Opening Session at NYAM 2010

TEACHING EVIDENCE ASSIMILATION FOR COLLABORATIVE HEALTH CARE

PROGRAM- August 11, 2010 8:00am

Morning Plenaries

9:00am 9:45am 10:00am 11:30am

Seminar I BREAK Small Group Session LUNCH

12:30 pm

Afternoon Plenaries

Peter Wyer MD Suzana Alves Silva MD MSc

Jo Ivey Boufford MD Sharon Straus MD MSc Rita Charon MD PhD

2:00 pm 3:00pm 3:15 pm 5:00 pm

Seminar II BREAK Small Group Session OPENING RECEPTION

TEACHING EVIDENCE ASSIMILATION FOR COLLABORATIVE HEALTHCARE

ACKNOWLEDGEMENTS SEBHC TEAM David Adinaro Saadia Akhtar * Abe Bornstein Barney Eskin * Louise Falzon Pat Gallagher TJ Jirasevijinda Eddy Lang* Barbara Lock* Stewart Wright* Pattie Mongelia Suzana Alves Silva* Judy Stribling* Stewart Wright*

INTERNATIONAL PLANNERS* Elie Akl Nancy Santesso Holger Schunemann Sharon Straus

NYAM TEAM Amy Kline Rick Ziehler* Tawana Wright

TEACHING EVIDENCE ASSIMILATION FOR COLLABORATIVE HEALTHCARE

SPONSORSHIP Funding for this conference is made possible [in part] by Grant No. 1R13HS018607-01 from the Agency for Healthcare Research and Quality (AHRQ). The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

TEACHING EVIDENCE ASSIMILATION FOR COLLABORATIVE HEALTHCARE

DISCLOSURES No Financial Disclosures Declared

TEACHING EVIDENCE ASSIMILATION • GRADE: Health Care Recommendations

• Policy

• Knowledge Translation • Adaptation/implementation • Individualized Care

• Delivery

WHY TEACH?

Traditional Training in EBM Doesn’t Work

Background:

Evidence-based Individualized Care • • • •

SR of effectiveness of EBM teaching to post-graduates 28 controlled studies; 5 involved integrated teaching Behavior change assessed via self-report Only integrated teaching affected skills, attitude or behavior • Validity of studies involving integrated teaching challengeable • BOTTOM LINE: evidence nil that traditional approaches to teaching evidence-based medicine affect behavior or patient care Coomarasamy A, et al BMJ 2004;329:1017

Background: Evidence-based Individualized Care

EBM Teaching at NYAM

• Practice based approach • Emphasis on initiation skills • Pilot study 2004-2006: graduates unable to derive a need for research evidence from a clinical encounter

Wyer P, et al Adv Health Sci Educ 2009;14:515

Background: Evidence-based Individualized Care

What is Practice Based Learning?

• Stemmler Fund Project 2006-2008 • Define and Assess Practice-Based Learning and Improvement Cognitive Skills (ACGME) • Clinical action first, information literacy second Chatterji M, et al J Grad Med Educ 2009;1:287

Policy Adaptation, Implementation: The New Frontier

• 2007 KT for EM Conference • Systems based care and clinical evidence • Cross specialty, multidisciplinary collaboration

Lang E, et al . Acad Emerg Med 2010;17:865

Dimensions of Evidence Based Care • “Evidence Based Guidelines” • “Evidence Based Individual Decision Making”

Eddy D. Health Affairs 2005;24:9

The Bridge • The Wright model • Evidence-informed QI linked to education • Multifaceted ED based care pathways in designated clinical areas • Systematically drew on clinical evidence Wright et al . Ann Emerg Med 2008;51:80

TEACH New York

Conferences

Home Centers

Care Initiatives Educational Initiatives

Active TEACH Projects • NYC: The Allen Hospital (Heart failure) • N Brunswick CA: St John’s Regional (Heart failure) • Grand Rapids: Spectrum Healch/U Michigan – Y1 Imaging for TIA – Y2 Acute brain ischemia in rural affiliates

• St Lukes Health Care System-Kansas City – Avoid unnecessary catheterization – Pre-op MRSA screening

• NYC: Brooklyn Hospital (Sepsis)

Design for Synergy • Preparation-Plenary-Seminar-Small Group • Seminars – Day 1: Track specific activity – Day 2: Cross track content sharing

• Day 3: Reportage

Teaching

• • • • •

Evidence Assimilation

‘Evidence-Informed Quality Improvement ‘Evidence-Informed‘ Individualized Care ‘Problematization’ The Narrative Dimension The Meaning of Effectiveness