evidence based healthcare management

Linking Hospital Managers to the Literature: An Evidence-based Approach

ROBIN FEATHERSTONEApril 14, 2011

Your Information Seeking Behaviour

Origins of the Evidence-based Movement

• 1990s: David Sackett et al. from McMaster coined the term, Evidence-based Medicine (EBM)

• Aimed to improve the quality of information used to make decisions

• Migrated to other sectors - dentistry, nursing, management, etc.

What is Evidence-based Health Services Management (EBHSM)?

• Aids in the decision-making process • Incorporates quality evidence from the literature• Seeks to evaluate managerial strategies and

improve the performance of health services organizations

(Kovner & Rundall, 2006)

Today’s Objective

• learn to search for the best quality information to practice evidence-based decision-making in hospital management

How Questions Influence Search Results

Relevancy

Retrieval(# of search results)

Broad Questions

Narrow Questions

High = lots of articles

Low = very few articles

High = directly relevant articles

Low = mostly irrelevant articles

Guidelines for Formulating a Question

1- What management tool/technique are you thinking of using?

2- What process or outcome do you wish to achieve?

3- What is the setting?

(Kovner & Rundall, 2006)

How do interdisciplinary teams function?

What workplace conditions are necessary to support collaboration among members of interdisciplinary teams?

From Thought to Question

Exercise – 5 minutes

• In pairs, develop a narrow question based on the following topics:

1.“Transforming Care at the Bedside”

2.Patient flows

Levels of Evidence Pyramid

UNFILTERED

Level 3: Single site studies

Level 4: Descriptive studies/Case Reports

Level 5. Expert Opinion

More TimeMore WorkMore Evidence

FILTERED

Level 1: Systematic Reviews of Randomized Controlled Trials

Level 2: Multicenter/Comparative studies

Less TimeLess WorkLess Evidence

Cochrane Library - DEMO

Cochrane Reviews -Approx. 4000 full-text reviews-Therapy, prevention and diagnosis information

Other Reviews -Approx. 16,000 abstracts-International coverage-Covers effects of clinical interventions

Clinical Trials -Approx. 600,000 summaries of ongoing or completed clinical trials-International coverage

Methods Studies -Summaries of reports of methods used in clinical trials

Technology Assessments

-Abstracts of studies assessing health care technologies

Economic Evaluations

-Abstracts and brief records of studies looking at costs and effects of competing healthcare interventions

Contents

Exercise

• Search the Cochrane Library to answer the question:

What are effective methods for increasing patient participation in clinical decision

making?

Medline via PubMed - DEMO

• produced by the National Library of Medicine (U.S.)

• indexes 5,500+ journals in the health sciences

• provides references and abstracts to journal articles

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FILTERED

Using Subject Headings

• Search each concept in your question separately

• Mapping each of your concepts to a subject heading will find: – the preferred search term in the database – articles about your topic

Exercise

Find articles that discuss procedures for patient admissions from the ER

Tip: Break down the question into its separate concepts before searching.

What is the MeSH term for:

Patient admissions?

Emergency room?

Procedures?

Subheadings• Use to investigate specific aspects of

your topic

• Narrows your searche.g., Patient Admission = ~15,600 results Patient Admission/methods = ~8 results

• Frequently used subheadings for management topics: /economics, /methods, /organization & administration, /statistics & numerical data

Combining search terms

• OR related terms for an individual concept; increases your search results e.g., tertiary care hospitals OR university teaching hospitals

• AND two/more concepts together to find relevant articles; decreases your search results e.g., re-engineering of jobs AND

health care services

PubMed DEMO: Find articles that discuss procedures for patient admissions from the ER

Applying limits

• Language

• Year

• Age group

• Publication Type, etc.

Exercise

What are the costs involved to support teaching activities

in a university teaching hospital?

15 minute break

Principles of Online Searching

1. Define your question. 2. Break down the question into its separate

concepts. 3. Search each concept separately.4. Combine search terms (AND/OR).5. Apply limits.6. Evaluate your results. 7. Modify your search strategy if

necessary.

Exercise

Does organizational culture impact patient safety management?

About PubMed HSR Queries Filter

• An automated method to filter your PubMed search

• Limits your results to studies about health care quality and costs- Appropriateness of care- Process assessment- Outcome assessment- Costs- Economics- Qualitative research

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FILTERED

Applying the HSR Queries Filter to your PubMed Search

• Copy your PubMed search strategy.• Go to PubMed’s homepage.• Click on the “Topic-Specific Queries” link.• Click on the “Health Services (HSR) Queries”

link.• Paste your PubMed search strategy in the

search box.

About ProQuest DatabasesContains:

• Business references (ABI/INFORM, CBCA, Research Library)

• Company profiles (Hoover’s)

• News sources (Canadian Newstand)

• Government and Industry Reports (Canadian Research Index)

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FILTERED

ProQuest Databases – Demo

Exercise

Go to http://muhclibraries.mcgill.ca/adminguide.php . In pairs, search ProQuest Databases to answer

the questions:

1.Does the implementation of “Transforming Care at the Bedside” impact on job satisfaction?

2.Who are Sodexo, Inc.’s main competitors?

Summary

• What resources will help you to find:

Systematic Reviews of RCTs?Process assessments?Company profiles?Newspaper articles?

UNFILTERED

FILTERED

• Where would you place the following resources on the pyramid?

- PubMed- Cochrane Library- ProQuest- HSR Queries filter

Summary cont’d.

Useful References on EBHSM1. Reay T, Berta W, Kohn MK. What's the evidence on evidence-based

management? Academy of Management Perspectives. 2009;23(4):5-18.

2. Rousseau DM, McCarthy S. Educating managers from an evidence-based perspective. Academy of Management Learning & Education. 2007;6(1):84-101.

3. Kovner AR, Rundall TG. Evidence-based management reconsidered. Frontiers of Health Services Management. 2006;22(3):3-22.

4. Chan KS, Morton SC, Shekelle PG. Systematic reviews for evidence-based management: how to find them and what to do with them. American Journal of Managed Care. 2004;10(11 Pt 1):806-12.

5. Walshe K, Rundall TG. Evidence-based management: from theory to practice in health care. Milbank Quarterly. 2001;79(3):429-57.