Carcharadon Group

(The Sharks)

Brad Brimhall, David Boyd, Rebecca Zakoor, Genny Zuniga, Kathleen Spencer, Francis Blais, Brenda Hage, Lilly Wang,Deborah Broadwater, Julie Frantsve-Hawley

Diagnostic Literature Information Portal: Gateway to evidence-based Diagnosis

The Problem

• Limited evidence-based evaluation of diagnostic literature.

• Must have evidence-based information on diagnosis as the first step to utilization evidence-based medicine (EBM).

• Documented high rate of errors of omission and commission in health care.

• Practice variation = cost variation.

Project Objectives

• Share with other users of health care information the accuracy of diagnostic testing (radiology, laboratory, pathology, physical examination findings, etc.)

• Train and educate health care providers to critically evaluate primary literature diagnostics.

• Provide concise, reliable evidence-based information to health care practitioners.

• Appropriate utilize diagnostic testing.

Evidence-Based Publications

Quality of Diagnostic Studies

A review in JAMA published in 1995 evaluated more than 1000 diagnostic papers via established parameters found the following:

50% of papers satisfied none of the parameters.

No paper fulfilled all parameters.

Reid MC, Lachs MS, Feinstein AR. JAMA 1995;274:645-651

Evidence-Based Medicine (EBM)

“...the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”

D.L. Sackett (Oxford University)D.L. Sackett (Oxford University)Sackett et al., 1996. BMJ 312: 7023.Sackett et al., 1996. BMJ 312: 7023.D.L. Sackett (Oxford University)D.L. Sackett (Oxford University)Sackett et al., 1996. BMJ 312: 7023.Sackett et al., 1996. BMJ 312: 7023.

EBM Framework

1. Determining clinical questions

2. Finding evidence

3. Assessing the quality of evidence

4. Summarizing findings & formulating conclusions

5. Using information to implement change

Sources of Evidence

Primary Data(raw data)

Primary Literature(original studies)

Secondary Literature(review articles)

Tertiary Literature(textbooks, etc.)

Systematic Reviews

Practice Guidelines

Cochrane Collaboration

Evaluating the Evidence

Level of Evidence: Diagnosis

Level Criteria1 Independent, masked comparison with reference

standard among an appropriate population of consecutive patients.

2 Independent, masked comparison with reference standard among non-consecutive patients or confined to a narrow population of study patients.

3 Independent, masked comparison with reference standard among non-consecutive patients or confined to a narrow population of study patients.

4 Reference standard not applied independently or masked.

5 Expert opinion with no explicit critical appraisal, based on physiology, bench research, or first principles.

Evidence and Diagnostics. www.jr2.ox.ac.uk/bandolier/booth/diagnos/Diagessy.html

Portal Features

Diagnostic Literature Information Portal

Robust Search Capability

Reliable & Valid

Multilingual Web-based Training

Serving a wide variety of health providers

Projected Needs

• Standardized Terminology (e.g. ICD-9, CPT)

• Database Design

• Education/Informatics (Training)

• Web Designer

• Webmaster (Maintenance)

• Evaluation

Development Timeline

• Jaws I Development of webpage and database, development of self-paced training module for reviewers, exemplar review development, tutorial development, evaluation tool development

• Jaws II Publication of reviews, evaluation of training, beta test portal.

• Jaws III Implementation, Evaluation of user satisfaction, system maintenance

Outcome Measures

• Number of reviews submitted

• Site “bites”

• Level of user satisfaction

• Links to other websites

Examples of EBM Portals

• American College of Physicians www.acpjc.org

• InfoPOEMS

www.infopoems.com

• Cochrane Reviews

www.cochrane.org/index0.htm

• Centre for evidence-based Medicine

www.cebm.net

FIN(i)

Questions

• Questions?

• Comments?