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Sharaf RN, Khullar D, Umscheid CA. Health Technology Assessment Centers-an Infrastructure for Health Systems to Translate Evidence into Practice. J Gen Intern Med 2020; 35:1296-1299. [PMID: 31900729 PMCID: PMC7174520 DOI: 10.1007/s11606-019-05534-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Ravi N Sharaf
- Division of Gastroenterology, Department of Medicine, Department of Healthcare Policy and Research, Jay Monahan Center for Gastrointestinal Health, Weill Cornell Medical Cancer, 1315 York Avenue Ground Floor, New York, NY, 10021, USA.
| | - Dhruv Khullar
- Department of Healthcare Policy & Research, Department of Medicine, Weill Cornell Medical College, 402 E 67th St, New York, NY, 10065, USA
| | - Craig A Umscheid
- University of Chicago Medicine and Biological Sciences, American School Building, 850 E. 58th Street, Suite 123, Office 128, MC 1135, Chicago, IL, 60637, USA
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Lavenberg JG, Cacchione PZ, Jayakumar KL, Leas BF, Mitchell MD, Mull NK, Umscheid CA. Impact of a Hospital Evidence-Based Practice Center (EPC) on Nursing Policy and Practice. Worldviews Evid Based Nurs 2019; 16:4-11. [PMID: 30714308 DOI: 10.1111/wvn.12346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND In 2006, our healthcare system created a hospital Evidence-based Practice Center (EPC) to support the local delivery of high-quality, safe and high value patient care. Since then, the importance of healthcare staff work life has also been highlighted, and together these four elements form the Quadruple Aim framework. Synergistic to this Aim, the Magnet® program promotes and recognizes organizational nursing excellence. OBJECTIVE To examine the EPC's work to inform nursing policy and practice in support of the goals of the Quadruple Aim framework and Magnet® designation. METHODS Methods used included the following: (1) descriptive analysis of the hospital EPC's database of rapid reviews; and (2) administration of a 40-item electronic questionnaire to nurses who requested an EPC review during fiscal years (FY) 2015 and 2016. RESULTS Of 308 rapid reviews completed in the EPC's first 10 years, 59 (19%) addressed nursing topics. The proportion of reviews relevant to nursing increased from 5% (2/39) in the center's first 2 years to 44% (25/60) in FY 2015-2016. The majority of nursing reviews (39/59) examined processes of care. Of 23 nurses eligible to participate in the survey, 21 responded (91%). Nurses with administrative or managerial responsibilities requested 70% of reviews; clinical nurse specialists and bedside nurses requested 17% and 9%, respectively. Reviews were used to support clinical program development (48%), provide clinical guidance (33%), update nursing policies or procedures (24%) and develop training and curricula (24%). Nurses were satisfied with the hospital EPC reviews (mean; 4.7/5), and 95% indicated they were likely to request a future review. LINKING EVIDENCE TO ACTION A dedicated hospital EPC in partnership with nursing offers a unique mechanism for promoting a culture of evidence-based practice. Nurses at all organizational levels use the services of a hospital EPC to inform nursing policy and practice and are highly satisfied with the process, supporting the Quadruple Aim and Magnet® designation.
