Evidence-Based HealthCare (EBHC) and Best Practices

Communication. Collaboration. Learning.

Conflict of Interest

Jerry Stonemetz, MD

Vice Chairman; Anesthesia & Critical Care Medicine

Johns Hopkins University

Founder and Chief Medical Information Officer for ShareSafe; have minority stake ownership

Will be discussing use of ShareSafe Social Media product

Evidence-Based Medicine

Decision

Clinical Expertise

Patient Values

Current Best

Evidence

Systematic approach:

• Lifelong self-directed learning

• Caring for patients triggers need

for important research-based

information about:

• Clinical issues

• Other healthcare issues

Dawes M, et al. Sicily statement on evidence-based practice. BMC Med Educ 5: 1 (2005) doi: 10.1186/1472-6920-5-1

Sackett D. Clinical epidemiology: what, who, and whither. J Clin Epidemiol 55: 1161–1166 (2002) doi: 10.1016/s0895-4356(02)00521

Research 15 Years Practice

Agency for Healthcare Research and Quality

Translating Research Into Practice

Conceptual Model of Evidence-based Decision Making in GPs

Sandra Zwolsman et al. Br J Gen Pract (2012);62:e511-e521. Adapted from:

Clinical problem

EBH steps

Experience, expertise

Education

Evidence

Physician’s preferences

Patient’s preferences

Decision

Sackett DL, Rosenberg WM, Gray JA, et al. Evidence based medicine: what it is and what it isn’t.

BMJ 312(7023):71–72 (1996).

Offringa M, Assendelft WJJ, Scholten RJPM. Introduction to evidence-based medicine.

Clinical treatment based on evidence. 3rd edn. Houten: Bohn Stafleu van Loghum (2010)

EBHC Competencies

Young T et al. What Are the Effects of Teaching Evidence-Based Health Care (EBHC)? Overview of Systematic Reviews. PLoS ONE 9(1): e86706. doi:10.1371/journal.pone.0086706 (2014)

Disseminating Evidence-Based Practices

Strategy 1 Highlight evidence base and relative simplicity of recommended practices.

Strategy 2 Align the campaign with the strategic goals of the adopting organizations.

Strategy 3 Increase recruitment by integrating opinion leaders into the enrollment process and employing a nodal organizational structure.

Strategy 4 Form a coalition of credible campaign sponsors.

Strategy 5 Generate a threshold of participating organizations that maximizes network exchanges.

Strategy 6 Develop practical implementation tools and guides for key stakeholder groups.

Strategy 7 Create networks to foster learning opportunities.

Strategy 8 Incorporate monitoring and evaluation of milestones and goals.

Bradley EH et al. Blueprint of effective strategies in the dissemination of evidence-based practices through a National Quality Campaign strategy.

The Commonwealth Fund 1399, Vol 86 (2010)

Best Practice in Healthcare

Practice not yet backed by rigorous research

May be local…hospital determines a particular practice has resulted in improved outcomes for its patient population

An imprecise and moving target Rapidly changing knowledge

Disagreement over the efficacy of recommended practices

Difficulty adjusting to new clinical, organizational and interpersonal routines

The need to modify practices to be context appropriate

Barriers to Implementation of EBHC and Best Practices

Communication

Collaboration

Learning

Metrics

Social Media in Healthcare

Patient engagement Education; obtaining information; disease networks

Healthcare Communities Fundraising; Customer Support; advertising new services

Physicians Online communities for discussing patient care issues; new research; updated clinical practices

Househ M. Social media in healthcare. Stud Health Technol Inform; 183: 244-8 (2013).

Mayo Clinic

Considered to have greatest use of Social Media

Created Mayo Clinic Center for Social Media

Has support from executive leadership

Currently less than 26% of all hospitals use Social Media

Pennic J. 5 reasons why Mayo Clinic dominates social media in healthcare. 2014. http://hitconsultant.net/2014/02/17/5-reasons-mayo-clinic-dominates-social-media-in-healthcare/

McKinsey Global Institute

Twice as much potential value lies in using social tools

to enhance communications, knowledge sharing, and

collaboration within and across enterprises.

Estimates suggest that by fully implementing social

technologies, companies have an opportunity to raise

the productivity of interaction workers—high-skill

knowledge workers, including managers and

professionals—by 20 to 25 percent.

Chui M et al. The social economy: Unlocking value and productivity through social technologies. McKinsey Global Institute 2012. http://www.mckinsey.com/insights/high_tech_telecoms_internet/the_social_economy

HCA – Medical Director, Anesthesia Services

172 hospitals; 122 surgical centers

> 2000 anesthesiologists/CRNAs

No method of common communication

Quandary – dissemination of ‘Best Practices’

Solution: ShareSafe

Johns Hopkins ACCM: Two Communities

Hospital Enterprise

“ShareSafe has changed the way we communicate. It has increased my productivity by 30 – 40%.”

Paul Read, RN, MSN CNO, Springhill Medical Center

(Mobile, AL)

HIPAA-secure communication

Private Discussion Groups

Creating the vision

Instantaneous Learning

Documentation Compliance: Best Practices

Concurrent Analytics : Engagement : Learning Status : Compliance