evidence-based approach for clinical...
TRANSCRIPT
![Page 1: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/1.jpg)
Evidence-Based Approach
for
Clinical Governance
Iranian Center for EBM
Sakineh Hajebrahimi MD Professor of Urology Department Tabriz University of Medical Sciences
![Page 2: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/2.jpg)
Agenda
Evolution of medicine and evidence-based medicine (EBM)
The EBM approach and evidence-based decision making
Translating research into practice and practice into research
![Page 3: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/3.jpg)
A Scenario
![Page 4: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/4.jpg)
Patient Physician relation-
Tabriz 2012
Hadi Mostafaie et al
![Page 5: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/5.jpg)
Archie Cochrane - 1972
![Page 6: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/6.jpg)
Certainty/ Agreement
Far from certainty (effectiveness)
Close to certainty (effectiveness)
Close to agreement 1 2
Far from agreement
3 4
Try to do no harm, 15% in area 2
![Page 7: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/7.jpg)
Beware of Initial Appearances
Looking at the surface is not enough!
![Page 8: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/8.jpg)
Evaluation of Medical Care
Safety Side effects acceptable?
Efficacy Can it work?
Effectiveness Does it work?
Efficiency Is there sufficient value?
![Page 9: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/9.jpg)
Efficacy: Net benefit optimal conditions
Effectiveness: Net benefit average conditions
![Page 10: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/10.jpg)
Patients’ Safety:
Efficacy
› If taken, does the treatment have an effect?
Effectiveness
› Will the treatment have good results if offered?
› Takes into account tolerability and harmful effects
› Better external validity
![Page 11: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/11.jpg)
Patient-oriented research
![Page 12: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/12.jpg)
The two "Death Valleys" of the
clinical translational
continuum
![Page 13: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/13.jpg)
Does an intervention work?
Case reports
Clinical experience
Case series
Case control study
Cohort study
Randomised, placebo controlled clinical study
![Page 14: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/14.jpg)
Clinical Decision Making
Clinical Problem: Asymptomatic 65 yo man
“Should I have that blood test to check
for prostate cancer?”
![Page 15: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/15.jpg)
Screening for Prostate Cancer Experts recommend for
YES - You should screen with PSA test:
American Cancer Society
American College of Radiology
American Urologic Association
Local experts, incentives
![Page 16: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/16.jpg)
Screening for Prostate Cancer Experts recommend against
NO - You should not screen with PSA:
US Preventive Services Task Force
Canadian Task Force
National Cancer Institute
others (Sweden, United Kingdom, etc.)
![Page 17: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/17.jpg)
Cons of Screening Screening PSA is Unproven
No randomized trial has shown benefit
Economic costs
• every man over 50
• unnecessary follow up Dx and Tx
Psychologic and social costs
• false positives think they have cancer
• false negatives think they don‟t
„do no harm’
![Page 18: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/18.jpg)
![Page 19: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/19.jpg)
Evolution of Evidence-based Medicine
Early 20th Century
Mid-Late 20th Century
(EBM)
End of 20th Century: Health Care Costs Explode
Early 21st Century Application of EBM
![Page 20: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/20.jpg)
The Evidence-Based Approach
![Page 21: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/21.jpg)
What is evidence based
medicine?
Evidence-based medicine(EBM) is the integration of best research evidence with clinical expertise and patient values (Sackett et al 1999)
![Page 22: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/22.jpg)
A model of Evidence Based
decisions
Patient Values Clinical Expertise
Best research evidence
Decision
![Page 23: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/23.jpg)
Realisations
Daily need for valid up to date information
Inadequacy of traditional resources
Gap between clinical judgment which over time while up to date theoretical knowledge over time
Time limitation for finding evidence
![Page 24: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/24.jpg)
FIVE steps
Convert information needs into an answerable question
Find the best evidence
Appraise validity, impact and applicability
Integrate appraisal with clinical expertise
Evaluate performance
![Page 25: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/25.jpg)
Limitations*
Time.
