1. 1 Public Employers Health Purchasing Committee Comparative Effectiveness And Clinical Guidelines

2. 2 System Redesign Increase Utilization of HTA process and Products Engage Community Physicians a. Best of Oregon: Academia, Area Leaders b. Local Input: On the ground Capitalize on local resources a. CEBP, EPC

3. 3 National, Regional and International Agency for Healthcare Research and Quality (AHRQ) http://www.ahrq.gov/ Institute for Clinical Systems Improvement (ICSI) http://www.icsi.org/ National Institute for Health and Clinical Excellence (NICE) http://www.nice.org.uk/ Canadian Agency for Drugs and Technology in Health (CADTH) http://www.cadth.ca/index.php/en/home

4. 4 Oregon Commissions Health Resources Commission a. Responsible for HTA Health Services Commission a. Prioritized List b. Evidence Based Guidelines

5. 5 Evidence-Based Medicine A Quick Introduction A Template for Change?

6. 6 Origins Ancient Era- Anecdotes and Historical Accounts Renaissance Era 1700’s-1900: Personal Journals, textbooks begin Transition Era 1900-1970: Textbooks and peer- reviewed Journals Modern Era: Technology, RCT’s McMaster University 1990’s

7. 7 Current Definition “The conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients.” Sackett et al. BMJ 1996;312:71-72 (13 January)

8. 8 EBM Requirements The Practice of Evidence-Based Medicine means integrating: Individual Clinical Expertise Best Available External Clinical Evidence Patient Concerns The full integration of these three components into clinical decisions enhances the opportunity for optimal clinical outcomes and quality of life.

9. 9 Why is EBM important? CAR Study: Crowley et al. 2003 520 Clinical Questions 53% Management Plan Confirmed 47% The literature changed the medication, diagnostic test, or prognostic information given to the patient.

10. 10 Evidence Evaluation Methodology

11. 11 The primary function of a good study is to show that the result is due to the intervention

12. 12 Evidence Pyramid

13. 13 Best vs. Best Available What to do? Best Practices! “Best of Oregon” Speight et al. MC-S April, 2010

14. 14 Local Input Baker City vs. Portland Practicality Eminence based medicine a. 23?

15. 15 Local Resources OHSU CEBP EPC

16. 16 Suggested Definition/Approach “The conscientious, explicit, and judicious use of the current best evidence and people in making system wide decisions about the care of patients.” Pass et al. NL2BP 2010; SL 16 (26 April)

17. 17 A Modest Proposal

18. 18 HSC Prioritized List Clinical Guidelines a. Lymphedema b. Bariatric surgery

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