17 year gap (was change with 1 day training)

Michael H. Kanter Michael.H.Kanter at KP.ORG
Sun Jun 3 23:24:41 UTC 2018


This is a complex subject.  I agree with all of the points below yet what strikes me odd is that while everyone acknowledges the time lag in moving from publication of new evidence to widespread implementation (one can argue a bit on how long this lag actually is), there is less written about how to shorten this time.  Folks may be interested into something I wrote for NEJM Catalyst on this subject.    A systematic look at published literature is part of the solution (see attachment).  What I have been noticing (not very scientific) is that the implementation of a practice is dependent on many things but practices  not implemented are often things that don’t have a vendor pushing it and require multidisciplinary teams to implement.  Although the article is not specifically geared towards diagnostic errors, given the paucity of vendors and multidisciplinary nature of diagnostic error mitigation, I would suspect that there would be a longer delay in implementing best diagnostic practices than other types of practices..

From: Tom Benzoni [mailto:benzonit at GMAIL.COM]
Sent: Sunday, June 3, 2018 9:17 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] 17 year gap (was change with 1 day training)


Caution: This email came from outside Kaiser Permanente. Do not open attachments or click on links if you do not recognize the sender.

________________________________
I wonder if we ourselves are demonstrating a cognitive error, name not important.

What is the disconfirming literature to our bemoaning clinical inertia?

There is plenty: all the clinical guidelines which we say should be followed...then we repeat this admonishment when the revision comes out...until it's withdrawn.

https://well.blogs.nytimes.com/2011/10/20/when-doing-nothing-is-the-best-medicine/
JAMA: When Clinical Inertia is a Clinical Safeguard"

I propose a project for SIDM:
Take Charlie Munger's advice on the psychology of human misjudgment and check ourselves:
Let's gather ALL guidelines and create a matrix:
Time on X
Items on Y
COI on Z
Debunk guidelines by:
Demonstrating that they change too quickly to ever be correct/followed, virtually guaranteeing clinical-inertia-by-design
Show how COI affects/changes guidelines
Discover that guidelines differ by body (even professional organization)
The cognitive and time loads are unreasonable

The goal is to make guideline writers accountable instead of holding practitioners to a Sisyphean standard.

tom.



On Sun, Jun 3, 2018 at 10:58 AM Lyn Behnke <lynbehnke at gmail.com<mailto:lynbehnke at gmail.com>> wrote:
I do agree, Peter, however, behavior change in 1 day is also way beyond expectation.  Unfortunately, in my neck of the woods, we are in a 10 to 15 year time warp based on our rural status, food, University, Book store, newspaper desert status.  Change comes very slowly to small remote rural areas.  So, although it may have been a “mem”, there rings an element of truth in some areas.  Thus my concern about creating practice change in 1 day.  I do appreciate the references and will be using them in my translational research course – especially the one from 23 June 2018.

I love this forum!
From: Elias Peter <pheski69 at GMAIL.COM<mailto:pheski69 at GMAIL.COM>>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, Elias Peter <pheski69 at GMAIL.COM<mailto:pheski69 at GMAIL.COM>>
Date: Sunday, June 3, 2018 at 8:24 AM
To: <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
Subject: [IMPROVEDX] 17 year gap (was change with 1 day training)

(Note: I’m branching a thread here, and have changed the subject line accordingly.)

The commonly cited figure of a 17-year gap to translate original research into clinical practice should be treated with some skepticism.

First, it is based on a single 18-year old paper that became a ‘meme’ after it was cited in the Institute of Medicine 2001 paper Crossing the Quality Chasm. Much has changed since 2000.

Second, there is no consensus in the published literature. Morris, Wooding and Grant list 23 widely divergent estimates in their 2011 review of this issue.

Third, speed is only one factor. Validity is another. Think, for example, of the rapid proliferation of stem cell therapy clinics at a time when the role of steam cell therapy remains very much uncertain.

I think the processes of knowledge adoption and behavior change are too complex to be easily or productively lumped into a single statistic. Think about the zombie preference for hydrochlorthiazide over chlorthalidone for hypertension, the lack of hand washing in medical settings, the use of eye patching for corneal abrasions or antibiotic ointment on wounds, the use of stenting in the setting of chronic and stable angina, the infatuation with nutraceuticals in the same culture that is skeptical about immunizations but loves things like stem cell therapy and proton beam therapy.

Peter Elias

(Morris, Zoë Slote, Steven Wooding, and Jonathan Grant. “The Answer Is 17 Years, What Is the Question: Understanding Time Lags in Translational Research.” Journal of the Royal Society of Medicine 104.12 (2011): 510–520. PMC. Web. 3 June 2018.)

(Lawrence W Green; Making research relevant: if it is an evidence-based practice, where's the practice-based evidence?, Family Practice, Volume 25, Issue suppl_1, 1 December 2008, Pages i20–i24, https://doi.org/10.1093/fampra/cmn055)

(Balas

EA
,
Boren

SA
.
,
Managing Clinical Knowledge for Health Care Improvement. Yearbook of Medical Informatics 2000: Patient-centered Systems
 ,
2000
Stuttgart, Germany
Schattauer
(pg.
65
-
70
))

******************


On 2018.06.02, at 8:33 PM, Lyn Behnke <lynbehnke at GMAIL.COM<mailto:lynbehnke at GMAIL.COM>> wrote:

Hmm. There is something banging in the back of my mind, but I believe it is related to the type of change you want to make.  Most changes in Medicine/nursing has some system change associated with it now days and it takes a long time to make a “simple” change.  In terms of new research, it takes about 17 years to get the new research into practice.  In terms of documentation changes, the EHR has to change, users have to be taught, programmers have to reprogram and it is quite a complicated procedure.  So, the 1 day of training is lost in all the lag time it takes to make a change.

From: Nick Rainey <nickraineydpt at GMAIL.COM<mailto:nickraineydpt at GMAIL.COM>>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, Nick Rainey <nickraineydpt at GMAIL.COM<mailto:nickraineydpt at GMAIL.COM>>
Date: Saturday, June 2, 2018 at 6:21 PM
To: <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
Subject: [IMPROVEDX] Change with 1 day training

I thought I read something recently either in this group or elsewhere about the difficulty of making actual practice change with a 1 day training. Anyone have any good quotes or written material on this?

Thanks in advance.
--
Nick Rainey
520-955-1820

________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/

________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1

or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX


Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/


________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/

________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1 or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX
Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/

________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/
NOTICE TO RECIPIENT:  If you are not the intended recipient of this e-mail, you are prohibited from sharing, copying, or otherwise using or disclosing its contents.  If you have received this e-mail in error, please notify the sender immediately by reply e-mail and permanently delete this e-mail and any attachments without reading, forwarding or saving them.  Thank you.

To unsubscribe from the IMPROVEDX:
mail to:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
or click the following link: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG

For additional information and subscription commands, visit:
http://www.lsoft.com/resources/faq.asp#4A

http://LIST.IMPROVEDIAGNOSIS.ORG/ (with your password)

Visit the searchable archives or adjust your subscription at:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

To unsubscribe from the IMPROVEDX list, click the following link:<br>
<a href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1" target="_blank">http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1</a>
</p>

HTML Version:
URL: <../attachments/20180603/e027ac44/attachment.html> ATTACHMENT:
Name: A Model for Implementing Evidence-Based Practices More Quickly.pdf Type: application/pdf Size: 638374 bytes Desc: A Model for Implementing Evidence-Based Practices More Quickly.pdf URL: <../attachments/20180603/e027ac44/attachment.pdf>


More information about the Test mailing list