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Team Shark

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Team Shark

  1. 1. Carcharadon Group (The Sharks) Brad Brimhall, David Boyd, Rebecca Zakoor, Genny Zuniga, Kathleen Spencer, Francis Blais, Brenda Hage, Lilly Wang,Deborah Broadwater, Julie Frantsve-Hawley Diagnostic Literature Information Portal: Gateway to evidence- based Diagnosis
  2. 2. The Problem • Limited evidence-based evaluation of diagnostic literature. • Must have evidence-based information on diagnosis as the first step to utilization evidence- based medicine (EBM). • Documented high rate of errors of omission and commission in health care. • Practice variation = cost variation.
  3. 3. Project Objectives • Share with other users of health care information the accuracy of diagnostic testing (radiology, laboratory, pathology, physical examination findings, etc.) • Train and educate health care providers to critically evaluate primary literature diagnostics. • Provide concise, reliable evidence-based information to health care practitioners. • Appropriate utilize diagnostic testing.
  4. 4. Evidence-Based Publications
  5. 5. Quality of Diagnostic Studies A review in JAMA published in 1995 evaluated more than 1000 diagnostic papers via established parameters found the following: 50% of papers satisfied none of the parameters. No paper fulfilled all parameters. Reid MC, Lachs MS, Feinstein AR. JAMA 1995;274:645-651
  6. 6. Evidence-Based Medicine (EBM) “...the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” D.L. Sackett (Oxford University)D.L. Sackett (Oxford University) Sackett et al., 1996. BMJ 312: 7023.Sackett et al., 1996. BMJ 312: 7023.
  7. 7. EBM Framework 1. Determining clinical questions 2. Finding evidence 3. Assessing the quality of evidence 4. Summarizing findings & formulating conclusions 5. Using information to implement change
  8. 8. Sources of Evidence Primary Data (raw data) Primary Literature (original studies) Secondary Literature (review articles) Tertiary Literature (textbooks, etc.) Systematic Reviews Practice Guidelines
  9. 9. Cochrane Collaboration
  10. 10. Evaluating the Evidence
  11. 11. Level of Evidence: Diagnosis Level Criteria 1 Independent, masked comparison with reference standard among an appropriate population of consecutive patients. 2 Independent, masked comparison with reference standard among non-consecutive patients or confined to a narrow population of study patients. 3 Independent, masked comparison with reference standard among non-consecutive patients or confined to a narrow population of study patients. 4 Reference standard not applied independently or masked. 5 Expert opinion with no explicit critical appraisal, based on physiology, bench research, or first principles. Evidence and Diagnostics. www.jr2.ox.ac.uk/bandolier/booth/diagnos/Diagessy.html
  12. 12. Portal Features Diagnostic Literature Information Portal Robust Search Capability Reliable & Valid Multilingual Web-based Training Serving a wide variety of health providers
  13. 13. Projected Needs • Standardized Terminology (e.g. ICD-9, CPT) • Database Design • Education/Informatics (Training) • Web Designer • Webmaster (Maintenance) • Evaluation
  14. 14. Development Timeline • Jaws I Development of webpage and database, development of self-paced training module for reviewers, exemplar review development, tutorial development, evaluation tool development • Jaws II Publication of reviews, evaluation of training, beta test portal. • Jaws III Implementation, Evaluation of user satisfaction, system maintenance
  15. 15. Outcome Measures • Number of reviews submitted • Site “bites” • Level of user satisfaction • Links to other websites
  16. 16. Examples of EBM Portals • American College of Physicians www.acpjc.org • InfoPOEMS www.infopoems.com • Cochrane Reviews www.cochrane.org/index0.htm • Centre for evidence-based Medicine www.cebm.net
  17. 17. FIN(i)
  18. 18. Questions • Questions? • Comments?

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