Evidence-Informed Public Health Decisions Made Easier: Take it one Step at a Time

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An afternoon workshop - held in partnership with the National Collaborating Centre for Methods and Tools - at the Ontario Public Health Convention April 7, 2011

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  • Developed through engagement with ph dms in ….Registry content is updated quarterly through comprehensive searches (7 electronic databases, 50 handsearched journals, reference lists of relevant reviews). All reviews are indexed, assessed for relevance and methodological quality by two independent reviewers. Two-page evidence summaries identify key findings and link evidence to actionable implications; The HE Registry houses over 2000 reviews, with summaries for 80 methodologically strong ones.
  • Developed through engagement with ph dms in ….Registry content is updated quarterly through comprehensive searches (7 electronic databases, 50 handsearched journals, reference lists of relevant reviews). All reviews are indexed, assessed for relevance and methodological quality by two independent reviewers. Two-page evidence summaries identify key findings and link evidence to actionable implications; The HE Registry houses over 2000 reviews, with summaries for 80 methodologically strong ones.
  • The registry sees 40,000 visitors annually (~105/day);. Through an online email management system – programming. pulls registered users’ topic areas of interest from Health Evidence registered users database and matches it to new reviews posted to the site since the last TM (enabling users to receive only content relevant to them) . Electronic tailored messages are sent quarterly to 5,000 registered users. Registered users tailor information to areas of interest; daily visits increase 500% following tailored messages built-in feedback links enable users to suggest site improvements; two knowledge brokers are available to support users in interpreting and applying evidence; social media provide a forum for improving awareness and registry use. A collaboration with PHAC Linkage to Health Evidence via PHAC site - 432CBPP – 297Specific to the CBPP, 297 CBPP users (or the total 432 PHAC visitors) linked from CBPP site to health-evidence.ca since launching the CBPP-HE simultaneous searches on CBPP on May 4, 201054  CBPP visitors submitted their CBPP search on H-E by clicking on the link in this screen capture:Social media engagement has produced three YouTube videos sharing users’ experiences with the registry, and a growing Twitter following (156 Followers) focused on EIDM. Real-time registry updates are posted to Twitter between quarterly updates. Seven modifiable EIDM tools are downloadable.
  • While both are national in scope, the two organizations provide capacity development through workshops and knowledge brokers at different levels of Canada’s public health system.NCCMT – national and provincial/territorialHE – local and regional
  • SystemsKnowledge management systemDatabase of best practice interventions/programs relevant to a specific content area. Based on pre-appraised high quality evidence.Computerized decision support systemIndividual client data is matched with relevant best evidence via an electronic record.(Haynes, 2007)SummariesAn outline of management options for a given health issue developed from the highest quality and most synthesized sources of research evidence.Draws on the lower layers of research evidence.Clinical practice guidelines
  • Two staged process:Calculate a summary statistic for each primary studyCalculate overall treatment effect size (weighted average)
  • Transition back to Pam to remind people where and how they can continue to develop their skills re: EIPHSay thanks to participants and to Jackie for leadership in preparing for the workshop and Rebecca for facilitatingRemind participants about knowledge fair that will be taking place after lunch
  • Evidence-Informed Public Health Decisions Made Easier: Take it one Step at a Time

    1. 1. Evidence-informed public health decisions made easier: Take it one step at a time<br />TOPHC, Toronto, ON<br />April 7, 2011<br />
    2. 2. Objectives<br />1. To understand the process of evidence-informed decision making in public health.<br />2. To clearly frame an answerable question.<br />3. To know where to find high quality relevant research.<br />4. To practice integrating the research evidence with other important factors that contribute to public health decisions.<br />5. To plan for implementation and evaluation<br />
    3. 3. Purpose<br /> Describe the steps involved in evidence-informed public health, and apply this process to a practice scenario relevant to public health<br />
