Evidence-based Claims Adjudication of Traffic Injury Claims in Ontario: Shifting the Focus from Cost to Care

2020 ◽  
Vol 48 (2) ◽  
pp. 154-164
Author(s):  
Keshini Moodley ◽  
Carol Cancelliere ◽  
Robert Power ◽  
Pierre Côté
Keyword(s):  
Evidence Based Medicine ◽  
Clinical Evidence ◽  
Automobile Insurance ◽  
Evidence Based ◽  
Clinical Interventions ◽  
Insurance System ◽  
Traffic Injury ◽  
Based Medicine

Background.— In the Ontario automobile insurance system, claims adjusters decide whether to approve, partially approve or deny funding for clinical interventions submitted by healthcare practitioners. Typically, these decisions are made based on cost, without considering the evidence on the effectiveness and safety of the interventions. Objective.— Develop an evidence-based claims adjudication framework, which can be used by automobile insurers to integrate clinical evidence into claims adjudication. Method.— We adapted the evidence-based medicine framework developed by Sackett et al1 to develop a framework for evidence-based claims adjudication. Conclusion.— An evidence-based claims adjudication framework may help insurers make claim decisions that will promote recovery of individuals injured in traffic collisions and reduce claims costs. The effectiveness and implementation of the framework needs to be evaluated.

An Ontology-Driven Approach to Clinical Evidence Modelling Implementing Clinical Prediction Rules

2013 ◽  
pp. 257-284 ◽  
Author(s):  
Derek Corrigan ◽  
Lucy Hederman ◽  
Haseeb Khan ◽  
Adel Taweel ◽  
Olga Kostopoulou ◽  
...  
Keyword(s):  
Primary Care ◽  
Evidence Based Medicine ◽  
Clinical Evidence ◽  
Evidence Based ◽  
Clinical Prediction ◽  
Clinical Prediction Rules ◽  
Prediction Rules ◽  
Support Provision ◽  
Primary Care Clinicians ◽  
Based Medicine

Diagnostic error is a major threat to patient safety in the context of the primary care setting. Evidence-based medicine has been advocated as one part of a solution. The ability to effectively apply evidence-based medicine implies the use of information systems by providing efficient access to the latest peer-reviewed evidence-based information sources. A fundamental challenge in applying information technology to a diagnostic clinical domain is how to formally represent known clinical knowledge as part of an underlying evidence repository. Clinical prediction rules (CPRs) can provide the basis for a formal representation of knowledge. The TRANSFoRm project defines the architectural components required to deliver a solution by providing an ontology driven clinical evidence service to support provision of diagnostic tools, designed to be maintained and updated from electronic sources of research data, to assist primary care clinicians during the patient consultation through delivery of up to date evidence based diagnostic rules.

scholarly journals Orthopaedic Surgical Content Associated with Resources for Clinical Evidence

2014 ◽  
Vol 34 (1) ◽  
pp. 17
Author(s):  
Sarah L Turvey ◽  
Nasir Hussain ◽  
Laura Banfield ◽  
Mohit Bhandari
Keyword(s):  
Evidence Based Medicine ◽  
Clinical Evidence ◽  
Medical Literature ◽  
Evidence Based ◽  
Surgical Interventions ◽  
Surgical Practice ◽  
Large Scope ◽  
Clinical Questions ◽  
Based Medicine ◽  
Database Content

Introduction: As evidence-based medicine is increasingly being adopted in medical and surgical practice, effective processing and interpretation of medical literature is imperative. Databases presenting the contents of medical literature have been developed; however, their efficacy merits investigation. The objective of this study was to quantify surgical and orthopaedic content within five evidence-based medicine resources: DynaMed, Clinical Evidence, UpToDate, PIER, and First Consult. Methods: We abstracted surgical and orthopaedic content from UpToDate, DynaMed, PIER, First Consult, and Clinical Evidence. We defined surgical content as that which involved surgical interventions. We classified surgical content by specialty and, for orthopaedics, by subspecialty. The amount of surgical content, as measured by the number of relevant reviews, was compared with the total number of reviews in each database. Likewise, the amount of orthopaedic content, as measured by the number of relevant reviews, was compared with the total number of reviews and the total number of surgical reviews in each database. Results: Across all databases containing a total of 13268 reviews, we identified an average of 18% surgical content. Specifically, First Consult and PIER contained 28% surgical content as a percentage of the total database content. DynaMed contained 14% and Clinical Evidence 11%, whereas UpToDate contained only 9.5% surgical content. Overall, general surgery, pediatrics, and oncology were the most common specialty areas in all databases. Discussion: Our findings suggest that the limited surgical content within these large scope resources poses difficulties for physicians and surgeons seeking answers to complex clinical questions, specifically within the field of orthopaedics. This study therefore demonstrates the potential need for, and benefit of, surgery-specific or even specialty-specific tools.

