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Teaching Evidence Assimilation for Collaborative Health Care

Teaching Evidence Assimilation for Collaborative Health Care Capacity Building for Knowledge Based Improvement Peter Wyer MD Chair, Section on Evidence Based Health Care New York Academy of Medicine. TEACHING EVIDENCE ASSIMILATION FOR COLLABORATIVE HEALTHCARE.

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Teaching Evidence Assimilation for Collaborative Health Care

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  1. Teaching Evidence Assimilation for Collaborative Health Care Capacity Building for Knowledge Based Improvement Peter Wyer MD Chair, Section on Evidence Based Health Care New York Academy of Medicine

  2. TEACHING EVIDENCE ASSIMILATION FOR COLLABORATIVE HEALTHCARE ACKNOWLEDGEMENTS TEACH 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 Honi g 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

  3. TEACHING EVIDENCE ASSIMILATION FOR COLLABORATIVE HEALTHCARE 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)

  4. Who Are We?The Section on Evidence Based Health Care at the New York Academy of Medicine

  5. Objectives: Capacity Building • Patient centered care • Responsiveness to change • Knowledge based improvement

  6. TEACHING(EVIDENCE ASSIMILATION) • Evidence Based Practice • Clinical Policies, Recommendations • Knowledge Translation/Implementation

  7. TEACHING(EVIDENCE ASSIMILATION) • Evidence Based Practice • Clinical Policies, Recommendations • Knowledge Translation/Implementation • Individual patients • Populations • Systems

  8. TEACHING(EVIDENCE ASSIMILATION) • Basic, or Foundational, Skills • Reviews, Appraising/adapting guidelines • Knowledge creation, implementation • Individual patients • Populations • Systems

  9. TEACHING(EVIDENCE ASSIMILATION) • Basic, or Foundational, Skills • Reviews, Appraising/adapting guidelines • Knowledge creation, implementation LEVEL 1 LEVEL 2 LEVEL 3

  10. Level 1 • Constructed priorities and preferences • Road Map defining evidence literacy • Narrative, clinical and epidemiological skills

  11. Level 2 • Clinical policies and recommendations • Specific health care settings • Guideline appraisal and adaptation • The GRADE system • Building in adaptability, actionability

  12. Level 3 • Team based problem definition • Gathering ‘internal’ + ‘external’ evidence • Consider health services, implementation research • Monitoring measurable and sustainable impact • Maintaining currency

  13. 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

  14. (Teaching)Evidence Assimilation

  15. Evidence from research: Lead protagonist or supporting cast? • Scientifically informed individualized care • Evidence-informed clinical policies • Knowledge-based quality improvement • The narrative dimension

  16. Scientifically Informed Clinical Practice Within Organized Health Care Settings

  17. Executive Management Individual patient care Clinical policy development Implementation Specialties Team Practitioners Care delivery Patients

  18. The TEACH Experience DRIVERS Clinical/Administrative Quality Improvement Intervention driven Limited team QI operationally in charge Shortcuts Direct planning to implement No baseline data 6 months to launch Modest results • Problem driven • Comprehensive team • QI present, subordinated • Systematic approach • Lit review • Chart review • Baseline outcomes • 18 months to launch • Prize winning results

  19. 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

  20. KT or QI

  21. Hence: EBM + QI ≠ KBI

  22. MODE CONTENT EXCHANGE Process Outcomes (Error reduction Variation decrease) Quality Improvement/TQM Internal Knowledge Clinical Outcomes (Adoption of innovation ‘De-adoption’ of unnecessary care) External Knowledge Knowledge Translation Nonaka: Organizational Kowledge Creation

  23. 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

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