    4. 4. Who are we?<br /> One of six National Collaborating Centres for Public Health created by the Government of Canada to renew and strengthen public health.<br />
    5. 5. Aims of the National Collaborating Centres<br />Increase awareness of new and existing knowledge. <br />Identify and help address public health priorities. <br />Collaborate with established public health networks. <br />Identify gaps in knowledge and relevant applied research.<br />
    6. 6. NCC Aboriginal Health<br />Prince George, BC<br />NCC Environmental Health<br />Vancouver, BC<br />NCC Infectious Diseases<br />Winnipeg, MB<br />NCC Determinants of Health<br />Antigonish, NS<br />NCC<br />Methods and Tools<br />Hamilton, ON<br />NCC Healthy Public Policy<br />Montreal and Quebec City, PQ<br />
    7. 7. Methods and tools for what?sharing what works in public health<br />
    8. 8. NCCMT products and services<br />DialoguePH<br />Public Health+<br />Workshops<br />Online learning modules<br />Webcasts<br />Webinars<br />Searchable Registry of Methods and Tools<br />Online Health Program Planner<br />sharing what worksin public health<br />
    9. 9. Health Evidence<br />Registry of systematic review evidence<br />Capacity building & knowledge translation <br />Research evaluating KT strategies<br />
    10. 10. Health-Evidence.ca database<br />2100+ reviews<br />Comprehensive & transparent process<br />Quality appraised<br />Evidence-summaries (86 well-done reviews)<br />
    11. 11. Health Evidence – engagement <br />40, 000 visitors annually (~110/day)<br />5,000 registered users<br />Tailoring options<br />Feedback and user queries<br />Knowledge brokers<br />HE-CBPP simultaneous searches<br />Social media strategy in development<br />YouTube<br />Twitter<br />
    12. 12. Complementary Activities<br />National in scope<br /><ul><li>Knowledge brokers functioning at different levels within overall PH system to build capacity</li></ul>Complementary services <br /><ul><li>HE: Access to content & tailoring through engagement
    13. 13. NCCMT: EIDM</li></li></ul><li>EIPH Workshop facilitators<br />Jackie Muresan <br />Kara DeCorby<br />Donna Ciliska<br />Pam Forsyth<br />
    14. 14. Evidence Transfer Gap<br />
    15. 15. Evidence of Gap in Acute and Primary Care<br />Consistent evidence of failure to translate research findings into clinical practice<br />30-40% patients do not get treatments of proven effectiveness<br />20-25% patients get care that is not needed or potentially harmful<br />Schuster, McGlynn, Brook (1998). Milbank Memorial Quarterly<br />Grol R (2001). Med Care<br />
    16. 16. What isEvidence-Informed Decision Making in Public Health?<br /> In addition to the best available research evidence, evidence-informed decisions in public health consider valuable evidence from a variety of sources:<br /><ul><li>community health issues and local context
    17. 17. existing public health resources
    18. 18. community and political climate</li></li></ul><li>What isEvidence-Informed Decision Making in Public Health?<br /> Decision makers must rely on their public health expertise to integrate all relevant factors into any conclusions or recommendations.<br />
    19. 19. What is Evidence-Informed Public Health?<br /> … the process of distilling and disseminating the best available evidence from research, context and experience, and using that evidence to inform and improve public health policy and practice. <br />
    20. 20. What is Evidence-Informed Public Health?<br /> Put simply, it means finding, using and sharing what works in public health. <br />
    21. 21. Why implement Evidence-Informed Public Health?<br />Effectively transfer knowledge from both quantitative and qualitative research into practice and policy.<br />Efficiently use limited health care resources.<br />
    22. 22. Why implement Evidence-Informed Public Health?<br />Create programs and actions that are both effective and appropriate for our communities and target populations.<br />Improve client satisfaction.<br />Strengthen public health in Canada.<br />
    23. 23. Why implement Evidence-Informed Public Health?<br /> Do what works … and don’t do what does not work!<br />
    24. 24. Barriers to Evidence-Informed Public Health<br />Lack of time<br />Difficulty accessing research<br />Lack of skills or confidence with critically appraising evidence<br />Difficulty interpreting results <br />Challenges with applying research findings to local context and setting<br />Insufficient power or support to make a change<br />Environment/organizational culture<br />(Keifer et al.,2005; Retsas, 2000; Thomas et al., 2004)<br />
    25. 25. Stages in the process of<br />Evidence-Informed Public Health<br />
