About us Established in 2010 as the Centre for Research in Evidence-Based Practice (CREBP), we transformed into the Institute for Evidence-Based Healthcare in 2019. The transition from Centre to Institute enabled us to provide advisory services informing provision of sustainable, evidence-based healthcare, and to facilitate research informed policy and practice. The transition has enabled us to increase our impact, partnerships, translational project opportunities, and develop new educational programs. Our research addresses four big, neglected problems in healthcare: antibiotic resistance, overdiagnosis, waste in research, and neglected non-pharmaceutical treatment. Our focus in these areas assists health systems to provide care that is patient-centred and informed by evidence, and enables patients to make decisions that are congruent with their values, preferences and circumstances.
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The Institute delivers world-class research, engagement and training that serves as a national and international resource for scholars, clinicians, system leaders, patients and families in the implementation of evidence-based clinical care. The effective integration of research into practice contributes to the health and healthcare of Australians, influences health policy, improves global health outcomes, and enhances Bond University as a leading private and independent University.
Professor Paul Glasziou AO Director: Institute for Evidence-Based Healthcare
Our purpose We aim to improve healthcare by better understanding the causes of, and solutions to, gaps between research evidence and its application in practice. To achieve this, we: • • • • •
Undertake research that closely aligns evidence and patient care; Support and extend collaborations between clinicians and health researchers to achieve higher value care; Enable patients and families to make evidence-informed health decisions that are congruent with their values and preferences; Lead and facilitate the teaching and learning of evidence-based practice; Develop young researchers for research programs in sustainable healthcare.
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Our research To achieve our aims, we will both synthesise and generate new evidence on four neglected problems in healthcare.
Antibiotic resistance currently leads to 30,000 avoidable deaths per year in both Europe and the USA, threatening elective surgery; and a resurgence of the bacterial diseases of the 19th century.
Overdiagnosis has led to a massive increase in the apparent prevalence of many diseases through disease definition change and overdetection, causing harm and rising healthcare costs.
Neglected non-pharmaceutical treatments are often as effective and as safe, or safer than their pharmaceutical cousins but are poorly described, poorly marketed”, and therefore, little used.
Waste in medical research is estimated to cost >$100 billion per year from avoidable design flaws, non-publication and poor reporting resulting in >85% avoidable waste.
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Research Centres The Centre for Research Excellence in Minimising Antibiotic Resistance in the Community (CRE-MARC) addresses the issue of antibiotic resistance. It builds on the work of CREMARA (The Centre for Research Excellence in Minimising Antibiotic Resistance for Acute Respiratory Infections: 2012-2018), in acute respiratory infections, extending this research into a second phase of implementation. The Centre for Using Healthcare Wisely is a collaborative research centre which focusses on detecting, measuring and communicating the harms of overdiagnosis and overtreatment. The Evidence-Based Practice Professorial Unit at Gold Coast University Hospital aims to ensure all healthcare workers are skilled users of research. The Unit is a joint initiative between Bond University and the Gold Coast Hospital and Health Service. The Centre for Evidence-Informed Health Decisions is primarily focussed on conducting research that helps people to make informed decisions about health – including health professionals, patients and the public. The Australasian EQUATOR (Enhancing the Quality and Transparency of Health Research) Centre is an international initiative that seeks to improve the reliability and value of published health research literature by promoting transparent and accurate reporting and wider use of robust reporting guidelines.
For more information, visit iebh.bond.edu.au/our-research
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Overdiagnosis Overdiagnosis threatens to harm health and health system sustainability. The team at the Institute is a national and international leader in understanding and addressing the problem of overdiagnosis.
Overdiagnosis occurs when commonly-used, correct diagnoses in health and medical care do more harm than good. Overtreatment, which generally follows overdiagnosis, occurs when people receive treatment they don’t need. When people are overtreated, they are unlikely to gain any benefit from the treatment, but may experience harms from it. In addition to research to understand the nature and drivers of overdiagnosis, the team researches potential solutions to address overdiagnosis and reduce the number of people who are unnecessarily impacted. Alongside other organisations in the healthcare landscape, we engage with consultant community members and develop national responses to overdiagnosis.
