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Component 1: Introduction to Health Care and Public Health in the U.S.

Component 1: Introduction to Health Care and Public Health in the U.S. 1.9: Unit 9: The evolution and reform of healthcare in the US 1.9a: Evidence Based Practice. Objectives. Describe evidence-based medicine, clinical practice guidelines, and quality indicators in medicine

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Component 1: Introduction to Health Care and Public Health in the U.S.

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  1. Component 1: Introduction to Health Care and Public Health in the U.S. 1.9: Unit 9: The evolution and reform of healthcare in the US 1.9a: Evidence Based Practice Health IT Workforce Curriculum Version 1.0/Fall 2010

  2. Objectives • Describe evidence-based medicine, clinical practice guidelines, and quality indicators in medicine • Introduction to the patient-centered medical home • Discuss the key aspects of health care reform in the U.S. Health IT Workforce Curriculum Version 1.0/Fall 2010

  3. Evidence Based Practice • Evidence Based practice (EBP) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient.” • EBP integrates “...individual clinical expertise with the best available external clinical evidence from systematic research.” Health IT Workforce Curriculum Version 1.0/Fall 2010

  4. Evidence Based Practice • EBP is a method that helps clinicians make decisions about patient care • EBP combines: • Clinician skills • Patient values • Evidence from research Health IT Workforce Curriculum Version 1.0/Fall 2010

  5. Evidence Based Practice:Practice Guidelines • Practice Guidelines are evidence-based recommendations • In 1990, Institute of Medicine (IOM) Committee advised the Public Health Service on Clinical Practice Guidelines: • Practice guidelines are “systematically developed statements to assist practitioners and patients in making decisions about appropriate health care” Health IT Workforce Curriculum Version 1.0/Fall 2010

  6. Evidence Based Practice:Clinical Decision Support (CDS) • CDS is “...a clinical system, application or process that helps health professionals make clinical decisions” • Clinical Decision Support Systems are “active knowledge systems which use two or more items of patient data to generate case-specific advice” Health IT Workforce Curriculum Version 1.0/Fall 2010

  7. Evidence Based Practice:Clinical Decision Support (CDS) • Some functions of decision support systems: • Administration • Management of complexity • Cost control • Decision support: Supporting clinical reasoning, promoting use of best practices Health IT Workforce Curriculum Version 1.0/Fall 2010

  8. Hierarchy Of Evidence • Literature is ranked in a hierarchy • The higher up in the ladder of evidence, the “better” the quality of the study • Why have a hierarchy? • Allows grading of studies • Allows comparison of methodologies • Provides a framework that can be used during the development of systematic review protocols • One method of hierarchical ordering: classify according to effectiveness, appropriateness and feasibility Health IT Workforce Curriculum Version 1.0/Fall 2010

  9. Hierarchy of Study Designs Health IT Workforce Curriculum Version 1.0/Fall 2010

  10. Some Terms Defined Bias: Inaccuracies that produce a false pattern of differences Blinding: Attempt to eliminate bias by hiding the intervention Validity: The extent to which a variable or intervention measures what it is supposed to measure Health IT Workforce Curriculum Version 1.0/Fall 2010

  11. Systematic Reviews • Systematic review: Search of the medical literature is conducted systematically using specific methods • Meta-analysis: A systematic review which uses quantitative methods to summarize the results • Systematic reviews can be conducted • Via journal clubs • Via data mining • Example: Cochrane Collaboration Health IT Workforce Curriculum Version 1.0/Fall 2010

  12. PICO • Questions that are asked during evidence based practice and research: • P = Patient • What are the characteristics of the patient/population/problem? • I = Intervention • What is the intervention, prognostic factor or exposure? • C = Comparison • What is the main alternative to compare with the intervention? • O = Outcomes • What is the measurement or improvement? Health IT Workforce Curriculum Version 1.0/Fall 2010

  13. Evidence Hierarchy Summarized Health IT Workforce Curriculum Version 1.0/Fall 2010

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