Extreme Makeover -- Data Edition: Inside the Box

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Extreme Makeover -- Data Edition: Inside the Box. Presentation at the CityMatch Conference, August 2007 Michael Kogan, Ph.D. U.S. Department of Health and Human Services (DHHS) Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau (MCHB) - PowerPoint PPT Presentation


<ul><li><p>Extreme Makeover -- Data Edition: Inside the Box Presentation at the CityMatch Conference, August 2007</p><p>Michael Kogan, Ph.D.U.S. Department of Health and Human Services (DHHS)Health Resources and Services Administration (HRSA)Maternal and Child Health Bureau (MCHB)Director, Office of Data and Program Development </p></li><li><p>Presentation OutlineDefinition of evidenceDiscussion of evidence-based medicineDiscussion of evidence-based public healthHow to use evidence-based approachesEvidence-based maternal and child health</p></li><li><p>What is Evidence?Information that is collected in an orderly way about a disease or its treatment. CDC website</p></li><li><p>Are Evidence-Based Practices Applicable Only to the Health Field?</p></li><li><p>Evidence-Based Baseball</p><p>Michael Lewis's book, Moneyball, documents the effective use of evidence-based practices by Billy Beane, the general manager of the Oakland Athletics. Lewis shows how Beane's reliance on theoretically relevant statistics and on a scientific approach to baseball allowed him to achieve winning seasons despite being burdened with severe budget constraints. </p></li><li><p>Evidence-Based BaseballWhat predicts which amateur hitters make it to the big leagues and become successful players:Ability to hit home-runs?Foot-speed?Fielding ability?Number of walks that a hitter drew?</p></li><li><p>Evidence-Based BaseballAnswer: The number of walks that a hitter drew, signifying his ability to understand how to control the strike zone.Lewis, Moneyball, 2003.</p></li><li><p>Evidence-Based BaseballWhat is the biggest predictor of runs scored by a team over a season:Number of home-runs?Team batting average?On-base percentage?Number of steals?</p></li><li><p>Evidence-Based BaseballAnswer: On-base percentage.Lewis, Moneyball, 2003.</p></li><li><p>What is Evidence-Based Medicine?Health care practices that are based on review of the current best evidence on the effectiveness of a test, drug, surgery or other medical practice. Based on collecting and analyzing all of the research studies that have been conducted on a particular intervention. These reviews are called meta-analyses and systematic reviews. </p></li><li><p>Rise of Evidence-Based MedicineFirst described in 1992A new approach to teaching medicineA revolution in medical practiceOther evidence-based approaches: ethics, psychotherapy, occupational therapy, dentistry, nursing, and librarianship</p></li><li><p>Factors Driving EBMOverwhelming size of the literatureInadequacy of textbooksDifficulty synthesizing evidence and translating into practiceIncreased number of randomized control trialsAvailable computerized databasesReproducible evidence strategies</p></li><li><p>Steps of EBMConvert the need for info. into an answerable questionTrack down the best evidenceCritically appraise that evidenceIntegrate the appraisal with ones clinical expertise and the individual patientEvaluate</p><p>Sackett DL. EBM: how to practice and teach EBM. Churchill Livingstone 2000</p></li><li><p>Differences between Medicine and Public Health</p></li><li><p>Differences between Medicine and Public Health (continued)</p></li><li><p>Development of Evidence Based Public HealthJenicek (1997) published a review discussing epidemiology, EBM, EBPHEpidemiology described as the foundation of both EBM and EBPHEBPH unique in using complex interventions with multiple community and societal issues</p></li><li><p>Definition of EBPH (1)EBPH is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of communities and populations in the domain of health protection, disease prevention, health maintenance and improvement.Jenicek (1997)</p><p>Jenicek M. J Epidemiol 1997;7:187-97</p></li><li><p>Definition of EBPH (2)</p><p>Evidence-based public health is defined as the development, implementation, and evaluation of effective programs and policies in public health through application of principles of scientific reasoning, including systematic uses of data and information systems, and appropriate use of behavioral science theory and program planning models.Brownson, et al, 2003</p></li><li><p>Steps of EBPHDevelop an initial statement of the issueSearch the scientific literature and organize informationQuantify the issue using sources of existing dataDevelop and prioritize program options; implement interventionsEvaluate the program or policy</p><p>Brownson RC. J Public Health Manag Pract 1999;5:86-87</p></li><li><p>Steps to Searching the Public Health Literature Determine the public health problem and define the question.Select information sources.Identify key concepts and terms.Conduct the search in subject-appropriate databases.Select documents for review.Abstract relevant information.Summarize and apply the literature review.Brownson, et al. 2003.</p></li><li><p>Evaluating the Quality and Methods of Public Health Research Results What are the results?Were the results similar from study to study?What are the overall results of the review?How precise were the results?Can a causal association be inferred?Are the results valid?Did the review explicitly address the PH question?Was the search exhaustive?Were the primary studies of high methodological quality?How can the results be applied to PH practice?How can the results be interpreted and applied?Were all the important PH outcomes considered?Are the benefits worth the costs and potential risks?Brownson, et al. 2003.