Evidence Informed Best Practice

Dr. Richard VolpeProfessor and Projects DirectorLife Span Adaptation Projects

University of Toronto

45 Walmer Road, Toronto, Ontario, Canadaemail: richard.volpe@utoronto.ca

April 24, 2007

“the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients” requiring the “integration of best research evidence with clinical expertise and patient values” (Sackett, 2000)

Evidence-Based Practice

Evidence-Based Decision Making(EBDM)

“The systematic application of the best available evidence to the evaluation of options

and to decision-making in clinical, management and policy settings.”

(Prime Minister’s National Forum on Health in 1997)

The Challenge of Evidence-Based Practice to Injury Prevention

Nature of Evidence

Shortage of Evidence

ONF Strategic Funding Initiative

Implement an evidence-based injury prevention practices in Ontario.

Evaluate their effectiveness and potential in reducing the incidence of head and spinal cord injury.

To assist communities and other interested stakeholders to go forward after the implementation evaluations and to secure long-term funding.

Determine policy impact and implications of implementations.

Inform and make recommendations to the provincial government and other stakeholders on the feasibility of this strategic initiative and any implications for future directions.

Objectives of the ONF Best Practice Reviews

Survey the range of neurotrauma prevention strategies and programs.

Identify examples of effective, evidence-based practice.

Describe, analyze and evaluate these in terms of their effectiveness for diverse age groups.

Develop and strengthen networks by mobilizing public support and encouraging the participation of stakeholders.

Provide a casebooks of exemplary, evidence based neurotrauma prevention efforts.

Create a means of distributing the casebooks, resource documents and field contacts.

Best Practice Nomination

• Theoretical relevance (capable of conceptual elaboration)• Inclusion of at least three of the five Es

(Education, Enactment, Engineering, Economics, Evaluation)

• Life span orientation• Exhibition of innovative and effective strategies• Employment of mixed research methods and perspectives

(triangulation)• Availability of sufficient documented evaluation research

information • Strong evidence for the reduction of incidence• Replicability and adaptability • Effort to address communication and dissemination issues

Knowledge Transfer:

Systematic Reviews

•Compendium of Effective, Evidenced Based Practices In the Prevention of Neurotrauma

•Preventing Neurotrauma: A Casebook of Evidenced Based Practices

•Road Safety Review

•Source book of Evidenced-Based Practices in the Prevention of Severe Injuries

•Science and Sustainability in Injury Prevention

•Preventing Severe Sports injuries

New South WalesNew South WalesStay On Your Feet (SOYF)Senior Falls Prevention

SOYF in Ontario

• Implement the SOYF Program in 3 trial communities

• Evaluate its effectiveness in reducing senior falls across the three communities

• Evaluate effectiveness of the program in the province

• Determine the feasibility of implementing the mutifaceted intervention within Ontario

• Determine policy impact and implications to seniors falls

• Inform and make recommendations to the provincial government and other stakeholders on feasibility

Upstate New York

Kingston Better Beginnings

Public Health

North BayNorth Bay General Hospital

North Bay Public HealthCCPIP

Midwives of North Bay

SudburySudbury General Hospital

Sudbury Public HealthMidwives of Sudbury

HamiltonMcMaster University

Public Health Services – Healthy Babies

TorontoUniversity of Toronto

Life Span Adaptation ProjectsInstitute of Child Study, OISE/UT

OshawaLakeridge Health Centre

MississaugaCredit Valley Hospital

OntarioBest Start Resource Centre

ONF Shaken Baby Syndrome Prevention Program

Safe Waitakere Community Injury Prevention Project(WCIPP)

AUCKLAND, NEW ZEALAND

ONF Implementation of a Community-Systems Approach to Injury Prevention- North Bay, Ontario

SUSTAINABILITY & SCALE

The Challenge of Evidence-Based Practice to Injury Prevention

Nature of Evidence

Shortage of Evidence

Evidence and Action

Evidence and Prevention

Identified Knowledge Domainsof

Public Health

General Public Health Epidemiology Biostatistics Vital Statistics & Surveillance Environmental Health Occupational Health Health Services Administration Social & Behavioral Sciences Health Promotion & Education Community Health

Maternal & Child HealthPublic Health Nursing Disaster Control & Emergency Services Communicable Diseases HIV/AIDS Nutrition Chronic Diseases & Conditions Public Health Laboratory Sciences Public Health Informatics Global Health

The Life Space

Socio-cultural

Physical Environment

Interpersonal

Internal States

Language

Values

Norms

Artifacts(man-made

objects)

NaturalObjects Genetic

Processes

BiochemicalProcesses

Primary Relationship

SecondaryRelationship

Cognition

We Know Enough:

Injuries are not the result of accidental events but are predictable.

Risk factors are identifiable and modifiable.

Risk factors can substitute for understanding causes.

Risk factors also point to protective factors.

More than one risk factor usually needed to bring about an adverse outcome.

More than one positive factor usually needed to produce a positive outcome.

Injury Prevention as

Change in Complex Systems

Life span transformations in individuals and groups that emerge

in the process of adaptation.

Evidence Informed Practice

Wisdom

“A wise person is one who uses his or her successful intelligence in order to seek a common good, by balancing intrapersonal, interpersonal, and extrapersonal interests; over the short and long terms; through the infusion of values; in order to adapt to, shape, and select environments.”

(Sternberg, 1990)