Evidence-based practice is having an impact on healthcare but “we still have robust evidence for only a relatively small proportion of what we do,” says David W. Bates, MD, MSc, chief quality officer and senior vice president of Brigham and Women’s Hospital and medical director of clinical and quality analysis for Partners HealthCare in Boston.
Healthcare also is struggling to push evidence to the variety of caregivers involved in a patient’s care. Bates is leading a discussion on Leveraging Evidence Across the Care Continuum this fall at the Healthcare Leadership Forum in Chicago along with Patricia Flatley Brennan, RN, PhD, the Lillian L. Moehlman Bascom Professor at the University of Wisconsin-Madison School of Nursing and College of Engineering and national program director of the Project HealthDesign. The conference is sponsored by Clinical Innovation + Technology and Elsevier Clinical Solutions.
Studies show that how organizations approach evidence-based practice plays a big role in how well it’s accepted by practitioners. Bates mentions a study which is not yet published but was presented at a recent meeting.
Researchers took three different behavioral approaches to getting people to practice medicine in an evidence-based way. The study focused on methods of preventing clinicians from prescribing antibiotics for acute respiratory infection because the evidence indicates it is not warranted. There was a strict approach that directed users not to prescribe the medication; an approach that compared users to their peers; and the third made it clear in the record that the user was prescribing the medication despite the evidence against it.
“The second two approaches appeared much more effective than the first one,” says Bates, “so it’s very important how you work on influencing people in addition to having the evidence.”
Evidence-based practice also is moving beyond the walls of practices and hospitals. “Evidence-based medicine is everywhere.” says Brennan.
Healthcare Leadership Forum: Leveraging Evidence Across the Care Continuum |
| HealthcareLeadershipForum.net Sept. 29−30, 2014 | Chicago |
Co-chairs:
The multidisciplinary conference, Leveraging Evidence Across the Care Continuum, will address the increase in patient-generated data and how it’s impacting evidence-based practice and evidence-based medicine. Traditionally, “the way we identify and generate evidence is all from the perspective of professionals,” says Brennan. What the provider needs to know about procedures and treatments is important but it’s not enough. Data from personal trackers and apps “give us a window into patients’ everyday lives,” says Brennan. That new source of evidence can serve as a bridge between the patient experience and professional knowledge, she says. Going forward, healthcare will see a great deal more patient-generated data, says Bates, which is having “a huge impact on helping us assess what’s working and what’s not and which approaches work better than others.” Providers have been reluctant to even accept these data, he adds, but they “are going to have to become comfortable with both accepting and using the information.” |
Patient impact
Work completed through Project HealthDesign, a national program of the Robert Wood Johnson Foundation designed to spark innovation in personal health technology, found that professional terms are only one part of the story, says Brennan. “When you give someone the technologies to support their self-care, it’s not enough to give them a way to see EHRs. You also have to track the care between care.” Information about health and wellness between office visits “is really very rich.”
Brennan cites a study conducted in Richmond, Va., which found that when people with asthma tracked their peak flows and use of their rescue inhalers, they learned a lot about their condition between visits that they never saw before. In some cases, the rescue inhaler wasn’t helping. In another, a patient was diagnosed with a completely different disease. Some patients confused their rescue and maintenance inhalers so neither worked correctly. “Patterns in everyday behavior actually help us give better professional care,” she notes.
Conference speakers will address how incorporating patient-generated data impacts workflow. “Simply tracking information from people and having them record it requires other changes,” says Brennan. Someone has to look at all the data which “makes people nervous because what if they miss something?”
To address that concern, she said a doctor created a dashboard job which is responsible for looking at the previous day’s reports to see what needs attention. That organization also changed its policies to establish what to do when certain patterns are detected.
Easing the Load
Care coordination is another hot topic, particularly how electronic tools can provide support. “We’ve found so far that many leading organizations doing a better job with care coordination are doing so with a lot of heavy lifting as opposed to using really cutting edge tools to enable communications and decrease the voltage drop that occurs when someone makes a transition,” says Bates.
Patients are particularly vulnerable during transitions of care and there are opportunities to do better, he adds.
The conference offers a robust platform for discussing these and other issues that will benefit from the experience and expertise of both speakers and attendees. Won’t you join us?
Editor
Editor Beth earned a bachelor’s degree in journalism and master’s in health communication. She has worked in hospital, academic and publishing settings over the past 20 years. Beth joined TriMed in 2005, as editor of CMIO and Clinical Innovation + Technology. When not covering all things related to health IT, she spends time with her husband and three children.