A.5 Evidence-informed practice Flashcards
Interpret health science evidence to inform decisions.
What does the Fourth Australian Atlas of Healthcare Variation examine?
Variation in healthcare use according to where people live, how their care is funded, and their level of socioeconomic disadvantage.
List the six clinical areas covered by the Fourth Australian Atlas of Healthcare Variation.
- Early planned births
- Chronic disease and infection
- Ear, nose and throat surgery in children and young people
- Lumbar spinal surgery
- Gastrointestinal investigations
- Medicines usage in older people
What is considered desirable variation in healthcare?
Variation that reflects differences in people’s healthcare needs or informed choices about treatment options.
What constitutes unwarranted variation in healthcare?
Variation due to patient care not supported by evidence, uncertainty about intervention’s place in therapy, or differences in access to and appropriateness of care.
What do the Atlases suggest about Australian healthcare?
Australian healthcare is suboptimal, featuring high rates of harmful interventions, preventable admissions, low rates of appropriate care in high-burden groups, and unexplained higher rates of interventions.
What percentage of heart failure patients received excellent care according to guidelines in a recent Australian study?
13%
What is the definition of health informatics according to Georgiou?
Health informatics can be described as the very engine room driving evidence-based medicine.
Define evidence-based practice.
Integrating the best available research evidence with clinical expertise and the patient’s unique values and circumstances.
What is the first step in evidence-based clinical practice?
Frame the clinical question.
What does the PICO framework stand for?
- Population
- Intervention
- Comparison
- Outcome
What does the ‘Population’ component of PICO refer to?
The scope of the problem, addressing the condition of interest and characteristics of the sub-population.
What does the ‘Intervention’ component of PICO describe?
What will be done differently with/for the patient or what is different about this patient.
What does the ‘Comparison’ component of PICO involve?
The alternative or contrast to the intervention.
What are the possible types of outcomes in the ‘Outcome’ component of PICO?
- Immediate
- Intermediate
- Longer term
What additional consideration can be added to PICO to form PICOT?
‘T’ for time frame for research.
What defines clinical practice guidelines?
Statements that include recommendations intended to optimize patient care, informed by a systematic review of evidence.
What role do systematic reviews play in evidence-based clinical practice?
They provide formal assessments of the scientific evidence related to a clinical question.
What is The Cochrane Collaboration known for?
Producing and disseminating systematic reviews of healthcare interventions.
What is the NHMRC’s two-step approach to assessing evidence?
- Summarize primary studies and systematic reviews
- Summarize information about the strength of the evidence
What are the three key questions to consider when reviewing evidence according to the NHMRC?
- Is there a real effect?
- Is the size of the effect clinically important?
- Is the evidence relevant to practice?
What is the hierarchy of evidence levels according to the NHMRC?
- I: Systematic review of RCTs
- II: One properly designed RCT
- III-1: Pseudo-randomised controlled trials
- III-2: Comparative studies with concurrent controls
- III-3: Comparative studies with historical control
- IV: Case series
What is the significance of clinical significance in relation to statistical significance?
Clinical significance refers to whether the difference between approaches is significant enough to warrant a change in practice.
What are the two main outcomes of RCTs that are not double-blind with inadequate allocation concealment?
Larger estimates in favour of the new intervention and exaggeration of the estimated treatment effect.
What is the primary aim of applying evidence in healthcare?
To identify individuals or groups for whom the proposed treatment is more likely to do good than harm.
What are the five questions recommended by NHMRC to assess applicability of interventions?
- What are the beneficial and harmful effects of the intervention?
- Are there variations in the relative treatment effect?
- How does the treatment effect vary with baseline risk level?
- What are the predicted absolute risk reductions for individuals?
- Do the benefits outweigh the harms?
What is the PDCA cycle used for in healthcare?
To introduce improvements in healthcare.
What are the four phases of the Plan-Do-Check-Act cycle?
- Planning
- Doing
- Checking
- Acting
What does the planning phase of the PDCA cycle involve?
- Identifying and analysing the problem
- Discussing scenarios
- Identifying data to be collected
- Clarifying roles and actions
In the PDCA cycle, what is the purpose of the ‘Doing’ phase?
Testing a potential solution on a small scale.
What is evaluated in the ‘Checking’ phase of the PDCA cycle?
How effective the test solution was and whether it could be improved.
What does the ‘Acting’ phase of the PDCA cycle entail?
Implementing the improved solution fully.
What is the difference between process evaluation and outcome evaluation?
Process evaluation monitors implementation, while outcome evaluation measures the realization of objectives.
What are immediate outcomes in the context of healthcare evaluation?
First-order changes, including participant behaviors and observable practice results.
What are the steps in the US CDC evaluation model?
- Engaging stakeholders
- Describing the program
- Focusing the evaluation design
- Gathering credible evidence
- Justifying conclusions
- Ensuring use and sharing lessons learned
What are the four groups of standards proposed by the CDC for evaluating quality?
- Utility standards
- Feasibility standards
- Propriety standards
- Accuracy standards
True or False: Evidence-based practice has no criticisms.
False
What common criticisms are associated with evidence-based clinical practice?
- Potential conflict between sources of guidelines
- Applicability of generalized evidence to specific cases
- Expense of generating and maintaining evidence
- Under-representation of negative results
- Impingement on clinicians’ professional autonomy
- Information overload
What are barriers to the systematic implementation of evidence-based practice?
- Relevant information is difficult to access
- Skill and resource deficiencies
- Lack of appropriately skilled clinicians
- Lack of systemic incentives
- Lack of influential leadership
- Long lead times in assimilating evidence
- Relevant information is highly dispersed
What opportunities does health informatics present to overcome barriers in evidence-based practice?
- Online knowledge management resources
- Decision support systems
- Remote care delivery
- Closer alignment of clinical governance
- ICT enabled leadership
- Electronic health records
- Data analytics
- Aggregation and clinical portals
