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Globalize the Evidence, Localize the Decision
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Globalize the Evidence, Localize the DecisionA Kaiser Permanente and BMJ Evidence Centre Collaborative Case Study
Klara Brunnhuber Carrie Davino-Ramaya Jill Haynes Carolyn Simpkins Gladys Tom
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Knowledge Generation & Implementation: Challenges in Healthcare
Large knowledge gaps vs. limited resources Time lag between robust new evidence and its
application in clinical care Research applicability and generalizability Easy access to the same high-quality knowledge
for clinicians, patients and consumers Rigorous EBM methods are resource-intensive,
time-consuming and require specialized skill sets
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Advantages of collaborations between EBM centers and guideline developers
Pooling of resources, skills and expertise for: Enhanced EBM quality Streamlined processes On-demand scalability Effective use of local expert knowledge and consensus Development of point-of-care infrastructure/Implementation tools
• Guideline Portal• Links to Electronic Health Record
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Kaiser Permanente and BMJ Evidence Centre Collaboration
Trusted global organizations EBM and quality focus Established processes Quality Assurance & Governance structures In-house skill and expertise with access to experts Resource-rich environment Experience in point-of-care tool development Sophisticated ICT systems
BASICS: Shared values and organizational similarities
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WHAT? Our Project:
STI Screening Tests Clinical Effectiveness and Diagnostic Accuracy
Evidence-Based / Risk-Based Screening in STIsHIV / Chlamydia trachomatis / Gonorrhea / Syphilis / Trichomoniasis
Hepatitis B / Hepatitis C
Primary Care Setting: Ambulatory setting
Population All persons aged >/= 12 at risk for acquiring HIV/STI (or younger if sexually active)
Impact of Comorbid STIs on HIV Transition/Acquisition and Progress
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Mid Atlantic, Ohio
Pacific NW
ColoradoHI
N Cal
S Cal
England
Georgia
An international Endeavour:
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WHO? Our Teams:
BMJEC: Information
Specialist Clinical Editor Data Analysts Copy Editor Senior Editor Business Manager
KP: Clinician Lead Methodologist EBM Analysts Guideline Development
Team (clinical experts) Guideline Quality Group National Guideline
Development Group
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WHEN? May 2010 to January 2011HOW?
1. Developing the key clinical questions: PICO2. Parameter setting 3. Search strategy and search4. Appraisal with study inclusion/exclusion5. Evidence quality assessment (incl Risk of Bias,
AMSTAR, GRADE)6. Evidence summaries7. Quality review 8. Guideline and tool development9. Implementation strategy and roll-out
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Global evidence: 112 searches (7 databases)129 studies from 36 countries (6 continents)
SRs, RCTs, observational and diagnostic studies
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Localized decisions
Representations from 8 Kaiser regions throughout the US
Aligned evidence with national regulatory requirements
4 full-assembly GDT meetings (STI prioritization, outcomes, implementation tools)
Single agreed guideline, localized implementation
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Guideline Summary
Clinician Tools
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Any challenges?
Time zones and cultural differencesMerging methodologiesQualitative vs quantitative emphasisSharing output templatesBalancing efficiency vs flexibilityScope creepManaging GDT members
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Lessons Learned…
Establish an early understanding of Strategic fit – Shared values and quality standards Complementing heterogeneity – Skills, capabilities Potential challenges – Time zones, cultural differences Organizational processes, resources & capabilities ICT resources and capabilities
Develop short- and long-term contracts Defining roles, responsibilities, expectations Governance, quality assurance, conflict resolution Financial considerations within larger context of collaboration
Agree processes, data extraction and output formats Develop communication strategy, e.g., for project status and
feedback Be proactive and allow flexibility COMMUNICATE!
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WHAT NEXT?
Implementation strategy: Publication EHR Guideline Portal
Further collaborations to address other knowledge gaps Promoting the concept of EBM collaborations across organizations and
country boundaries towards faster and better development of guidelines
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KP + BMJEC Collaboration = Formula for Success…..
BMJ EC + Kaiser PermanenteGlobalize the Evidence, Localize the Decision
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Globalize the Evidence, Localize the Decision
ANY QUESTIONS?
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Addendum: PICO Clinical Questions & Problem Formulations
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Clinical Question #1
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Clinical Question #2