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Affiliation(s)
- Julia G Lavenberg
- Penn Medicine Center for Evidence-based Practice, Philadelphia, PA, USA
| | - Pamela Z Cacchione
- Penn Presbyterian Medical Center, Associate Professor of Geropsychiatric Nursing, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Brian F Leas
- Penn Medicine Center for Evidence-based Practice, Philadelphia, PA, USA
| | | | - Nikhil K Mull
- Penn Medicine Center for Evidence-based Practice, Assistant Professor of Clinical Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Craig A Umscheid
- Penn Medicine Center for Evidence-based Practice, Vice Chair, Quality and Safety, Department of Medicine, Associate Professor of Medicine and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Guth RM, Herring AA, Merz LR. Implementation of an Evidence-Based Care Program Within a Multihospital Health Care System. Am J Med Qual 2018; 34:144-151. [DOI: 10.1177/1062860618789360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Hartling L, Guise JM, Hempel S, Featherstone R, Mitchell MD, Motu'apuaka ML, Robinson KA, Schoelles K, Totten A, Whitlock E, Wilt TJ, Anderson J, Berliner E, Gozu A, Kato E, Paynter R, Umscheid CA. Fit for purpose: perspectives on rapid reviews from end-user interviews. Syst Rev 2017; 6:32. [PMID: 28212677 PMCID: PMC5316162 DOI: 10.1186/s13643-017-0425-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 02/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing demand for rapid reviews and timely evidence synthesis. The goal of this project was to understand end-user perspectives on the utility and limitations of rapid products including evidence inventories, rapid responses, and rapid reviews. METHODS Interviews were conducted with key informants representing: guideline developers (n = 3), health care providers/health system organizations (n = 3), research funders (n = 1), and payers/health insurers (n = 1). We elicited perspectives on important characteristics of systematic reviews, acceptable methods to streamline reviews, and uses of rapid products. We analyzed content of the interview transcripts and identified themes and subthemes. RESULTS Key informants identified the following as critical features of evidence reviews: (1) originating from a reliable source (i.e., conducted by experienced reviewers from an established research organization), (2) addressing clinically relevant questions, and (3) trusted relationship between the user and producer. Key informants expressed strong preference for the following review methods and characteristics: use of evidence tables, quality rating of studies, assessments of total evidence quality/strength, and use of summary tables for results and conclusions. Most acceptable trade-offs to increase efficiencies were limiting the literature search (e.g., limiting search dates or language) and performing single screening of citations and full texts for relevance. Key informants perceived rapid products (particularly evidence inventories and rapid responses) as useful interim products to inform downstream investigation (e.g., whether to proceed with a full review or guideline, direction for future research). Most key informants indicated that evidence analysis/synthesis and quality/strength of evidence assessments were important for decision-making. They reported that rapid reviews in particular were useful for guideline development on narrow topics, policy decisions when a quick turn-around is needed, decision-making for practicing clinicians in nuanced clinical settings, and decisions about coverage by payers/health insurers. Rapid reviews may be more relevant within specific clinical settings or health systems; whereas, broad/national guidelines often need a traditional systematic review. CONCLUSIONS Key informants interviewed in our study indicated that evidence inventories, rapid responses, and rapid reviews have utility in specific decisions and contexts. They indicated that the credibility of the review producer, relevance of key questions, and close working relationship between the end-user and producer are critical for any rapid product. Our findings are limited by the sample size which may have been too small to reach saturation for the themes described.
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Affiliation(s)
- Lisa Hartling
- Department of Pediatrics, University of Alberta, ECHA 4-472, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
| | - Jeanne-Marie Guise
- Scientific Resource Center for the AHRQ Effective Health Care Program, Portland VA Research Foundation, 3710 SW U.S. Veterans Hospital Road, Portland, OR, 97239, USA
