Optimising real time clinical librarian support to enhance the evidence base in radiotherapy clinical protocols

Clinical teams are professionally driven to adopt the latest evidence-based care ensuring optimal outcomes for patients. There can be delays in the latest evidence reaching practice. The radiotherapy multi-professional team in partnership with Clinical Librarians developed a lean process to undertake the real-time evidence-based live update of clinical radiotherapy protocols. Principles of Quality Function Deployment were deployed to create a lean process. The process was evaluated for the percentage difference to the radiotherapy protocol parameters over two years. Satisfaction of the live update was scored from 1: Very dissatisfied to 5: Very satisfied. Since 2014, 12 protocols have been through the process. The live update resulted in 80% of differences to the clinical protocol compared to the previous two years. Among 10 respondents, a mode of 5 was scored for satisfaction. This novel approach has been successful in providing a lean process ensuring that the latest evidence reaches radiotherapy practice.

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Alternative medicine under the Mental Health Care Act, 2017: Future implications and concerns

Indian Journal of Medical Ethics ◽

10.20529/ijme.2022.004 ◽

2022 ◽

Vol 07 (01) ◽

pp. 37-41

Author(s):

Ramdas Ransing ◽

Sujita Kumar Kar ◽

Vikas Menon

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Alternative Medicine ◽

Mental Healthcare ◽

Evidence Base ◽

Evidence Based ◽

Insufficient Evidence ◽

Indian Government ◽

Evidence Based Care

In recent years, the Indian government has been promoting healthcare with an insufficient evidence base, or which is non-evidence-based, alongside delivery of evidence-based care by untrained practitioners, through supportive legislation and guidelines. The Mental Health Care Act, 2017, is a unique example of a law endorsing such practices. In this paper, we aim to highlight the positive and negative implications of such practices for the delivery of good quality mental healthcare in India.

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Transgender adolescents and genital-alignment surgery: Is age restriction justified?

Clinical Ethics ◽

10.1177/1477750919845087 ◽

2019 ◽

Vol 14 (2) ◽

pp. 94-103

Author(s):

Edmund Horowicz

Keyword(s):

Young People ◽

Clinical Guidelines ◽

Gender Dysphoria ◽

Evidence Base ◽

Cultural Norms ◽

Evidence Based ◽

Professional Issues ◽

Standards Of Evidence ◽

Current Concerns ◽

Evidence Based Care

In the case of controversial interventions there is a need for clinical guidelines to be founded on ‘expert opinion’ and an evidence base, in order to minimise individual clinicians making subjective decisions influenced by bias or cultural norms. This paper considers international clinical guidelines that through recommendation effectively prohibit the provision of genital-alignment surgery for competent adolescents with gender dysphoria. I argue that although the rationale for this particular guideline is based on serious concerns, these need to be better understood to allow reconsideration of this unilateral prohibitive recommendation. I do not propose that genital-alignment surgery should be prima-facia provided for any adolescent with gender dysphoria. Instead I argue that by developing our understanding of the current concerns, we can allow guidelines to incorporate a margin of clinical discretion, to allow clinicians to provide genital-alignment surgery to some adolescents, where clinically appropriate. In facilitating this we can move towards establishing a solid evidence-base. The basis of this position is that clinical guidelines and medical practice should treat these young people with the same standards of evidence-based care as others who have less controversial conditions. Whilst this paper uses English law and UK professional regulation for context, many of the ethical, legal and professional issues highlighted are applicable to other jurisdictions.

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Measuring and Improving Evidence-Based Patient Care Using a Web-Based Gamified Approach in Primary Care (QualityIQ): Randomized Controlled Trial (Preprint)

10.2196/preprints.31042 ◽

2021 ◽

Author(s):

Trever Burgon ◽

Linda Casebeer ◽

Holly Aasen ◽

Czarlota Valdenor ◽

Diana Tamondong-Lachica ◽

...

