WELCOME TO: Teaching Evidence Assimilation

for Collaborative Health Care

ACKNOWLEDGEMENTS

TEACH TEAM LIBRARIANS INTERNATIONAL ADVISORS NYAM TEAM

Saadia Akhtar Louise Falzon Ian Graham Claudette Dykes-Brown

Barney Eskin Pat Gallagher Jeremy Grimshaw Amy Kline

Eddy Lang Pattie Mongelia Holger Schunemann Francine Leinhardt

Barbara Lock John Oliver Sharon Straus Anna Pomykala

Suzana Alves Silva Judy Stribling Tawana Wright

Stewart Wright Rick Ziehler

TEACHING EVIDENCE ASSIMILATION FOR COLLABORATIVE HEALTHCARE

SPONSORSHIP

Funding for this conference is made possible [in part] by Grant No. 1R13HS018607-01 from the Agency for Healthcare Research and Quality (AHRQ). The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

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)

TEACHING EVIDENCE ASSIMILATION FOR COLLABORATIVE HEALTHCARE

TEACH: EVIDENCE ASSIMILATION

• GRADE: Health Care Recommendations

• Knowledge Translation

• Individualized Care

• Policy

• Adaptation/implementation

• Delivery

Dimensional Fragmentation

• “Evidence Based Guidelines”

• “Evidence Based Individual Decision Making”

Eddy D. Health Affairs 2005;24:9

Dimensional Fragmentation

• “Flexner II”

• Inadequate learner engagement in population health

• Inadequate learner engagement in quality improvement

Irby DM. Acad Med 2010;85:220

TEACH Global Objective

To facilitate harmonization of the 3 dimensions of evidence informed health care in such a way as to maximize the value of clinical research to health care policy and practice

(Teaching) Evidence Assimilation

• ‘Evidence-informed’ clinical policies

• ‘Evidence-informed quality improvement

• ‘Evidence-informed‘ individualized care

A Common Skill Matrix Across Dimensions

• Constructivist problem delineation

• Formulating information needs

• Finding the most relevant evidence

• Evaluating evidence quality and importance

• Evaluating relevance, interpreting applicability

• Integration/assimilation

Individualized Care (Track 3)

• Constructed priorities

• The importance of ‘narrative evidence’

• Use actual case material as content

• Use Road Map to define evidence literacy

• Case example: the case of paroxysmal AF

KT = Evidence based QI (Track 2)

• Collective (‘constructed’) problem definition• Systematically gather ‘internal’ + ‘external’

evidence• Draw on health services and implementation

research• Measurable and sustainable impact • Maintain currency• Case example: Allen Hospital HF project

The GRADE System (Track 1)

• Special case that proves the rule

• Lack of standardization in PG development

• GRADE highly structured, challenging

• Building in adaptability, actionability

TEACH Longitudinal Program(Collaborative Health Care)

TEACH

ConferencesCare Initiatives

Educational Initiatives

New York Home Centers

The Wright Model

• Evidence-informed QI linked to education

• Multifaceted care pathways in designated clinical areas

• Systematically draws on clinical evidence

Wright et al . Ann Emerg Med 2008;51:80

Active TEACH Projects• NYC: The Allen Hospital (Heart failure)

• N Brunswick CA: St John’s Regional (Pain management)

• Grand Rapids: Spectrum Health/U Michigan– Y1 Imaging for TIA– Y2 Acute brain ischemia in rural affiliates

• St Lukes Health Care System-Kansas City, MO– Reduce catheter associated UTI

PROGRAM- August 10, 2011

8:00am Morning Plenaries Peter Wyer MD 8:30am Seminars

Track 1 GRADE Faculty Team Track 2+3 Suzana Alves Silva MD PhD Allen Hospital TEACH Project Panel9:45am BREAK10:00am Small Group Session12:00pm LUNCH

1:00 pm Afternoon Plenaries Jean Slutsky PA MSPH Yngve Falck-Ytter MD 2:00 pm Work time/Special interest group meetings 3:00pm Small Group Session 5:00 pm OPENING RECEPTION

TEACHING EVIDENCE ASSIMILATION FOR COLLABORATIVE HEALTH CARE