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“We know harm can come from overdiagnosis ... there is no doubt we need some sort of approach to address it.” Professor Brendan Murphy Sydney Morning Herald, 2018 (then Chief Medical Officer of Australia, currently Secretary of the Department of Health)
are better; • Financial incentives at the health system level; • Technological change enabling identification of smaller and more minor abnormalities; • Professional fear of missing disease and Potential drivers and solutions cognitive biases in decision making; and
to
Our community engagement team has been working on methods to improve healthcare through our deliberative democracy research.
Australian researchers developed a collaboration to address overdiagnosis and overtreatment. overdiagnosis This alliance is the Wiser Healthcare research collaboration on overdiagnosis.
• Public expectations that clinicians will “do something”. In preparation for a national plan of response, a map of the possible drivers of overdiagnosis and its potential solutions was developed by our team from the medical literature. Examples of the key drivers across the five interrelated domains include: • • • • •
Cultural beliefs that more tests and treatments are better, Financial incentives at the health system level, Technological change enabling identification of smaller and more minor abnormalities, Professional fear of missing disease and cognitive biases in decision making, and Public expectations that clinicians will “do something”.
Possible drivers and potential solutions to overdiagnosis and related overuse
POSSIBLE DRIVERS
POSSIBLE SOLUTIONS
CULTURE Beliefs; for example, more = better Faith in early diagnosis Intolerance of uncertainty Biased media reporting Medicalisation
INDUSTRY AND TECHNOLOGY Industry promotion Diagnostic test sensitivity Medicine as a business Industry expands markets
Ind
Culture
lth System Hea and Techn olo try s u s i o s e n als of Pr
gy
HEALTH SYSTEM Financial incentives Expanding disease definitions Quality measures Complexity of care Guidelines Screening
CULTURE Awareness / information campaigns Healthy scepticism about early diagnosis Address uncertainty Improve media reporting
Patients and Public
PROFESSIONALS Fear of litigation Fear of missing disease Flaws in training Lack of confidence or knowledge Over-reliance on tests PATIENT AND PUBLIC Over-reliance on tests Lack of confidence or knowledge Expectation clinicians will “do something”
HEALTH SYSTEM Reform incentives from quantity to quality Reform disease definition Reform quality measures Reform guidelines Reform screening More research on OD and OU Multicomponent inverventions INDUSTRY AND TECHNOLOGY Better regulate promotion Better evaluation of tests Declare, reduce, exclude COIs Better evaluate disease definitions PROFESSIONALS Reform litigation driver Comfort with uncertainty Educate and inform Interventions for providers Reduce test over-reliance PATIENT AND PUBLIC Shared decision making Education and information campaigns Promote “doing something”
Source: Pathirana T, Clark J, Moynihan R. Mapping the drivers of overdiagnosis to potential solutions. 2017. BMJ, 358: j3879 Source: Pathirana T, Clark J, Moynihan R. Mapping the drivers of overdiagnosis to potential solutions. 2017. BMJ, 358: j3879. 7
Informed community voices We also know that often the people affected most by health policies and guidelines are not meaningfully consulted. When informed about the challenges of overdiagnosis and overtreatment, community members (those most directly affected by the health condition) may provide important and unique contributions to potential solutions. Our community engagement team researches methods to improve engagement and meaningful consultation with patients and the public through our deliberative democracy research.
For more information, visit iebh.bond.edu.au
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Centre for Research Excellence in Minimising Antibiotic Resistance in the Community (CRE-MARC) Antibiotic resistance currently causes 30,000 avoidable deaths per year in Europe and the USA, threatens elective surgery, and foreshadows a resurgence of the bacterial diseases of the 19th century, with primary care becoming a major contributor to the problem.
What are we doing? 1. Community antibiotic stewardship implementation studies - with several Primary Healthcare Networks and Practice-Based Research Networks, culminating in a randomised trial of interventions known to be effective at reducing antibiotic prescribing. 2. Skin and soft-tissue infections (SSTIs) and urinary tract infections (UTIs) – generating and synthesising evidence about antibiotic benefits and harms for these conditions (which together with acute respiratory infections covers >85% indications for antibiotic use in primary care) and developing interventions to improve appropriateness of antibiotic use for these conditions. 3. Residential aged care facilities – tackling the problem of very high antibiotic use by exploring the drivers, and using information about enablers and barriers to design interventions that improve the appropriateness of antibiotic use. 4. GP registrars – developing and evaluating targeted educational interventions. 5. Addressing other important, but neglected, questions about antibiotic resistance - by conducting both primary studies and systematic reviews of the literature.