Keyword(s):

Primary Care ◽

Real Time ◽

Primary Care Physicians ◽

Primary Care Providers ◽

The United States ◽

Physician Satisfaction ◽

Evidence Based ◽

Clinical Decisions ◽

Care Providers ◽

Evidence Based Care

BACKGROUND Unwarranted variability in clinical practice is a challenging problem in practice today, leading to poor outcomes for patients and low-value care for providers, payers, and patients. OBJECTIVE In this study, we introduced a novel tool, QualityIQ, and determined the extent to which it helps primary care physicians to align care decisions with the latest best practices included in the Merit-Based Incentive Payment System (MIPS). METHODS We developed the fully automated QualityIQ patient simulation platform with real-time evidence-based feedback and gamified peer benchmarking. Each case included workup, diagnosis, and management questions with explicit evidence-based scoring criteria. We recruited practicing primary care physicians across the United States into the study via the web and conducted a cross-sectional study of clinical decisions among a national sample of primary care physicians, randomized to continuing medical education (CME) and non-CME study arms. Physicians “cared” for 8 weekly cases that covered typical primary care scenarios. We measured participation rates, changes in quality scores (including MIPS scores), self-reported practice change, and physician satisfaction with the tool. The primary outcomes for this study were evidence-based care scores within each case, adherence to MIPS measures, and variation in clinical decision-making among the primary care providers caring for the same patient. RESULTS We found strong, scalable engagement with the tool, with 75% of participants (61 non-CME and 59 CME) completing at least 6 of 8 total cases. We saw significant improvement in evidence-based clinical decisions across multiple conditions, such as diabetes (+8.3%, P<.001) and osteoarthritis (+7.6%, P=.003) and with MIPS-related quality measures, such as diabetes eye examinations (+22%, P<.001), depression screening (+11%, P<.001), and asthma medications (+33%, P<.001). Although the CME availability did not increase enrollment in the study, participants who were offered CME credits were more likely to complete at least 6 of the 8 cases. CONCLUSIONS Although CME availability did not prove to be important, the short, clinically detailed case simulations with real-time feedback and gamified peer benchmarking did lead to significant improvements in evidence-based care decisions among all practicing physicians. CLINICALTRIAL ClinicalTrials.gov NCT03800901; https://clinicaltrials.gov/ct2/show/NCT03800901

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Measuring and Improving Evidence-Based Patient Care Using a Web-Based Gamified Approach in Primary Care (QualityIQ): Randomized Controlled Trial

Journal of Medical Internet Research ◽

10.2196/31042 ◽

2021 ◽

Vol 23 (12) ◽

pp. e31042

Author(s):

Trever Burgon ◽

Linda Casebeer ◽

Holly Aasen ◽

Czarlota Valdenor ◽

Diana Tamondong-Lachica ◽

...

Keyword(s):

