evidence based healthcare management
TRANSCRIPT
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Linking Hospital Managers to the Literature: An Evidence-based Approach
ROBIN FEATHERSTONEApril 14, 2011
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Your Information Seeking Behaviour
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Origins of the Evidence-based Movement
• 1990s: David Sackett et al. from McMaster coined the term, Evidence-based Medicine (EBM)
• Aimed to improve the quality of information used to make decisions
• Migrated to other sectors - dentistry, nursing, management, etc.
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What is Evidence-based Health Services Management (EBHSM)?
• Aids in the decision-making process • Incorporates quality evidence from the literature• Seeks to evaluate managerial strategies and
improve the performance of health services organizations
(Kovner & Rundall, 2006)
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Today’s Objective
• learn to search for the best quality information to practice evidence-based decision-making in hospital management
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How Questions Influence Search Results
Relevancy
Retrieval(# of search results)
Broad Questions
Narrow Questions
High = lots of articles
Low = very few articles
High = directly relevant articles
Low = mostly irrelevant articles
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Guidelines for Formulating a Question
1- What management tool/technique are you thinking of using?
2- What process or outcome do you wish to achieve?
3- What is the setting?
(Kovner & Rundall, 2006)
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How do interdisciplinary teams function?
What workplace conditions are necessary to support collaboration among members of interdisciplinary teams?
From Thought to Question
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Exercise – 5 minutes
• In pairs, develop a narrow question based on the following topics:
1.“Transforming Care at the Bedside”
2.Patient flows
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Levels of Evidence Pyramid
UNFILTERED
Level 3: Single site studies
Level 4: Descriptive studies/Case Reports
Level 5. Expert Opinion
More TimeMore WorkMore Evidence
FILTERED
Level 1: Systematic Reviews of Randomized Controlled Trials
Level 2: Multicenter/Comparative studies
Less TimeLess WorkLess Evidence
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Cochrane Library - DEMO
Cochrane Reviews -Approx. 4000 full-text reviews-Therapy, prevention and diagnosis information
Other Reviews -Approx. 16,000 abstracts-International coverage-Covers effects of clinical interventions
Clinical Trials -Approx. 600,000 summaries of ongoing or completed clinical trials-International coverage
Methods Studies -Summaries of reports of methods used in clinical trials
Technology Assessments
-Abstracts of studies assessing health care technologies
Economic Evaluations
-Abstracts and brief records of studies looking at costs and effects of competing healthcare interventions
Contents
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Exercise
• Search the Cochrane Library to answer the question:
What are effective methods for increasing patient participation in clinical decision
making?
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Medline via PubMed - DEMO
• produced by the National Library of Medicine (U.S.)
• indexes 5,500+ journals in the health sciences
• provides references and abstracts to journal articles
UNFILTERED
FILTERED
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Using Subject Headings
• Search each concept in your question separately
• Mapping each of your concepts to a subject heading will find: – the preferred search term in the database – articles about your topic
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Exercise
Find articles that discuss procedures for patient admissions from the ER
Tip: Break down the question into its separate concepts before searching.
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What is the MeSH term for:
Patient admissions?
Emergency room?
Procedures?
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Subheadings• Use to investigate specific aspects of
your topic
• Narrows your searche.g., Patient Admission = ~15,600 results Patient Admission/methods = ~8 results
• Frequently used subheadings for management topics: /economics, /methods, /organization & administration, /statistics & numerical data
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Combining search terms
• OR related terms for an individual concept; increases your search results e.g., tertiary care hospitals OR university teaching hospitals
• AND two/more concepts together to find relevant articles; decreases your search results e.g., re-engineering of jobs AND
health care services
PubMed DEMO: Find articles that discuss procedures for patient admissions from the ER
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Applying limits
• Language
• Year
• Age group
• Publication Type, etc.
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Exercise
What are the costs involved to support teaching activities
in a university teaching hospital?
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15 minute break
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Principles of Online Searching
1. Define your question. 2. Break down the question into its separate
concepts. 3. Search each concept separately.4. Combine search terms (AND/OR).5. Apply limits.6. Evaluate your results. 7. Modify your search strategy if
necessary.
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Exercise
Does organizational culture impact patient safety management?
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About PubMed HSR Queries Filter
• An automated method to filter your PubMed search
• Limits your results to studies about health care quality and costs- Appropriateness of care- Process assessment- Outcome assessment- Costs- Economics- Qualitative research
UNFILTERED
FILTERED
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Applying the HSR Queries Filter to your PubMed Search
• Copy your PubMed search strategy.• Go to PubMed’s homepage.• Click on the “Topic-Specific Queries” link.• Click on the “Health Services (HSR) Queries”
link.• Paste your PubMed search strategy in the
search box.
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About ProQuest DatabasesContains:
• Business references (ABI/INFORM, CBCA, Research Library)
• Company profiles (Hoover’s)
• News sources (Canadian Newstand)
• Government and Industry Reports (Canadian Research Index)
UNFILTERED
FILTERED
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Exercise
Go to http://muhclibraries.mcgill.ca/adminguide.php . In pairs, search ProQuest Databases to answer
the questions:
1.Does the implementation of “Transforming Care at the Bedside” impact on job satisfaction?
2.Who are Sodexo, Inc.’s main competitors?
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Summary
• What resources will help you to find:
Systematic Reviews of RCTs?Process assessments?Company profiles?Newspaper articles?
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UNFILTERED
FILTERED
• Where would you place the following resources on the pyramid?
- PubMed- Cochrane Library- ProQuest- HSR Queries filter
Summary cont’d.
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Useful References on EBHSM1. Reay T, Berta W, Kohn MK. What's the evidence on evidence-based
management? Academy of Management Perspectives. 2009;23(4):5-18.
2. Rousseau DM, McCarthy S. Educating managers from an evidence-based perspective. Academy of Management Learning & Education. 2007;6(1):84-101.
3. Kovner AR, Rundall TG. Evidence-based management reconsidered. Frontiers of Health Services Management. 2006;22(3):3-22.
4. Chan KS, Morton SC, Shekelle PG. Systematic reviews for evidence-based management: how to find them and what to do with them. American Journal of Managed Care. 2004;10(11 Pt 1):806-12.
5. Walshe K, Rundall TG. Evidence-based management: from theory to practice in health care. Milbank Quarterly. 2001;79(3):429-57.