1. Translating Evidence into Practice Danny Liew Melbourne EpiCentre Medical Unit 1

2. Application of Evidence in Practice education and training access to, and interpretation of, evidence identifying and overcoming barriers culture change outcomes research: ‘practice-based evidence’

3. Overview (the problem with) evidence-based practice outcomes research –comparative effectiveness research –health technology assessment

4. Evidence-Based Practice

5. Efficacy vs Effectiveness efficacy: intervention ‘works’ in a research (clinical trial) setting effectiveness: intervention ‘works’ in the real-life setting often a large gap

6. circumscribed populations focus: benefit >> harm artificial environment short-term ?competing morbidity and mortality ?costs Clinical Trial vs Real-Life Settings

7. Can it work? (Efficacy) Does it work? (Effectiveness) Is it worth it? (Cost-Effectiveness) Evidence generation Evidence synthesis Decision- making Evidence-Based Practice Luce BR et al. Milbank Q. 2010;88:256-76.

8. Can it work? (Efficacy) Does it work? (Effectiveness) Is it worth it? (Cost-Effectiveness) Evidence generation Evidence synthesis Decision- making Clinical guidelines Clinical trials Clinical practice Health policy Regulatory approval Systematic reviews EBP - Current View Various methods Modified from: Luce BR et al. Milbank Q. 2010;88:256-76.

9. Can it work? (Efficacy) Does it work? (Effectiveness) Is it worth it? (Cost-Effectiveness) Evidence generation Evidence synthesis Decision- making Clinical guidelines Clinical trials Clinical practice Health policy Regulatory approval Systematic reviews Comparative effectiveness research Health technology assessment EBP - Ideal View Epidemiology, Registries Modified from: Luce BR et al. Milbank Q. 2010;88:256-76. Cost data

10. Comparative Effectiveness Research

11. Aspirin for Primary Prevention in the Elderly BMJ. doi:10.1136/bmj.38456.676806.8F (published 20 May 2005)

12. Aspirin for Primary Prevention in the Elderly BMJ. doi:10.1136/bmj.38456.676806.8F (published 20 May 2005)

13. Aspirin for Primary Prevention in the Elderly

14. Health Technology Assessment

15. dominated dominant net health gainnet health loss net positive costs net negative costs (cost saving) x incremental cost-effectiveness ratio = net cost/net health effect Cost-Effectiveness Plane

16. Aspirin in At-Risk Groups Cardiovasc Ther. 2011. doi: 10.1111/j.1755-5922.2011.00291.x.

17. Summary beyond efficacy, EBP should encompass effectiveness and cost-effectiveness ‘practice-based evidence’: 2-way street between research and practice rich source of relevant data available in hospital settings

19. © Copyright The University of Melbourne 2008

20. Aspirin for Primary Prevention Ann Intern Med. 2002;136:161-72.

21. McKeon Review

22. total years lived quality-adjusted life years (QALYs) lived Summary Health Measures current best practice new intervention

23. Statins for Primary Prevention in Korea Clin Ther. 2009;31:2919-30.

24. Heart Lung Circ. 2009;18:388-92.

25. Application of Evidence in Practice

26. Health Services Research

28. Health services evaluation* Can it work? (Efficacy) Does it work? (Effectiveness) Is it worth it? (Cost-Effectiveness) Evidence generation Evidence synthesis Decision- making Clinical guidelines Clinical trials Clinical practice Health policy Regulatory approval Systematic reviews Comparative effectiveness research Health technology assessment* EBP - Ideal View Epidemiology, Registries *Health services research = HTA + HSE + other Modified from: Luce BR et al. Milbank Q. 2010;88:256-76. Cost data