Primary Care ◽

Real Time ◽

Primary Care Physicians ◽

Primary Care Providers ◽

The United States ◽

Physician Satisfaction ◽

Evidence Based ◽

Clinical Decisions ◽

Care Providers ◽

Evidence Based Care

Background Unwarranted variability in clinical practice is a challenging problem in practice today, leading to poor outcomes for patients and low-value care for providers, payers, and patients. Objective In this study, we introduced a novel tool, QualityIQ, and determined the extent to which it helps primary care physicians to align care decisions with the latest best practices included in the Merit-Based Incentive Payment System (MIPS). Methods We developed the fully automated QualityIQ patient simulation platform with real-time evidence-based feedback and gamified peer benchmarking. Each case included workup, diagnosis, and management questions with explicit evidence-based scoring criteria. We recruited practicing primary care physicians across the United States into the study via the web and conducted a cross-sectional study of clinical decisions among a national sample of primary care physicians, randomized to continuing medical education (CME) and non-CME study arms. Physicians “cared” for 8 weekly cases that covered typical primary care scenarios. We measured participation rates, changes in quality scores (including MIPS scores), self-reported practice change, and physician satisfaction with the tool. The primary outcomes for this study were evidence-based care scores within each case, adherence to MIPS measures, and variation in clinical decision-making among the primary care providers caring for the same patient. Results We found strong, scalable engagement with the tool, with 75% of participants (61 non-CME and 59 CME) completing at least 6 of 8 total cases. We saw significant improvement in evidence-based clinical decisions across multiple conditions, such as diabetes (+8.3%, P<.001) and osteoarthritis (+7.6%, P=.003) and with MIPS-related quality measures, such as diabetes eye examinations (+22%, P<.001), depression screening (+11%, P<.001), and asthma medications (+33%, P<.001). Although the CME availability did not increase enrollment in the study, participants who were offered CME credits were more likely to complete at least 6 of the 8 cases. Conclusions Although CME availability did not prove to be important, the short, clinically detailed case simulations with real-time feedback and gamified peer benchmarking did lead to significant improvements in evidence-based care decisions among all practicing physicians. Trial Registration ClinicalTrials.gov NCT03800901; https://clinicaltrials.gov/ct2/show/NCT03800901

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Enhanced surgical recovery programmes in the ICU

10.1093/med/9780199600830.003.0364 ◽

2016 ◽

Author(s):

Michael J. Scott ◽

Monty Mythen

Keyword(s):

Enhanced Recovery ◽

Surgical Stress ◽

Evidence Based ◽

Local Policy ◽

Key Factors ◽

Optimal Outcomes ◽

Early Return ◽

Enteral Diet ◽

Goal Directed Fluid Therapy ◽

Evidence Based Care

Enhanced recovery programmes (ERPs) are evidence-based care pathways starting from the point of patient referral right through the peri-operative period until discharge home. The ERP aims to reduce surgical stress and enhance post-operative physiological function with resulting early return of enteral diet and mobilization to improve outcomes. There are 20 evidence-based elements, many of which are delivered by a multidisciplinary team. Many elements support a treatment intervention, but some aim to avoid an intervention, which can negatively impact on recovery. An ERP with good compliance has been shown to reduce length of stay and medical complications. Minimal access surgery, high quality analgesia, and goal-directed fluid therapy are key factors ensuring optimal outcomes. There has been successful adoption and transfer of enhanced recovery principles into many surgical specialties. There is wide variation in the use of critical care within ERPs depending on local policy and patient risk factors.

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Informatics, evidence-based care, and research; implications for national policy: a report of an American Medical Informatics Association health policy conference

Journal of the American Medical Informatics Association ◽

10.1136/jamia.2009.001370 ◽

2010 ◽

Vol 17 (2) ◽

pp. 115-123 ◽

Cited By ~ 32

Author(s):

Meryl Bloomrosen ◽

Don E Detmer

Keyword(s):

Health Policy ◽

American Medical ◽

Medical Informatics ◽

Health Informatics ◽

National Policy ◽

Evidence Base ◽

Evidence Based ◽

Health Records ◽

American Medical Informatics Association ◽

Evidence Based Care

Abstract There is an increased level of activity in the biomedical and health informatics world (e-prescribing, electronic health records, personal health records) that, in the near future, will yield a wealth of available data that we can exploit meaningfully to strengthen knowledge building and evidence creation, and ultimately improve clinical and preventive care. The American Medical Informatics Association (AMIA) 2008 Health Policy Conference was convened to focus and propel discussions about informatics-enabled evidence-based care, clinical research, and knowledge management. Conference participants explored the potential of informatics tools and technologies to improve the evidence base on which providers and patients can draw to diagnose and treat health problems. The paper presents a model of an evidence continuum that is dynamic, collaborative, and powered by health informatics technologies. The conference's findings are described, and recommendations on terminology harmonization, facilitation of the evidence continuum in a “wired” world, development and dissemination of clinical practice guidelines and other knowledge support strategies, and the role of diverse stakeholders in the generation and adoption of evidence are presented.

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