TEAM-beta: Treatment and Evidence Algorithmic Mapping - a platform for an efficient decision support tool for clinicians, researchers and funders Presented by Dalton Wolfe at the Canadian Knowledge Mobilization Forum, June 19-20, 2012, Ottawa, Ontario, Canada

1. TEAM-beta: Treatment and Evidence
Algorithmic Mapping – a platform for an
efficient decision support tool for clinicians,
researchers and funders
Dalton Wolfe1, Jane Hsieh2, Jennifer Hunter2, Amanda Khan1, Saagar Walia1 & the
Spinal Cord Injury Knowledge Mobilization Network
1: Parkwood Hospital, Lawson Health Research Institute
2: Ontario Neurotrauma Foundation
Canadian Knowledge Mobilization Forum 2012 - June 20, 2012

2. Foothills Medical
Centre: SCI
Rehabilitation Clinic
Glenrose Rehabilitation Hospital

3. Outline
Objective: to describe the rationale and early concept
development behind TEAMbeta (clinical decision making
support tool)
• Problem Identification: Too Much Information, Not Enough
Knowledge (Is Practice Evidence-Informed?)
• Solution: TEAMbeta, a map to information that is clinically
relevant  Knowledge  Action
• Initial Features and Methods

4. A Vast Sea of Information: But is it Being Used in
Practice (i.e. Behaviour Change)?
Challenges for Knowledge Users
• Ever increasing volume and
complexity
• Access hindered by multiple
barriers (competing demands,
cost, feasibility)
• Application hampered by inertia
and inability to apply appropriately
• What to do??? (Information 
Knowledge  Action

5. Spinal Cord Injury Rehabilitation Evidence
(SCIRE): Knowledge Product
• Canadian collaboration
between scientists and
clinicians
• www.scireproject.com
• Expert synthesis 
evidence statements

6. SCIRE: Knowledge Product Platform
Standards of Care
1. Standards of Care
(Informing SCI KMN,
etc.)
2. Outcome Measure
Standardization
(Outcome Measure
Toolkit)
3. Clinical Practice
Development (e.g.,
Canadian Physical
Activity / Pressure Ulcer
Guidelines
Knowledge Translation
1.Case Studies
(Modeling Evidence
 Practice)
2.TEAMbeta
3.Outcome
Measurement “How-
to” Videos
4.SCI-U (eLearning
modules directed to
the person with SCI =
self-management)
Research / Care
Priorities
1.Consensus Priority
Setting Activities
(base on Gap
Analysis, strengths,
etc.)

7. SCIRE: Influencing Decision-Making
• Typical approaches to
consensus-seeking
activities do not place
decision making in the
context of practice
• Ultimate goal … To
influence practice so
as to improve
outcomes

8. Our Challenge
• How do we get
information to users in a
way they will use it?
• Goal: to enhance
decision making and
influence practice
(action) by …
– Clinicians
– Researchers
– Funders / Policy makers /
Administrators

9. Our Solution: TEAMbeta
• An algorithm to guide
decision making that is
consistent with the
clinical situation (for
pain management in
persons with SCI)
 Assessment
 Diagnosis
 Treatment
• Each node represents
links to further
information

10. Applying the Solution to the Real World
Identifying implementation targets for the Spinal Cord Injury
Knowledge Mobilization Network (SCI KMN)
• The SCI KMN is 6 Canadian rehab centres applying the principles
of Implementation Science for best practice adoption
Parkwood Hospital - London, ON
Toronto Rehab - Toronto, ON
Glenrose Hospital –
Edmonton, AB
Foothills Hospital –
Calgary, AB
IRDPQ –
Québec City, QC
IRGLM–
Montreal, QC

11. Delphi: Selecting Practices as Targets
for Implementation
• Successive rounds of considering practice options and voting
• Participants voted according to set criteria
DRAFT
Canadian
Practice
Guidelines on
Pressure Ulcers
48 Practices
Best Practices
1……………...23
Best Practices
1……………...12
1. ASSESSMENT: Conduct a
comprehensive, systematic
assessment of risk factors
2. EDUCATION: Provide
structured pressure ulcer
prevention education
Round 1 Round 2 Round 3
• Before: this was done by reviewing long lists of information
about evidence behind practice options
• After TEAMbeta: this information will be provided in a
clinically relevant way

12. Methods: Building the Content,
Defining the Specs
Pain Advisory Team (PAT)
• 8 subject matter experts (variety of clinical perspectives)
• Facilitated through collaboration platform (SharePoint)
Specification and Features Advisory Team (SFAT)
• 4 subject matter experts (2 IT, 2 clinical)
Core Development Team (CDT)
• Data abstraction from CPGs, systematic reviews, meta-analyses, etc.
• Iterative prototyping with IT partner

13. TEAMbeta Features
• The map will parallel
the structure of the
International SCI Pain
(ISCIP) classification
system, which first
identifies pain sub-
types and highlights
associated treatment
options
• Web-based (platform
independent) software
system
• Interactivity enabled by
zoom and pan functions

14. TEAMbeta Features
• Overall shape and
colour of treatment
option will reflect a
class of treatment
• Illustrative icons link to
underlying information
(i.e. active/greyed-out =
info available/not)
• Icon colour-coding will
illustrate status at-a-
glance associated with
the underlying
information
Gabapentin
Tricyclic
…
…

15. Gabapentin
Evidence
Guidelines
How-to
??????
• There is level 1 evidence that Gabapentin
and pregabalin improve neuropathic pain
post SCI.
• There is level 4 evidence that the
anticonvulsant Gabapentin is more effective
when SCI pain is <6 months than >6
months.
 Source: SCIRE; This evidence is based on
these articles
TEAMbeta Features
• By clicking on the
appropriate icon, it will
take you to the
underlying information

16. Gabapentin
Tricyclic
Enabling the Delphi
Process
…
…
• Icons to initiate voting
and view past results
• Enable culling over
successive rounds

17. Lots of ideas – Long-term Development
• Use gaming concepts
(i.e., motivational
rewards, competition,
etc.).
• Community of practice
• Ideas emerging from
PAT / SFAT
Gabapentin
How-to
Guidelines
How-to
Evidenc
Method of Administration: Oral
Recommended Dose: cc mg bid
Contraindications: safm dsein sdfdsoe dfs ssfs.
Source: www.drquacky .com
Congratulations!!
You have completed the quest to
examine and apply 5 “How-To”
sections for pain treatments.
You will receive 5 gold bars …

18. Comments?
Key Concept
• Decision-making  Practice Change
(Action) will be aided by placing
information in an appropriate context.