| | - Susanne Hempel
- Evidence-based Practice Center, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Robin Featherstone
- Alberta Research Center for Health Evidence, University of Alberta, Edmonton Clinic Health Academy 4-486D, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Matthew D Mitchell
- ECRI-Penn AHRQ Evidence-based Practice Center, University of Pennsylvania Health System, 3535 Market St. Suite 50, Philadelphia, PA, 19104, USA
| | - Makalapua L Motu'apuaka
- Scientific Resource Center for the AHRQ Effective Health Care Program, Portland VA Research Foundation, 3710 SW U.S. Veterans Hospital Road, Portland, OR, 97239, USA
| | - Karen A Robinson
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Karen Schoelles
- ECRI Institute, 5200 Butler Pike, Plymouth Meeting, PA, 19462, USA
| | - Annette Totten
- Pacific Northwest Evidence-based Practice Center, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Evelyn Whitlock
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, 3800N. Interstate Ave, Portland, OR, 97227, USA.,Patient-Centered Outcomes Research Institute, 1919 M Street, Washington, DC, 20036, USA
| | - Timothy J Wilt
- Minnesota Evidence-based Practice Center, Minneapolis VA Center for Chronic Disease Outcomes Research and the University of Minnesota, 1 Veterans Drive, 111-0, Minneapolis, MN, 55417, USA
| | - Johanna Anderson
- Scientific Resource Center for the AHRQ Effective Health Care Program, Portland VA Research Foundation, 3710 SW U.S. Veterans Hospital Road, Portland, OR, 97239, USA
| | - Elise Berliner
- Agency for Healthcare Research and Quality, 5600 Fishers Lane, Rockville, MD, 20857, USA
| | - Aysegul Gozu
- Agency for Healthcare Research and Quality, 5600 Fishers Lane, Rockville, MD, 20857, USA
| | - Elisabeth Kato
- Agency for Healthcare Research and Quality, 5600 Fishers Lane, Rockville, MD, 20857, USA
| | - Robin Paynter
- Scientific Resource Center for the AHRQ Effective Health Care Program, Portland VA Research Foundation, 3710 SW U.S. Veterans Hospital Road, Portland, OR, 97239, USA
| | - Craig A Umscheid
- Center for Evidence-based Practice, University of Pennsylvania, 3535 Market Street, Mezzanine, Suite 50, Philadelphia, PA, 19104, USA
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Abou-Setta AM, Jeyaraman M, Attia A, Al-Inany HG, Ferri M, Ansari MT, Garritty CM, Bond K, Norris SL. Methods for Developing Evidence Reviews in Short Periods of Time: A Scoping Review. PLoS One 2016; 11:e0165903. [PMID: 27930662 PMCID: PMC5145149 DOI: 10.1371/journal.pone.0165903] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 10/19/2016] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Rapid reviews (RR), using abbreviated systematic review (SR) methods, are becoming more popular among decision-makers. This World Health Organization commissioned study sought to summarize RR methods, identify differences, and highlight potential biases between RR and SR. METHODS Review of RR methods (Key Question 1 [KQ1]), meta-epidemiologic studies comparing reliability/ validity of RR and SR methods (KQ2), and their potential associated biases (KQ3). We searched Medline, EMBASE, Cochrane Library, grey literature, and checked reference lists, used personal contacts, and crowdsourcing (e.g. email listservs). Selection and data extraction was conducted by one reviewer (KQ1) or two reviewers independently (KQ2-3). RESULTS Across all KQs, we identified 42,743 citations through the literature searches. KQ1: RR methods from 29 organizations were reviewed. There was no consensus on which aspects of the SR process to abbreviate. KQ2: Studies comparing the conclusions of RR and SR (n = 9) found them to be generally similar. Where major differences were identified, it was attributed to the inclusion of evidence from different sources (e.g. searching different databases or including different study designs). KQ3: Potential biases introduced into the review process were well-identified although not necessarily supported by empirical evidence, and focused mainly on selective outcome reporting and publication biases. CONCLUSION RR approaches are context and organization specific. Existing comparative evidence has found similar conclusions derived from RR and SR, but there is a lack of evidence comparing the potential of bias in both evidence synthesis approaches. Further research and decision aids are needed to help decision makers and reviewers balance the benefits of providing timely evidence with the potential for biased findings.
