the knowledge egg stanford
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The Knowledge Egg
Øystein Eiring, Geir Kristian Lund, Endre Aas. Innovation group and project management, EviCare, Norway.
1. The problem 2. Making a solution 3. The Egg
The problem
02/15/10 2
Clinicians need knowledge from research, but:
Problem 1: Most research findings are not reliable
2: Most research is not readable at point-of-care
Problem 3: Most reseach is not relevant
02/15/10 3
Evidence-based practice the heroic way
4
Evidence-based practice the heroic way
02/15/10 5
Evidence-based practice the heroic way
6
Are there short-cuts to evidence-based
practice?
7
Building a solution
02/15/10 8
February 15, 2010 9
Shortcut # 1: Pre-appraised single studies
2. Knowledge refinery: – Reading the 130
best journals– Throwing 90
percent +– 7000 clinicians
asked for relevance
23 000 pre-appraised studies: MacPLUS
February 15, 2010 10
Shortcut # 1: Pre-appraised single studies
2. Knowledge refinery: – Reading the 130
best journals– Throwing 90
percent +– 7000 clinicians
asked for relevance
23 000 pre-appraised studies: MacPLUS
Problem:
will miss other studies about the same topic
Shortcut # 2: systematic reviews
Identifies all research about an intervention
Assesses quality of research and throws most
Summarizes the rest
Systematic reviews are more reliable than single studies
Shortcut # 2: systematic reviews
Identifies all research about an intervention
Assesses quality of research and throws most
Summarizes the rest
Systematic reviews are more reliable than single studies
Problem:
covers few topics and most often not conclusive
Shortcut # 3: clinical guidelines
Research only describes what is
Guidelines describe what should be done
Shortcut # 3: clinical guidelines
Research only describes what is
Guidelines describe what should be done
take into account values, resources, politics, patients opinions, expert opinion
Need quality assessment
Problem:
too lenghty to be useful at point of care
Shortcut # 3: clinical guidelines
Research only describes what is
Guidelines describe what should be done
take into account values, resources, politics, patients opinions, expert opinion
Need quality assessment
Shortcut # 4: evidence-based textbooks
16
Shortcut # 4: evidence-based textbooks
17
Problem:
lack local adaptation and ownership
Shortcut # 5: Evidence-based procedures
…care pathways
…care plans
…order sets
18
Building a solution
What if we combined all the short-cuts
in a hierarchy?
(some are better than others)
19
The 6S Model
Quality-assessed single studies
Systematic reviews
Quality-assessed systematic reviews
Single studies that need quality assessment
Guidelines and evidence-based textbooks
Localprotocols,pathwaysin CDSS
Seek answers
as close to the top
as possible
Quality-assessed single studies
Systematic reviews
Quality-assessed systematic reviews
Single studies that need quality assessment
Guidelines and evidence-based textbooks
Localprotocols, pathwaysin CDSS
More reliable,
relevant and
readable
Building a solution: full-text access
02/15/10 22
Norwegian Health Library: core features
Publicly funded
Access for the whole population preferred
Quality assessments of knowledge -AGREE
6S increasingly used as fundamental knowledge model
02/15/10 23
24
Scientific journals
Bibliographic databases
Evidence-bases textbooks
Clinical guidelines
Systematic reviews
What if we merged
the hierarchy
with full-text
local, national and international
knowledge resources?
25
26
The Knowledge Egg
27
The Knowledge Egg
Evidence-based local procedures/pathways
Evidence-based textbooks
Guidelines
Systematic reviews
Quality-assessed studies
Other studies
28
One search into all resources
Instruction
Usage: by the individual clinician at point-of-care
02/15/10 29
Here is the answer-in the top of the egg!
Usage: by those making procedures and pathways
30
Benefits: –everything in your hand
Common interface for local, international and national knowledge
Continuous updating
Underlying machinery not visible
Decision support –not dictatorship
31
Benefits: –everything in your hand
EBM despite low information literacy among health personnel
Shared knowledge between clinicians and patients
32
Norwegian Electronic Health Library
Øystein Eiring, Geir Kristian Lund, Endre Aas. Innovation group and project management, EviCare, Norway.
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