strategy for evidencebased health services 1220793142612657 9

7/30/2019 Strategy for Evidencebased Health Services 1220793142612657 9

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Strategy for evidence-basedhealth services

a collaboration between Innlandet Hospital Trust

and the Norwegian Knowledge Center for the

Health Services

ystein Eiring, psychiatrist, Editor Norwegian Electronic Health Library/Mental Health, Medical Advisor.


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Menu for 30 minutes

About the NorwegianKnowledge Center

About Innlandet HealthTrust

Challenges

Strategy and action plan

Summary


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Norwegian Knowledge Centre for the

Health Services Founded 2004

Organised under TheDirectorate for Health

Affairs

Scientifically andprofessionally independent

No authority to develop

health policy orresponsibility to implementpolicies

120 employees in Oslo


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The Centre: Mission

Gathers and disseminatesevidence

about the effect and

quality of methods andinterventions

Uptake of evidence by thehealth services


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The Centre: Central tasks 1

HTA reports

Systematic reviews

Overviews of overviews andearly warnings

Projects that aim to improve thequality of patient information

Surveys of patients and

employees experiences withhealth services

Support to the health services ofpoor countries through theprovision of evidence


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The Centre: Central tasks 2

Support to the government the regional health authorities the health services in general

Host of The National ElectronicHealth Library

Quality Measurement andPatient Safety

Host of the National Council forQuality and Prioritization


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Access to knowledge has varied widely

National Hospital

Rural hospital


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Why does the Health Library exist?

Equality: Equal access to healthservices implies equal access toknowledge

Quality: Quality assessment ofknowledge is quality assessment ofhealth services

Economy: National subscriptionsand licenses saves time and money


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August 28, 2013Helsebiblioteket 9

Journals


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Databases


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Systematic

reviews


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Clinical guidelines


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Reference books


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Specialist libraries


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Challenges for the knowledge center

Bein well knownamong even morehealth workers

Being known for evenmore relevant services

Develop a project

that targets the healthtrusts

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Innlandet Health Trust

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8/28/2013Helsebiblioteket 17


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Population 390 000

8 hospitals + 33 other

units

8427 employees

Ann. budget CAD 1 bn

1301 beds

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Challenge: The evidence-practice gap

Interventions usedwithout sound evidence

Interventions withsound evidence notused

The individual healthworker decides


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Challenge: The evidence-practice gap

30-45 % of treatmentsnot evidence-based

Need more specific gapanalyses

Lack of benchmarking

Lack of indicatorsystems

Lack of comparingdata


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Challenge: Infrastructure

Lack of computers

Lack of internet access

Lack of access to paidinternet resources

outside of universityhospitals

1000s of clinicalprotocols

Quality of? In use?


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Challenge: The individual health worker

Knowledge aboutknowledge

Awareness of EBM needs

Core EBM skills

Digital competence


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Challenge: Users perspective

Increasing demand for

Transparency Influence

Shared decisionmaking

Tailored information


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Collaboration: trust knowledge center

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The four Ss model

Systems

Synopsis

Systematic

reviews and guidelines

Studies


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Aknowledge and

identify informationneed

Formulatequestions

Search forliterature

Critically appraise

Evaluate knowledge incontext of

experience, patientvalues andpreferences

Put in practice

Individual health worker model


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EPRQuality-assessed

guidelines

Quality-

asessed

research

Knowledge

support

Patient

information

Internet as transparent, common arena

-Patient information mirror clinical protocols

-minimize double work

-support patients as change agents

What Innlandet produces and carries through

PatientClinician

Educational institutions,Knowledge Center, governmental agencies,

Electronic Health Library

Pipeline model


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Strategy in the trust: Core components

Find and create perceivedneeds

Build on existingstructures and processes

Evidence-basedknowledge supportsystems

Evidence-basedimplementation

Create good examples


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Task areas

Basic infrastructure and prerequisites

Knowledge systems

The individual health worker

Task force: supportive administration


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Task 1: Policy of the trust soaked in EBM

EBM one of threeprioritized areas

Prominent place inquality policy

Cornerstone of inter-and intranet policy

National and regionalconferences

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Task 2: Educated and enthusiastic

leaders Professional advisory

boards created for allclinical fields

Given basic trainingin EBM

Mandate: responsible

for fostering evidence-based medicine

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Task 3: EBM policy for the library

services Formal training of

librarians

EBM training by

librarians Responsible for the

overall training plan

Administer toolkit for

those who makeprotocols

Manual, courses,search ++

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Task 4: more computers and better

internett access Higher pc density

Wireless

Mobile units ie. HHC

Open zone

Flexible login

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Task 5: Better knowledge support

In addition to theHealth Library

Tender in process

Will be used for Benchmarking

EBM clinical carepathways

Template for betterprotocols

Point-of-care supporttool

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6: New inter- and intranet services

CEO and boardendorsed new policy :

Knowledge platform

Empower usersthrough information

Tool for cooperationand communication

Building trustculture

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7: Evidence based home made

knowledge support Systematic and explicit

knowledge search behind Clinical protocols Care pathways

Care plans

Process in accordancewith simplified Agree

To be published on theinternet

Can look to GAC

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9. Training of individual health workers

Inhouse training bylibrarians/clinicians

e-learning from sept 1. Rolls Royce training

on a secluded spot

Training trainers

Training leaders Training makers of

knowledge support

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10. Mass media

EBM news and EBMeducation

Intranet

PsychNews

Paper magazine

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What is not yet fully included

Research unit

Patient informationproject

Monitoring unit

Nurses education

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Some shortcomings

EBM thinking doesnot permeate the

wards Depends heavily on

a few enthusiasts

Lack of perceived

need for EBM

Resistance fromsome leaders


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Perspective ahead

The regional healthtrust now adoptsstrategy and actionplan

Full-hearted supportfrom CEOs paves theway ahead

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Discussion!


Norwegian Electronic Health Library

Norwegian Electronic Health Library

strategy for evidencebased health services 1220793142612657 9

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