    26. 26. Stages in the process of<br />Evidence-Informed Public Health<br />Clearly define the question or problem<br />
    27. 27. Scenario<br />You are a public health nurse working on a team that focuses on healthy living and physical activity. Despite walking being free and relatively safe, a recent survey of adults in the community indicated few people were walking regularly or engaging in any exercise. In a team meeting, you discuss whether a community-wide strategy should be implemented to promote walking and increase physical activity among sedentary adults. You are unsure which intervention would be most effective, and whether specific subgroups should be targeted (vs. a broader approach). Your supervisor has asked you to identify the best available research about the effectiveness of interventions to promote walking, and share with the team.<br />
    28. 28. Define the question<br />P opulation<br />I ntervention<br />C omparison<br />O utcome<br />(T) ime<br />
    29. 29. Stages in the process of<br />Evidence-Informed Public Health<br />Efficiently search for research evidence<br />
    30. 30. Searching<br />Start here with a question <br />6S Pyramid <br />(DiCenso et al., 2009; Haynes et al. 2005; Robeson et al., 2010)<br />
    31. 31. 6S pyramid of pre-processed research evidence<br />(DiCenso et al., 2009; Haynes et al. 2005; Robeson et al., 2010)<br />
    32. 32. Searching<br />Start here with a question <br />(program* OR intervention*) AND (walking)<br />0<br />174<br />3<br />18<br />329<br />Google Scholar 103,000<br />Google 38,200,000 <br />(DiCenso et al., 2009; Haynes et al. 2005; Robeson et al., 2010)<br />
    33. 33. health-evidence.ca<br />Online registry of reviews evaluating effectiveness of public health interventions.<br />Provides quality rating for every review<br />Summary statements are available for some high quality reviews and include:<br />PICO and main findings of the study<br />Methodological strengths and weaknesses<br />Implications for policy/practice<br />
    34. 34.
    35. 35.
    36. 36.
    37. 37.
    38. 38. What is a systematic review?<br />A rigorous summary of all primary research evidence relevant to a focused question.<br />Evidence is consolidated through a systematic process to avoid possible sources bias at various stages in the review process.<br />(Haynes, 2007)<br />
    39. 39. Define the question<br />Steps of a Systematic Overview<br />Review of reference lists of articles<br />Systematic manual search of key journals<br />Computerized databases<br />Consultation with experts<br />Search of personal files<br />Identify studies<br />Review for relevance<br />Not Relevant<br />Reject<br />Relevant<br />Evaluate methodological quality<br />Extract data<br />Analyze data<br />Draw conclusions<br />
    40. 40. What is a meta-analysis?<br />A method for combining the results of several independent studies that measure the same outcomes so that an overall summary statistic can be calculated.<br />(Dawson-Saunders & Trapp, 1994)<br />
    41. 41. Royal S, Kendrick D, Coleman T. Non-legislative interventions for the promotion of cycle helmet wearing by children. Cochrane Database of Systematic Reviews 2005, Issue 2<br />
    42. 42. Richardson, C.R., Newton, T.L., Abraham, J.J., Sen, A., Jimbo, M., Swartz, A.M.(2008). A meta-analysis of pedometer-based walking interventions and weight loss. Annals of Family Medicine, 6(1), 69-77.<br />
    43. 43. Narrative summary vs. Meta-analysis<br />Clinical heterogeneity<br />Multiple outcomes<br />Availability of data<br />* Review authors need to justify the method they choose<br />
    44. 44. Is the summary statement useful?<br />What is the “actionable message”?<br />
    45. 45. What if you do not find an answer in health-evidence.ca?<br />
    46. 46. http://www.guideline.gov/<br />
    47. 47. http://www.ncbi.nlm.nih.gov/pubmed/<br />
    48. 48.
    49. 49. Public Health+<br />
    50. 50. www.nccmt.ca<br />
    51. 51. http://cbpp-pcpe.phac-aspc.gc.ca/<br />
    52. 52. Stages in the process of<br />Evidence-Informed Public Health<br />Critically and efficiently appraise the research methods<br />
    53. 53.
    54. 54. Practice appraisal<br />Refer to NCCMT’s online learning modules for additional practice: http://www.nccmt.ca/modules/index-eng.html<br />Week long critical appraisal course at McMaster<br />
    55. 55. Stages in the process of<br />Evidence-Informed Public Health<br />Interpret information; understand how to prioritize conflicting results <br />
    56. 56. Stages in the process of<br />Evidence-Informed Public Health<br />Adapt the information <br />to the local community<br />
    57. 57.
