The Alzheimer Knowledge Exchange

Seniors continue to be the fastest growing part of the population over the next 25 years, with a 39% increase within the next decade. Dementia rates double every 5 years over age 65 and will increase by 30% within this decade (ASO, 2007) Currently, 165,000 people have dementia in Ontario (ASO, 2007). This population of older, frail adults have increasing rates of morbidity from all chronic diseases but more so, having increasing rates of co-morbidity that challenges paid and unpaid care providers.

The needs of these individuals create exceptional demands on providers. Persons with dementia require as much as 40% more family doctor time in contrast to a patient not diagnosed with dementia (Tranmer et al., 2003).  Dementia is the third leading cause of hip fractures and is associated closely with other morbidities leading to fractures (Egan et al., 2008).  As much as 73% of those in LTC have Alzheimer disease or a related dementia (Sharkey, 2008).

Partially as a result of these pressures, care professionals, academics and students are expected acquire more information, make sense of it, and apply that new knowledge in practice in order to improve the quality of care provided to older adults with complex chronic disease and dementia.  In addition, Ontario’s chronic disease and prevention management model calls for a more active (and thus informed) involvement of the person and his or her caregivers in the management of disease (Wagner, 1998). Given the wealth of information out there, these expectations have enormous implications in terms of individual and organizational capacity, often resulting in performance gaps.

The Alzheimer Knowledge Exchange (AKE) helps to close these gaps by facilitating the transfer of knowledge into practice and helping to connect researchers, policy makers, educators and care providers working in the field of Alzheimer disease and related dementia with the knowledge and expertise they seek.  A Community of Practice (CoP)* dedicated to improving the quality of life for persons with Alzheimer disease and related dementia (ADRD), the AKE leverages the knowledge and expertise of the ADRD community to:

• Support learning needs of people seeking practice change
• Identify and support change champions by developing and nurturing of relevant communities of practice*

*A CoP is a group of people who have made a commitment to be available to each other to:

• offer support to share learning,
• consciously develop new knowledge, and
• share discoveries with anyone engaged in similar work,
• in order to advance individual and organizational practice (Wheatley, 2007).

The AKE has taken an evidence-based approach to knowledge transfer, building on the concepts introduced by Kitson et al. (1998), Sullivan et al. (2004) and Rycroft-Malone et al. (2002), integrating them with Wagner’s chronic disease management model (1998), and the lived experience and practice-based evidence of the ADRD community. Aligned with the Interprofessional Education for Collaborative Patient-Centred Practice approach under the Pan-Canadian Health Human Resources Strategy, the AKE facilitates knowledge transfer by providing access to research and practice-based evidence that is clear and relevant, ensuring the context shares the characteristics valued by a learning organization, and by providing facilitation mechanisms that are appropriate to the needs of the CoP members (Rycroft-Malone et al., 2002). In addition, the AKE provides and promotes multiple opportunities for knowledge exchange  (i.e. the mutual sharing of research and data knowledge and/or of practice and experience based knowledge for the purpose of improving practice) – another important contributor to the success of knowledge transfer (Rycroft-Malone et al., 2002).  The AKE is actively engaged in all 5 non-linear phases of knowledge transfer as outlined by Sullivan et al. (2004):

• Knowledge Generation –building reciprocal linkages between the researcher, educator, caregiver and policy maker to inform ADRD research agendas
• Knowledge Translation – working in partnership with CoP members and relevant stakeholders to identify opportunities for knowledge translation and to develop practical, evidence-based resources
• Knowledge Awareness and Access – leveraging technology in order to provide researchers, educators, caregivers and policy makers with awareness of and access to relevant resources and explicit and tacit knowledge in the field of ADRD
• Knowledge Use – facilitating the use of knowledge (transfer of knowledge into practice) by providing knowledge exchange support and resources to CoP members and sub-CoPs
• Knowledge Accumulation and Retrieval – accumulating ‘stories’ from CoP members in order to build on successes and facilitate the development of new partnerships

In addition to responding to the information needs of the CoP members and providing opportunities for knowledge exchange, the AKE provides service via:

1. Knowledge Brokering: people who facilitate networking, connections, communications and knowledge translation

2. Library Service: people who provide paid caregivers in the province of Ontario with free access to health related evidence and the services of Seniors Health Information Specialists

3. Communities of Practice: groups of people who work together over time to identify innovations, translate evidence and help implement changes to improve care of people with ADRD; the AKE is currently supporting or nurturing the development of 10 topic-specific CoPs, including:

• Health Care Consent and Advance Care Planning
• Primary Care
• Dementia Networks
• Driving and Dementia
• Design and Dementia
• Knowledge Transfer and Exchange Champions
• Care for the Unpaid Caregiver
• Psychogeriatric Resource Consultants
• Policy and Seniors Health
• Dementia Champions in Academia

4. Access to Technology: free tools that help people collaborate and learn together

5. AKE Resource Centre: an online repository of ADRD links, resources, and blogs

In addition, members of the AKE have access to a number of resources and tools including, online meeting space and a toll-free teleconference line, an online resource repository, a password-protected collaboration space, opportunities for education and knowledge exchange, updates from champions in the field of ADRD and seniors health.

A CoP within the Seniors Health Research Transfer Network (SHRTN - see the September edition of thefirstCanadianhealthcareconference.ca for more information), the AKE benefits from the insight provided by the SHRTN Board of Directors, and the partnerships between the AKE Coordination Team and the SHRTN Communities of Practice, Knowledge Brokers, and Information Specialists.  In addition, the AKE Steering Committee, consisting of representatives from different sectors supporting persons with dementia, ensure that voice of the person, family, and care provider are heard and support the development of linkages with other key partners.

Applying the concepts of knowledge transfer and exchange in this field is still fairly new in Ontario; however, by leveraging the knowledge and expertise of change champions, the AKE will continue to refine a model that will best meet the needs of people with dementia and those that support them and share these innovations on a national platform.

references:

1. Alzheimer Society of Ontario. (2007). Projected Prevalence of Dementia: Ontario Local Health Integration Networks.  Retrieved from:
   
2. Egan, M., Jaglal, S., Wells, J., Stolee, P. (2008). Factors associated with second hip fracture: a systematic review.  Clinical Rehabilitation. 22:3. 272-282.
3. Kitson, A., Harvey, G., McCormack, B. (1998). Quality and Safety in Health Care. 7. 149-158.
4. Rycroft-Malone, J., Kitson, A., Harvey, G., McCormack, B., Seers, K., Tetchen, A. (2002). Ingredients for change: revisiting a conceptual framework.  Quality and Safety in Healthcare. 11. 174–180.
5. Sharkey, S. (2008). People Caring for People: Impacting the quality of life and care of residence of long-term care homes. A report of the Independent Review of Staffing and Care Standards for Long-term Care Homes.
6. Tranmer, J.E., Croxford, R., Coyte, P.C. (2003).  Dementia in Ontario: Prevalence and Health Services Utilization. Canadian Journal on Aging, 22:4. 369-379.
7. Wagner EH. (1998). Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice. 1. 2-4  Retrieved from: http://www.improvingchroniccare.org/change/index.html
8. Wheatley, M. (2007). Finding our way: Leadership for an uncertain time. Berrett-Koehler Publishers

Accessing information is becoming less of an issue then having the time to wade through it. In order to advance your practice, how do you achieve a balance between finding the latest and greatest and getting your day-to-day work done?  Is there anything (tools, resources, people, etc.) that could make finding and using information easier for you ? - Megan Harris