public employers health purchasing committee
DESCRIPTION
Public Employers Health Purchasing Committee. Comparative Effectiveness And Clinical Guidelines. System Redesign. Increase Utilization of HTA process and Products Engage Community Physicians a. Best of Oregon: Academia, Area Leaders b. Local Input: On the ground - PowerPoint PPT PresentationTRANSCRIPT
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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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