Shortage of coherent and consistent
scientific evidence (therapeutic
nihilism).
Challenges of applying evidence to
care of individual patients.
General barriers to the practice of
quality medicine (e.g. costs, patient
expectations, etc.).
![Page 26: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/26.jpg)
Why do we need systematic
reviews of the evidence?
No-one can possibly read, or find, all the trials and all the data about all specific clinical questions
Once found, trials may appear to give conflicting or contradictory results
![Page 27: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/27.jpg)
But what about?
Qualitative research
Focus groups,
Delphi
techniques,
Interviews
Audits, surveys
etcetera
Non-research
RCTs
SRs
![Page 28: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/28.jpg)
CER, HTA and EBM Comparative effectiveness research (CER)
Absolute and relative clinical effectiveness of alternative
management strategies across patients, populations and
routine practice settings
Evidence generation and synthesis
Evidence based medicine (EBM)
Individual clinical decision making and policy and group-
focused evidence-based decision process (clinical
guidelines, reimbursement coverage decisions)
Health technology assessment (HTA)
Explicit, comprehensive assessment long-term benefit–risk
tradeoff (benefits; harms)
International Working Group for HTA Advancement. Luce BR, Drummond MF, Jonsson B, Neumann PJ, Schwartz JS, Siebert U, Sullivan SD. EBM, HTA, and CER: Clearing the Confusion. Milbank Memorial Fund Quarterly. In press.
![Page 29: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/29.jpg)
Relationships of Evidence Processes:
EBM, CER, and HTA
International Working Group for HTA Advancement. Luce BR, Drummond MF, Jonsson B, Neumann PJ, Schwartz JS, Siebert U, Sullivan SD. EBM, HTA, and CER: Clearing the Confusion. Milbank Memorial Fund Quarterly. In press.
![Page 30: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/30.jpg)
Evidence Processes
International Working Group for HTA Advancement. Luce BR, Drummond MF, Jonsson B, Neumann PJ, Schwartz JS, Siebert U, Sullivan SD. EBM, HTA, and CER: Clearing the Confusion. Milbank Memorial Fund Quarterly. In press.
![Page 31: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/31.jpg)
Evidence Assessment:
Goal
To provide a rigorous scientific basis for clinical and policy decision making to: • Optimize health outcomes • Reduce incorrect decision making and
resulting missed opportunities and harms
• Improve quality of care, patient and
population health and efficiency of health services delivery
![Page 32: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/32.jpg)
Comparative Effectiveness Research:
How will the evidence be used?
• Individual patient care
• Clinical guidelines
• Reimbursement
Outcomes of interest and quality and integrity of data analysis and interpretation may differ across uses and users
![Page 33: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/33.jpg)
![Page 34: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/34.jpg)
Now we have found some evidence. Can we apply
the evidence to this case?
Validity
Impact
applicability
![Page 35: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/35.jpg)
Relevance of evidence based
medicine to pharmacists
All areas of practice require decisions about optimal therapy (including no therapy) to improve patient outcomes
Information often comes to the pharmacist in an incomplete fashion
Pharmacists giving advice and being proactive in therapeutics need accurate information sources
![Page 36: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/36.jpg)
Some limitations of evidence
based medicine
Many questions do not have answers!
Evidence from populations - relevance to individual
Trials - not „real‟ usage
Lack of local ownership of recommendations
Clinical effectiveness vs cost effectiveness
![Page 37: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/37.jpg)
Research and Clinical Effectiveness
All clinical decisions and actions initiated by or on
behalf of the HOSPITAL should be:
• Promote and monitor clinical effectiveness
• Encourage and monitor the use of evidence based
practice
![Page 38: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/38.jpg)
Some of the steps include:
• Developing and agreeing evidence based protocols of
care
• Ensuring that the standards and guidelines are implemented throughout the HOSPITAL
• Providing training on searching for evidence is available to all staff.
