Knowledge Broker, My Next Career

Marie Prothero RN, MSN, FACHE

PhD Student University of Utah College of Nursing

What is a Knowledge Broker?

Do you believe there is a gap between practice and research?  Do you wonder if your patients are receiving the most clinically relevant care? If you answered yes to either of these questions then you may need a knowledge broker.  A knowledge broker is an intermediary between the people who produce research (scientist) and those who use it (policy makers, general public and people working in healthcare).   A knowledge broker works to bridge the gap that exists between these two groups. 

Close to two million research papers are published each year in 28,000 journals.  Last year the Food and Drug Administration approved 41 drugs and in 2013 27 new drugs were approved.  When you start to compound these numbers year and after year it’s no wonder healthcare providers are unable to keep up with current research.  Synthesizing, analyzing and translating relevant research findings are complex and require a specific set of skills.  One strategy that might resolve this dilemma is the implementation of a Knowledge Broker.

Knowledge brokering is the process of bringing people together for the purpose of moving knowledge forward.  Knowledge Brokers work to let end users know about current research and work with researchers to make their work more accessible and meaningful to healthcare providers and policy makers.  This translates to transferring knowledge from one group to another in order to foster implementation of clinical research and at times, create new knowledge. 

Examples of successful implementation

In 1996 the Canadian government founded The Canadian Health Services Research Foundation  with the purpose of establishing a knowledge broker group.  This organization has individuals with expertise in healthcare and research.  Their goals include bringing researchers and decision makers together to identify gaps in research and fund the researchers who investigate those gaps.  The final outcome of this work was to bring healthcare leaders, patients and families, and researchers together in a collaboration to find optimum solutions to current healthcare issues.

Another successful example includes Healthcare Improvement Scotland.  This organization uses apps to help guide physicians and other providers to sift through the large number of research articles and find the most cost effective solutions.  They scrutinize research to establish clinical evidence to solve some of their most pressing issues to improve patient care.  This organization also provides regulatory oversight to the hospitals in Scotland. 

What does it take to be a successful Knowledge Broker?

• Opinion leader and an entrepreneurial spirit
• Credibility in research and practice settings
• Excellent communicator, must be able to translate research into easy to understand practical information
• Negotiator of both the research and decision making environments
• Be able to see and think about the big picture
• Build relationships and ask researchable questions
• Problem solver, innovator and change agent
• Be able to present one-on-one and in large groups

Driving forces to push this paradigm shift forward

The need to identify and implement evidence based practice continues to be a top priority.  Effective knowledge exchange depends on groups of individuals with common concerns, values and a desire to work together.   There is an increased need for research to reach all levels and have a big impact to society and the economy.  In a highly competitive world market knowledge has become increasingly important. 

Passive dissemination of research has not been as successful as one would hope (Haynes & Haines, 1998).  Hospitals continue to struggle with full implementation of CMS core measures in the care of stroke, anterior myocardial infarction, pneumonia and venous thrombosis prevention.  

Researchers and users do not speak the same language nor do they have the same incentives.  A Knowledge Broker could facilitate the lack of common language, culture, unspoken rules to bring both parties together. 

Barriers to adoption/Why has this concept not been more widely accepted?

One barrier to adoption is finding the right person for the job.  Most experts in research stay in research and experts in the practice setting often are lacking skills to analyze and synthesize research.  Additional barriers could be funding of the position and the need to develop the skills and credibility to maneuver between both settings?  

Organizations must also commit and support research implementation.  This can be difficult without support from all levels of management in an organization.   Many organizations struggle to implement change particularly in practice settings where evidence base practice implementation is not embedded in the culture of the organization. 

Academic structure promotes grant procurement and academic publication over engagement with health service.  Researcher to researcher collaboration is well organized while the opposite of researcher to practitioner interchanges about implementation of research findings is sporadic.  Structures and incentives in healthcare organizations do not do any better in advancing scientific research.  Most healthcare organizations are focused on market share, cost reduction and containment, and regulatory compliance.  Unless the healthcare setting is part of a large academic setting they are not equipped to translate the plethora of research into practice.   The lack of understanding and recognition from both sides continue to push both parties apart.

Do Knowledge Brokers have a future?

The practicality of KB is still being scrutinized.  There are examples in the literature that suggest they play a role in assisting with knowledge dissemination and implementation.  However an important note in the literature is the credibility of the KB with both groups and their ability to promote collaborative relationships and networks.  A continued focus on designing implementing and evaluating solutions may further the need for KB or it may eliminate the need.

