Transcript OvidSP April 2010 Enhancements Customer

Implementing Evidence
into Practice
International
Clinical Librarian
Conference
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Introductions
Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC
Chief Nurse and Publisher
Wolters Kluwer Health
Lippincott Williams & Wilkins/Ovid Technologies
Mark Barragry
Senior Director of Strategic Markets and Partnerships
Wolters Kluwer Health
Ovid Technologies
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In the beginning…
• The Cochrane Model
– Archie Cochrane,
epidemiologist from Britain
– Care should not be done just
because it’s always been
done that way
– Evidence-based care will:
• ensure quality care
• improve patient
outcomes
• improves cost efficiencies
Record
Analyze
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Question
Experiment
Defining evidence-based practice (EBP)
• Evidence-based practice or evidence-based
decision-making is based on:
– External evidence – systematic reviews, randomized control trials,
best practice, and clinical practice guidelines that support a
change in clinical practice
– Internal evidence – health care institution based quality
improvement projects, outcome management initiatives, and
clinical expertise
– Patient preferences and values – what does the patient really want
Evidence-based care improves quality of life
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Hierarchy of evidence-based information
Translated EvidenceClinical Decision
Support
Systematic Reviews and Practice
Guidelines
Original Research and Review Articles
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(adapted from Haynes, 2007)
Evidence-based healthcare information and practice
Evidencebased
allied
health
Evidencebased
medicine
Evidencebased nursing
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Why healthcare providers use evidence-based practice
• Leads to highest quality care and patient outcomes
• Reduces health care costs
• Reduces geographic variations in the delivery of care
• Increases healthcare provider empowerment and role satisfaction
• Reduces healthcare provider turnover rate
• Increases reimbursement from 3rd party payers
• Reduces complications and payment denials
• Meets the expectation of an informed public
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7 steps of EBP
0: Cultivate a spirit of inquiry
1: Ask the question in the PICOT format
2: Search for and collect the most relevant and best evidence
3: Critically appraise the evidence
4: Integrate the best evidence with the healthcare provider’s
experience/ expertise and patient preference
5: Evaluate outcomes of the practice decision
6: Disseminate the outcomes of the EBP decision
(Melynk,B., Fineout-Overholt,E. Evidence-based practice in nursing & healthcare. 2010, 2nd Edition)
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Key initiatives
• Cochrane Collaboration (http://www.cochrane.org)systematic reviews focused on medicine and overall healthcare
• Joanna Briggs Institute – systematic reviews and best practice
recommendations focused on nursing and overall healthcare
• Campbell Collaboration – systematic reviews focused on social sciences
• Guidelines International Network (G-I-N) –
International Guideline Library – 94 organizations
• World Health Organization (WHO) – focused on
public health guidelines
• Germany - German Agency for Quality Medicine
• United Kingdom - National Institute for Health
and Clinical Evidence (NICE) – guidelines focused
on interventional procedures, clinical practice and technology appraisals
• Netherlands - Dutch Institute for Healthcare Improvement (CBO)
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Barriers to implementing EBP in health care institutions
• Lack of EBP skills or knowledge
• Misperceptions or negative attitudes
about research and EBP
• Lack of belief that EBP improves
outcomes
• Too much information in journals –
information overload
• Lack of time and resources to search
for and appraise evidence
• Overwhelming patient loads
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Barriers to implementing EBP in health care institutions
• Organization constraints and lack of
administrative support
• Lack of EBP mentors
• Demands from patients for a certain type
of treatment
• Peer pressure to continue to practice
steeped in tradition
• Resistance to change
• Lack of consequences for not
implementing EBP
• Lack of autonomy over practices and
incentives
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How can institutions support EBP?
• Leaders need to support and encourage
a culture of EBP
• Medical librarians need to teach researchers
and healthcare providers how to search
• Healthcare providers and researchers need
the time to critically appraise studies and
implement findings
• Researchers need to be taught how to write
clear reports that can be translated into
practice
• EBP mentors need to be readily
available and accessible
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How can institutions support EBP?
• Provide proper tools and resources – access to evidence-based
journals and databases
• Provide an adequate number of computers throughout the
institution and make sure they have intranet and internet
capability
• Clinical systems need to incorporate EBP information
• Clinical practice policies and procedures need to be based on
evidence
• Initiate journal clubs
• Support EBP rounds
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Ovid products that support EBP
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MEDLINE
Evidence-Based Medicine Reviews (EBMR) – Cochrane Reviews
Transplant Library
British Medical Journal
Embase
PsycINFO
Joanna Briggs Institute - PACESetterS
OvidMD
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OvidMD
“Putting Research into Practice”
The first clinical tool from Ovid for physicians and other clinicians to
find quick answers to clinical questions backed by comprehensive,
evidence-based research from trusted sources.
A clinical lens based on evidence-based content:
– Evidence-Based Guidelines
A synthesis of best available evidence written by physicians
for physicians that recommends a course of action
– UpToDate Professional Topics
Literature-driven updating system; more than 440
journals are monitored by editors and authors.
– Current Opinion full-text journals
Contain peer-reviewed articles on research,
techniques and diagnostic methods
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In summary…
• Healthcare practice based on evidence:
– Improves healthcare practice
– Improves patient outcomes
– Lowers healthcare costs
• Librarians are in a key role to facilitate evidence-based practice
by:
– Leveraging their expertise to teach and assist healthcare providers with search
and obtaining the best search results
– Assisting in appraising the evidence for validity, reliability, and applicability
– Leading educational opportunities to educate healthcare providers on the
importance of evidence-based practice
– Facilitating a journal club to discuss the latest clinical practice guidelines
around specific conditions and diseases
– Being the “Evidence Mentor” for the institution
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References
• Eddy, D. Evidence-based medicine: A unified approach; Health Affairs,
24, no.1 (2005)
• Guyatt, G. Evidence-based medicine has come a long way; BMJ, 2004,
Oct. 30th.
• Hemingway, P. What is a systematic review? Hayward Group Ltd; April
2008.
• Liang, L. The gap between evidence and practice; Health Affairs, 26,
no.2 (2007)
• Melnyk, B. Fineout-Overholt, E. Evidence-based practice in nursing &
healthcare. LWW, Philadelphia, June 2010; 2nd edition
• McClellan, M. McGinnis, M., Nabel, E., et.al. Evidence-based medicine
and the changing nature of healthcare: Meeting summary; IOM
Roundtable on evidence-based medicine; National Academies Press;
2008.
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Questions?
Thank You!