This research solidifies the Institute as one of Australia’s leading authorities on the issue of antibiotic resistance, labelled by the World Health Organization (WHO) as a key global health concern facing our generation. For more information, visit CREMARC
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Neglected Non-Pharmaceutical Treatments Non-pharmaceutical treatments, which include exercise, psychotherapy, manual procedures and selfmanagement, are just as, or more, effective and safe as their drug counterpart. However, they are poorly described and marketed, and therefore, underused in healthcare. Along with the RACGP, in 2013 we initiated the Handbook of Non-Drug Interventions (HANDI) that mimics existing drug pharmacopoeias, including indications, contra-indications and ‘dosing’, and aims to make ‘prescribing’ a non-drug therapy as easy and precise as writing a medication prescription.
To further improve the uptake of non-pharmaceutical treatments in healthcare we are conducting research in three areas: • • •
Synthesising evidence or generating new evidence of potential new non-drug treatments for handi; Improving uptake of the existing evidence-based treatments in handi; and Developing and evaluating of patient versions of these non-pharmaceutical treatments to enhance treatment fidelity and enable use of decision aids.
The treatments included in HANDI have been assessed by the HANDI project team and are informed by evidence.
For more information, visit the HANDI website
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Waste in Medical Research Improving research quality and reproducibility to avoid research waste.
We have estimated that avoidable design flaws, nonpublication, and inadequate reporting, renders over 85% of medical research a wasted effort. This equates to over $100 billion dollars worth of avoidable research waste globally every year. We undertake research to understand and ameliorate many of these problems by focusing on poor research reporting, particularly its consequences for non-pharmaceutical interventions, and developing and evaluating automation tools to improve the speed of evidence synthesis.
The EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network is an international initiative that seeks to improve the reliability and value of published health research literature by promoting transparent and accurate reporting and wider use of robust reporting guidelines. We are one of 5 global EQUATOR Centres. equator-network.org
Waste occurs at four stages of research 1
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3
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Questions relevant to clinicians and patients?
Appropriate design and methods?
Accessible full publication?
Unbiased and usable report?
Over 50% studies designed without reference to systematic reviews of existing evidence
Over 50% of studies never published in full
Over 30% of trial interventions not sufficiently described
Low priority questions addressed Important outcomes not assessed Clinicians and patients not involved in setting research agendas
Over 50% of studies fail to take adequate steps to reduce biases, e.g. unconcealed treatment allocation 50%
Biased underreporting of studies with disappointing results
Over 50% of planned study outcomes not reported Most new research not interpreted in the context of systematic assessment of other relevant evidence
50%
50%
85% Research waste = over $100 Billion / year
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Evidence-Based Practice Professorial Unit
Who we are The Evidence-Based Practice Professorial Unit (EBBPU) is a joint initiative between Bond University and the Gold Coast Hospital and Health Services. The integration of best evidence into routine clinical care is essential to improving patient outcomes and ensuring the effectiveness and efficiency of health services. Our aim is to educate, facilitate and inspire healthcare workers to become active users, participators and leaders in research and evidence-based practice. Evidence-Based Practice Professorial Unit, Bond Research and Education Unit, Level 2, Pathology and Education Building, Gold Coast University Hospital, Southport QLD Email: EBP_unit@bond.edu.au | Phone: 07 5595 1405
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What we do
Training and education • •
Customised Evidence-Based Practice Workshops Interactive lectures: “From asking answerable questions to implementation of evidence”
Building research capability • • • •
Minimising low value care • • • •
Deprescribing at end of life Reducing overdiagnosis and overtreatment Identifying and minimise low value services Encouraging evidence-based clinical decision making
Decision support • • •
Advisory services • • • •
Expert panel review of research proposals Policy and guideline reviews and advice Project plan consultations Co-investigator hub
Research mentoring and partnership Enhancing research activity and productivity Assisting the implementation of high quality research into practice Building a sustainable culture of evidence-based practice
Evaluating clinical decision aids Shared decision-making Implementing tools into regular workflow and clinical services
Evidence checks • • • •
Conducting accelerated systematic reviews Support with statistical analyses Qualitative and quantitative evidence synthesis Facilitating online journal clubs
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Shared decision-making What is shared decision-making and why is it important?
