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 research…and what happens in real life • Take advantage of biomedical knowledge

5. Objectives • Understand the Steps in the American Dietetic Association’s Evidence Analysis Process • Identify topics and features in the ADA’s 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. 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 Evidence-Based Practice Committee 2006-2007 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 Pediatric Weight Management Measuring Energy Expenditure Childhood Overweight Chronic Kidney Disease Critical Illness Disorders Of Lipid Metabolism Diabetes 1&2 Celiac Disease Gestational Diabetes Heart Failure Hypertension Oncology Spinal Cord Injury Unintended Weight Loss Non-nutritive Sweetener Nutrition In Athletic Performance Fiber Hydration Nutrition Counseling HIV/AIDS Bariatric Surgery Nutrition New topic? Vegetarian Nutrition 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 Master’s degree; many have PhD’s • Trained at ADA’s 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/recommendations as needed

37. Summary • ADA’s Evidence Analysis Library can be found at www.adaevidencelibrary.com • For questions contact: eal@adaevidencelibrary.com