the first international conference for evidence-based healthcare

The First International Conference for Evidence-based Healthcare

First International Conference on

Evidence-based healthcareThe Inaugural Conference of the

International Society of Evidence-based Health Care

India International Centre, New DelhiWorkshops: 6 October 2012

(Pre-Conference workshops on topics related to EBHC)

Conference: 7-8 October 2012www.isehcon2012.com

Who should attend?

• Physicians, nurses, pharmacists, chiropractors, naturopaths, involved in the implementation of evidence including frontline healthcare professionals

• Educators involved in teaching and training in evidence based healthcare

Speakers

• Kameshwar Prasad, Paul Glasziou, Gordon Guyatt, Luz Letelier, Victor Montori

www.isehcon2012.com

The second principle of evidence-based medicine

changes everythingVictor M. Montori, MD, MSc

Professor of MedicineKER UNIT - Mayo Clinic

montori.victor@mayo.edu @vmontori

DisclosuresDisclosures

Relevant Financial RelationshipsRelevant Financial RelationshipsNoneNone

Off Label UsageOff Label UsageNoneNone

Relevant Financial RelationshipsRelevant Financial RelationshipsNoneNone

Off Label UsageOff Label UsageNoneNone

Our confidence in estimates of risk and benefit

from the body of evidence

contributes to

our confidence in making decisions.

Our confidence in estimates of risk and benefit

from the body of evidence

contributes to

our confidence in making decisions.

Confidence in the estimates of risk and benefit

Bias

Imprecision

Inconsistency

Indirectness

Biased reporting

Our confidence in estimates of risk and benefit

from the body of evidence

contributes to

our confidence in making decisions.

body of evidence

Trelle et al. BMJ 2011;342:c7086

Our confidence in estimates of risk and benefit

from the body of evidence

contributes to

our confidence in making decisions.

Appropriate care

Care < Need

Underuse

Appropriate care

Glasziou and Haynes ACP JC 2005

Care > NeedCare < Need

Underuse Overuse

Appropriate care

Geographic variation in overuse

Variation in overuse by procedure (n=172)Preventive services

PSA 16-36%Urinalysis 37%

Follow-up colonoscopy: 61%Pap smear: 58%

Korenstein D, et al. Arch Intern Med 2012: 172: 171-8

Shah ND et al. NEJM 2012

Sources of waste and their projected growth to 2020

Berwick, D. M. et al. JAMA 2012;307:1513-1516

Care > NeedCare < Need

Underuse Overuse

Appropriate care

Guidelines

Every patient with diabetes is a ‘coronary heart disease risk equivalent’

Every patient with diabetes should take a statin and achieve LDL < 100 mg/dL

ATP III, 2004

Minnesota Community Measurement

Weymiller et al. Arch Intern Med 2007

Weymiller et al. Arch Intern Med 2007

Weymiller et al. Arch Intern Med 2007

>90% <20%~50%

% who opted for treatment

% who should take statins based on ATP III

>90% >90%>90%

The evidence alone is never sufficient to make a decision.

Context and patient values, preferences and goals should be considered.

Encounter Research

Care > NeedCare < Need

Underuse Overuse

Appropriate care

Care > WantCare < Want

Undertreatment Overtreatment

Desirablecare

A survey of 627 US primary care clinicians

Sirovich BE et al. Arch Intern Med 2011

50% of my patients get too much care

50% of primary care docs are too aggressive60% of specialists are too aggressive

35% practice much more aggressively than what they would like

Weymiller et al. Arch Intern Med 2007

Statin Choice

Statin Decision Aid

Web-based tool

34

Mullan et al Arch Intern Med 2009

55

DiabetesHypertension

High cholesterol

DepressionBad back

Can’t sleep

Obese

A1c 8.2%LDL high

HCTZBeta-blocker

MetforminGlipizide

Neuropathy

108 kg

Pain

Endocrinologist

Podiatrist

Dietitian

Dizzy

Take off workGet a ride

Take pills

Check sugars

Avoid salt, fats, carbs

Exercise

Check his feet

3 2 1Numbers don’t add up

Deadline is nowtake work home

perform!

Daughter back at home2 beautiful girls

Wasted!

mortgagedebt

insurance

Care > NeedCare < Need

Underuse Overuse

Appropriate care

Care > WantCare < Want

Undertreatment Overtreatment

Desirablecare

Care > CanCare < Can

Undertreatment Overtreatment

Feasiblecare

WORKLOAD

CAPACITY

Encounter Research

NEED

WANT

CAN

APPROPRIATE

DESIRABLE

FEASIBLE

http://shareddecisions.mayoclinic.org

http://minimallydisruptivemedicine.org

Needhttp://www.gradeworkinggroup.org

Want

Can

7th International Shared Decision Making Conference

Lima, Perú - June 16-19 2013

www.isdm2013.org

Our confidence in the research contributes to

our confidence in making decisions.The evidence alone is never sufficient

to make a decision.