Teaching Evidence Assimilation for Collaborative Health Care

1. 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

2. ACKNOWLEDGEMENTS

3. 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)

4. Objectives: Capacity Building • Patient centered care • Responsiveness to changing knowledge • Evidence based improvement

5. TEACHING(EVIDENCE ASSIMILATION) • Evidence Based Practice • Clinical Policies, Recommendations • Knowledge Translation/Implementation

6. TEACHING(EVIDENCE ASSIMILATION) • Evidence Based Practice • Clinical Policies, Recommendations • Knowledge Translation/Implementation • Individual patients • Populations • Systems

7. TEACHING(EVIDENCE ASSIMILATION) • Basic foundational skills • Reviews, guideline appraisal/adaptation • Knowledge creation, implementation • Individual patients • Populations • Systems

8. Level 1 • Narrative, clinical and epidemiological skills • Constructed priorities and preferences • Road Map defining evidence literacy

9. Level 2 • Practice based health technology assessment • Clinical policies and recommendations • Specific health care settings • Guideline appraisal and adaptation • The GRADE system

10. 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

11. 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

12. (Teaching)Evidence Assimilation

13. Evidence from research: Lead protagonist or supporting cast? • Scientifically informed individualized care • Evidence-informed clinical policies • Knowledge-based quality improvement • The narrative dimension

14. (TeachingEvidence Assimilation for) Collaborative Health Care

15. It Takes A Village……… • Clinical nurses • Academic nursing • Clinical specialists • Academic physicians • Managers • Librarians • Researchers • Consumer advocates • Educators • Epidemiologists • Health ministry officials

16. Scientifically Informed Clinical Practice Within Organized Health Care Settings

17. Executive Management Individual patient care Clinical policy development Implementation Specialties Team Practitioners Care delivery Patients

18. “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

19. MODE CONTENT EXCHANGE Process Outcomes (Error reduction Variation decrease) Quality Improvement/TQM Internal Knowledge Clinical Outcomes (Adoption of innovation ‘De-adoption’ of unnecessary care) External Knowledge Knowledge Translation Nonaka: Organizational Kowledge Creation