Individuals who are facilitating this work may not always be called a “knowledge brokers”.  Often they are called change agents, facilitators, technology transfer officers, knowledge translators and innovative brokers.

Nurses at all levels of an organization must take all opportunities to engage with researchers to solve problems and generate new knowledge whenever possible.  The nursing profession must also identify research needs and lobby for an active role in the research process.  

When an organization decides to utilize a KB they must commit financial resources and personnel time in order to create a positive change.  Many organizations may want to move in this direction but simply don’t know how.  Knowledge brokers will need to continue to market their value to researchers and healthcare providers.

K* (Star) Initiative was established in the United Kingdom to help knowledge brokers organize and create a support system.  This organization is facilitating knowledge brokers with the tools they need to be successful in their jobs.  Most examples of knowledge brokering are in countries with a single payer model (socialized medicine).  This may be one reason why coordination of resources and implementation of evidence based practice has become some important. 

Future Implications: Is it right for me?

Knowledge brokering is somewhat new and seems to be gaining momentum in healthcare to fast-track the exchange of knowledge between research, practice and policy environments.  Working as a nurse, nurse administrator, hospital administrator and quality director has given me skills to communicate and mediate at all levels of a healthcare organization.  My next endeavor is to build my skills as a nurse researcher.  Could combining my new research skills with my previous skills facilitate my role as a knowledge broker?  My desire to advance science where it matters most is at the bedside.  This new and exciting role as a knowledge broker could be my next career.

References:

Clark, G., & Kelly, L. (2005). New directions for knowledge transfer and knowledge brokerage in Scotland: Scottish Executive Social Research.

Haynes, B., & Haines, A. (1998). Getting research findings into practice: Barriers and bridges to evidence based clinical practice. BMJ: British Medical Journal, 317(7153), 273.

Holgate, S. (2008). Emerging professions: Knowledge broker. Science.

Lomas, J. (2007). The in-between world of knowledge brokering. BMJ: British Medical Journal, 129-132.

Meyer, M. (2010). The rise of the knowledge broker. Science Communication, 32(1), 118-127.

Ward, V., House, A., & Hamer, S. (2009). Knowledge brokering: the missing link in the evidence to action chain? Evidence & Policy: a Journal of Research, Debate and Practice, 5(3), 267.

Ward, V. L., House, A. O., & Hamer, S. (2009). Knowledge brokering: exploring the process of transferring knowledge into action. BMC Health Services Research, 9(1), 12.

Wright, N. (2013). First-time knowledge brokers in health care: the experiences of nurses and allied health professionals of bridging the research-practice gap. Evidence & Policy: a Journal of Research, Debate and Practice, 9(4), 557-570.

Links to Resources

Canadian Health Services Research Foundation http://www.chsrf.ca/

Healthcare Improvement Scotland http://www.healthcareimprovementscotland.org

Knowledge Broker by PHCRIS: https://www.youtube.com/watch?v=knUj6HjsHro

K*Initiative:  http://inweh.unu.edu/archive/River/KnowledgeManagement/KStar.htm

https://www.canchild.ca/en/canchildresources/knowledge brokering.asp

https://en.widipedia/org/wiki/knowledge_broker

http://sciencecareers.sciencemag.org/career_magazine/previous_issues/articles/2012_06_08/caredit.a1200064

https://www.youtube.com/watch?v=knUj6HjsHro

This work is by Marie Prothero and is licensed under a Creative Commons Attribution 4.0 International License

Translational Science: Let us put our money where our mouth is

Marc-Aurel Martial

PhD Student University of Utah College of Nursing

How much attention is devoted to implementing scientific discoveries?

One of the first English idioms I learned after arriving in the US while playing billiard with my uncle is “Put your money where your mouth is.” As I reviewed the literature on translational science and one of its components, implementation science, the gap between scientific discoveries and public health gains startled me. Often between 1% and 5% of individuals may benefit from scientific discoveries (Glasgow, et al., 2012). Yet, spending on implementation research in 2002 was only 1.5% of the biomedical research funding (Woolf, 2008). I couldn’t stop thinking about this idiom in relation to the current global discussion about translational and implementation science because of the low amount of attention and resources that is devoted to implementing scientific discoveries.

How things have been and still are

Initially the term "translational research" was used to define both the transformation of knowledge from natural sciences to produce new biomedical treatments and the implementation of treatment options into clinical practice (Woolf, 2008). This has been coined “bench-to-bedside” research (Woolfe, 2008). The Institute of Medicine differentiated these two phases of translational research as T1 (biomedical research that produces new treatments) and T2 (implementation research). The National Institutes of Health (NIH) defined implementation science as “the study of methods to promote the integration of research findings and evidence into healthcare policy and practice.”

