Evidence Analysis Process

1
Evidence Analysis Process

• Deborah S. Cummins, PhD
• Nov. 8, 2006

2
EAL Home Page
www.adaevidencelibrary.com
Online Resource with the best available
research on important dietetics topics in
a practitioner-friendly format
3

• Evidence-Based Dietetics Practice
• is the use of systematically reviewed
  scientific evidence in making food and nutrition
  practice decisions
• by integrating best available evidence with
  professional expertise and client values to
  improve outcomes.

Definition developed by ADA Evidence-based
Practice Committee with input from Research
Committee, Quality Management Committee, and
Scope of Dietetics Practice Task Force. Approved
by ADA House of Delegates Leadership Team
4
Why Evidence-based?

• Improve quality of healthcare
• Decrease wide variations in practice
• Reduce the gap between what is known from
  researchand what happens in real life
• Take advantage of biomedical knowledge

5
Objectives

• Understand the Steps in the American Dietetic
  Associations Evidence Analysis Process
• Identify topics and features in the ADAs
  Evidence Analysis Library

6
Resources

• Check Resources on EAL for additional PowerPoint
  presentations.

7

• Steps in the ADA Evidence Analysis
• Process

8
Steps in EA Process

• Select topic Appoint expert working group
• Define questions and Determine inclusion/exclusion
  criteria
• Conduct literature review for each question
• Analyze articles/ Critical appraisal
• Complete overview table and evidence summary
• Develop conclusion statement and reach consensus
  on grade
• Publish to online EAL
• If appropriate, go to next phase write position
  paper, develop guideline toolkit
• Review and Revise to keep information current

9
Steps in the EA Process

• 1. Select Topic Appoint Expert Working Group
• Responsibility of Evidence-based Practice
  Committee

10
Structure of EBP Committee

• Joint HOD and BOD appointed committee
• Actively practicing in acute care, long-term
  care, ambulatory care, and public health
• Trained as evidence analysts
• Representatives from QM, Research, NCP/SL, DPBRN
  Committees and BOD

11
Evidence-Based Practice Committee 2006-2007

• Marion Franz, MS, RD, CDE (Chair)
• Kathleen Niedert, MBA, RD, LD, FADA (Vice Chair)
• Elvira Johnson, MS, RD, CDE, LDN
• Margie Tate, MS, RD
• David Frankenfield, MS, RD

• Nancy Lewis, PhD, RD, FADA
• Kim Robien, PhD, RD, FADA, CNSD
• Rita Johnson, PhD, RD, LDN, FADA
• Trisha Furman, MS, RD, LD, FADA

EBP Committee reports jointly to House of
Delegates and Board of Directors
12
Roles and Responsibilities of EBP Committee

• Oversee
• Evidence analysis process and the Evidence
  Analysis Library
• Development of Evidence-Based Guidelines and
  Toolkits
• Promote the implementation of evidence-based
  dietetic practice
• Specific functions
• Appoint workgroup members
• Prioritize evidence analysis projects
• Determine format and content of products
• Evaluate EA process

13
HOD
BOD
Content published on EAL
Project is ongoing
Workgroup appointed
Evidence-Based Practice Committee
Adult Weight Management
Critical Illness
Chronic Kidney Disease
Pediatric Weight Management
Measuring Energy Expenditure
Childhood Overweight
Disorders Of Lipid Metabolism
Hypertension
Heart Failure
Diabetes 12
Gestational Diabetes
Celiac Disease
Oncology
Spinal Cord Injury
Unintended Weight Loss
Non-nutritive Sweetener
Nutrition In Athletic Performance
Fiber
Nutrition Counseling
Bariatric Surgery Nutrition
HIV/AIDS
Hydration
Vegetarian Nutrition
New topic?
EBP Committee appoints an expert workgroup for
each project.
14
Expert Work Group(6-8 persons for each project)

• Experts in the field
• Appointed by EBP Committee
• Key functions
• develop questions
• review materials (articles, worksheets,
  summaries)
• Formulate conclusion statements (answer to
  question)
• Assign Grade to strength of the evidence
• Develop Guidelines, if appropriate

15
Steps in the EA Process

• 2. Define Questions and
• Determine Inclusion/ Exclusion Criteria
• Responsibility of Expert Work Group

