Establishing an Enterprise-Wide Knowledge Translation Infrastructure in the Military Health System Richard F. Stoltz, Ph.D.; Lynn B. Hallard, M.S.L.S.; Subhamoy Pal, Ph.D.; Aaron M. Sawyer, Ph.D.; William Klenke, M.A., M.M.A.S.; Jason Berger, B.A.; Rebecca John, M.H.S. Background The Military Health System (MHS) is responsible for a comprehensive range of functions to support the health care of 9.4 million active duty and retired US military personnel and their dependents: it funds research, develops solutions, trains and manages providers and treats patients. A significant portion of research investments go towards developing knowledge products, such as clinical support tools and practice guidelines. These products often take too long to reach clinicians, or are not used as intended, leaving a gap between what we know and what we do with respect to clinical care. Developing an enterprise-wide knowledge translation infrastructure would act as a bridge between the MHS’s research and development (R&D) and practice communities, shifting away from ad hoc and personality-driven processes toward a system that is standardized and integrated.
How an Enterprise-Wide Knowledge Translation Capability Could Improve the MHS
KNOWLEDGE TRANSLATION
Better Care
Better Health
Lower Cost
Current State and Envisioned Future State of the MHS
Improved Readiness
Robust knowledge translation will enhance the quality of care by moving more research-based solutions to the field faster. Providers adopting evidenced-based practices and products will improve health outcomes for their patients. Efficiency will increase by defining pathways, aligning needs with expenditures and continuously evaluating outcomes. The latest tools and open communication between researchers and practitioners will help the military stay medically ready.
Visualizing the Future of MHS Knowledge Translation
CURRENT STATE
The figure below is a proposed vision for an enterprise-wide MHS knowledge translation infrastructure. The large gray circles on the right and left represent the health R&D and practice communities, respectively. Each of these communities has civilian (gray ovals) and military (purple ovals) components that currently contribute to the development, dissemination, implementation and evaluation of knowledge products. This design will leverage the strengths of existing stakeholder groups and their capabilities, while enhancing the connections between them.
Knowledge translation efforts are variable and inefficient; it takes more than a decade to move research-backed innovations into clinical practice
FUTURE STATE It takes less than five years to move research to the field in the MHS because of the system’s standardized, well-coordinated knowledge translation pathways
Components that are needed for effective translation between R&D and practice communities are pictured in the middle of the figure. MHS leadership and stakeholders are at the top — they will oversee the process and provide policy, resource and governance support. Directly below that is the MHS knowledge translation capability, which will support coordination across MHS components to produce knowledge and materiel products and help facilitate their use among end users in military treatment facilities (MTFs) and deployed medical settings.
Conclusions and Implications Knowledge Translation Action Group (KTAG) – Building the Foundation
The MHS is a complex global organization with a challenging mission. MHS providers should have the most up-to-date research to provide the best care to their patients. Currently, that is not happening uniformly across the MHS. Improved policies, processes and systems are needed to close systemic gaps and move knowledge and materiel products from the sidelines to the field. The creation of an enterprise-wide knowledge translation infrastructure is a practical way to solve this challenge for the MHS.
Leveraging existing MHS knowledge translation expertise, the DHA-initiated KTAG is organized into five working groups. They are highlighted below with a description of their core purpose in relation to maximizing the impact of knowledge products to support the readiness, health and well-being of service members and their families. Transition Agreements
Dissemination and Implementation
Enable efficient and effective handoffs between stakeholders in the knowledge product lifecycle to accelerate the transition of research to practice
Equip knowledge product lifecycle stakeholders for more effective dissemination and implementation planning, increasing the adoption and impact of knowledge products
Evaluation Improve knowledge product evaluation capabilities in dissemination and implementation to strengthen feedback loops between end users and those responsible for the iterative improvement of knowledge products
Key Terms Promote MHS-wide consistency of definitions for knowledge translation to enable more effective collaboration among knowledge product lifecycle stakeholders
Building a robust, enterprise-wide knowledge translation capability in the MHS will not be easy, but it is necessary. With this infrastructure in place, proponents within the system will define objectives up front, coordinate more effectively with partners and document handoffs. In addition, we anticipate this infrastructure will enable better measurement of performance and return on investment, which can support effective decision-making by MHS leaders and a healthier, more battle-ready military population.
Knowledge Readiness Levels
References Agency for Healthcare Research & Quality. (2017). AHRQ's Knowledge Transfer Initiative: Tools for states and organizations. Retrieved from: https://www.ahrq.gov/policymakers/measurement/quality-by-state/kttools.html
Develop a functional framework to facilitate evaluation and prioritize research for knowledge products that intend to address requirements and fill gaps
Canadian Institutes of Health Research. (2012). Guide to knowledge translation and planning at CIHR: Integrated and end-of-grant approaches. More about knowledge translation at CIHR. Ottowa, Ontario, Canada: Author. Retrieved from: http://www.cihr-irsc.gc.ca/e/45321.html Grimshaw, J., Eccles, M., Lavis, J., Hill, S., & Squires, J. (2012). Knowledge translation of research findings. Implementation Science (7) 50. Retrieved from: https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-7-50 Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st Century. Washington, DC: Author. Retrieved from: https://www.nap.edu/catalog/10027/crossing-the-quality-chasm-a-new-health-system-for-the Note: CPGs = Clinical Practice Guidelines, CRs = Clinical Recommendations, MHS = Military Health System, MTFs = Military Treatment Facilities, R&D = Research and Development, USUHS = Uniformed Services University of the Health Sciences, VA = Department of Veterans Affairs
Rabin, B., Brownson, R., Haire-Joshu, D., Kreuter, M., & Weaver, N. (2008). A glossary for dissemination and implementation research in health. Journal of Public Health Management and Practice, 117-123. Retrieved from http://chipcontent.chip.uconn.edu/chipweb/documents/DI/Rabin_etal_2008.pdf
For additional information, contact Ms. Lynn Hallard (
[email protected]),or visit http://dcoe.mil/about/knowledge-translation
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