While both T1 and T2 research are important, most people think that translational research refers to T1 (Woolf, 2008). For every dollar spent on biomedical research in 2010, only pennies were apportioned to implementation research (Glasgow, et al., 2012) despite the fact that only 50% of patients in the US receive recommended health services (Woolf, 2008). For example, only half of individuals with high blood pressure are being successfully treated (Glasgow, et al., 2012). The concept of accountability for the implementation of interventions and the resulting outcomes has evolved. Accountability for patient outcomes has shifted from the patient to the healthcare provider.

How things will be (are becoming)

The definition of translational science has been expounded from the two phases (T1 and T2) to include additional phases of research to provide greater clarity. So, the scope has shifted to “bench-to-bedside” and “bedside-to-community.” For instance, Dougherty & Conway (2008) presented three types or phases of translational research. The first phase (T1) focuses on translation from basic sciences to clinical efficacy, while the second phase (T2) and third phase (T3) focus on, respectively, translation of clinical efficacy to clinical effectiveness and translation of clinical effectiveness to the delivery of health services. According to Drolet & Lorenzi (2011), these three phases (T1-T3) are “translation chasms” or gaps between four landmarks in the evolution from basic scientific knowledge, to proposed human application, to proven clinical application, to clinical practice, which ultimately leads to public health gains. The Institute of Translational Health Sciences (ITHS) proposes five phases of translational research which are problem identification (T0), discovery research (T1), health application to access efficacy (T2), science of dissemination and implementation (T3), and evaluation of health impact on real world populations (T4).

There is a growing recognition that implementation science can benefit more people than basic scientific research that aims to produce new interventions (Woolf, 2008). For example, more strokes can be prevented if the focus is on aspirin administration to patients who meet criteria than on developing newer anti-platelets (Woolf, 2008). There is an assumption that implementation research should be expanded beyond clinical settings and clinical providers (Woolf, 2008). Some scientists view new interventions and implementation like a serum and a syringe and believe just as doing more research on the serum will not yield to a better syringe, doing more research on new interventions will not produce better implementation methods. The concept of accountability for patient outcomes is shifting from the provider to the health services system. There is greater understanding that health systems are not prepared to achieve their goals and resources at various levels need to be aligned to better support providers.

Driving forces leading to the shift

Implementation science emerged from shifting accountability to organizations and evaluating the implementation of planned policies (Lobb & Colditz, 2013). It focuses on methods that accelerate the successful implementation of interventions. Increased funding and interest in closing the gap between scientific discoveries and public health gains are fueling the advancement of implementation science (Lobb & Colditz, 2013). For example, as seen in the two figures below, implementation teams that utilize implementation drivers can implement 80% of new interventions effectively over three years; without a team, only 14% of new interventions are implemented in seventeen years. The NIH, the European Commission, and the United Kingdom have made translational research a priority (Woolf, 2008). For example, the NIH has established translational research centers, initiated the Clinical and Translational Science Award, and funded translational research programs at academic institutions. Additionally, private institutions have developed similar programs.     

Facilitators to implementation

Skilled teams that employ implementation drivers are the linchpin to achieving sustainable  integration of new and effective interventions into clinical practice and delivering outcomes that are socially significant. The formula for successful implementation of innovations that yields meaningful public health gains is the product of effective interventions, sound implementation methodology, and enabling contexts. The stronger each component is, the stronger the result will be.  

Barriers to adoption

Although certain disciplines, such as sociology, and organizational behavior have used implementation science for many years, its application to public health questions is new (Lobb & Colditz, 2013). Therefore, there are few small and fragmented studies with inadequate coordination efforts and insufficient communication of results and lessons learned. Additionally, little agreement exists on methodological approach for the field. Caseload and the lack of factors such as financial resources, knowledge, time, perception of utility, and motivation threaten the implementation of innovations. Finally, certain characteristics of an intervention such as its high cost or the failure of the research design to be representative of the target population may inadvertently hinder adoption of a new intervention (Lobb & Colditz, 2013). For instance, a case study in rural West Virginia points out several contextual barriers to implementation of evidence-based interventions, including the challenge of rural residents to walk long distances to receive an evidence-based intervention.

