PROGRAM- August 11, 2010 8:00am Morning Plenaries Peter Wyer MD

Suzana Alves Silva MD MSc 9:00am Seminar I 9:45am BREAK10:00am Small Group Session11:30am LUNCH

12:30 pm Afternoon Plenaries Jo Ivey Boufford MD Sharon Straus MD MSc Rita Charon MD PhD 2:00 pm Seminar II 3:00pm BREAK 3:15 pm Small Group Session 5:00 pm OPENING RECEPTION

TEACHING EVIDENCE ASSIMILATION FOR COLLABORATIVE HEALTH CARE

ACKNOWLEDGEMENTS

SEBHC TEAM INTERNATIONAL PLANNERS* NYAM TEAM

David Adinaro Elie Akl Amy Kline Saadia Akhtar * Nancy Santesso Rick Ziehler* Abe Bornstein Holger Schunemann Tawana Wright Barney Eskin * Sharon Straus Louise Falzon Pat Gallagher TJ Jirasevijinda Eddy Lang* Barbara Lock* Stewart Wright* Pattie Mongelia Suzana Alves Silva* Judy Stribling* Stewart Wright*

TEACHING EVIDENCE ASSIMILATION FOR COLLABORATIVE HEALTHCARE

SPONSORSHIP

Funding for this conference is made possible [in part] by Grant No. 1R13HS018607-01 from the Agency for Healthcare Research and Quality (AHRQ). The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercialpractices, or organizations imply endorsement by the U.S. Government.

TEACHING EVIDENCE ASSIMILATION FOR COLLABORATIVE HEALTHCARE

DISCLOSURES

No Financial Disclosures Declared

TEACHING EVIDENCE ASSIMILATION FOR COLLABORATIVE HEALTHCARE

TEACHING EVIDENCE ASSIMILATION

• GRADE: Health Care Recommendations

• Knowledge Translation

• Individualized Care

• Policy

• Adaptation/implementation

• Delivery

WHY TEACH?

Traditional Training in EBM Doesn’t Work

Background: Evidence-based Individualized Care

• SR of effectiveness of EBM teaching to post-graduates• 28 controlled studies; 5 involved integrated teaching• Behavior change assessed via self-report• Only integrated teaching affected skills, attitude or behavior• Validity of studies involving integrated teaching

challengeable• BOTTOM LINE: evidence nil that traditional approaches to

teaching evidence-based medicine affect behavior or patient care

Coomarasamy A, et al BMJ 2004;329:1017

Background: Evidence-based Individualized Care EBM Teaching at NYAM• Practice based approach• Emphasis on initiation skills• Pilot study 2004-2006: graduates

unable to derive a need for research evidence from a clinical encounter

Wyer P, et al Adv Health Sci Educ 2009;14:515

Background: Evidence-based Individualized Care What is Practice Based Learning?

• Stemmler Fund Project 2006-2008• Define and Assess Practice-Based Learning

and Improvement Cognitive Skills (ACGME)• Clinical action first, information literacy

second

Chatterji M, et al J Grad Med Educ 2009;1:287

Policy Adaptation, Implementation: The New Frontier• 2007 KT for EM Conference• Systems based care and clinical

evidence• Cross specialty, multidisciplinary

collaboration

Lang E, et al . Acad Emerg Med 2010;17:865

Dimensions of Evidence Based Care

• “Evidence Based Guidelines”• “Evidence Based Individual Decision Making”

Eddy D. Health Affairs 2005;24:9

The Bridge• The Wright model• Evidence-informed QI linked to

education• Multifaceted ED based care pathways in

designated clinical areas• Systematically drew on clinical evidence

Wright et al . Ann Emerg Med 2008;51:80

TEACH

ConferencesCare InitiativesEducational Initiatives

New York Home Centers

Active TEACH Projects• NYC: The Allen Hospital (Heart failure)• N Brunswick CA: St John’s Regional (Heart failure)• Grand Rapids: Spectrum Healch/U Michigan

– Y1 Imaging for TIA– Y2 Acute brain ischemia in rural affiliates

• St Lukes Health Care System-Kansas City– Avoid unnecessary catheterization– Pre-op MRSA screening

• NYC: Brooklyn Hospital (Sepsis)

Design for Synergy• Preparation-Plenary-Seminar-Small Group• Seminars

– Day 1: Track specific activity– Day 2: Cross track content sharing

• Day 3: Reportage

Teaching Evidence Assimilation• ‘Evidence-Informed Quality Improvement• ‘Evidence-Informed‘ Individualized Care• ‘Problematization’• The Narrative Dimension• The Meaning of Effectiveness