• Developing systems to determine whether clinically effective practice is being implemented at grass roots level.
• Ensuring that research governance arrangements are in place
• Ensuring that evidence based prescribing is implemented
![Page 39: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/39.jpg)
Summary
Evidence based medicine is an effective tool to maximise optimal outcomes for our patients
Pharmacists need to learn how to incorporate evidence based principles in their practice
Pharmacists can contribute to local implementation of evidence based guidelines
![Page 40: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/40.jpg)
Final important steps
Apply results in practice
range of behavioural and educational interventions to facilitate culture of change
Evaluate your performance
Audit
Accreditation
Ongoing evaluation alongside innovation (compare health services research)
![Page 41: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/41.jpg)
Evidence-based . . . .
Evidence-based Medicine (EBM)
• Patient care based on evidence from the best available studies
Evidence-based Decision Making • EBM extended to include population-based decision making
in the form of guidelines and formulary decisions using formal evidence criteria and deliberative processes
Comparative Effectiveness • Subset of EBM which assesses alternative therapies
![Page 42: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/42.jpg)
Goals of Explicit,
Evidence-based Approach Credibility
Transparency
• People can understand what you did
Systematic
Reproducibility, limit bias
• Different people would get same result
Identify gaps in evidence
• Highlight where we need better evidence
Reduce the chance of “getting it wrong”
![Page 43: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/43.jpg)
Evidence Review
and Synthesis (Formulary Committee Staff,
EPCs, DERP)
Evidence-Based
Decision Making (Formulary Committee
of PBM, Private Payer,
States)
Economic
Information
Studies
Framing
Key Questions
Rigor Required
Decisions
1
Evidence
Review
2
3
Budget
Constraints
Dynamic Relationship Between Evidence
Review & Synthesis and Evidence-based
Decision Making
Acceptability
Teutsch S, Berger M, Evidence Synthesis and Evidence-based Decision Making: Related But Distinct Processes. Medical Decision Making 2005;25:487-9.
![Page 44: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/44.jpg)
The Two Faces of “TRIP”
Funding research on transferring research into practice
versus
Embedding the transfer of research into practice within the culture of universities, health care organizations and research funders
![Page 45: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/45.jpg)
Efficacy vs. Effectiveness Clinical Trials Clinical Practice
Efficacy Effectiveness
Single diagnosis High-risk patients with co-morbid conditions
Drug vs. placebo Multiple drug choices and alternatives
Exclusions of user groups e.g., elderly
Use is generally unlimited
Clinical endpoints, biomarkers
Death, disability, QoL
Genetics/biology Sociology/psychology
“Artificial” settings Real world clinics
![Page 46: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/46.jpg)
Consequences of EBM Paradigm
Basic Science
Clinical Research
EBM Literature
Synthesis
Evidence-based Guidelines
Reimbursement, Coverage
and Incentives
Comparative Effectiveness
Inform R&D Needs Relative Value (Cost Effectiveness)
Bio
med
ical
Mo
del
EB
M /
HE
CO
N
Mo
del
Po
licy
Decis
ion
s
Determine Access
to Services
Determine
Appropriate Care
Quality Improvement
Determine Outcomes
Of Care
![Page 47: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/47.jpg)
Translating Research into Practice
Study systems for quality improvement
• Organization and structure of care
• Reimbursement and incentives
• Information systems
• Community and patient engagement
• Training
![Page 48: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/48.jpg)
“In the midst of every challenge
lies opportunity”
Albert Einstein
&
“The illiterate of 21st century will not be those who cannot read and
write, but those who cannot learn, unlearn and relearn”
![Page 49: Evidence-Based Approach for Clinical Governanceircebm.tbzmed.ac.ir/uploads/89/CMS/user/file/191/seminars/clinical... · Evidence-Based Approach for Clinical Governance Iranian Center](https://reader031.vdocuments.mx/reader031/viewer/2022031412/5c65f6c309d3f252168b9fbe/html5/thumbnails/49.jpg)
Thanks