    58. 58. Stages in the process of<br />Evidence-Informed Public Health<br />Decide whether (and plan how) to implement the change in practice or policy<br />
    59. 59. Implementation<br />Situational assessment <br />Identify barriers and facilitators in the organization, the people, and the change you are trying to make.<br />Identify key people.<br />Obtain approval from appropriate leadership.<br />Create a project timeline.<br />(Dobbins et al. 2005; Fineout-Overholt & Johnston, 2006)<br />
    60. 60. Implementation Toolkit<br />http://www.rnao.org/Page.asp?PageID=924&ContentID=823<br />Related resources:<br />DiCenso A et al. A toolkit to facilitate the implementation of clinical practice guidelines in healthcare settings. Hospital Quarterly 2002;5(3):55-60.<br />Dobbins M et al. Changing Nursing Practice: Evaluating the Usefulness of a Best-Practice Guideline Implementation Toolkit. Nursing Leadership 2005;18(1):34-45.<br />
    61. 61. Implementation <br />What is the message?<br />To whom (audience)?<br />By whom (messenger)?<br />How (transfer method)?<br />With what expected impact (evaluation)?<br />(Institute of Work & Health with J. Lavis, 2006. <br />www.iwh.on.ca)<br />
    62. 62. Identify Strategies to Disseminate Information<br /><ul><li> Policy change
    63. 63. Education
    64. 64. Academic detailing/outreach visits
    65. 65. Audit and feedback
    66. 66. Opinion leaders
    67. 67. Knowledge broker
    68. 68. Champions
    69. 69. Reminders: prompts; patient reminds staff
    70. 70. Interactive educational meetings/workshops
    71. 71. Multiple interventions</li></li></ul><li>http://www.thcu.ca/ohpp/<br />
    72. 72. Stages in the process of<br />Evidence-Informed Public Health<br />Assess the effectiveness of the change in practice or policy<br />
    73. 73. Evaluation<br />How will you know if people are using the evidence? <br />Have they changed their practice? <br />Does it make any difference to patients?<br />Decide on indicators (structure, process, outcome)<br />Gather baseline data<br />
    74. 74. Stages in the process of<br />Evidence-Informed Public Health<br />
    75. 75. Stages in the process of<br />Evidence-Informed Public Health<br />
    76. 76. Stages in the process of<br />Evidence-Informed Public Health<br />
    77. 77. Stages in the process of<br />Evidence-Informed Public Health<br />
    78. 78. Stages in the process of<br />Evidence-Informed Public Health<br />
    79. 79. Stages in the process of<br />Evidence-Informed Public Health<br />
    80. 80. Stages in the process of<br />Evidence-Informed Public Health<br />
    81. 81. Stages in the process of<br />Evidence-Informed Public Health<br />
    82. 82. Step ‘0’Reflecting on areas of uncertainty<br />Examine practice critically.<br />Acknowledge uncertainty in your practice.<br />Formulate a focused clinical questions through the process of reflective practice.<br />Will contribute to professional practice requirements. <br /> (Johnston & Fineout-Overholt, 2005; Witmer & Cullum, 1999)<br />
    83. 83. Road ahead<br />Individual skills<br />Organizational<br /> capacity, leadership<br /> resources<br /> and culture<br />
    84. 84. How can I continue to develop the skills needed for EIPH?<br />On-line learning modules<br />http://www.nccmt.ca/modules/index-eng.html<br />Dialogue PH<br />On-line support and discussion<br />EIDM workshops offered by Health Evidence or NCCMT <br />
    85. 85. NCCMT future directions<br />Renewed website<br />Upcoming conferences with networking opportunities: CHNC, CPHA, <br />New modules<br />Web casts<br />Digital stories..share yours with us!<br />Discussion forums linked to CHNETworks<br />
    86. 86. HE future directions<br />More summary statements are on the way!<br />Plans to disseminate <br />Continuing work with public health units<br />Improving health-evidence.ca (watch for our survey!)<br />
    87. 87. Feedback<br />Your input is needed to determine whether this workshop was effective in meeting your learning needs.<br />Please take a minute to complete the evaluation form in your packages and provide your comments or suggestions.<br />
    88. 88. Contact Info<br />Jackie Muresan, RN, MSc<br />Knowledge Broker<br />National Collaborating Centre for Methods and Tools (NCCMT)<br />McMaster University<br />905-525-9140, x 20453<br />jmures@mcmaster.ca<br />Donna Ciliska, RN, PhD<br />Professor and Scientific Director<br />905-525-9140, x 22529<br />ciliska@mcmaster.ca<br />Kara DeCorby, MSc<br />Research Coordinator<br />Health Evidence<br />McMaster University<br />905-525-9140, ext. 20461<br />kdecorby@health-evidence.ca<br />

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