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The First International Conference for Evidence-based Healthcare. First International Conference on Evidence-based healthcare The Inaugural Conference of the International Society of Evidence-based Health Care India International Centre, New Delhi Workshops: 6 October 2012

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slide2

First International Conference on

Evidence-based healthcare

The Inaugural Conference of the

International Society of

Evidence-based Health Care

India International Centre, New Delhi

Workshops: 6 October 2012

(Pre-Conference workshops on topics related to EBHC)

Conference: 7-8 October 2012

www.isehcon2012.com

slide3

Who should attend?

  • Physicians, nurses, pharmacists, chiropractors, naturopaths, involved in the implementation of evidence including frontline healthcare professionals
  • Educators involved in teaching and training in evidence based healthcare
  • Speakers
  • Kameshwar Prasad, Paul Glasziou, Gordon Guyatt, Luz Letelier, Victor Montori
  • www.isehcon2012.com
the second principle of evidence based medicine changes everything
The second principle of evidence-based medicine changes everything

Victor M. Montori, MD, MSc

Professor of Medicine

KER UNIT - Mayo Clinic

montori.victor@mayo.edu

@vmontori

disclosures
Disclosures
  • Relevant Financial Relationships
  • None
  • Off Label Usage
  • None
slide6
Our confidence in estimates of risk and benefit

from the body of evidence

contributes to

our confidence in making decisions.

slide7
Our confidence in estimates of risk and benefit

from the body of evidence

contributes to

our confidence in making decisions.

slide8

Confidence in the estimates of risk and benefit

Bias

Imprecision

Inconsistency

Indirectness

Biased reporting

slide9
Our confidence in estimates of risk and benefit

from the body of evidence

contributes to

our confidence in making decisions.

slide10
body of evidence

Trelle et al. BMJ 2011;342:c7086

slide11
Our confidence in estimates of risk and benefit

from the body of evidence

contributes to

our confidence in making decisions.

slide13

Care < Need

Underuse

Appropriate

care

slide15

Care < Need

Care > Need

Overuse

Underuse

Appropriate

care

slide16

Geographic variation in overuse

Variation in overuse by procedure (n=172)

Preventive services

PSA 16-36%

Urinalysis 37%

Follow-up colonoscopy: 61%

Pap smear: 58%

Shah ND et al. NEJM 2012

Korenstein D, et al. Arch Intern Med 2012: 172: 171-8

slide17

Sources of waste and their projected growth to 2020

Berwick, D. M. et al. JAMA 2012;307:1513-1516

slide18

Care < Need

Care > Need

Overuse

Underuse

Appropriate

care

guidelines
Guidelines

Every patient with diabetes is a ‘coronary heart disease risk equivalent’

Every patient with diabetes should take a statin and achieve LDL < 100 mg/dL

ATP III, 2004

slide24

% who opted for treatment

>90%

~50%

<20%

% who should take statins based on ATP III

>90%

>90%

>90%

slide25
The evidence alone is never sufficient to make a decision.

Context and patient values, preferences and goals should be considered.

slide27

Care < Need

Care > Need

Overuse

Underuse

Appropriate

care

slide28

Care < Want

Care > Want

Overtreatment

Undertreatment

Desirable

care

a survey of 627 us primary care clinicians
A survey of 627 US primary care clinicians

50% of my patients get too much care

50% of primary care docs are too aggressive

60% of specialists are too aggressive

35% practice much more aggressively than what they would like

Sirovich BE et al. Arch Intern Med 2011

slide30

Statin Choice

Weymiller et al. Arch Intern Med 2007

slide35

55

3 2 1

Get a ride

Dietitian

Numbers don’t add up

Take off work

Deadline is now

Endocrinologist

108 kg

take work home

Obese

High cholesterol

perform!

LDL high

Avoid salt, fats, carbs

insurance

Metformin

A1c 8.2%

Diabetes

mortgage

Check sugars

Glipizide

debt

Hypertension

Dizzy

HCTZ

Take pills

Wasted!

Beta-blocker

Daughter back at home

Depression

Can’t sleep

Exercise

2 beautiful girls

Bad back

Neuropathy

Pain

Podiatrist

Check his feet

slide36

Care < Need

Care > Need

Overuse

Underuse

Appropriate

care

slide37

Care < Want

Care > Want

Overtreatment

Undertreatment

Desirable

care

slide38

Care < Can

Care > Can

Overtreatment

Undertreatment

Feasible

care

slide39

WORKLOAD

CAPACITY

slide40

DESIRABLE

Encounter Research

WANT

CAN

NEED

FEASIBLE

APPROPRIATE

slide41

Need

http://www.gradeworkinggroup.org

Want

http://shareddecisions.mayoclinic.org

Can

http://minimallydisruptivemedicine.org

7 th international shared decision making conference
7th International Shared Decision Making Conference

Lima, Perú - June 16-19 2013

www.isdm2013.org

slide43
Our confidence in the research contributes to

our confidence in making decisions.

The evidence alone is never sufficient

to make a decision.