1 Public Employers Health Purchasing Committee Comparative Effectiveness And Clinical Guidelines
Jan 20, 2016
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Public Employers Health Purchasing Committee
Comparative EffectivenessAnd
Clinical Guidelines
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System Redesign• Increase Utilization of HTA process and Products• Engage Community Physicians
a. Best of Oregon: Academia, Area Leadersb. Local Input: On the ground
• Capitalize on local resourcesa. CEBP, EPC
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National, Regional and International• Agency for Healthcare Research and Quality (AHRQ)
http://www.ahrq.gov/
• Institute for Clinical Systems Improvement (ICSI)http://www.icsi.org/
• National Institute for Health and Clinical Excellence (NICE)http://www.nice.org.uk/
• Canadian Agency for Drugs and Technology in Health (CADTH)http://www.cadth.ca/index.php/en/home
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Oregon Commissions
• Health Resources Commissiona. Responsible for HTA
• Health Services Commissiona. Prioritized Listb. Evidence Based Guidelines
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Evidence-Based MedicineEvidence-Based Medicine
A Quick IntroductionA Quick IntroductionA Template for Change?A Template for Change?
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Origins
• Ancient Era- Anecdotes and Historical Accounts• Renaissance Era 1700’s-1900: Personal Journals,
textbooks begin• Transition Era 1900-1970: Textbooks and peer-
reviewed Journals• Modern Era: Technology, RCT’s McMaster
University 1990’s
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Current Definition
“The conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients.”
Sackett et al. BMJ 1996;312:71-72 (13 January)
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EBM RequirementsThe Practice of Evidence-Based Medicine means
integrating:• Individual Clinical Expertise• Best Available External Clinical Evidence• Patient ConcernsThe full integration of these three components into
clinical decisions enhances the opportunity for optimal clinical outcomes and quality of life.
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Why is EBM important?
CAR Study: Crowley et al. 2003• 520 Clinical Questions• 53% Management Plan Confirmed• 47% The literature changed the medication,
diagnostic test, or prognostic information given to the patient.
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Evidence Evaluation
Methodology
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The primary function of The primary function of a good study is to show a good study is to show that the result is due to that the result is due to
the interventionthe intervention
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Evidence PyramidEvidence Pyramid
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Best vs. Best Available
What to do? Best Practices!“Best of Oregon”
Speight et al. MC-S April, 2010
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Local Input
• Baker City vs. Portland• Practicality• Eminence based medicine
a. 23?
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Local Resources
OHSUCEBPEPC
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Suggested Definition/Approach
“The conscientious, explicit, and judicious use of the current best evidence and people in making system wide decisions about the care of patients.”
Pass et al. NL2BP 2010; SL 16 (26 April)
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A Modest Proposal
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HSC
• Prioritized List• Clinical Guidelines
a. Lymphedemab. Bariatric surgery
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