Helping to facilitate shared decisionmaking
Overuse of low-value healthcare and underuse of effective healthcare are deeply entrenched and both represent suboptimal care. Their drivers include: cognitive biases, poor communication, knowledge uncertainty, and structural and financial elements of health systems. Health systems are now striving to provide optimal, high-value care, which can be described as care that is patient-centred and where the benefits and harms are weighed up and informed by evidence.
Research activities of the Centre for EvidenceInformed Health Decisions include the development and dissemination of patient decision aids and the development of online and interactive training courses in shared decision making. These courses enable clinicians of any discipline to complete an accredited training activity at a time and location that is convenient to them – thus overcoming some of the barriers to shared decision making uptake. The courses have been adopted by health organisations and various speciality colleges throughout Australia and the United Kingdom.
A key strategy to achieving this is shared decision making; a process which enables patients to make evidence-informed health decisions that are congruent with their values and preferences, after increasing the uptake of effective ones. It is a key component of most healthcare reform models and policies to emerge in recent years. Strategies that can be used to facilitate shared decision making include the use of patient decision aids, clinician training, and the integration of shared decision making tools into evidence syntheses such as guidelines.
For more information, visit iebh.bond.edu.au
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Cochrane Acute Respiratory Infections Group Cochrane is an international collaboration of 50 groups that produce comprehensive systematic reviews on a broad range of health topics. The Cochrane Acute Respiratory Infections (ARI) Group has been hosted at Bond University since 2004 with funding provided by the Australian National Health and Medical Research Council. The group’s main function is to support review authors through the editorial process to produce high quality systematic reviews for publication in the Cochrane Library. The main goals are to improve the quality of healthcare worldwide, and to provide timely evidence to guide clinical and policy health decisions. Our team includes clinical experts, statistician, information specialist, and managing editors.
Examples of our systematic reviews are: 1. Jefferson T, Del Mar CB, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, van Driel ML, Jones MA, Thorning S, Beller EM, Clark J, Hoffmann TC, Glasziou PP, Conly JM. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database of Systematic Reviews 2020, Issue 11. Art. No.: CD006207. DOI: 10.1002/14651858.CD006207.pub5. 2. Schuetz P, Wirz Y, Sager R, et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database of Systematic Reviews 2017, Issue 10. Art. No.: CD007498. DOI: 10.1002/14651858.CD007498.pub3 3. Hemilä H, Chalker E. Vitamin C for preventing and treating the common cold. Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.: CD000980. DOI: 10.1002/14651858.CD000980. pub4
For more information, visit ari.cochrane.org
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Accelerated Systematic Reviews Systematic reviews are considered the highest-level evidence to underpin clinical decisions, guidelines, and policy decisions because they synthesise all of the existing evidence that answers a specific question, using methods that are transparent, robust and reproducible. 2 Week Systematic Review (2weekSR) Systematic Reviews (SRs) are time and resource-intensive to produce, taking on average 45 weeks to complete, and typically requiring five or more personnel. The team at the Institute have developed and validated an award-winning process for decreasing the time to produce a review to approximately 2 weeks. This is achieved by integrating the use of automation tools, complementary expertise, and agile project management methodology, whilst retaining high quality and robustness of the processes. For up to date information on the 2weekSR and our tools, please visit our website: iebh.bond.edu.au, or follow the team on Twitter @2weekSR.
