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Public Employers Health Purchasing Committee

Public Employers Health Purchasing Committee. Comparative Effectiveness And Clinical Guidelines. System Redesign. Increase Utilization of HTA process and Products Engage Community Physicians a. Best of Oregon: Academia, Area Leaders b. Local Input: On the ground

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Public Employers Health Purchasing Committee

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  1. Public Employers Health Purchasing Committee Comparative Effectiveness And Clinical Guidelines

  2. System Redesign • Increase Utilization of HTA process and Products • Engage Community Physicians a. Best of Oregon: Academia, Area Leaders b. Local Input: On the ground • Capitalize on local resources a. CEBP, EPC

  3. National, Regional and International • Agency for Healthcare Research and Quality (AHRQ) http://www.ahrq.gov/ • Institute for Clinical Systems Improvement (ICSI) http://www.icsi.org/ • National Institute for Health and Clinical Excellence (NICE) http://www.nice.org.uk/ • Canadian Agency for Drugs and Technology in Health (CADTH) http://www.cadth.ca/index.php/en/home

  4. Oregon Commissions • Health Resources Commission a. Responsible for HTA • Health Services Commission a. Prioritized List b. Evidence Based Guidelines

  5. Evidence-Based Medicine A Quick Introduction A Template for Change?

  6. Origins • Ancient Era- Anecdotes and Historical Accounts • Renaissance Era 1700’s-1900: Personal Journals, textbooks begin • Transition Era 1900-1970: Textbooks and peer-reviewed Journals • Modern Era: Technology, RCT’s McMaster University 1990’s

  7. Current Definition “The conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients.” Sackett et al. BMJ 1996;312:71-72 (13 January)

  8. EBM Requirements The Practice of Evidence-Based Medicine means integrating: • Individual Clinical Expertise • Best Available External Clinical Evidence • Patient Concerns The full integration of these three components into clinical decisions enhances the opportunity for optimal clinical outcomes and quality of life.

  9. Why is EBM important? CAR Study: Crowley et al. 2003 • 520 Clinical Questions • 53% Management Plan Confirmed • 47% The literature changed the medication, diagnostic test, or prognostic information given to the patient.

  10. Evidence Evaluation Methodology

  11. The primary function of a good study is to show that the result is due to the intervention

  12. Evidence Pyramid

  13. Best vs. Best Available What to do? Best Practices! “Best of Oregon” Speight et al. MC-S April, 2010

  14. Local Input • Baker City vs. Portland • Practicality • Eminence based medicine a. 23?

  15. Local Resources OHSU CEBP EPC

  16. Suggested Definition/Approach “The conscientious, explicit, and judicious use of the current best evidence and people in making system wide decisions about the care of patients.” Pass et al. NL2BP 2010; SL 16 (26 April)

  17. A Modest Proposal

  18. HSC • Prioritized List • Clinical Guidelines a. Lymphedema b. Bariatric surgery

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