public employers health purchasing committee

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Public Employers Health Purchasing Committee

Comparative EffectivenessAnd

Clinical Guidelines

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System Redesign• Increase Utilization of HTA process and Products• Engage Community Physicians

a. Best of Oregon: Academia, Area Leadersb. Local Input: On the ground

• Capitalize on local resourcesa. CEBP, EPC

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National, Regional and International• Agency for Healthcare Research and Quality (AHRQ)

http://www.ahrq.gov/

• Institute for Clinical Systems Improvement (ICSI)http://www.icsi.org/

• National Institute for Health and Clinical Excellence (NICE)http://www.nice.org.uk/

• Canadian Agency for Drugs and Technology in Health (CADTH)http://www.cadth.ca/index.php/en/home

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Oregon Commissions

• Health Resources Commissiona. Responsible for HTA

• Health Services Commissiona. Prioritized Listb. Evidence Based Guidelines

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Evidence-Based MedicineEvidence-Based Medicine

A Quick IntroductionA Quick IntroductionA Template for Change?A Template for Change?

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Origins

• Ancient Era- Anecdotes and Historical Accounts• Renaissance Era 1700’s-1900: Personal Journals,

textbooks begin• Transition Era 1900-1970: Textbooks and peer-

reviewed Journals• Modern Era: Technology, RCT’s McMaster

University 1990’s

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Current Definition

“The conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients.”

Sackett et al. BMJ 1996;312:71-72 (13 January)

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EBM RequirementsThe Practice of Evidence-Based Medicine means

integrating:• Individual Clinical Expertise• Best Available External Clinical Evidence• Patient ConcernsThe full integration of these three components into

clinical decisions enhances the opportunity for optimal clinical outcomes and quality of life.

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Why is EBM important?

CAR Study: Crowley et al. 2003• 520 Clinical Questions• 53% Management Plan Confirmed• 47% The literature changed the medication,

diagnostic test, or prognostic information given to the patient.

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Evidence Evaluation

Methodology

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The primary function of The primary function of a good study is to show a good study is to show that the result is due to that the result is due to

the interventionthe intervention

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Evidence PyramidEvidence Pyramid

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Best vs. Best Available

What to do? Best Practices!“Best of Oregon”

Speight et al. MC-S April, 2010

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Local Input

• Baker City vs. Portland• Practicality• Eminence based medicine

a. 23?

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Local Resources

OHSUCEBPEPC

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Suggested Definition/Approach

“The conscientious, explicit, and judicious use of the current best evidence and people in making system wide decisions about the care of patients.”

Pass et al. NL2BP 2010; SL 16 (26 April)

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A Modest Proposal

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HSC

• Prioritized List• Clinical Guidelines

a. Lymphedemab. Bariatric surgery

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