Filling the CPG production-utilization gap: The Spinal Cord Injury Knowledge Mobilization Network

Dr. R. J. Riopelle, McGill University; Scientific Director 

The launch of the Health Council of Canada CPG video series is a welcome and timely contribution to the directions emerging from the November 2011 Canadian Clinical Practice Guidelines (CPG) Summit. This series will continue to nurture a growing national effort to design, disseminate and utilize CPGs across Canada. That said, there remains a notable gap between the design of these guidelines and their utilization in clinical settings.

The Spinal Cord Injury Knowledge Mobilization Network (SCI KMN) is an emerging knowledge mobilization initiative with a stakeholder-driven agenda to standardize care for secondary complications associated with SCI using contemporary evidence-based CPGs in rehabilitation centres across Canada.

SCI KMN is a Community of Practice composed of 6 rehabilitation sites in 3 provinces (AB, ON, QC) that is steered by the Ontario Neurotrauma Foundation Knowledge Curator (ONF KC) and supported by a public (health jurisdictions) - private partnership. In this regard, SCI KMN activities map precisely to the Health Care Innovation Working Group of the Council of the Federation provincial and territorial-specific deployment strategy.

The Network is composed of Knowledge Producers, Knowledge Users (providers), and End Users (patients) engaged in participatory research that directs itself to the goal of a health transformation value equation - a patient outcomes numerator, and a provider performance/resource utilization denominator. Outcomes and performance data is captured in site quality scorecards, and in a global data collection platform to inform continuous quality improvement for national care standardization.

A 2010 community survey by the Rick Hansen Institute (RHI) determined that the most urgent secondary complications associated with SCI that needed to be addressed were in the areas of pressure ulcer prevention and management, pain management, and urinary bladder management. To respond to these needs, SCI KMN Phase 1 was launched in early 2011 using contemporary CPGs as part of an integrated package of ‘causal factors’ directed to building institutionalization of, and innovation capacity for, standardization of care.

SCI KMN Phase 2 (2013-2018) contemplates expansion of the Community of Practice to two additional provinces (BC, NB) and scaling of activities across the care continuum, involving eight rehabilitation sites with the potential to access 80% of SCI patients in Canada. Building on its ‘by the people, for the people, no stone unturned’ approach, Phase 2 activities will embrace a Community of Innovation to enrich its causal factors package in response to participant demand: a health system adapted implementation guide, decision support tools for patients and providers, an innovation broker training program, and introduction of Patient Reported Outcomes into the patient practice portfolio, all in the interests of optimizing patient outcomes/impact for social and economic benefit, and provider performance/resource utilization for economic benefit.

Consensus among providers and patients that CPGs are an essential part of the health quality agenda represent a necessary ingredient for care standardization. However, the necessary and sufficient conditions for filling the CPG production-utilization gap directed to making a difference requires a ‘developmental causal factors approach’ such as referred to above.