Evidence synthesis activities of a hospital evidence‐based practice center and impact on hospital decision making

Jayakumar, Kishore L.; Lavenberg, Julia; Mitchell, Matthew D.; Doshi, Jalpa A.; Leas, Brian F; Goldmann, David R.; Williams, Kristina; Brennan, Patrick J.; Umscheid, Craig A.

doi:10.1002/jhm.2498

Cited by 9 publications

(32 citation statements)

References 43 publications

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“…18,19 In one study, the most common technologies reviewed by HTA programs were drugs (24%), devices (19%), and care processes (12%). 18 Service managers in Australia considered safety and effectiveness the most important criteria when introducing or discontinuing new technologies. However, they acknowledged that budgetary considerations heavily influenced decisions about the uptake and diffusion of new technologies.…”

Section: Adoption Of Medical Technologymentioning

confidence: 99%

“…21 Several other studies described decisions for which organizations requested evidence syntheses, including choices between alternatives when standardizing products across a system, and choosing between vendors or manufacturers of similar products. [18][19][20][21][22][23][24] A health system in Australia sought evidence to inform decisions about disinvesting in technologies and practices. 25 …”

Section: Adoption Of Medical Technologymentioning

confidence: 99%

“…Several other studies reported evidence requested for determining implementation strategies for clinical programs or policies. 18,19,22,28,29 When researchers in British Columbia, Canada, gathered researchers and decisionmakers from various levels in the six provincial health authorities to consider priority setting for future research in health care, 30 they learned that staff were concerned about deciding how to effectively make decisions and set priorities, suggesting a need for evidence about the process of decisionmaking in health systems.…”

Section: Health Services Offeringsmentioning

confidence: 99%

“…A similarly designed study in a large academic health care system suggested the same. 18 Members of Pharmacy and Therapeutics committees (pharmacists and physicians from various health systems and organizations) participating in focus groups 34 were asked about their use of AHRQ EPC Program Comparative Effectiveness Reviews (CERs). Only 26% reported using the reviews in their organizations.…”

Section: Types Of Evidence Synthesis Sought By Health Systemsmentioning

confidence: 99%

“…In general, they preferred summaries that were brief, presented in a "graded" format (key messages, executive summary) or presented verbally. 11,18,22,35 Two systematic reviews 49,50 addressed decisionmakers preferences for various derivative products based on systematic reviews. One found that decisionmakers described summary of findings tables with event rates and absolute differences as preferable.…”

Section: Tools For Promoting Use Of Evidence In Health System Decisionsmentioning

confidence: 99%

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A Framework for Conceptualizing Evidence Needs of Health Systems

Schoelles¹,

Umscheid²,

Lin³

et al. 2017

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PrefaceThe Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based Practice Centers (EPCs), sponsors the development of evidence reports and technology assessments to assist public-and private-sector organizations in their efforts to improve the quality of health care in the United States.The reports and assessments provide organizations with comprehensive, science-based information on common, costly medical conditions and new health care technologies and strategies. The EPCs systematically review the relevant scientific literature on topics assigned to them by AHRQ and conduct additional analyses when appropriate prior to developing their reports and assessments.To improve the scientific rigor of these evidence reports, AHRQ supports empiric research by the EPCs to help understand or improve complex methodologic issues in systematic reviews. These methods research projects are intended to contribute to the research base in and be used to improve the science of systematic reviews. They are not intended to be guidance to the EPC program, although may be considered by EPCs along with other scientific research when determining EPC program methods guidance.AHRQ expects that the EPC evidence reports and technology assessments will inform individual health plans, providers, and purchasers as well as the health care system as a whole by providing important information to help improve health care quality. The reports undergo peer review prior to their release as a final report.If AcknowledgmentsThe authors gratefully acknowledge the input of the late Robert Lewis Kane, M.D., who was a member of our workgroup until his unexpected death on March 6, 2017. Dr. Kane stimulated the conversation of our workgroup with his ideas and challenges, and inspired creation of the initial framework for our efforts (See Appendix B).The authors also acknowledge two health system representatives, Lucy Savitz, Ph.D., and Charles P. Friedman, Ph.D. for their feedback on our initial framework and draft report. A Framework for Conceptualizing Evidence Needs of Health Systems Structured AbstractObjectives. To develop a framework for understanding the evidence needs of health systems to inform the AHRQ EPC Program future efforts.Data sources. Three data sources were used: (a) peer-reviewed literature from a systematic search of English-language publications in MEDLINE from January 2007-April 2017, (b) original data from four programs serving health system requests for evidence syntheses, and (c) input during a face-to-face meeting at AHRQ in June 2017 from health system stakeholders and EPC investigators.Methods. Data were synthesized narratively and thematically. We developed an initial framework to guide discussion and qualitative analysis. We built consensus around themes and refinement of the framework through weekly phone conferences, electronic communications, and a face-to-face meeting of workgroup members and health systems experts. Results.From the literature review, we found that health systems seek evidence to ...

