translating evidence into practice danny liew melbourne epicentre medical unit 1
TRANSCRIPT
Translating Evidence into Practice
Danny Liew
Melbourne EpiCentreMedical Unit 1
Application of Evidence in Practice
• education and training
• access to, and interpretation of,
evidence
• identifying and overcoming barriers
• culture change
• outcomes research: ‘practice-based
evidence’
Overview
• (the problem with) evidence-based
practice
• outcomes research
– comparative effectiveness research
– health technology assessment
Evidence-Based Practice
Efficacy vs Effectiveness
• efficacy: intervention ‘works’ in a
research (clinical trial) setting
• effectiveness: intervention ‘works’ in
the real-life setting
often a large gap
• circumscribed populations
• focus: benefit >> harm
• artificial environment
• short-term
• ?competing morbidity and
mortality
• ?costs
Clinical Trial vs Real-Life Settings
Can it work?(Efficacy)
Does it work?(Effectiveness)
Is it worth it?(Cost-Effectiveness)
Evidence generation
Evidence synthesis
Decision-making
Evidence-Based Practice
Luce BR et al. Milbank Q. 2010;88:256-76.
Can it work?(Efficacy)
Does it work?(Effectiveness)
Is it worth it?(Cost-Effectiveness)
Evidence generation
Evidence synthesis
Decision-making
Clinicalguidelines
Clinicaltrials
Clinicalpractice
Healthpolicy
Regulatoryapproval
Systematicreviews
EBP - Current View
Variousmethods
Modified from: Luce BR et al. Milbank Q. 2010;88:256-76.
Can it work?(Efficacy)
Does it work?(Effectiveness)
Is it worth it?(Cost-Effectiveness)
Evidence generation
Evidence synthesis
Decision-making
Clinicalguidelines
Clinicaltrials
Clinicalpractice
Healthpolicy
Regulatoryapproval
Systematicreviews
Comparativeeffectiveness
research
Healthtechnologyassessment
EBP - Ideal View
Epidemiology,Registries
Modified from: Luce BR et al. Milbank Q. 2010;88:256-76.
Cost data
Comparative Effectiveness Research
Aspirin for Primary Prevention in the Elderly
BMJ. doi:10.1136/bmj.38456.676806.8F (published 20 May 2005)
Aspirin for Primary Prevention in the Elderly
BMJ. doi:10.1136/bmj.38456.676806.8F (published 20 May 2005)
Aspirin for Primary Prevention in the Elderly
Health Technology Assessment
dominated
dominant
net health gain
net health loss
net positive costs
net negative costs
(cost saving)
x
incremental cost-effectiveness ratio= net cost/net health effect
Cost-Effectiveness Plane
Aspirin in At-Risk Groups
Cardiovasc Ther. 2011. doi: 10.1111/j.1755-5922.2011.00291.x.
Summary
• beyond efficacy, EBP should
encompass effectiveness and cost-
effectiveness
• ‘practice-based evidence’: 2-way
street between research and practice
• rich source of relevant data available
in hospital settings
© Copyright The University of Melbourne 2008
Aspirin for Primary Prevention
Ann Intern Med. 2002;136:161-72.
McKeon Review
total years lived
quality-adjusted life years (QALYs) lived
Summary Health Measures
current best practice
new intervention
Statins for Primary Prevention in Korea
Clin Ther. 2009;31:2919-30.
Heart Lung Circ. 2009;18:388-92.
Application of Evidence in Practice
Health Services Research
Health servicesevaluation*
Can it work?(Efficacy)
Does it work?(Effectiveness)
Is it worth it?(Cost-Effectiveness)
Evidence generation
Evidence synthesis
Decision-making
Clinicalguidelines
Clinicaltrials
Clinicalpractice
Healthpolicy
Regulatoryapproval
Systematicreviews
Comparativeeffectiveness
research
Healthtechnology
assessment*
EBP - Ideal View
Epidemiology,Registries
*Health services research = HTA + HSE + other
Modified from: Luce BR et al. Milbank Q. 2010;88:256-76.
Cost data