PT 610: EBP and Information Management

Using the Biomedical Using the Biomedical Library & It’s Resources:Library & It’s Resources:Becoming Efficient Information Becoming Efficient Information

ManagersManagers

Physical TherapyPhysical Therapy

Fall 2008Fall 2008

Clista ClantonClista Clanton

Information Services LibrarianInformation Services Librarian Education CoordinatorEducation Coordinator Contact Information:Contact Information:

Phone: (251) 414-8210Phone: (251) 414-8210 Fax: (251) 460-7638Fax: (251) 460-7638 Email: Email: [email protected]

Baugh Biomedical Library – Campus SiteBaugh Biomedical Library – Campus Site Primarily supports the academic health Primarily supports the academic health

sciences (College of Medicine, College of sciences (College of Medicine, College of Nursing & Allied Health)Nursing & Allied Health)

University of South Alabama:University of South Alabama:

Biomedical Biomedical LibraryLibrary Sites Sites

University of South Alabama:University of South Alabama:Biomedical Library SitesBiomedical Library Sites

University Medical Center siteUniversity Medical Center site Primarily supports the clinical medicine Primarily supports the clinical medicine

specialties-collection concentrates on patient specialties-collection concentrates on patient care and treatmentcare and treatment

University of South Alabama:University of South Alabama:Biomedical Library SitesBiomedical Library Sites

Children’s and Women’s Hospital siteChildren’s and Women’s Hospital site Primarily supports obstetrics, gynecology, and Primarily supports obstetrics, gynecology, and

pediatrics – which is reflected by the library’s pediatrics – which is reflected by the library’s collection.collection.

What is Evidence Based Practice (EBP)What is Evidence Based Practice (EBP)

A process by which you: (1) ask clinical questions that can be answered through research and other evidence sources; (2) find the best evidence to answer these clinical questions; (3) appraise the validity of the evidence to support answers to clinical questions; (4) integrate the evidence with clinical expertise and patients’ perspectives; and (5) evaluate the effectiveness of carrying out all of the above.

Short definition: “the integration of best research evidence with clinical expertise and patient values.”1

1Sackett, DL. Evidence-based medicine: how to practice and teach EBM. New York: Churchill-Livingston, 2000.

Evidence Based Practice (EBP)Evidence Based Practice (EBP)

Research Evidence

Evidence-based practice moves beyond the anecdotal treatment modes of the past toward the future of objective, data driven, scientifically researched practice regimes.

• Meta-analyses• Systematic Reviews• Clinical Trials• Other types of research studies (both quantitative and qualitative)

The Medical LiteratureThe Medical Literature Primary – original Primary – original

researchresearch Experimental (an Experimental (an

intervention is made or intervention is made or variables are manipulated)variables are manipulated)

Randomized Control TrialsRandomized Control Trials Controlled trialsControlled trials

Observational (no Observational (no intervention or variables intervention or variables are manipulated)are manipulated)

Cohort studiesCohort studies Case-control studiesCase-control studies Case reportsCase reports

Secondary – reviews Secondary – reviews of original researchof original research ReviewsReviews Meta-analysisMeta-analysis Systematic reviewsSystematic reviews Practice guidelinesPractice guidelines Decision analysisDecision analysis Consensus reportsConsensus reports Editorial, commentaryEditorial, commentary

Evidence Pyramid

Case Series/Case Reports

Case Control Studies

Cohort Studies

Randomized Controlled Trial

Systematic Review

Meta-analysis

Animal Research

Real world factors that decide Real world factors that decide clinician’s approach to the literature:clinician’s approach to the literature:

Clinician’s awareness that new information is availableClinician’s awareness that new information is available Perception that current options are unacceptable or Perception that current options are unacceptable or

didn’t workdidn’t work Availability of familiar sourcesAvailability of familiar sources Perceived likelihood that an answer can be foundPerceived likelihood that an answer can be found Fear of liability if the correct approach is not followedFear of liability if the correct approach is not followed Time available to search for the answerTime available to search for the answer

Green ML, Ciampi MA, Ellis PJ. Residents’ medical information needs in clinics: are they being met? Am J Med. 2000; 109:218-23.Ely JW, Osheroff JA, Ebell MH, et al. Analysis of questions asked by family doctors regarding patient care. BMJ. 1999;319:358-61.Ebell MH, Shaughnessy AF. Information mastery: integrating continuing medical education with the information needs of clinicians. J Cont Ed Health Prof. 2003;23:S53-62.

Patient-Centered Patient-Centered Information ManagementInformation Management

Usefulness of any information source =

Relevance X Validity

Work

Slawson DC, Shaughnessy AF. Teaching evidence-based medicine: Should we be teaching information management instead? Acad Med 2005;80:685-689

Information ManagementInformation Management

Focuses on using currently available Focuses on using currently available information tools to remain up to dateinformation tools to remain up to date With new valid informationWith new valid information That is relevant to the care of patientsThat is relevant to the care of patients Is accessible while taking care of patientsIs accessible while taking care of patients