Transcript
Carcharadon Group
(The Sharks)
Brad Brimhall, David Boyd, Rebecca Zakoor, Genny Zuniga, Kathleen Spencer, Francis Blais, Brenda Hage, Lilly Wang,Deborah Broadwater, Julie Frantsve-Hawley
Diagnostic Literature Information Portal: Gateway to evidence-based Diagnosis
The Problem
• Limited evidence-based evaluation of diagnostic literature.
• Must have evidence-based information on diagnosis as the first step to utilization evidence-based medicine (EBM).
• Documented high rate of errors of omission and commission in health care.
• Practice variation = cost variation.
Project Objectives
• Share with other users of health care information the accuracy of diagnostic testing (radiology, laboratory, pathology, physical examination findings, etc.)
• Train and educate health care providers to critically evaluate primary literature diagnostics.
• Provide concise, reliable evidence-based information to health care practitioners.
• Appropriate utilize diagnostic testing.
Evidence-Based Publications
Quality of Diagnostic Studies
A review in JAMA published in 1995 evaluated more than 1000 diagnostic papers via established parameters found the following:
50% of papers satisfied none of the parameters.
No paper fulfilled all parameters.
Reid MC, Lachs MS, Feinstein AR. JAMA 1995;274:645-651
Evidence-Based Medicine (EBM)
“...the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”
D.L. Sackett (Oxford University)D.L. Sackett (Oxford University)Sackett et al., 1996. BMJ 312: 7023.Sackett et al., 1996. BMJ 312: 7023.D.L. Sackett (Oxford University)D.L. Sackett (Oxford University)Sackett et al., 1996. BMJ 312: 7023.Sackett et al., 1996. BMJ 312: 7023.
EBM Framework
1. Determining clinical questions
2. Finding evidence
3. Assessing the quality of evidence
4. Summarizing findings & formulating conclusions
5. Using information to implement change
Sources of Evidence
Primary Data(raw data)
Primary Literature(original studies)
Secondary Literature(review articles)
Tertiary Literature(textbooks, etc.)
Systematic Reviews
Practice Guidelines
Cochrane Collaboration
Evaluating the Evidence
Level of Evidence: Diagnosis
Level Criteria1 Independent, masked comparison with reference
standard among an appropriate population of consecutive patients.
2 Independent, masked comparison with reference standard among non-consecutive patients or confined to a narrow population of study patients.
3 Independent, masked comparison with reference standard among non-consecutive patients or confined to a narrow population of study patients.
4 Reference standard not applied independently or masked.
5 Expert opinion with no explicit critical appraisal, based on physiology, bench research, or first principles.
Evidence and Diagnostics. www.jr2.ox.ac.uk/bandolier/booth/diagnos/Diagessy.html
Portal Features
Diagnostic Literature Information Portal
Robust Search Capability
Reliable & Valid
Multilingual Web-based Training
Serving a wide variety of health providers
Projected Needs
• Standardized Terminology (e.g. ICD-9, CPT)
• Database Design
• Education/Informatics (Training)
• Web Designer
• Webmaster (Maintenance)
• Evaluation
Development Timeline
• Jaws I Development of webpage and database, development of self-paced training module for reviewers, exemplar review development, tutorial development, evaluation tool development
• Jaws II Publication of reviews, evaluation of training, beta test portal.
• Jaws III Implementation, Evaluation of user satisfaction, system maintenance
Outcome Measures
• Number of reviews submitted
• Site “bites”
• Level of user satisfaction
• Links to other websites
Examples of EBM Portals
• American College of Physicians www.acpjc.org
• InfoPOEMS
www.infopoems.com
• Cochrane Reviews
www.cochrane.org/index0.htm
• Centre for evidence-based Medicine
www.cebm.net
FIN(i)
Questions
• Questions?
• Comments?
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