EVIDENCE-BASED PRACTICE IN SPLINTING THE INJURED HAND

Hand Surgery ◽  
2002 ◽  
Vol 07 (02) ◽  
pp. 215-218 ◽  
Author(s):  
Cecilia W. P. Li-Tsang ◽  
Mary M. L. Chu
Keyword(s):  
Exponential Growth ◽  
Evidence Based Medicine ◽  
Clinical Evidence ◽  
Evidence Based Practice ◽  
Treatment Effectiveness ◽  
Daily Practice ◽  
Evidence Based ◽  
Asian Countries ◽  
Based Medicine ◽  
New Evidence

Evidence-based medicine has been practised in the early 1990s in the Western countries and its model has aroused interests in the Asian countries including Hong Kong in the late 1990s. The need for evidence-based practice was called upon by Sackett and his colleagues14–16 mainly because of the exponential growth of new evidence of treatment effectiveness. There is a great demand for clinicians to search for the best evidence and to incorporate into the daily practice so as to ensure the best quality and standard of treatment. This paper is to review the development and process of evidence-based practice in the area of hand splinting for our local clinicians. Some major problems were identified in the delivery of clinical evidence-based practice, and suggestions have been made to overcome these problems with a view in supporting its model in the local clinical field.

scholarly journals Clinical evidence: an avenue to evidence-based medicine

2010 ◽  
Vol 35 (7) ◽  
pp. 634-635 ◽  
Author(s):  
P. D. Rossdale ◽  
L.B. Jeffcott ◽  
M. A. Holmes
Keyword(s):  
Evidence Based Medicine ◽  
Clinical Evidence ◽  
Evidence Based ◽  
Based Medicine

scholarly journals Aspiração endotraqueal de adultos intubados: evidências para boas práticas

2018 ◽  
Vol 18 (6) ◽  
pp. 767 ◽  
Author(s):  
Pablo Costa Cortêz ◽  
Roberta Lins Gonçalves ◽  
Daniel Crespo Lins ◽  
Fernanda Figueirôa Sanchez ◽  
Jerônimo Correia Barbosa Neto ◽  
...  
Keyword(s):  
Evidence Based Medicine ◽  
Clinical Evidence ◽  
Cochrane Review ◽  
Cochrane Library ◽  
Evidence Based ◽  
Terapia Intensiva ◽  
Based Medicine

Introdução: A aspiração endotraqueal é o procedimento invasivo mais realizado em indivíduos intubados em unidades de terapia intensiva. Contudo, existem poucos estudos nacionais de boa qualidade metodológica sobre o assunto, não havendo no Brasil consenso da literatura e/ou padronização da técnica. Objetivos: Estabelecer recomendações baseadas em evidências científicas sobre a aspiração endotraqueal em adultos intubados. Métodos: Revisão sistemática de estudos secundários: diretrizes, guidelines e revisões sistemáticas em inglês e português, pesquisada nas bases de dados PubMed, Cochrane, Cochrane Review, Cochrane Library, Scielo Org, Scielo Brasil, PEDro, Clinical Evidence e Evidence Based Medicine. Resultados: Foram incluídos cinco artigos com classificação entre C e D pelo R-Amstar. Conclusão: A aspiração endotraqueal deve ser realizada em adultos intubados por pessoal qualificado, assepticamente, sempre que necessária. Não deve exceder 15 segundos por aspiração e nem ser realizada rotineiramente, e sim, na presença de secreções – grau de recomendação A. A sonda de aspiração deve ter um diâmetro menor que 50% do tubo endotraqueal e a hiperoxigenação com fração inspirada de oxigênio a 100% no ventilador deve ser utilizada – grau de recomendação A. A pressão de sucção não deve exceder 150 mmHg negativos – grau de recomendação B. É recomendada a aspiração subglótica, especialmente naqueles indivíduos com mais de 72 horas de ventilação mecânica invasiva – grau de recomendação A.Palavras-chave: sucção, aspiração mecânica, drenagem por sucção.

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