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Teaching Evidence Assimilation for Collaborative Health Care
Building Capacity for Scientifically Informed Healthcare
Peter Wyer MDCo-Chair, Section on Evidence Based Health Care
New York Academy of MedicineDepartment of Medicine, Columbia University Medical Center
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ACKNOWLEDGEMENTS
SEBHCSEBHC TEACH TeamTEACH Team AdvisorsAdvisors NYAM StaffNYAM Staff
Arlene SmaldonePeter WyerCo-Chairs
Barney EskinSecretary
Michael CantorTreasurer
Saadia AkhtarBarney Eskin Louise FalzonPat GallagherEddy LangJudy HonigPattie MongeliaAleksandr Tichter Dorice Vieira Patricia QuinlinSuzana Alves SilvaArlene SmaldoneAlexandr TichterCraig Umscheid TJ Jirasevijinda
Ian Graham Dave Davis Deborah KorensteinJohn Lavis Sharon Straus Yngve Falck-Ytter
Donna FingerhutClaudette Dykes-Brown Francine LeinhardtAndrew MartinTawana Wright
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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, Best Practice, EB Journals)Cochrane Collaboration (Cochrane Library) EBSCO (Dynamed, CINAHL)
Elsevier (Clinical Key)McGraw-Hill-JAMA (JAMA Evidence)
Wolters-Kluwer (Joanna Briggs)
TEACHING EVIDENCE ASSIMILATION FOR COLLABORATIVE HEALTHCARE
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Objectives:
• Patient centered care
• Responsiveness to changing knowledge
• Evidence 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 foundational skills
• Reviews, guideline appraisal/adaptation
• Knowledge creation, implementation
• Individual patients
• Populations
• Systems
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Level 1
• Narrative, clinical and epidemiological skills
• Constructed priorities and preferences
• Road Map defining evidence literacy
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Level 2
• Practice based health technology assessment
• Clinical policies and recommendations
• Specific health care settings
• Guideline appraisal and adaptation
• The GRADE system
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Level 3
• Team based problem definition• Gathering ‘internal’ + ‘external’ evidence• Analysis of barriers and facilitators• Consider health services, implementation research• Educational interventions, decision support• 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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(Teaching Evidence Assimilation for) Collaborative Health Care
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It Takes A Village………
• Clinical nurses• Academic nursing• Clinical specialists• Academic physicians• Managers• Librarians• Researchers• Consumer advocates• Educators• Epidemiologists• Health ministry officials
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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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“QI” “KT”
• Process OC• Error• Variation• Short turn around• QI team• Industrial standards
• Patient-centered OC• Unnecessary care • Innovation• Intermediate turn around• Broad engagement• Scientific standards
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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