NCCMT Webinar: Leveraging evidence for policy change: Reducing carbon monoxide exposure in long-term care facilities

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@ncceh
Funded by the Public Health Agency of Canada | Affiliated with McMaster University
Production of this presentation has been made possible through a financial contribution from the Public Health Agency of Canada. The
views expressed here do not necessarily reflect the views of the Public Health Agency of Canada..
Leveraging evidence for policy change:
Reducing carbon monoxide exposure in
long-term care facilities
Presenters:
Susan Snelling, PhD
Daniel Fong, MPH, CPHI(C)
May 17, 2017 1:00 – 2:30 PM ET

@ncceh
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Housekeeping
Use Chat to post comments and/or
questions during the webinar
• ‘Send’ questions to All (not
privately to ‘Host’)
Connection issues
• Recommend using a wired
Internet connection (vs.
wireless),
• WebEx 24/7 help line
• 1-866-229-3239
Participant Side
Panel in WebEx
Chat

@ncceh
3
After Today
The PowerPoint presentation (in English and French)
and English audio recording will be made available.
These resources are available at:
PowerPoint:
https://www.slideshare.net/NCCMT/presentations
Audio Recording:
https://www.youtube.com/user/nccmt/videos

@ncceh
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How many people are watching
today’s session with you?
Poll Question #1
A. Just me
B. 1-3
C. 4-5
D. 6-10
E. >10

NCC
Infectious
Diseases
Winnipeg, MB
NCC
Methods
and Tools
Hamilton, ON
NCC Healthy
Public Policy
Montreal, QC
NCC
Determinants
of Health
Antigonish, NS
NCC
Aboriginal
Health
Prince George, BC
NCC
Environmental
Health
Vancouver, BC
5

@ncceh
Presenters
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Daniel Fong, MPH, BSc, Btech, CPHI(C)
Environmental Health and Knowledge
Translation Scientist, National
Collaborating Centre for Environmental
Health
Susan Snelling, PhD
Senior Knowledge Translation Specialist,
National Collaborating Centre for
Methods and Tools

@ncceh
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Outline of Today’s Webinar
• Introduction to
NCCMT and NCCEH
• A model for
evidence-informed
decision making, with
a focus on ways to
adapt and use
research evidence
With reference to
methods & tools
relevant for
environmental health
practitioners, using
an example of
reducing carbon
monoxide exposure
in long-term care
facilities

@ncceh
National Collaborating Centre for
Methods and Tools (NCCMT)
Vision
• The effectiveness and efficiency of Canada’s public
health system will be guided by the production,
sharing and use of high quality evidence.
Mission
• The NCCMT will enhance evidence-informed public
health practice and policy in Canada by providing
leadership and expertise in supporting the uptake of
what works in public health into practice.
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@ncceh
National Collaborating Centre for Environmental
Health (NCCEH)
Focus:
• NCCEH focuses on the health risks associated with
the physical environment
• Improve the ability of public health to make evidence-
informed decisions and implement evidence-
informed interventions
Target Audience:
• PHIs, MHOs, other environmental public health
practitioners and policy-makers
• Engage key stakeholders working in areas of
environmental health to synthesize evidence-based
resources
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@ncceh
What is Evidence-Informed Public
Health?
… the process of distilling and disseminating
the best available evidence from research, context
and experience, and using that evidence to inform
and improve public health policy and practice.
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@ncceh
A Model for Evidence-Informed
Decision-Making in Public Health
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@ncceh
Stages in the process of
Evidence-Informed Public Health
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@ncceh
Scenario: Leveraging evidence for policy change
• Initial incident w/ carbon monoxide (CO) exposure in a long-term care
facility (LTCF) led to 31 sent to hospital, contributed to 3 deaths
• Needed evidence-based approach to address indoor carbon monoxide
exposure to residents and staff in long-term care facilities
• Collaboration between:
• NCCEH/BCCDC,
• Health Canada,
• Saskatoon Health Region (SHR), SK
• Interior Health Authority (IHA), BC.
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How can the steps of Evidence-Informed
Public Health be applied to this scenario?

@ncceh
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Clearly define the question or
problem

@ncceh
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Efficiently search for research
evidence

@ncceh
Recommended Tool: Search
www.healthevidence.org
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@ncceh
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@ncceh
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Critically and efficiently appraise
the research methods

@ncceh
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Interpret information;
understand how to prioritize
conflicting results

@ncceh
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Adapt the information
to the local community

@ncceh
A Model for Evidence-Informed
Decision-Making in Public Health
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@ncceh
Adapt: Adapt to local context
• 2013 – consultation with stakeholders to discuss
the development of a health-protective CO
management strategy in LTCFs.
• 2015 – SHR CO monitoring policy was examined
and evaluated.
• 2016 – Adapt learnings into the a CO Monitoring
and Response Framework.
• CO is a potential threat to LTCF residents across
Canada (target population)
• Can be locally implemented (rural/urban, large/small)
• Can find parallel departments/individuals in many
health authorities to fill the required roles and
responsibilities for implementation
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@ncceh
Recommended Tools: Adapt
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http://www.nccmt.ca/resources/search/24
• Applicability and Transferability of Evidence

@ncceh
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Decide whether
(and plan how) to implement
the change in practice or policy