16
Example Question for evidence analysis
formulated by AWM workgroup
How effective is the consumption of low glycemic
index foods for reducing energy intake and
promoting weight loss?
17
Search Plan Resultsfor each question
Reports Inclusion Exclusion Criteria
Date of Search Inclusion Criteria -Age -Setting
(outpatient) -Sample Size -Acceptable dropout
rate -Year Range -English Language Databases
Searched Search Terms List of Articles
18
Steps in the EA Process

• 3. Literature Review
• Creation of sort list Responsibility of Lead
  Analyst with ADA Librarian
• Approval of sort list
• Responsibility of Expert Work Group

19
Evidence Analysts

• Experts in critically analyzing articles
• Must have at least Masters degree many have
  PhDs
• Trained at ADAs EA workshop
• Mentored by ADA Staff and Lead Analysts
• Read and analyze articles
• Complete worksheets
• Complete quality checklists
• Complete overview tables
• Complete evidence summaries

20
Included articles andExcluded articles (with
reason)
List Reason for exclusion For each article
not Included in the Analysis e.g. Sample size
Too small
21
Steps in the EA Process

• 4. Critically appraise each article
• Completion of worksheet and quality criteria
  checklist
• Responsibility of analyst
• Reviewed by lead analyst
• Approved by workgroup

22
Example Worksheet

• Citation / PubMed ID
• Date
• Study Design
• Class
• Rating (/0/-)
• Research Purpose
• Inclusion Criteria
• Exclusion Criteria
• Description of Study Protocol
• Data Collection Summary
• Description of Actual Data Sample
• Summary of Results
• Author Conclusion
• Reviewer Comments

23
Example Quality Criteria Checklist
Questions related to relevance and
validity Determines if article is rated
as Positive Quality Negative Quality Neutral
Quality
24
Steps in the EA Process

• 5. Summarize the articles into an overview table
  and a Narrative evidence summary
• Responsibility of analyst and lead analyst
• Approved by workgroup

25
Overview Table
Low Glycemic Diets
Lists Citation, Study Design, Quality Rating,
Sample Size, Interventions and Outcomes in table
format enables user to compare studies side by
side
26
Narrative Evidence Summary
Example Summary of evidence for Low Glycemic
Diets question
27
Evidence Summary - bibliography
Citations linked to worksheets at the bottom of
the Evidence Summary
28
Steps in the EA Process

• 6. Develop Conclusion Statement - the answer to
  the question and Assign Grade
• Responsibility of Expert Work Group

29
Example Conclusion Statement
Eight randomized controlled trials report no
significant differences in energy intake or body
weight after the consumption of a low-glycemic
index diet. Grade I
Grade
30
Explanation of Grades
of Grade I questions on EAL
31
Steps in the EA Process

• 7. PUBLISH to ONLINE LIBRARY (EAL)
• Copyediting
• Publish
• Question, Conclusion, Grade, Evidence Summary,
  Overview Table, Worksheets and Quality checklists
  for each article, and Search Plan Results all
  published together.
• Available to all ADA members and EAL subscribers.
• Responsibility of ADA Staff

32
EAL Content Growthcomparison of Oct 15 2004
Oct 15 2006
33
EAL Usage (Number of pages viewed)
EAL Launched Sept 2004
Overall Total Page Views 9/2004 11/7/2006 1
Million 1,351,815
34
EAL Usage Worldwide

• Users from 114 different countries

35
Steps in the EA Process

• After publication of questions to online library,
  there are 3 possible options.
• Project is concluded or -
• Evidence analysis is incorporated into an ADA
  Position Paper or -
• Develop Guideline and Toolkit
• (specific steps for guideline development can be
  found in a companion presentation)

36
Steps in the EA Process

• Annual Review of Evidence Analysis Guideline
  Projects
• Review
• re-run searches for each question
• determine if revision is needed
• document date of review
• Revise
• revise using EA process
• Update rating of conclusion statements/recommendat
  ions as needed

37
Summary

• ADAs Evidence Analysis Library can be found at
• www.adaevidencelibrary.com
• For questions contact
• eal_at_adaevidencelibrary.com