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Section: Adoption Of Medical Technologymentioning

confidence: 99%

Section: Adoption Of Medical Technologymentioning

confidence: 99%

Section: Health Services Offeringsmentioning

confidence: 99%

Section: Types Of Evidence Synthesis Sought By Health Systemsmentioning

confidence: 99%

Section: Tools For Promoting Use Of Evidence In Health System Decisionsmentioning

confidence: 99%

See 3 more Smart Citations

A Framework for Conceptualizing Evidence Needs of Health Systems

Schoelles¹,

Umscheid²,

Lin³

et al. 2017

Self Cite

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The Penn Medicine Center for Evidence-Based Practice: Supporting the Quality, Safety, and Value of Patient Care Through Evidence-Based Practice at the Systems Level (USA)

Umscheid

Mitchell

Leas

et al. 2016

Hospital-Based Health Technology Assessment

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Health Technology Assessment Centers—an Infrastructure for Health Systems to Translate Evidence into Practice

2020

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evidence" (data derived from a system's own clinical, utilization and expenditure estimates); 8 (4) conduct economic analyses as needed; 7 (5) combine results from the HTA process with stakeholder input to forge standardized guidelines, clinical pathways, and clinical decision support tools that directly bridge evidence and stakeholder values and preferences with clinical practice 2 and last; (6) analyze results of implementation and strategize needed enhancements. 7 Although many US health systems seek evidence to guide acquisition of technology and pharmaceuticals or the implementation of new care delivery models, 8 most do not have the infrastructure to obtain or implement evidence in practice. 7 Health system-based HTA centers fill this void.As an example, University of Pennsylvania Health System established the Center for Evidence-based Practice in 2006 to support health system-based HTA and the integration of evidence into practice. 9 Startup cost and infrastructure were minimal; initial support partially funded two physicianadministrators and a masters-level research analyst. Staffing grew as demand for services grew, to four full-time analysts, one administrative assistant, and two physician faculty codirectors who each dedicated 0.50 full-time equivalents to the effort. At Penn, evidence reviews are generated on topics requested by clinical and administrative leaders. Local patterns of care are analyzed and econometric analyses conducted as needed. The end-products are rapid reviews and cost analyses that put clinical evidence into local context, and ensure that best practices inform care and expenditure decisions. Since 2006, in total, 450 new rapid evidence reviews or economic evaluations have been produced and the Center has disseminated or implemented over 250 clinical pathways and 25 computerized clinical decision support interventions, resulting in improved patient outcomes and the delivery of high-value care. 7 For example, as a result of Penn's healthcare systembased HTA process, the appropriate use of venous thromboembolism prophylaxis has increased 30%. 10 The decision to use chlorhexidine as opposed to iodine for preoperative skin antisepsis was estimated to not only decrease surgical site infections but also to incur cost savings of $500,000 per year 11 -less than the expenditure to initially run the Center for Evidence-based Practice.Another example of health system-based HTA is the Kaiser Permanente Interregional New Technologies Committee, JGIM 1296

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Evidence synthesis activities of a hospital evidence‐based practice center and impact on hospital decision making

Cited by 9 publications

References 43 publications

A Framework for Conceptualizing Evidence Needs of Health Systems

A Framework for Conceptualizing Evidence Needs of Health Systems

The Penn Medicine Center for Evidence-Based Practice: Supporting the Quality, Safety, and Value of Patient Care Through Evidence-Based Practice at the Systems Level (USA)

Health Technology Assessment Centers—an Infrastructure for Health Systems to Translate Evidence into Practice

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