HIEBM Flashcards
What is implementation science
the study of methods to promote the integration of findings into healthcare policy and practice - research on how to get research into practice
What are the barriers to implementation?
Organisation, Peer Group, Individual, Limits to human processing
Explain the two cycle process (implementing interventions to change practice)
1) adapt knowledge to local context, asses barriers to use, implement interventions to change practice
2) monitor knowledge, evaluate outcomes, sustain knowledge use
Why is organisation a barrier to implementation of research findings?
The researchers may have to wrong skill mix, they may not have obtained the right equipment or necessary funding
How can your Peer group prevent implementation?
Members may have different standards of care and therefor believe more should be researched or things should be changed before the research is implemented.
How do individuals act as barriers to implementation?
they may not have the knowledge needed
Why should we use a wide range of interventions?
many interventions are effective under some circumstances however none are effective under all. T4 a range of interventions will “cover our bases”.
How did Hippocrates and Galenus help improve evidence based medicine?
Hippocrates - ensured doctors were professionals and good citizens (held accountable)
Galenus - used evidence/scientific discovery to aid healthcare
Who first showed the cause of scurvy?
James Lind - scurvy is dues to a lack of citrus fruits
Medicine systematic reviews can be stored where?
the Cochrane library, this is a collection of systematic reviews for all of medicine, allowing it to be scientifically assessed.
How many types of evidence are there and what are they?
3 types
Research, Clinical Practice, Patient experience.
Why is there a hierarchy of evidence?
in order to provide the best care and treatment all three types of evidence must be combined.
the hierarchy will vary depending on the case and patient.
What is the hierarchy of evidence? (bottom to top)
Bottom - background info/expert opinion
- Case controllled studies/case series
- Cohort studies
- RCTs
- Critically appraised topics & articles
Top - systematic reviews & Meta-analysis
How does the NHS decide to introduce new drugs?
how effective is the intervention vs current drugs, does it extend life && Quality of life
What are QAL years?
Quality adjusted life years - the amount of extra “good” years the drugs/treatment provides
Is evidence interpreted?
Yes, in order to ensure it doesn’t only apply in the lab.
it is frequently updated & summated globally
What is the WHO checklist?
a surgical safety checklist to be competed before surgery. research showed mortality decreased by 47%
Why did the WHO checklist fail?
it wasnt used as there was no formal process of how to use it, so the evidence(checklist) was not replicated the same way as the initial study.
What is the LHS?
Learning Health System
What are the 3 data types and how do they interact?
Routinely collected data, specific research data, Actionable data.
Both routinely collected data and specific research data feed into Actionable data.
What does the LHS allow?
movement of data between data types. data moves from research into clinical practice via DSRs (decision support roles)
What is the Learning Health System?
a system that provides the best evidence allowing the best care to be given for patients via the collection of data and sharing of knowledge.
What is EHR
Electronic health Records - the LHS is integrated into the EHR to allow automatic checks for clinical trials
What is clinical trail data used for?
It is used to complete Report forms & is stored in EHRs and research databases.
What is the TRANSFoRM project?
it allows the LHS to be used in many different environments
What is CDIM used for?
rhe transform project uses CDIM to integrate all data sources so that people from diff. hospitals/softwares can use the sam info.
What % of Deaths in the US are due to Medical errors?
3%
Why do Medical Errors happen?
Because of personal factors or environmental factors (ergonomic and human factors)
How User interfaces account for memory limitations?
the interface provides 4-5 concise options at once as working memory can only recall 9 items max.
Define CDSS
Clinical Decision Support Systems
what are CDSS’
they aid users in making decisions by reducing errors. they are fast and anticipate a user’s need
e.g. predictive text
3 criteria for CDSS usability
Effectiveness - can users perform the task
Efficiency - how well is the task completed
Satisfaction - was the user satisfied using the item
How does User-centered design work?
ADEI
Analysis, Design, Evaluation & Implementation
users and stakeholders are involved throughout development. Ensures the user is at the heart of the product creation
Define Big Data (4 Vs)
Data with a large variety, velocity, volume and Veracity(quality)
what are the 8 principles of NICE
Evidence, Value for money, fairness, Provide explanation, limits of autonomy, consultation not consensus, non-discriminatory & reduce inequalities
What are the five criteria of Prioritization & Rationing?
Clinical need Clinical effectiveness Cost effectiveness Capacity to benefit Patient characteristics
Define clinical need
the idea that “all that is clinically necessary and medically possible should be financed”
Define clinical effectiveness
Only interventions/treatment that achieve their goals should be financed
Define capacity to benefit
Patients who gain the most from treatment should be made the priority - e.g. it will save their life
Define Patient characteristics
when prioritizing treatment we should consider patient age, lifestyle and the severity of their disease.
Define cost effectiveness
the costs of treatment must match their expected benefit, cant pay a lot for nothing
define “quality care”
care that is positive, safe and effective
What are the 5 steps to putting Evidence Based Medicine into practice ?
5 A's Assess Ask Acquire Appraise (risk) Apply
How do we assess in EBM?
ask clinical questions to ensure we have all the
CORRECT clinical information
What method of questioning is used in EBM
PICO method
define the PICO method
A questioning style used in EBM.
Patient - what is wrong with this patient?
Information - what treatment are they on/are you interested in
Comparison - can different effects be expected versus another treatment
Outcome - what outcome are you interested in happening
“In Patients With End stage Renal disease w/ atrial fibrillation, who are given anticoagulation, does it prevent complications / from an embolic event?””
how is evidence acquired in EBM
where can it be acquired?
search literature for research about trials and revies to help answer your PICO questions.
Pubmed, Uptodate, Dynamed, Clinical guidelines
what 3 questions must be asked when appraising information received from studies?
does the study fit my patient ? (is the population group applicable)
are the results valid?
are the results clinically significant?
what % is a high risk?
1% - 1/100
how is EBM applied?
all 3 types of evidence are used in order to successfully apply EBM to patients
what % is a moderate-low risk?
0.1% - 0.01%
1/1000 - 1/10000
what are the 3 types of evidence ?
Patient values + Best Research evidence + Clinical expertise
what are the 3 types of evidence ?
Patient values + Best Research evidence + Clinical expertise
define “stopping practice”
divesting from obsolete treatments when there are better ones available
What is a low value intervention?
the cost of the treatment is not representative of the value(outcome). the ratio is low.
What are the negative effects of a blanket ban?
all types of “low value” treatments would be banned which would cause some patients to be at risk.
What is Real World Data ?
What is the relationship between RWD and Clinical trials?
all healthcare data collected outside of clinical trials, from patient registries, observational studies & Electronic health records.
RWD can be used to create more specific clinical trials in terms of population size.
Where is RWD stored?
Claims Databases
Social Networking
EHRs
Define RWD
RWD = Real world studies & Real world evidence