Potential impact

Implementation research has the tremendous potential to reduce the gap between knowledge and practice. It promises to close the access and disparity chasms. It is likely to reduce morbidity and mortality more than the discovery of new diagnostic and treatment options (Woolf, 2008). The consequences of inadequate translation of research from “bench-to-bedside” and “bedside-to-community” are too costly in terms of losses of human lives and “billions of research dollars” (Drolet & Lorenzi, 2011). Now is the time to put our money where our mouth is by allocating more funding to implementation science so that we may achieve, in a future not too distant, greater public health gains from extant scientific discoveries.

Recommended readings/links

1.      Drolet, B.C. & Lorenzi, N.M. (2011). Translational research: understanding the continuum from bench to bedside. Translational Research, 157(1), 1-5. doi: 10.1016/j.trsl.2010.10.002

2.      Glasgow, R. E., Vinson, C., Chambers, D., Khoury, M. J., Kaplan, R. M., & Hunter, C. (2012). National Institutes of Health Approaches to Dissemination and Implementation Science: Current and Future Directions. American Journal of Public Health, 102(7), 1274–1281. doi:10.2105/AJPH.2012.300755

3.      Lobb, R. & Colditz, G.A. (2013). Implementation Science and its Application to Public Health. Annual Review of Public Health, 34, 235-251. doi: 10.1146/annurev-publhealth-031912-114444
4.      Woolf, S.H. (2008). The Meaning of Translational Research and Why It Matters. Journal of American Medical Association, 299(2), 211-213. doi: 10.1001/jama.2007.26

5.      T-Phases of Translational Health Research at https://www.iths.org/investigators/definitions/translational-research/

6.      Learn Implementation at http://nirn.fpg.unc.edu/learn-implementation

7.      Dougherty, D. & Conway, P.H. (2008). The “3T’s” Road Map to Transform US Health Care: The “How” of High-Quality Care. Journal of American Medical Association, 299(19), 2319-2321. doi: 10.1001/jama.299.19.2319

8.      Frequently Asked Questions About Implementation Science at http://www.fic.nih.gov/News/Events/implementation-science/Pages/faqs.aspx

This work is by Marc-Aurel Martial is licensed under a Creative Commons Attribution 4.0 International License

Data Mining and the Electronic Health Record: A land mine or a gold mine for nursing research?

Linda H. Eaton, PhD, RN, AOCN, Post-Doctoral Fellow

T32 Interdisciplinary Training in Cancer, Aging and End of Life Care

University of Utah College of Nursing                                                                         

https://commons.wikimedia.org/wiki/File Exploding_landmine_(16958280).jpg

Documentation of patient data is a necessary and essential component of patient care. In the past, patient data was documented in the paper medical record and used by the healthcare team to communicate and track a specific patient’s health status, treatment, and outcomes. Today, due to the electronic health record (EHR), an enormous amount of patient data is readily accessible to providers, healthcare organizations, researchers, and insurers. Through data mining, important research questions can be addressed such as identifying best practices to improve quality of care and reduce health care costs.

https://www.flickr.com/photos/11139043@N00/1439804758 

What is data mining?

Data mining is a methodology used in healthcare and other fields for analyzing large databases and summarizing the data into useful information. Although causality is not established by data mining, patterns, associations, or relationships among the data can generate new information for predicting the likelihood of future events. Data mining is based on statistical concepts and developments from several disciplines including machine learning, artificial intelligence, data visualization, and pattern recognition (Berger & Berger, 2004).

How is Data Mining Changing the Research Paradigm? 

Data mining is changing the paradigm for how clinical research is conducted. The current paradigm is based on a carefully controlled study which takes years for findings to be implemented in practice. With data mining, data are readily available from a large numbers of participants. These may be patients who would not routinely participate in a traditional study due to lack of interest or time, or because they are too sick, i.e., multiple chronic diseases, critical health condition, end of life. Thus, data mining can address research questions that are not easily addressed by a traditional study.

https://zh.wikipedia.org/wiki/%E5%A4%A7%E6%95%B8%E6%93%9A

The potential implications of this paradigm change for nursing research are several. Data mining can support the discovery of important relationships among clinical data, nursing interventions, and patient outcomes. It generates knowledge beyond what can be learned in a carefully controlled study. Data represent the “real world” which strengthens the applicability of study findings to practice. With the use of data mining, nursing knowledge generation may be accelerated.

