An EIDM Journey

Help is out there!

Presenters Today

• Megan Ward, MD MHSc CCFP FRCP(C): Associate Medical Officer of Health, Peel Public Health

• Bev Bryant, BScN, Med: Manager Education and Research, Peel Public Health

• Lori Greco, MHSc: Knowledge Broker, health-evidence.ca

• Jessie McGowan, PhD: Health and Library Consultant, Toronto; Adjunct Professor, Departments of Medicine and Family Medicine, University of Ottawa; Associate Editor, Journal of Clinical Epidemiology

Peel Public Health

• 1.3 million population

• Mississauga, Brampton and Caledon

• 624 FTE

• Annual growth of 30,000

• Ethnically diverse

Vision:

Broad application of EIDM processes among Peel Public Health staff at all levels over the next ten years, resulting in the systematic inclusion of research evidence into decision making.

The REAL VISION

• Striding into Dr Mowat’s Office!

• Peel Public Health reports are a MUST read!

CHSRF Survey

• Library services lacking profoundly

• Time/skill to follow an evidence informed process

• Question formulation, search, critical appraisal skills, synthesis and applicability

• No consistent requirement for use of evidence

But:

• Strong support from Senior Management

• Strategic priority

Missing Components

• Library services, especially reference

• Access to and knowledge of high quality information, especially pre-processed and pre-appraised

• Building workforce capacity and skill

• Process of bringing evidence to practice questions

For Today

• Our focus is on the first two– with a taste of training!

Library Needs assessment

• Lack of access to information– Databases– On line and print journals– Search expertise– Low reference service capacity

• Lack of skills • “Work-Arounds”• Low use

But, there was some awareness:

• Preference and value pre-processed and pre-appraised literature

• Value of evidence-based philosophies• Demand for more training

Two years later: Library

• Two reference librarians

• Appropriate databases and access

• Improved web-presence

• High demand for service

• Beginning ‘PUSH’ activities

• Library as knowledge hub

Two (or more) Years Later: EIDM

• Staff to critical appraisal training

• Process for ‘rapid review’ of the evidence

• Increasing access to pre-processed and pre-appraised sites

One of the helpers along the way:

Health-Evidence.ca

Pre-processed literature

Examples:• Guidelines• Policy briefs• Overviews• Systematic reviews

Pre-processed

DiCenso, Bayley, & Haynes, 2009

Single studies

Syntheses

Synopses of syntheses

Summaries

Systems

Synopses of single studies

Synthesized Research Value:

• Summarize the existing best information to give a picture of what is currently known

• Saves time of reading individual studies

• More reliable results than individual studies

• Respond to a large scope of questions to provide guidance in practice

Work has been done for you!

MethodsRigorous scientific methods:• Develop question • Identify criteria for included studies• Search for literature• Apply inclusion, quality criteria• Analytic synthesis of findings• Draw conclusions• Practice implications (guidelines, policy

briefs)

Maureen Dobbins

Director

Paula Robeson

Knowledge Broker

Heather Husson Project ManagerKara DeCorby, Project Coordinator

Lori Greco

Knowledge BrokerDaiva Tirilis

Research Assistant

Lyndsey McRae

Research Assistant

Robyn Traynor

Research Assistant /

Coordinator

The Health Evidence Team

Health-evidence.ca

Health-evidence.ca

Health-evidence.ca

Health-evidence.ca

Other Health Evidence Services

• Facilitated Evidence Review

• Literature Searching & Instruction

• Mentoring & Brokering Support

More help along the way:

Library Services Consultation

6S Hierarchy

Canadian context

Here’s the interactive part:

• Anatomy of a systematic review

• Four simple questions

• Example of pre-processed literature

• Where to find pre-appraised literature

Reflections:

Your organization

• Where are you on the journey?

• Is there a small step you can take?

• Is there help that you can access?

• Some resources for help…

Help:

• Health evidence.ca:

http://health-evidence.ca/• Canadian Virtual Health Library:

Welcome to the Canadian Virtual Health Library! | CVHL

More help:

• Donna Ciliska with NCCMT– National Collaborating Centre for Methods an

d Tools

• CHSRF Assessment Tool

Is research working for you? CHSRF - Self-Assessment Tool

More Help on Pre-appraised:

Sources of pre-appraised evidence– NCCs http://www.nccph.ca/en/home.aspx– CDC comm guide

http://www.thecommunityguide.org/index.html– Public health +

http://www.nccmt.ca/tools/public_health_plus-eng.html– NICE http://www.nice.org.uk/– Cochrane library

http://www.thecochranelibrary.com/view/0/index.html– Campbell collaboration

http://www.campbellcollaboration.org/

The following links provide help on the steps of bringing evidence to a practice question

Taken from Peel Public Health’s Library Website: Public Health: Peel Health Library

Conceptual Model

• Worksheet : Peel Health Library: Step 1 – Developing a Conceptual Model

• CDC Community Guide– Every guideline has a framework– The Community Guide - Diabetes Prevention

and Control

Question and Search

• Plain language and PICOT format:• Sources of pre-appraised evidence

– Health evidence.ca http://health-evidence.ca/– NCCs http://www.nccph.ca/en/home.aspx– CDC comm guide http://www.thecommunityguide.org/index.html– Public health +

http://www.nccmt.ca/tools/public_health_plus-eng.html– NICE http://www.nice.org.uk/– Cochrane library

http://www.thecochranelibrary.com/view/0/index.html– Campbell collaboration http://www.campbellcollaboration.org/

Critical Appraisal

• Healthevidence.ca review tool http://health-evidence.ca/tools

• CASP tools http://www.sph.nhs.uk/what-we-do/public-health-workforce/resources/critical-appraisals-skills-programme

• AGREE II tool http://www.agreetrust.org/resource-centre/training/introduction/

Data Extraction

• Peel Public Health Tool• Adapted from NCCMT

– Table, templatePeel Health Library: Tools for Rapid Reviews

Applicability and Transferability

• NCCMT website http://www.nccmt.ca/

• http://www.nccmt.ca/pubs/2007_12_AT_tool_v_nov2007_ENG.pdf

• Stop a program

• Start a program

Report Structure

• CHSRF 1:2: 20 (1:3:25)http://www.chsrf.ca/publicationsandresources/pastseries/communicationnotes/10-06-01/d497a465-5398-4ec8-addf-d7cbf86b1e43.aspx

Manager’s Checklist

• Our tool http://www.peelregion.ca/health/library/manager-checklist.asp

Contact Information

• Megan Ward: megan.ward@peelregion.ca

• Jessie McGowan: jmcgowan@uottawa.ca

• Lori Greco: lgreco@mcmaster.ca

• Bev Bryant: beverley.bryant@peelregion.ca