</p></li><li><p>How are Decisions Usually Made? Decisions on policies and programs are often made based on:Personal experienceWhat we learned in formal trainingWhat we heard at a conferenceWhat a funding agency required/ suggested What others are doing </p></li><li><p>Evidence and Public Health Decision Making Good newsStrong evidence on the effect of many policies/ programs aimed to improve public health</p><p>Major efforts underway to assess the body of evidence for wide range of public health interventions </p></li><li><p>What Works to Improve the Publics Health?Bad newsMany public health professionals are unaware of this evidenceSome who are aware dont use it Many existing disease control programs have interventions with insufficient evidence while others use interventions with strong evidence of effectivenessLack of use of effective interventions can adversely affect fulfilling mission and getting public support </p></li><li><p>Barriers Facing Evidence-Based Public HealthEvidence-based research tells you what you should do, not what you can do What a lot of us are facing is no matter how much evidence you have, you just dont have enough resources.A Title V Director (interviewed for an evaluation study)</p></li><li><p>Evidence-Based Maternal and Child HealthTrue or False:The more prenatal care a woman receives, the better her birth outcomes?</p></li><li><p>Evidence-Based Maternal and Child HealthFALSE:If a woman receives MORE than the recommended amount of care, she is more likely to have worse birth outcomes.</p></li><li><p>Evidence-Based Maternal and Child HealthTrue or false:For women who are experiencing problems with their pregnancy, bed rest is effective in preventing preterm labor.</p></li><li><p>Evidence-Based Maternal and Child HealthFALSE:Obstetric practices for which there is little evidence of effectiveness in preventing or treating preterm labor include bed rest.Goldenberg, Obstetrics and Gynecology, 2002</p></li><li><p>ResourcesMedline search (http://www.ncbi.nlm.nih.gov/sites/entrez)Cochrane Collaboration (www.cochrane.org)Task Force on Community Preventive Services (http://www.thecommunityguide.org/)National Guideline Clearinghouse (http://www.guideline.gov/) The Institute of Medicine (www.iom.edu)Evidence-Based Practice for Public Health (http://library.umassmed.edu/ebpph/)Best Practices at the Local Level (http://archive.naccho.org/modelPractices/)</p></li><li><p>ResourcesPromising Practices Network for Children (http://promisingpractices.net/programs_outcome.asp)</p></li><li><p>AcknowledgmentsJonathan Fielding, MD, Los Angeles County Dept. of Health ServicesNeal Kohatsu, MD, University of IowaHarvey Fineberg, MD, Harvard University</p></li><li><p>Contact InformationMichael Kogan, Ph.D.HRSA/MCHBDirector, Office of Data and Program Development5600 Fishers Lane, Room 18-41Rockville, MD 20857301-443-3145mkogan@hrsa.gov</p><p>8MCHB PRESENTATIONFEBRUARY 2001PETER C. VAN DYCK, MD, MPHKERRY PAIGE NESSELER, RN, MS</p><p>Evidence-Based Medicine (EBM) was first described in 1992. It was hailed as a new approach to teaching medicine and was once described in the New York Times as a revolution in medical practice. EBM has spawned a host of evidence-based approaches including: ethics, psychotherapy, occupational therapy, dentistry, nursing, and librarianship.</p><p>Evidence-Based Medicine (EBM) was first described in 1992. It was hailed as a new approach to teaching medicine and was once described in the New York Times as a revolution in medical practice. EBM has spawned a host of evidence-based approaches including: ethics, psychotherapy, occupational therapy, dentistry, nursing, and librarianship.</p><p>Clearly, one of the overriding factors has been the explosive growth of the medical literature. The development of the Internet continues to expand the quantity and availability of medical information. The problem has been how to quickly and efficiently obtain high-quality, information that is relevant to each patient or clinical encounter, in both inpatient and outpatient settings.Textbooks, while compiling a lot of information in one location, are frequently out-of-date in key areas by the time they are published.Because of the overwhelming volume of medical literature, it has been difficult to sort through and extract what is needed for ones unique practice.Although randomized controlled trials (RCTs) are expensive and time-consuming to conduct, their numbers increase because they provide essential scientific information particularly regarding interventions which may carry significant risks.The development of an array of computerized databases and new evidence strategies has facilitated the growth of EBM.</p><p>The process of EBM has been described as a series of steps, as follows:Convert the need for info. about prevention, diagnosis, prognosis, therapy, and causation into an answerable questionTrack down the best evidence to answer that questionCritically appraise that evidence for its validity (closeness to the truth), impact (size of effect), and applicability (usefulness in ones clinical practice)Integrate the appraisal with ones clinical expertise and with the patients unique biology, values, and circumstancesEvaluate ones effectiveness in executing the first four steps and seek ways of improving ones EBM approach.</p><p>Jenicek noted that epidemiology was the foundation for both Evidence-Based Medicine (EBM) and Evidence-Based Public Health (EBPH).Key terms in this definition of EBPH areEXPLICIT: Use defined methodsJUDICIOUS: Use judgmentBEST EVIDENCE: Sort through the literature and identify what is usefulThese are the steps of Evidence-Based Public Health (EBPH) as described by Brownson et al.I would substitute age increment for the age of the children in the first bullet.Search the literature using some of the resources previously described and organize the information.</p></li></ul>