Characteristics of Old and New Research Paradigms

Traditional Research Model	Data Mining Research Model
Requires monitoring by a human subjects committee	May be exempt to monitoring by a human subjects committee
Doesn’t require team science	Requires team science
Often difficult to enroll patients	Patients are readily available
May have high patient burden	Low patient burden
Expensive	Expensive
Very controlled	“real world”
Limit to number of research variables	Unlimited number of research variables
Limited data	Big data
May take years to complete	Can be completed in a shorter amount of time

What Challenges Exist with Data Mining?

Potential challenges with data mining need careful consideration. Some of these challenges are unique to data mining and others are typical challenges in any research study.

https://pixabay.com/en/magnifying-glass-question-mark-globe-68207/

Quality of Data

• Missing data, misspellings of medical terms, and redundant data all impact data quality. As with any research study, if data entry is poor, it will have a negative impact on the study findings. Cleaning of data is an essential step of data mining to ensure accurate findings, but it does not fix missing data.
• Clinical nurses need to be educated about the critical need for accurate and complete documentation. They need to understand that their documentation in the EHR may be data for a research study that can inform and change nursing practice. 

Standardized of Language

• Multiple labels are often used to represent the same concept.
• Standardized language needs to be used in the EHR in order to generate meaningful findings from data mining. It also better facilitates the communication and exchange of data between different information technology systems.
• Nursing needs to be involved in developing the standardized language; otherwise, data mining will not provide answers to nursing research questions.

Patient Privacy

• De-identification of EHR data is essential. 
• Any information that may identify the patient must be removed. This requires careful attention from the research team.

Interpretation of findings

• o Due to the large sample sizes provided by the EHR system, statistical significance is often attained. 
• o It is essential that a nurse expert determine if the statistical significance has clinical merit.

   ..”a difference, to be a difference, must make a difference”  (Sacristan, 2013)

Summary
Data mining is changing the research paradigm. As the National Institutes of Health Big Data to Knowledge Initiative is achieved, we will see more research studies using data mining of the EHR. This methodology has a huge potential for generating nursing knowledge in a timely manner, but must be carefully implemented by a research team that is experienced in the technological, statistical, and clinical practice aspects of data mining. As the potential for data mining is realized, we will see an explosion of nursing knowledge that will improve patient outcomes and clinical practice.

Links to Hyperlinked Text:

Electronic Health Record (EHR): http://healthit.gov/providers-professionals

Data Mining: http://confidenceconnected.com/blog/2012/10/09/data_mining_in_a_healthcare_setting/

Patterns, associations, or relationships: http://www.anderson.ucla.edu/faculty/jason.frand/teacher/technologies/palace/datamining.htm

Standardized Language: http://journals.lww.com/ornursejournal/Fulltext/2013/07000/The_benefits_of_data_mining.1.aspx

National Institutes of Health Big Data to Knowledge Initiative:

http://commonfund.nih.gov/bd2k/index

Other Links:

http://www.ihealthbeat.org/perspectives/2013/electronic-health-record-data-mining-is-it-a-dirty-word

http://www.nytimes.com/2013/01/15/health/mining-electronic-records-for-revealing-health-data.html?_r=0

Key References:

Berger, AM & Berger, CR (2004). Data mining as a tool for research and knowledge development in nursing. CIN: Computers, Informatics, Nursing, 22(3), 123-131.

Goodwin, L, VanDyne, M, Lin, S & Talbert, S (2003). Data mining issues and opportunities for building nursing knowledge. Journal of Biomedical Informatics, 36 (2003), 379-388.

Sacristan, JA (2013). Patient-centered medicine and patient-oriented research: improving health outcomes for individual patients. BMC Medical Informatics and Decision Making, 13(6), 1-8.

Windle, PE (2004). Data mining: an excellent research tool. Journal of PeriAnesthesia Nursing, 19(5), 355-356.

This work is by Linda H. Eaton is licensed under a Creative Commons Attribution 4.0 International License

Patient Centered Research: “Facing ambiguity and touching discovery”

Echo L. Warner MPH

PhD Student, University of Utah College of Nursing

Photo courtesy of the CDC

History of PCR: Healthcare has been informed, historically, by empirical evidence-based medicine. Evidence-based medicine is focused on clinical guidelines, protocols, and best practices that are identified using population based approaches (i.e., the best approach for the biggest group of people) (Romana, 2006).  However, a paradigm shift has occurred over the last few decades as healthcare providers and administrators have begun to realize the integral nature and value of patient centered care. In contrast to evidence-based medicine, patient centered care and research prioritizes the voice of the patient and supports clinical discretion (Romana, 2006). Dr. John Noble first described the need for patient centered research (PCR) in 1989 (Noble, 1989). Noble (1989) described PCR as an approach to discovering new knowledge and identifying strategies to improve the patient experience by engaging patients and clinicians in the study of the social, psychological, and individual factors that influence the healthcare experience (Noble, 1989).