@ncceh
Implement: Decide whether (and plan how) to
implement the adapted evidence into practice or policy
• Pilot in Interior Health
• Assess what’s needed
o Initial discussions between Health and NCCEH
• Internal Working Group to plan
o Health, Plant Services, Residential/Clinical Services,
Support Services, Occupational hygiene
• Training to disseminate info
o Managers, staff involved
o Webinars, presentations, teleconference meetings, on-
site training and follow-up for each LTCF
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@ncceh
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http://www.ncceh.ca/sites/default/files/Carb
on_Monoxide_Framework_Implementation
_Guide_Aug_2016.pdf
• Provides rationale,
background
• CO Monitoring and
Response
Framework
• Steps for
implementation
• Sample forms,
checklists,
instructions

@ncceh
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Assess the effectiveness
of the change in
practice or policy

@ncceh
Evaluate: Evaluate the effectiveness of
implementation efforts
• Was implemented as planned?
• What worked? What could be improved?
• Did the intervention have its intended
outcomes? Capture identify elevated indoor
CO?
• Finally, experience and knowledge gained from
this process were used to develop two guides
for implementing and evaluating the framework
for those who wish to implement in other LTCFs
across Canada.
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@ncceh
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http://www.ncceh.ca/sites/default/files/Carb
on_Monoxide_Framework_Evaluation_Gui
de_Mar_2017.pdf
• Evaluation design,
approach
• Key questions,
indicators
• Sample
analysis/reporting
of results
• How to use findings
• Resources

@ncceh
Recommended Tool: Evaluate
Improving Future Decisions: Optimizing the
Decision Process from Lessons Learned
Use it to evaluate your use of evidence in
making decisions.
A reflective practice tool.
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@ncceh
Stages in the process of Evidence-
Informed Public Health
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@ncceh
Recommended tool: Evidence-Informed
Decision Making Checklist
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 EIDM Phases & Steps
File Path / Link to
Saved Location on:
(insert name of your
network here)
 1. Define question
 Was a clear answerable search question developed?
What was the question?
P
I
C
O

2. Search for relevant evidence
 Was a comprehensive search strategy employed to find the best available evidence to
address this question?
PICO search terms table (See: Developing an Efficient Search Strategy Using PICO)
 Years searched:
Pyramid results (See: Levels & Sources of Public Health Evidence)
Search results (See: Keeping Track of Search Results: A Flowchart)
References saved in reference management software database (e.g. Reference Manager / RefWorks)
What relevance criteria were used to determine evidence for quality assessment:
Primary
Titles and abstracts as found in reference management database
 Save as separate reference management database.
Secondary
Relevance assessment of full document versions
 Save as separate reference management database.
How many papers remained following relevance assessment(s)? (See: Flowchart, above)
 3. Appraise
 Was quality assessment conducted on relevant evidence?
How many papers remained after quality assessment? (See: Flowchart, above)
 4. Synthesize
 What were the results of the review of the evidence?
What were the actionable messages from the evidence?
 5. Adapt.
 NCCMT’s Applicability and Transferability tool;
 AHRQ’s Will It Work Here? A Decisionmaker's Guide to Adopting Innovations
 6. Implement.
 7. Evaluate.

@ncceh
NCCMT Registry of Methods and Tools
Resources to support use of research evidence in
public health
http://www.nccmt.ca/resources/registry
A free, searchable, online collection of knowledge
translation methods and tools for public health
• Summary statements
• Web links (when available) to Methods and Tools
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@ncceh
NCCMT Registry of Methods of Tools
for Knowledge Translation
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@ncceh
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Your Comments/Questions
• Use Chat to post comments
and/or questions
• ‘Send’ questions to All (not
privately to ‘Host’)
Chat
Participant Side
Panel in WebEx

@ncceh
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Your Feedback is Important
Please take a few minutes to share your thoughts on
today’s webinar.
Your comments and suggestions help to improve the
resources we offer and plan future webinars.
The short survey is available at:
https://nccmt.co1.qualtrics.com/jfe/form/SV_ac1Y9GJC0riJjJb

@ncceh
Join us for our next webinar
Methods and Tools for Integrating Health
Equity into Public Health Program Planning
and Implementation
Date: Wednesday June 28, 2017
Time: 12:00 – 1:30pm ET
Join us for a discussion of methods and tools that can be used to support
evidence-informed decision making in the context of health equity. Learn
about resources to help you apply health equity principles to planning
processes that contribute to evidence informed public health.
Register at: https://health-evidence.webex.com/health-
evidence/onstage/g.php?MTID=e7eb0670c5a2541d58a1e94a2cc35cda2
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@ncceh
Funded by the Public Health Agency of Canada | Affiliated with McMaster University
Production of this presentation has been made possible through a financial contribution from the Public Health Agency of Canada. The
views expressed here do not necessarily reflect the views of the Public Health Agency of Canada..
For more information:
NCCMT website: www.nccmt.ca
Contact: nccmt@mcmaster.ca
NCCEH website: www.ncceh.ca
Contact: contact@ncceh.ca

NCCMT Webinar: Leveraging evidence for policy change: Reducing carbon monoxide exposure in long-term care facilities

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NCCMT Webinar: Leveraging evidence for policy change: Reducing carbon monoxide exposure in long-term care facilities