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Introduction to Healthcare and Public Health in the US

Explore evidence-based medicine, practice guidelines, and quality indicators in healthcare, focusing on the patient-centered medical home model and key issues driving US healthcare reform.

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Introduction to Healthcare and Public Health in the US

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  1. Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture a This material (Comp1_Unit9a) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

  2. The Evolution and Reform of Healthcare in the USLearning Objectives • Describe evidence-based medicine, clinical practice guidelines, and quality indicators in medicine (Lecture a, b, c) • Describe the patient-centered medical home model (Lecture d) • Discuss the key issues driving healthcare reform in the US (Lecture e) Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture a

  3. Evidence-Based Practice(Sackett, 1996) • Evidence-Based Practice (EBP) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient.” • EBP integrates “...individual clinical expertise with the best available external clinical evidence from systematic research.” Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture a

  4. Evidence-Based Practice • EBP is a method that helps clinicians make sound decisions about patient care • EBP combines: • Clinician skills • Patient values • Evidence from research Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture a

  5. Evidence-Based Practice:Practice Guidelines • Practice guidelines are evidence-based recommendations • In 1990, Institute of Medicine (IOM) Committee advised the Public Health Service on Clinical Practice Guidelines: • Practice guidelines are “systematically developed statements to assist practitioners and patients in making decisions about appropriate healthcare” Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture a

  6. Evidence-Based Practice:Clinical Decision Support (CDS) • CDS is “...a clinical system, application or process that helps health professionals make clinical decisions” • Clinical Decision Support Systems are “active knowledge systems which use two or more items of patient data to generate case-specific advice” Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture a

  7. Evidence-Based Practice:Clinical Decision Support (CDS) • Some functions of decision support systems: • Administration • Management of complexity • Cost control • Decision support: Supporting clinical reasoning, promoting use of best practices Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture a

  8. Hierarchy Of Evidence • Literature is ranked in a hierarchy • The higher up in the ladder of evidence, the “better” the quality of the study • Why have a hierarchy? • Allows grading of studies • Allows comparison of methodologies • Provides a framework that can be used during the development of systematic review protocols • One method of hierarchical ordering: classify information according to effectiveness, appropriateness and feasibility Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture a

  9. Hierarchy of Study Designs 9.1 Chart: The Hierarchy of Study Designs Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture a

  10. Some Terms Defined • Bias: Inaccuracies that produce a false pattern of differences • Blinding: Attempt to eliminate bias by hiding the intervention • Validity: The extent to which a variable or intervention measures what it is supposed to measure Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture a

  11. Systematic Reviews • Systematic review: Search of the medical literature is conducted systematically using specific methods • Meta-analysis: A systematic review which uses quantitative methods to summarize the results • Systematic reviews can be conducted • Via journal clubs • Via data mining • Example: Cochrane Collaboration Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture a

  12. Systematic Reviews (Continued) 9.2 Chart: Oxford EBM Hierarchy Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture a

  13. PICO • Questions that are asked during Evidence-Based practice and research: • P = Patient • What are the characteristics of the patient/population/problem? • I = Intervention • What is the intervention, prognostic factor or exposure? • C = Comparison • What is the main alternative to compare with the intervention? • O = Outcomes • What is the measurement or improvement? Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture a

  14. The Evolution and Reform of Healthcare in the USSummary – Lecture a • Definitions for EBP • Practice guidelines • Clinical decision support • Hierarchy of evidence • Systematic reviews Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture a

  15. The Evolution and Reform of Healthcare in the US References – Lecture a References Clinical Decision Support. (n.d.). Retrieved December 6, 2011, from HIMSS website: http://www.himss.org/ASP/topics_FocusDynamic.asp?faid=313 Manchikanti, L., Singh, V., Helm II, S., Schultz, D. M., Datta, S., & Hirsch, J. (2009). Evidence-Based Medicine - An Introduction to an Evidence-Based Approach to Interventional Techniques in the Management of Chronic Spinal Pain. Pain Physician, 12(E1-E33), Retrieved from http://www.painphysicianjournal.com/2009/july/2009;12;E1-E33.pdf Sackett, D. L., Rosenberg, W. M., Muir Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996, January 13). Editorial - Evidence-Based medicine: what it is and what it isn't. BMJ, 312(71), Retrieved from http://www.hsl.unc.edu/Services/Tutorials/EBM/whatis.htm Schardt, C., & Mayer, J. (2010, July). The Well-Built Clinical Question. Retrieved December 6, 2011, from University of North Carolina at Chapel Hill - Health Sciences Library, Tutorials website: http://www.hsl.unc.edu/Services/Tutorials/EBM/Question.htm Charts, Tables, Figures • 9.1 Chart: The Hierarchy of Study Designs – adapted from Oxford Center for Evidence-based Medicine - Levels of Evidence . (2009, March). Retrieved December 6, 2011, from Center for Evidence Based Medicine website: http://www.cebm.net/index.aspx?o=1025 • 9.2 Chart: Oxford Center for Evidence-based Medicine - Levels of Evidence . (2009, March). Retrieved December 6, 2011, from Center for Evidence Based Medicine website: http://www.cebm.net/index.aspx?o=1025 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture a

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