Teaching Evidence Assimilation for Collaborative Health Care

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• Teaching Evidence Assimilation for Collaborative
  Health Care
• Building Capacity for Scientifically Informed
  Healthcare
• Peter Wyer MD
• Co-Chair, Section on Evidence Based Health Care
• New York Academy of Medicine
• Department of Medicine, Columbia University
  Medical Center

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ACKNOWLEDGEMENTS

SEBHC TEACH Team Advisors NYAM Staff
Arlene Smaldone Peter Wyer Co-Chairs Barney Eskin Secretary Michael Cantor Treasurer Saadia Akhtar Barney Eskin Louise Falzon Pat Gallagher Eddy Lang Judy Honig Pattie Mongelia Aleksandr Tichter Dorice Vieira Patricia Quinlin Suzana Alves Silva Arlene Smaldone Alexandr Tichter Craig Umscheid TJ Jirasevijinda Ian Graham Dave Davis Deborah Korenstein John Lavis Sharon Straus Yngve Falck-Ytter Donna Fingerhut Claudette Dykes-Brown Francine Leinhardt Andrew Martin Tawana Wright

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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, Best Practice, EB
  Journals)
• Cochrane Collaboration (Cochrane Library)
• EBSCO (Dynamed, CINAHL)
• Elsevier (Clinical Key)
• McGraw-Hill-JAMA (JAMA Evidence)
• Wolters-Kluwer (Joanna Briggs)

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Objectives
Capacity Building

• Patient centered care
• Responsiveness to changing knowledge
• Evidence based improvement

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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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Executive
Management
Individual patient care
Clinical policy development
Implementation
Specialties
Team
Practitioners
Care delivery
Patients
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TEACH
Care Initiatives
Conferences
Educational Initiatives
Organizational Clients
New York
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The TEACH Experience
DRIVERS

• Clinical/Administrative

• Quality Improvement

• Problem driven
• Comprehensive team
• QI present, subordinated
• Systematic approach
• Lit review
• Chart review
• Baseline outcomes
• 18 months to launch
• Prize winning results

• Intervention driven
• Limited team
• QI operationally in charge
• Shortcuts
• Direct planning to implement
• No baseline data
• 6 months to launch
• Modest results

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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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MODE
CONTENT
EXCHANGE
Process Outcomes (Error reduction Variation
decrease)
Quality Improvement/TQM
Internal Knowledge
Clinical Outcomes (Adoption of innovation De-adop
tion of unnecessary care)
External Knowledge
Knowledge Translation
Nonaka Organizational Kowledge Creation