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TEACH: LEVEL II – CLINICAL POLICIES AND GUIDELINES STREAM TEACH Plenary NYAM August 8 th, 2012 Craig A Umscheid, MD, MSCE, FACP Assistant Professor of.

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Presentation on theme: "TEACH: LEVEL II – CLINICAL POLICIES AND GUIDELINES STREAM TEACH Plenary NYAM August 8 th, 2012 Craig A Umscheid, MD, MSCE, FACP Assistant Professor of."— Presentation transcript:

1 TEACH: LEVEL II – CLINICAL POLICIES AND GUIDELINES STREAM TEACH Plenary NYAM August 8 th, 2012 Craig A Umscheid, MD, MSCE, FACP Assistant Professor of Medicine and Epidemiology Director, Center for Evidence-based Practice Medical Director, Clinical Decision Support University of Pennsylvania

2 2 Goal To gain knowledge, attitudes and skills required to develop and adapt clinical policies and guidelines for implementation in specific health care settings.

3 3 Faculty  Karen Schoelles, MD, MS Director, AHRQ EPC, ECRI Institute, Plymouth Meeting, PA  Jonathan Treadwell, PhD Associate Director, AHRQ EPC, ECRI Institute, Plymouth Meeting, PA  Louise Falzon, MSLS Cochrane and Columbia University, NY, NY.  Ian Graham, PhD Vice-President, Knowledge Translation and Public Outreach Portfolio, Canadian Institutes of Health Research.  Richard Rosenfeld, MD, MPH Professor and Chairman, Otolaryngology, SUNY Downstate, Editor-in- Chief, Otolaryngology – Head and Neck Surgery, President, American Society of Pediatric Otolaryngology

4 4 Objectives

5 5 Objectives (continued)

6 6 Daily Schedule

7 7 An Illustrative Case: Surgical Site Infections You’re the Chair of the Department of Surgery Quality Committee at your medical center, and you receive a call from your Chief Medical Officer regarding a report that your state just released about SSI rates at medical centers across the state. It’s not good news. Your medical center had the highest rate of SSIs in the state.

8 8 Using evidence to define the problem  Does it warrant attention? Is it a misperception?  Local evidence Anecdote vs. data Compare over time, across units, across institutions Structure, process, outcome  Peer-reviewed evidence National estimates Compare local practices to national recommendations Potential causes and solutions identified in published studies Mitchell MD, et al. Integrating local data into hospital-based healthcare technology assessment: two case studies. Int J Technol Assess Health Care. 2010;26(3):294-300. Lavis JN, et al. Using research evidence to clarify a problem. Health Research Policy and Systems. 2009, 7(Suppl 1):S4 doi:10.1186/1478-4505-7-S1-S4.

9 9 Building a team to define and address the problem  Key stakeholders  Multidisciplinary  Champions  Executive leadership (credibility, resources, influence)  Conflicts of interest  Consumer Participation In Evaluation (PIE) Matrix Harris C, Turner T and Wilkinson F. Guideline Development Toolkit. (2008) The Centre for Clinical Effectiveness, Southern Health, Melbourne, Australia.

10 10 Framing options to address the problem  Frame or “fit” problem within priorities of leadership to motivate support and solutions Lavis JN. Using research evidence to clarify a problem. Health Research Policy and Systems. 2009, 7(Suppl 1):S4 doi:10.1186/1478-4505-7-S1-S4

11 11 PICO and Analytic Frameworks

12 12 Daily Schedule

13 13 Pyramid: 3 dimensional “3-S” model linking study designs to electronic resources Silva SA, Wyer PC. The Roadmap: a blueprint for evidence literacy within a Scientifically Informed Medical Practice and Learning (SIMPLE) model. The International Journal of Person Centered Medicine. 2012. (In press)

14 14 National Guideline Clearinghouse

15 15 PubMed: Guidelines and Reviews

16 16 Cochrane Library: Reviews and HTAD

17 17 Daily Schedule

18 18 Trustworthy Guidelines

19 19 IOM IOM domains 1. Establishing transparency 2. Management of conflict of interest 3. Guideline development group composition 4. Clinical practice guideline - systematic review intersection 5. Establishing evidence foundations for and rating strength of recommendations 6. Articulation of recommendations 7. External review 8. Updating

20 20 AGREE II Instrument  Tool to assess the quality of clinical practice guidelines.  Composed of 23 items in 6 domains: Scope and purpose (3 items) Stakeholder involvement (3 items) Rigor of development (8 items) Clarity of presentation (3 items) Applicability (4 items) Editorial independence (2 items)  Two Overall Assessments: Rating of the overall quality of the guideline Whether the user recommends the guideline for use in practice AGREE II: Advancing guideline development, reporting and evaluation in health care. Brouwers et al., Journal of Clinical Epidemiology 63 (2010) 1308e1311

21 21 Daily Schedule

22 22 Hospital-based Health Tech Assessment J Gen Intern Med. 2010; 25(12):1352–5

23 23 Daily Schedule

24 24

25 25 Daily Schedule

26 26 CAN-IMPLEMENT©: a six step model

27 Tool 2.3a Skills Assessment Checklist

28 Tool 4.1o Recommendations Matrix (template)

29 29 Daily Schedule

30 30 Daily Schedule

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