1. Evidence for ‘excellence in care’
4/15/2017 9:26 PM
Evidence for ‘excellence in care’
Dr Sandy Muecke - Director, Research
Ms Nada Curac - Project Officer
Ms Darryn Binks - Manager, Clinical Professional Development
excellence in care
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The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION.

3. Aim
To describe the processes and frameworks used to develop an evidence-based model to underpin clinical policy decision-making practices in NSW Ambulance.

4. 4/15/2017 9:26 PM
Current process
‘Protocols’ define clinical practice for NSW Ambulance clinicians:
Informed using ‘ad hoc’ processes
Uncertainty around alternative, more appropriate processes to guide development
Difficulties in accessing and appraising literature (time / skills)
© 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries.
The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION.

5. Current process Review of ‘Medical Director’ role:
Changes to scope of practice
Principles of evidence-based practice (EBP) used in wider health since 1990s

6. Method Two-step process: Reviews of the academic and grey literature:
To inform a model
2. Stakeholder discussions (Consensus Meetings):
To assess organisational acceptability / feasibility of any proposed EBP model

7. Method Literature reviews 1) Prehospital literature Medline and CINAHL
2000 to May 2012
Prehospital studies
Included information on processes or frameworks for protocol or guideline development/review
Additional grey literature search ‘Google’

8. Method Literature reviews 2) Wider health EBP literature
Initial search n = > 58,000 articles
Used ‘snow ball’ approach
Previous work with Professor John Lavis
‘SUPPORT Tools’ series: Lavis, Oxman et al 2009 (Health Research Policy & Systems journal)
Other useful studies identified through secondary reference search

9. Results Prehospital Review Seven studies fulfilled criteria
Three really useful (2 x USA, 1 x Canada)

10. Results What is ‘evidence’? Medical effectiveness research evidence
“generated through a prescribed set of processes and procedures recognized as scientific”
context-free guidance for ideal situation
Colloquial evidence
views and expertise of stakeholders
Social-science research evidence
context-sensitive guidance - geographic or resource constraints, organisational feasibility, patient needs, costs
determines what is actually possible
Lomas J, et al. Conceptualizing and combining evidence for health system guidance. Final report. Ontario, Canada: Canadian Health Services Research Foundation; 2005.
‘Local’ evidence

11. Results
From Oxman et al. SUPPORT tools for evidence-informed health policymaking (STP) 1: What is evidence-informed policymaking? Health Research Policy and Systems 2009;7 Figure 1, page 4

12. Results Organisational issues:
Success dependant on committed leadership and provision of purposive human and structural resources
Common problems include “lack of organizational arrangements”
Success evasive when unfunded, unstructured grassroots efforts
EBP processes not well understood within ambulance services
Guideline construction is a lengthy “painstaking” process

13. Results Process issues
Evidence-informed health policymaking should be systematic and transparent
Consider construction of a database of appraised prehospital research evidence (Dalhousie University, Nova Scotia, Canada)
Research evidence is not the only type of information needed to inform the judgements necessary for policy decision making
Clinical evidence can inform, but never replace, individual clinical expertise
A step-wise set of processes described in published papers (prehospital and wider health literature)

14. Results 2. Stakeholder discussions (Consensus Meetings): Draft report:
What EBP is and isn’t / what constitutes ‘evidence’?
Case for change
Methods
Proposed six-phase model
Required organisational resources
Draft report to stakeholders and Executive Director, Clinical Governance – review and amendments
Second draft version to Clinical Governance Committee - final review and amendments
Final report – CE approval March 2013

15. Results Six-phase model ‘Medical effectiveness research’ evidence
Generate locally relevant knowledge
Seek and synthesise evidence
Decision-making: discuss and agree
Construct or amend protocol
Implement
Evaluate
Results
Six-phase model
‘Medical effectiveness research’ evidence
‘Local’ evidence

16. Summary
Used EBP processes to construct a systematic and transparent clinical policy decision-making model for NSW Ambulance

17. Current implementation status
‘Research Officer: Protocols and Practice’
Newly created ‘knowledge broker’ position
Collaboration with Senior Staff Specialist, Protocol Committee, Director of Research
Literature reviews (in line with protocol updates)
Critical appraisal, ‘levels of evidence’, ‘class of recommendation’
Convene stakeholder meetings (‘policy dialogues’)
Synthesis: ‘research summaries’, ‘policy briefs’
Support NSW Ambulance project managers
Database construction and maintenance

18. Evidence for ‘excellence in care’

19. Next steps Database of appraised prehospital research studies to:
Consider development of guidelines at a national level, with adaptions by state services into locally applicable protocols
Eliminate duplication of effort between states
Standardisation of prehospital care
Relies upon ‘network’ of reviewers with appropriate skills
Consider contributing to Canadian database