Accelerated systematic reviews same robust methodology in a fraction of the time. Our work on automation of evidence synthesis is in collaboration with ICASR (International Collaboration for the Automation of Systematic Reviews). icasr.github.io
For more information, visit sr-accelerator.com
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Systematic Review Accelerator (SRA) The Systematic Review Accelerator (SRA) is a suite of automation tools, purpose-built to speed up multiple steps in the Systematic Review (SR) process. SRA tools assist with many steps of a systematic review, including searching for citations, citation screening and write-up of review findings, among others. Existing tools are being continuously reviewed and refined, and additional tools are being developed. The SRA tools are freely available for anyone in the world to use. Some of our current tools include:
Word frequency analyser
Polyglot search translator
Assists with designing the search strings to find the relevant literature to answer the systematic review question.
Automatically (rather than manually) translates the search string between multiple databases (which have their own syntaxes).
Deduplicator
Disputatron
Identifies and removes duplicate studies from search results (to decrease the reference screening workload).
Detects screening decision disagreements between reviewers. This speeds up the resolution of the disagreements process.
Search refiner
Revman replicant
Refines the search strategy so that it is maximally efficient in finding only the relevant literature and leaving out irrelevant literature (decreases the screening workload).
Automatically writes the results of the systematic review from meta-analyses (forest plots) thus decreasing errors and time to complete the write-up.
Screenatron
Methods wizard
Increases the speed of title/abstract screening by combining customizable hotkeys with a streamlined user interface to allow the reviewer to quickly include or exclude articles.
A semi-automated tool to guide the systematic review team through the writeup of the methods section of a systematic review protocol.
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Externally commissioned workshops that meet your needs We can provide you and your team with workshops to meet your specific needs. We conduct initial discussions to understand your training needs and then develop content and practical exercises accordingly, in collaboration with you. For more information, costs and to discuss your requirements, please contact our Institute Manager, Chrissy Erueti on iebh@bond.edu.au.
“Overall a fabulous learning experience, skilled and deeply knowledgeable presenters.” — SR, workshop participant.
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Workshops The team at the Institute offer a range of stimulating and engaging workshops on study design and protocol writing, knowledge translation, writing for publication, evidence-based practice, and understanding and conducting systematic reviews. Evidence-based practice Evidence-Based Practice is the cornerstone of an efficient clinical practice and an effective healthcare system. This 1-day workshop aims to develop clinicians’ and researchers’ skills in evidence-based practice. During this workshop participants will gain the skills to: • • • • • •
Convert a need for information or a clinical query into a clear answerable question; Efficiently find and select research evidence to answer these questions; Critically appraise the trustworthiness of research evidence; Accurately interpret research evidence; Incorporate patients’ values and preference in clinical decision making (for clinicians); Communicate findings of research evidence.
Systematic reviews This workshop provides an introduction to understanding and conducting systematic reviews. It is aimed at clinicians and researchers who want to understand how to use a systematic review and gain a basic understanding of how to conduct a systematic review. During this workshop participants will: • • • • •
Gain and understanding of systematic reviews and how they can inform practice; Develop skills in quickly assessing the quality of systematic reviews and interpreting their results; Gain an understanding of the steps involved in doing a systematic review; Be aware of new tools that can make the process of doing a systematic review easier and faster; Gain practical experience in some key steps.
Designing good studies and writing protocols This 2-day workshop is designed to take researchers from a research question to a complete study protocol. It is aimed at newer researchers who have a good understanding of evidence-based practice and study design, and are now ready to design their own research project. Study designs suitable to bring to this workshop include randomised trials, cohort studies (prospective or retrospective), case-control studies, and surveys. During this workshop participants will: • • • •
Learn how to develop a research question using the PICO framework; Understand the importance of choosing an appropriate study design; Be able to identify the critical elements of a good study protocol; Practice writing your own research study protocol.
Publication school: the secrets of success in writing & publishing research articles This 2-day workshop aims to develop essential writing skills to help achieve success in planning, writing, publishing, and communicating research through traditional journals and other channels. During this workshop participants will gain the skills to: • •
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Write the key sections of a research article efficiently and effectively. Use reporting guidelines such as CONSORT, PRISMA, and STROBE to guide the writing task, assist publication, and improve the impact of your research. Find the right journal and navigate different journal’s editorial processes. Respond to, and provide constructive peer review.
