use What is the impact of Aphasia Pathway use compared to current practice measured by direct and indirect measures of: i. Consumer health ii. Adopter behaviour / attitudes iii. Service / system changes. Sustain knowledge use Is Aphasia Pathway use sustained? If not, why not? If sustained, does it get modified further? How do clinicians integrate additional new knowledge into the pathway? What factors predict or contribute to sustained usage of the Aphasia Pathway vs. lack of sustained adoption? ACTION CYCLE Suggested actions required for implementation of the Aphasia Pathway into clinical practice.

7 Aim 1 Systematic Review (Rohde et al, 2013) To determine if there were any quality clinical guidelines available for stroke and aphasia. AGREE II tool 19 multidisciplinary stroke and speech pathology specific clinical practice ADAPTE Collaboration tool

8 Systematic review results Highest in both AGREEII and ADAPTE evaluations The Australian Clinical Guidelines for Stroke Management (2010) New Zealand Clinical Guidelines for Stroke Management (2010) Most comprehensive The Royal College of Speech and Language Therapists (2005) aphasia guideline Therapy focused Evidence-Based Review of Stroke Rehabilitation (Salter et al., 2008) ANCDS evidence reviews (Beeson & Robey, 2006)

9 Conclusions from systematic review No high quality aphasia clinical guidelines across the continuum of care exist High quality stroke clinical guidelines do contain some relevant recommendations for aphasia rehabilitation. Stroke clinical guidelines chart best practice across the patient journey Best practices in aphasia rehabilitation could be incorporated into a pathway with collated recommendations from the stroke clinical guidelines as the basis of the evidence for the pathway

10 Aim 2: Describe the Australian Aphasia Rehabilitation Pathway Select / tailor / implement What interventions are successful in implementing guidelines / pathways? How can the Aphasia Pathway implementation be tailored to identified barriers and facilitators? Assess barriers / facilitators What are the barriers / facilitators in relation to the: i. Pathway itself (content / style) ii. Adopters (clinicians / managers) iii. Context / setting (e.g., public and private service contexts)? Adapt knowledge locally Will the Aphasia Pathway be implemented in original form? Will clinicians adapt it to their own contexts and how? How have they adapted currently available guidelines / pathways? What factors are key in deciding to adapt guidelines / pathways? Monitor knowledge use Is the Aphasia Pathway being used and how? If not, are there modifications to assist with re-implementation? KNOWLEDGE CREATION Filtering CCRE research knowledge into more synthesized, user-friendly forms. Knowledge Inquiry Individual CCRE research studies (Acute + rehab + community) Knowledge Synthesis Systematic Reviews (CCRE / others) Tools / Products Aphasia Pathway Identify clinical problem Do clinicians perceive a knowledge-action gap in aphasia practice? Is this gap observed? Identify, review, select knowledge Are clinicians aware of the Aphasia Pathway and do they believe it will fill that gap? How do they perceive guidelines / pathways? Are they using current stroke guidelines? What can we learn from these for our Pathway? Evaluate outcomes of use What is the impact of Aphasia Pathway use compared to current practice measured by direct and indirect measures of: i. Consumer health ii. Adopter behaviour / attitudes iii. Service / system changes. Sustain knowledge use Is Aphasia Pathway use sustained? If not, why not? If sustained, does it get modified further? How do clinicians integrate additional new knowledge into the pathway? What factors predict or contribute to sustained usage of the Aphasia Pathway vs. lack of sustained adoption? ACTION CYCLE Suggested actions required for implementation of the Aphasia Pathway into clinical practice.

11 How are we developing the pathway? A community of practice (CoP) approach to Knowledge Transfer CCRE Aphasia Community of Practice: 12 investigators 24 research affiliates 33 doctoral students 200 clinical affiliates Two initial face to face meetings + ed versions of the AARP for comment using Google documents

12 Overview of the Australian Aphasia Rehabilitation Pathway (AARP)

13 User-friendly web-based interface for the Australian Aphasia Rehabilitation Pathway (AARP)

14 Australian Aphasia Rehabilitation Pathway (AARP) RECEIVING THE RIGHT REFERRALS Summary Recommendations & ideal practice Practical tips Prehospital care & staff education Referral processes Communication screening by nonspeech pathologists Clinician/Practitioner perspective Client/Patient perspective Resources

15 Australian Aphasia Rehabilitation Pathway (AARP)

16 Australian Aphasia Rehabilitation Pathway (AARP)

17 Aim 3: Describe the translation of the complex system to a user-friendly web-based system More systematic reviews are needed in specific topic areas Further consensus on the evidence will use the RAND/UCLA Appropriateness Method (RAM) The perspectives of consumers and expert clinicians for each topic will be collected through the Community of Practice Launch date October 2013

18 Future translational research Identify barriers to implementation of the AARP Develop evidence-based tailored strategies to overcome barriers Evaluate the uptake and effectiveness of the AARP Measure the overall impact on aphasia rehabilitation in Australia via a pre-post national clinician s survey (See Rose et al (in press) for pre- pathway survey results)

19 Further information