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Teaching Evidence Assimilation for Collaborative Health Care
Capacity Building for Knowledge Based Improvement
Peter Wyer MDChair, Section on Evidence Based Health Care
New York Academy of Medicine
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ACKNOWLEDGEMENTSTEACH TEAM LIBRARIANS INTERNATIONAL ADVISORS NYAM TEAM
Saadia Akhtar Louise Falzon Ian Graham Eileen Budd
Barney Eskin Pat Gallagher Dave Davis Donna Fingerhut
Eddy Lang Pattie Mongelia John Lavis Francine Leinhardt
Judy Honig Dorice Vieira Sharon Straus Sharon Ching
Aleksandr Tichter Jamie Graham Yngve Falck-Ytter Tawana Wright
Suzana Alves Silva Yingting Zhang Claudette Dykes-Brown
Arlene Smaldone
Craig Umscheid
TJ Jirasevijinda
Stewart Wright
TEACHING EVIDENCE ASSIMILATION FOR COLLABORATIVE HEALTHCARE
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DISCLOSURES
No Faculty Disclosures Declared
Generous Donation of Electronic Resources: Annals of Internal Medicine (ACP Journal Club)
BMJ Group (Clinical Evidence, Evidence Based Nursing)EBSCO (Dynamed, CINAHL)
McGraw-Hill-JAMA (JAMA Evidence) Wolters Kluwer (OVID, UpToDate)
TEACHING EVIDENCE ASSIMILATION FOR COLLABORATIVE HEALTHCARE
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Who Are We?The Section on Evidence Based Health Care
at the New York Academy of Medicine
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Objectives:
• Patient centered care
• Responsiveness to change
• Knowledge based improvement
Capacity Building
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TEACHING (EVIDENCE ASSIMILATION)
• Evidence Based Practice
• Clinical Policies, Recommendations
• Knowledge Translation/Implementation
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TEACHING (EVIDENCE ASSIMILATION)
• Evidence Based Practice
• Clinical Policies, Recommendations
• Knowledge Translation/Implementation
• Individual patients
• Populations
• Systems
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TEACHING (EVIDENCE ASSIMILATION)
• Basic, or Foundational, Skills
• Reviews, Appraising/adapting guidelines
• Knowledge creation, implementation
• Individual patients
• Populations
• Systems
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TEACHING (EVIDENCE ASSIMILATION)
• Basic, or Foundational, Skills
• Reviews, Appraising/adapting guidelines
• Knowledge creation, implementation
LEVEL 1
LEVEL 2
LEVEL 3
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Level 1
• Constructed priorities and preferences• Road Map defining evidence literacy• Narrative, clinical and epidemiological skills
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Level 2
• Clinical policies and recommendations• Specific health care settings• Guideline appraisal and adaptation• The GRADE system• Building in adaptability, actionability
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Level 3
• Team based problem definition• Gathering ‘internal’ + ‘external’ evidence• Consider health services, implementation research• Monitoring measurable and sustainable impact • Maintaining currency
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A Common Skill Matrix Across Dimensions
• Problem delineation• Formulating information needs• Finding the most relevant evidence• Appraising evidence quality and importance• Evaluating relevance, interpreting applicability• Assimilation
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(Teaching) Evidence Assimilation
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Evidence from research: Lead protagonist or supporting cast?
• Scientifically informed individualized care• Evidence-informed clinical policies • Knowledge-based quality improvement• The narrative dimension
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Scientifically Informed Clinical Practice Within Organized Health
Care Settings
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Management
Individual patient care
Clinical policydevelopment
Implementation
Executive
Specialties
Care delivery
Practitioners Team
Patients
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The TEACH Experience
Clinical/Administrative• Problem driven• Comprehensive team• QI present, subordinated• Systematic approach
– Lit review– Chart review– Baseline outcomes
• 18 months to launch• Prize winning results
Quality Improvement• Intervention driven• Limited team• QI operationally in charge• Shortcuts
– Direct planning to implement– No baseline data
• 6 months to launch• Modest results
DRIVERS
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Attributes “QI” vs “KT”• Process OC• Error• Variation• Short turn around• QI team• Industrial standards
• Patient-centered OC• Unnecessary care • Innovation• Intermediate turn around• Organizational engagement• Scientific standards
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KT or QI
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Hence: EBM + QI ≠ KBI
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Quality Improvement/TQM
Knowledge Translation
Process Outcomes(Error reductionVariation decrease)
Clinical Outcomes(Adoption of innovation‘De-adoption’ of unnecessary care)
Internal Knowledge
External Knowledge
MODE CONTENT EXCHANGE
Nonaka: Organizational Kowledge Creation
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Comparative Effectiveness and Practice Based Research: The Frontiers of “EBP”
• The importance of local, or ‘internal’ evidence • The importance of practice experience• PBR-blurring the boundary between ‘research’
and ‘practice’• Classical clinical research remains valuable,
frequently crucial, but nontheless indirect