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Collaborations The EQUATOR Network is an international initiative that seeks to improve the reliability and value of published health research literature by promoting transparent and accurate reporting and wider use of robust reporting guidelines. In addition to helping carry out the strategic vision of the EQUATOR Network in Australia and the Asia-Pacific region, the focus of the Australasian EQUATOR Centre is on reducing waste and enhancing the value of biomedical research. equator-network.org
Wiser Healthcare is a group of collaborating researchers based in Australia. Their aim is to conduct research that will reduce overdiagnosis and overtreatment in Australia and around the world. The group has been awarded multiple grants from the National Health and Medical Council: a $2.5 million Centre for Research Excellence (CRE) 2016-2021; a $10 million Program Grant 2017-2021; and recently another $2.5 million CRE grant - Wiser Healthcare: Better value for All Australians (2022-2026). wiserhealthcare.org.au
Suppression of epidemics cannot rely solely on the hope of effective vaccines and/or medical treatment: we need a “Plan B” of effective Behavioural, Environmental, Social and Systems Interventions (BESSI) to reduce transmission. bessi-collab.net
GoldNet Research
GoldNet Research is a network of health professionals that aims to support impactful research through collaboration. The network welcomes GPs, practice managers, practice nurses, and others working in primary care to join our network. goldnetresearch.com.au
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The NHMRC Partnership Centre for Health System Sustainability brings together researchers, policy makers, providers, clinicians and consumers from across the nation to find strategies to ensure our health system delivers value based care to our citizens well into the future. We believe that an effective and efficient health system is the hallmark of a caring, well-functioning society. healthsystemsustainability.com.au
International Society for Evidence-Based Health Care. The mission of the Society for Evidence-Based Health Care is to develop, and encourage research in, the appropriate usage of evidence in health care decision making and to promote and provide professional and public education in the field. isehc.net
The Centre for Evidence-Based Medicine aims to develop, teach and promote evidence-based healthcare through a variety of methods so that all healthcare professionals can maintain the highest standards of medicine. cebm.net
This website is a place to share and exchange documentation, information, and resources on how to increase the value of both basic and applied research and reduce or avoid wasting research. rewardalliance.net
For more information, visit iebh.bond.edu.au/about-us/our-partners
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Services Our work covers a wide range of services, programs and activities that address big, neglected problems in healthcare. The Institute delivers world-class research, engagement and training and serves as a national and international resource for health system leaders, industry partners, scholars, clinicians, patients and families in the implementation of evidence-based clinical care.
Evidence reviews
Advisory services
Contract research
Accelerated systematic reviews that provide a concise summary of evidence to answer specific questions
Evidence-based practice advice to inform health service planning, reviews of guidelines and policy
Research services, including review of research proposals, conducting a wide range of study designs, and evidence reviews
Research and translation
Consumer engagement
Education
Facilitating community juries and focus groups, to help inform decisions and service planning
Tailored education services to build research capacity
Minimising low value care
Reducing over-diagnosis and overtreatment
Coaching and support services to develop and deliver research translation projects
Shared decision making Developing and testing decision aids for patients and clinicians
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Preventing unnecessary treatments, maximizing the use of non-drug interventions and deprescribing at the end of life
Reducing unnecessary screening and testing and implementing evidence-based practice
Support our work Help us to address big, neglected problems in healthcare. The Institute for Evidence-Based Healthcare welcomes supporters from the corporate and philanthropic sectors. We are grateful to the many corporations, organisations and individuals who have already generously given time, funding or other support. Your support will give us greater ability to provide services that will help people provide and receive sustainable, evidence-based healthcare and enable our research to continue to influence policy and practice. This support assists health systems to provide appropriate care that is patient-centred and where the benefits and harms are weighed up and informed by evidence. It will enable patients to make evidence-informed health decisions that are congruent with their values and preferences. You can help improve the health and healthcare of Australians and improve global health outcomes! For more information on the Institute, please visit our website: iebh.bond.edu.au or contact us via email: iebh@bond.edu.au
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The Institute for Evidence-Based Healthcare Building 5, Level 4 Bond University GoldCoast Queensland 4229 Australia Email: iebh@bond.edu.au Phone: +61 7 5595 4482 iebh.bond.edu.au
@Institute4EBH
iebh.bond.edu.au MB10404
CRICOS Provider Code 00017B TEQSA Provider ID PRV12072