Transcript Diapositiva 1

Providing evidence for
healthcare decision
Silvia Pregno
Rome, October 15, 2012
Helping inform patients, clinicians and policymakers
Health professionals, patients,
policymakers and the public all
want to make healthcare decisions
that are informed by the best
available research evidence.
Helping inform patients, clinicians and policymakers
This requires reliable summaries
(systematic reviews) of the
evidence of the advantages and
disadvantages of our options.
Helping inform patients, clinicians and policymakers
It also requires
complex judgements.
Helping inform patients, clinicians and policymakers
Systematic reviews of the
effects of healthcare provide
essential, but not sufficient
information for making well
informed decisions.
Helping inform patients, clinicians and policymakers
Review authors and people who use
reviews draw conclusions about
the quality of the evidence (how
confident we can be in the estimates of
effects), either implicitly or explicitly.
Such judgments guide subsequent
decisions.
Helping inform patients, clinicians and policymakers
For example, clinical actions are likely
to differ depending on whether one
concludes that the evidence that
warfarin reduces the risk of stroke in
patients with atrial fibrillation is
convincing (high quality) or that it is
unconvincing (low quality).
Helping inform patients, clinicians and policymakers
Similarly, policy decisions are likely to
differ depending on whether one
concludes that the evidence that
specialised stroke units reduce the risk
of death and disability (compared with
treating acute stroke patients in
general medical wards) is convincing
or not.
The GRADE Working Group
The GRADE Working Group is a collaboration of
over 60 organisations from around the world that
has developed a systematic and transparent
approach to making judgments about :
•the quality of evidence (how confident we are in
estimates of effect) and
• the strength of recommendations (how confident we are
that the desirable effects of adherence to a
recommendation outweigh the undesirable effects).
The GRADE Working Group and health care decision
To benefit from this work, health care decision
makers need to:
• have access to evidence-based clinical
recommendations or briefs describing policy options,
•be able to understand that information and
•be enabled to make decisions that reflect their own
values or the values of those affected.
Maximizing the Impact of Systematic
Reviews in Health Care Decision Making:
A Systematic Scoping Review of
Knowledge-Translation Resources
DUNCAN CHAMBERS, PAUL M. WILSON,
CARL A. THOMPSON, ANDRIA HANBURY,
KATHERINE FARLEY, and KATE LIGHT
The Milbank Quarterly, Vol. 89, No. 1, 2011 (pp. 131–156)
Conclusions:
Systematic review producers provide a variety
of resources to help policymakers, of which
focused summaries are the most common.
More evaluations of these resources are
required to ensure users’ needs are being met,
to demonstrate their impact, and to justify
their funding.
The DECIDE
DECIDE is an international collaborative
research project linked to the GRADE Working
Group that will develop and evaluate strategies
for communicating and disseminating evidencebased recommendations and policy briefs.
The DECIDE
These strategies will be tailored to the
information needs of patients, clinicians
and policymakers.
The DECIDE
They will include frameworks to help
people to go from evidence to decisions, as
well as strategies for communicating
research findings
The DECIDE
• The DECIDE project started in January 2011 and will
run for five years.
• It has received funding from the European Union 7th
Framework Programme (FP7/2007-2013) under grant
agreement number 258583. More information about the
project can be found on our web pages.
The DECIDE Project
The DECIDE Project
Structure of the project
Phase 1 – Strategy development and user testing
 Task 1: Brainstorming workshops
 Task 2: Stakeholder group feedbacks
 Task 3: Survey of policy makers and managers – their view on current
dissemination strategies
 Task 4: User testing – how DECIDE’s dissemination strategies work with
real users
Phase 2 – Evaluating the strategies
Phase 3 – Testing the strategies with real guidelines
The DECIDE-WP2
Work Package 2
Policymaker and manager
focussed strategies for
communicating evidence-based
recommendations
The DECIDE-WP2
• The WP2 has been leaded from the start by
Alessandro Liberati at the Italian Cochrane
Centre in Modena
• Starting from January 2012, it is leaded by
Marina Davoli and now at the Department of
Epidemilogy, Lazio Regional Health
Service-Italy
The DECIDE-WP2
Target audience
Policy makers and managers and their support
staff with responsibility for making coverage
decisions.
These coverage decisions can take place at
national and/or regional level depending on the
type of interventions.
The DECIDE-WP2
Coverage decision: decisions by third party
payers (public or private health insurers)
about :
•whether and how much to pay for drugs,
tests, devices or services and
•under what conditions.
The DECIDE –WP2
Main objectives
1- To develop and test a “conceptual framework”
that - in the context of the GRADE method –
can assist policy makers and managers in going
from the assessment of quality of evidence to
decision(s)
The DECIDE –WP2
Main objectives
2-To promote understanding of how evidence can
be best communicated to policy makers and
managers that have to make coverage decisions,
and identify what information is relevant to
them
The DECIDE –WP2
Main objectives
3-To develop and evaluate tools and
strategies for communicating evidencebased recommendations to policy makers
and managers
The DECIDE –WP2
Where are we ?
Phase 1 – Strategy development and user testing
We developed the first two tasks trough the comments and
suggestions coming from an Italian Advisory Board and
meetings in different settings, both in Italy and in other countries,
with our stakeholders
 Task 1: Brainstorming workshops
 Task 2: Stakeholder group feedbacks
The DECIDE-WP2
Where are we going?
Phase 1 – Strategy development and user testing
Task 3: Survey of policy makers and managers – their view on
current dissemination strategies
Task 4: User testing – how DECIDE’s dissemination strategies
work with real users
The DECIDE –WP2
Framework to go from evidence to decision
It contains:
• different domains defined by different criteria
• criteria defined by question
• evidence
• judgments about the above mentioned criteria
• comments
A framework example
The DECIDE
The DECIDE
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The Decide-WP2
Trough the comments and suggestions coming
from the Italian Advisory Board ‘s brainstorming
workshops and stakeholder group feedbacks, we
obtained some first results reassumed in a poster
presented at the Cochrane Colloquium in
Auckland
Those results are, at the same time, challenges
The DECIDE –WP2
The DECIDE-WP2 : What our stakeholders need
Seriousness of the problem:
• More data about burden
Benefits and Harms:
•Indirect comparison
•Definition of uncertainty of the effect
•Explanation about GRADE approach
•What is a desirable effect?
•Missing outcome
•Efficacy vs effectiveness
The DECIDE-WP2 : What our stakeholders need
Equity:
•Better definition
•Efficacy and context conditioned
•Inappropriate use of resources substracted to other
effective intervention
Values:
Consider both patientand caregiver values
Costs:
More information needed
Providing evidence for healthcare decision
Thank you
The DECIDE –WP2
The DECIDE
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