evidence based healthcare management
TRANSCRIPT
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
UNFILTERED
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
UNFILTERED
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)
UNFILTERED
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.