CADTH_2014_D1_There_and_Back_Again__An_HTA_Analysts_Tale_of_Evidence-Informed_Decision_Making__Daniel Grigat
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From Evidence to Policy

From Evidence to Policy

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CADTH_2014_D1_There_and_Back_Again__An_HTA_Analysts_Tale_of_Evidence-Informed_Decision_Making__Daniel Grigat CADTH_2014_D1_There_and_Back_Again__An_HTA_Analysts_Tale_of_Evidence-Informed_Decision_Making__Daniel Grigat Presentation Transcript

  • There and Back Again: An HTA Analyst’s Tale of Evidence-Informed Decision Making Daniel Grigat, MA HTA Analyst, Knowledge Translation Research, Innovation, and Analytics Alberta Health Services CADTH, April 2014
  • 2 Presentation Objectives  HTA in the Alberta Context  Stories of success and challenges
  • 3
  • 4 11.21 8.73 7.68 5.92 4.29 5.53 0 2 4 6 8 10 12 South Zone Calgary Zone Central Zone Edmonton Zone North Zone Best Large RHA/Zone (Central West LHIN, ONT) Risk-AdjustedRate(per1,000) Source = CIHI CHRP 5-Day In-Hospital Mortality Following Major Surgery - 2010/11
  • 5 Presentation Objectives
  • 6 Strategic Clinical Networks • Multidisciplinary (Researchers, Clinicians, Support Units, Policy-Makers, Patients) • Evidence-Based • Strategic and Innovative • Accessibility (reduce variation in care) • Sustainability (Choosing Wisely)
  • 7 Strategic Clinical Networks 1. Addiction & Mental Health 2. Obesity, Diabetes and Nutrition 3. Emergency 4. Cancer 5. Cardiovascular and Stroke 6. Bone & Joint Health 7. Seniors Health 8. Critical Care 9. Surgery 10. Respiratory 11. Primary Care and Chronic Disease 12. Maternal, Newborn and Youth Health 13. Kidney
  • HTA Partners (IHE, UofA, UofC) From Micro to Macro: The Alberta Health Technologies Decision Process Alberta Advisory Committee on Health Technologies AHW Health Technologies Policy Unit Screening Sub-Committee Executive Team/ Minister AHS AH Strategic Clinical Networks Assessing System Needs Assessing Technology and Policy Development Decision/implementation From Alberta Health
  • 9 Evidence-Based Decision Making
  • 10 Knowledge to Action Cycle
  • 11 Clinical Opportunity Identification Evidence Synthesis Evidence- informed Decision Making Implementation and Evaluation
  • 12 Clinical Opportunity Identification Evidence Synthesis Frequent Users of Emergency Medical Services Complex High Needs Users Rapid Reviews: Patient Profiles, Case Management Lack of: clarity, clear intervention, coordination with other efforts or agencies, cost benefits
  • 13 Clinical Opportunity Identification Evidence Synthesis Edmonton Inner City Health Research & Education Network Multi-disciplinary Case Management for inner-city persons Evidence: existing RR, update SR, new RR Next Steps: Funding, Implementation and Evaluation
  • 14 Evidence Synthesis Policy Diabetic Foot Care Pathway How do we prevent, identify, and treat diabetic foot ulcers? PICO (wound care, orthopaedics, contact casting) Policy Implications: uninsured services Barrier: clinical independence, comfort with orthopaedics, fear of policy process
  • 15 Evidence Synthesis Policy Repetitive Transcranial Magnetic Stimulation Treatment Resistant Major Depressive Disorder ECT: invasive (safety, access), stigmatized (acceptability) Promising evidence but unanswered questions on optimal use Next Steps: Policy, Implementation, Evaluation Barriers: Time Frame
  • 16 Bariatric Surgery HTA: treatments for obesity, surgery 5-10 year outcomes Current provision of service 0.5%. Barriers: funding, OR management, surgeon support / late engagement, HTA didn’t answer clinical optimization questions Next Steps: Surgery SCN, answer optimization questions Evidence- informed Decision Making Implementation and Evaluation
  • 17 Enhanced Recovery After Surgery Evidence-based CPGs. Barriers: resistance to practice change (e.g. anaesthesiology) KT: Leadership Support, Clinical Champions, Clinical Informatics, Targeted Training Programs, Robust Evaluation Next Steps: Scale Up, Test Implementation Strategies Evidence- informed Decision Making Implementation and Evaluation
  • 18 Lessons Learned Stakeholders must be engaged from the public to the front lines to universities to the Minister
  • 19 Lessons Learned Translation is continuous and iterative: Clinical Need -> Research Question(s) -> Policy Implications -> Operational Options -> Clinical Need
  • 20 Lessons Learned Problems require a lot of definition before solutions are sought If I had one hour to save the world I would spend fifty-five minutes defining the problem and only five minutes finding the solution.
  • 21 Lessons Learned Funding frameworks tend to drive the conceptualization of problems (from Dens to HTR to PRIHS)
  • 22 Lessons Learned Time Matters – evidence is often sought too late in the process, more structured planning is required, clinical time and policy time are out of sync
  • 23 Lessons Learned Consideration of policy options should include clinical experts, research experts, and the persons who will be tasked with implementing directives
  • 24 Lessons Learned Knowledge Translation and change management is hard work. Change does not happen by emailing CPGs or issuing directives.
  • 25 Acknowledgements  Dr. Ulrich Wolfaardt, Dr. Don Juzwishin, Barbara Hughes, Rosmin Esmail  Strategic Clinical Networks: Obesity Diabetes Nutrition; Addiction and Mental Health; Emergency; Cancer  Ministry of Alberta Health  Dr. Gabrielle Zimmerman and CADTH
  • 26 Questions and Comments? Clinical Opportunity Identification Evidence Synthesis Evidence- informed Decision Making Implementation and Evaluation