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Affiliation(s)
- Ahmed M. Abou-Setta
- Knowledge Synthesis Platform, George & Fay Yee Center for Healthcare Innovation, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maya Jeyaraman
- Knowledge Synthesis Platform, George & Fay Yee Center for Healthcare Innovation, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Abdelhamid Attia
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, El-Manial, Cairo, Egypt
| | - Hesham G. Al-Inany
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, El-Manial, Cairo, Egypt
| | - Mauricio Ferri
- World Health Organization, Geneva, Republic and Canton of Geneva, Switzerland
| | - Mohammed T. Ansari
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Chantelle M. Garritty
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kenneth Bond
- Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada
| | - Susan L. Norris
- World Health Organization, Geneva, Republic and Canton of Geneva, Switzerland
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Peterson K, Floyd N, Ferguson L, Christensen V, Helfand M. User survey finds rapid evidence reviews increased uptake of evidence by Veterans Health Administration leadership to inform fast-paced health-system decision-making. Syst Rev 2016; 5:132. [PMID: 27491354 PMCID: PMC4974754 DOI: 10.1186/s13643-016-0306-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 06/20/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To provide evidence synthesis for faster-paced healthcare decision-making, rapid reviews have emerged as a streamlined alternative to standard systematic reviews. In 2012, the Veterans Affairs Evidence-based Synthesis Program (VA ESP) added rapid reviews to support Veterans Health Administration (VHA) operational partners' more urgent decision-making needs. VHA operational partners play a substantial role in dissemination of ESP rapid reviews through a variety of routes, including posting on the VA ESP's public website ( http://www.hsrd. RESEARCH va.gov/publications/esp/ ). As demand for rapid reviews rises, much progress has been made in characterizing methods and practices. However, evidence synthesis organizations still seek to better understand how and when rapid reviews are being used. METHODS The VA ESP administered an online survey to rapid review operational partners. The survey assessed the nature of decision-making needs, overall perception of review content, resulting actions, and implementation timeframe. We use descriptive statistics and narrative methods to summarize findings. RESULTS Between October 2011 and April 2015, we completed 12 rapid reviews for 35 operational partners. Operational partners were primarily non-academic subject matter experts with VA operations' decision-making authority. The most common topic categories reviewed were policy or system (50 %) or process of care (42 %) initiatives. Median report completion time was 14.5 weeks. Survey response rate was 46 %, with at least one operational partner responding for 92 % of reports. Reviews served multiple purposes including policy directive or regulation (72 %), supporting program development and evaluation (55 %), identifying future research needs (45 %), and determining implementation strategy (45 %). Overall, operational partners' perception of report content was positive. A majority of rapid reviews were used immediately and informed actions ranking high on the Institute of Medicine's Degrees of Impact framework: 45.4 % effected change, 18.2 % inspired action, 18.2 % informed the field, 9.1 % received recognition, and 9.1 % spread a message. CONCLUSIONS VA ESP rapid reviews have increased the VHA's uptake of evidence to inform time-sensitive system-level decision-making. Key areas of interest for future evaluation include assessing user perception of our streamlined methods and the quality of our efforts to inform users of these methods, as well as comparing the usability and impact of our rapid and standard systematic reviews.
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Affiliation(s)
- Kim Peterson
- VA Portland Health Care System, Veterans Affairs Evidence-Based Synthesis Program, 3710 SW U.S. Veterans Hospital Road, Portland, OR 97239 USA
- Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97239 USA
| | - Nicole Floyd
- VA Portland Health Care System, Veterans Affairs Evidence-Based Synthesis Program, 3710 SW U.S. Veterans Hospital Road, Portland, OR 97239 USA
| | - Lauren Ferguson
- VA Portland Health Care System, Veterans Affairs Evidence-Based Synthesis Program, 3710 SW U.S. Veterans Hospital Road, Portland, OR 97239 USA
- Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97239 USA
| | - Vivian Christensen
- VA Portland Health Care System, Veterans Affairs Evidence-Based Synthesis Program, 3710 SW U.S. Veterans Hospital Road, Portland, OR 97239 USA
| | - Mark Helfand
- VA Portland Health Care System, Veterans Affairs Evidence-Based Synthesis Program, 3710 SW U.S. Veterans Hospital Road, Portland, OR 97239 USA
- Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97239 USA
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