PCORI PCR Focused Funding Announcements	Funds Available	Application Dates
Patient-Powered Research Networks (PPRN) Research Demonstration Projects	$18 million	9/30/2015
Improving Methods for Conducting Patient-Centered Outcomes Research- Cycle 2	$12 million	11/3/2015
Engagement Award: Knowledge, Training and Development, and Dissemination Awards	Varies	10/1/2015

Example of PCR:

In an effort to provide the best and most appropriate patient centered care there has become an increasing focus on PCR over the last few decades. In 2010, the Obama administration devised the Patient Centered Outcomes Research Initiative (PCORI), in an effort to allocate funding toward studying what kind of healthcare is most effective for certain patients. PCORI also prioritized four domains of research: improving healthcare systems, communication and dissemination, health care disparities, and accelerating patient-centered and methods research (Sox, 2012). Specifically, the goal of this priority is to develop an informed community of patients, a focus on patient preferences, and development of innovative methodologies that engage and emancipate patient perspectives to improve the healthcare experience (Sox, 2012). A major focus of PCR is patient involvement from conception and design of a study throughout interpretation and dissemination. PCR focuses on questions and outcomes that matter to patients. Currently the PCORI initiative is engaged in funding innovative PCR. Examples of funded PCR studies are described on the PCORI website. In an effort to adhere to their mission of patient centeredness, PCORI also publishes a public blog encompassing a range of topics from new funding announcements to research results (Table 1).  PCORI is one example of the burgeoning new research that is patient-centric and that aims to improve the patient experience from birth through death.

Challenges of PCR: It has yet to be examined whether and how PCR improves upon prior research approaches. In other words, research is needed that measures the effectiveness, cost-efficiency, and ultimately the power of PCR to change patient experiences while still preserving utmost clinical care. That being said, similar to other research methods and frameworks, PCR has its drawbacks. Challenges to conducting PCR include foundational differences between researchers and patients including focusing on outcome metrics that are not prioritized among both groups equally, limited and differing availability and desire to engage in PCR, and language barriers (Perez, 2013). Moreover, unintended consequences of PCR such as unequal power relations between researchers and patients may limit the depth and breadth of PCR. Lastly, the long-term impact of PCR is unknown. Additional research is needed to more fully understand the practical application of PCR and how this type of research approach influences patient care.

Photo courtesy of the CDC

Future Directions: In his TEDx talk at the University of Minnesota, The Future of Patient-Centered Care, Dr. Dave Moen, MD describes his journey from working as an emergency medicine physician to rediscovering the value of patient centered care while caring for victims of domestic violence. Like Dr. Moen, as healthcare professionals and researchers, we are all on a journey to understand the future of patient centered care, and the PCR that will ultimately guide the implementation of this care. In the future, we can undoubtedly learn more by exploring new research methodologies that extend beyond the bounds of evidence-based medicine. In other words, by directly involving patients in PCR, we may be more fully able to improve the patient centered care experience. While the transition from evidence-based medicine to patient centered care represents an evolving change in the way that healthcare providers and patients make decisions, we are still left with unanswered questions about PCR.

References and Additional Recommended Links:

Noble J. Patient-centered Research: Through the Looking Glass in Search of a Paradigm. Journal of General Internal Medicine. 1989;4:555-557.

Perez B, Cummings L, Schrag J, Mead H, Jewers M. Facilitators and Barriers to Providing Patient-Centered Chronic Disease Care to Patient Populations at Risk for Health and Health Care Disparities in Safety Net Settings. America’s Essential Hospitals. 2013.

Romana H. Is Evidence-Based Medicine Patient-Centered and Is Patient-Centered Care Evidence-Based? Health Services Research. 2006;41(1):1-8.

Sox H. The Patient-Centered Outcomes Research Institute Should Focus on High-Impact Problems That Can Be Solved Quickly. Health Affairs. 2012;31(10):2176-2182.

http://www.pcori.org/assets/2014/01/PCORI-Facilitators-Barriers-Providing-Patient-Centered-Chronic-Disease-Care-120613.pdf

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-16-2011/No2-May-2011/Overview-and-Summary-Patient-Centered-Care.html

This work is by Echo Warner is licensed under a Creative Commons Attribution 4.0 International License