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

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

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

Objectives:

• Patient centered care

• Responsiveness to changing knowledge

• Evidence based improvement

Capacity Building

TEACHING (EVIDENCE ASSIMILATION)

• Evidence Based Practice

• Clinical Policies, Recommendations

• Knowledge Translation/Implementation

TEACHING (EVIDENCE ASSIMILATION)

• Evidence Based Practice

• Clinical Policies, Recommendations

• Knowledge Translation/Implementation

• Individual patients

• Populations

• Systems

TEACHING (EVIDENCE ASSIMILATION)

• Basic foundational skills

• Reviews, guideline appraisal/adaptation

• Knowledge creation, implementation

• Individual patients

• Populations

• Systems

Level 1

• Narrative, clinical and epidemiological skills

• Constructed priorities and preferences

• Road Map defining evidence literacy

Level 2

• Practice based health technology assessment

• Clinical policies and recommendations

• Specific health care settings

• Guideline appraisal and adaptation

• The GRADE system

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

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

(Teaching) Evidence Assimilation

Evidence from research: Lead protagonist or supporting cast?

• Scientifically informed individualized care

• Evidence-informed clinical policies

• Knowledge-based quality improvement

• The narrative dimension

(Teaching Evidence Assimilation for) Collaborative Health Care

It Takes A Village………

• Clinical nurses• Academic nursing• Clinical specialists• Academic physicians• Managers• Librarians• Researchers• Consumer advocates• Educators• Epidemiologists• Health ministry officials

Scientifically Informed Clinical Practice Within Organized Health

Care Settings

Management

Individual patient care

Clinical policydevelopment

Implementation

Executive

Specialties

Care delivery

Practitioners Team

Patients

“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

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