evidence-based healthcare (ebhc) and best...
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Evidence-Based HealthCare (EBHC) and Best Practices
Communication. Collaboration. Learning.
Conflict of Interest
Jerry Stonemetz, MD
Vice Chairman; Anesthesia & Critical Care Medicine
Johns Hopkins University
Founder and Chief Medical Information Officer for ShareSafe; have minority stake ownership
Will be discussing use of ShareSafe Social Media product
Evidence-Based Medicine
Decision
Clinical Expertise
Patient Values
Current Best
Evidence
Systematic approach:
• Lifelong self-directed learning
• Caring for patients triggers need
for important research-based
information about:
• Clinical issues
• Other healthcare issues
Dawes M, et al. Sicily statement on evidence-based practice. BMC Med Educ 5: 1 (2005) doi: 10.1186/1472-6920-5-1
Sackett D. Clinical epidemiology: what, who, and whither. J Clin Epidemiol 55: 1161–1166 (2002) doi: 10.1016/s0895-4356(02)00521
Research 15 Years Practice
Agency for Healthcare Research and Quality
Translating Research Into Practice
Conceptual Model of Evidence-based Decision Making in GPs
Sandra Zwolsman et al. Br J Gen Pract (2012);62:e511-e521. Adapted from:
Clinical problem
EBH steps
Experience, expertise
Education
Evidence
Physician’s preferences
Patient’s preferences
Decision
Sackett DL, Rosenberg WM, Gray JA, et al. Evidence based medicine: what it is and what it isn’t.
BMJ 312(7023):71–72 (1996).
Offringa M, Assendelft WJJ, Scholten RJPM. Introduction to evidence-based medicine.
Clinical treatment based on evidence. 3rd edn. Houten: Bohn Stafleu van Loghum (2010)
EBHC Competencies
Young T et al. What Are the Effects of Teaching Evidence-Based Health Care (EBHC)? Overview of Systematic Reviews. PLoS ONE 9(1): e86706. doi:10.1371/journal.pone.0086706 (2014)
Disseminating Evidence-Based Practices
Strategy 1 Highlight evidence base and relative simplicity of recommended practices.
Strategy 2 Align the campaign with the strategic goals of the adopting organizations.
Strategy 3 Increase recruitment by integrating opinion leaders into the enrollment process and employing a nodal organizational structure.
Strategy 4 Form a coalition of credible campaign sponsors.
Strategy 5 Generate a threshold of participating organizations that maximizes network exchanges.
Strategy 6 Develop practical implementation tools and guides for key stakeholder groups.
Strategy 7 Create networks to foster learning opportunities.
Strategy 8 Incorporate monitoring and evaluation of milestones and goals.
Bradley EH et al. Blueprint of effective strategies in the dissemination of evidence-based practices through a National Quality Campaign strategy.
The Commonwealth Fund 1399, Vol 86 (2010)
Best Practice in Healthcare
Practice not yet backed by rigorous research
May be local…hospital determines a particular practice has resulted in improved outcomes for its patient population
An imprecise and moving target Rapidly changing knowledge
Disagreement over the efficacy of recommended practices
Difficulty adjusting to new clinical, organizational and interpersonal routines
The need to modify practices to be context appropriate
Barriers to Implementation of EBHC and Best Practices
Communication
Collaboration
Learning
Metrics
Social Media in Healthcare
Patient engagement Education; obtaining information; disease networks
Healthcare Communities Fundraising; Customer Support; advertising new services
Physicians Online communities for discussing patient care issues; new research; updated clinical practices
Househ M. Social media in healthcare. Stud Health Technol Inform; 183: 244-8 (2013).
Mayo Clinic
Considered to have greatest use of Social Media
Created Mayo Clinic Center for Social Media
Has support from executive leadership
Currently less than 26% of all hospitals use Social Media
Pennic J. 5 reasons why Mayo Clinic dominates social media in healthcare. 2014. http://hitconsultant.net/2014/02/17/5-reasons-mayo-clinic-dominates-social-media-in-healthcare/
McKinsey Global Institute
Twice as much potential value lies in using social tools
to enhance communications, knowledge sharing, and
collaboration within and across enterprises.
Estimates suggest that by fully implementing social
technologies, companies have an opportunity to raise
the productivity of interaction workers—high-skill
knowledge workers, including managers and
professionals—by 20 to 25 percent.
Chui M et al. The social economy: Unlocking value and productivity through social technologies. McKinsey Global Institute 2012. http://www.mckinsey.com/insights/high_tech_telecoms_internet/the_social_economy
HCA – Medical Director, Anesthesia Services
172 hospitals; 122 surgical centers
> 2000 anesthesiologists/CRNAs
No method of common communication
Quandary – dissemination of ‘Best Practices’
Solution: ShareSafe
Johns Hopkins ACCM: Two Communities
Hospital Enterprise
“ShareSafe has changed the way we communicate. It has increased my productivity by 30 – 40%.”
Paul Read, RN, MSN CNO, Springhill Medical Center
(Mobile, AL)
HIPAA-secure communication
Private Discussion Groups
Creating the vision
Instantaneous Learning
Documentation Compliance: Best Practices
Concurrent Analytics : Engagement : Learning Status : Compliance