Article type
Year
Abstract
Background: Ideally, clinical care is based on real-time, best available evidence. In reality, research findings take on average 17 years to translate into policy and practice. Developing and implementing health system guidelines using a rapid review process can reduce the time it takes to integrate emerging evidence into care. Recently, Oregon Health & Science University (OHSU) created a learning health system with local community hospitals, focused on delivery of consistent, evidence-based care in the region. As part of that system, OHSU created the Office of Clinical Integration and Evidence-based Practice (OCI-EBP), a team dedicated to reviewing, evaluating, and applying best available health care evidence.
Objectives: The objectives of the OCI-EPB are to enable the learning health system to rapidly adapt as best evidence and health care delivery evolves, as well as relieve clinicians from time-consuming evidence review and summation, to improve the experience and outcomes for clinicians and patients.
Methods: Guideline topics are nominated by an oversight committee, and are developed in partnership with multidisciplinary content expert teams, engaging representatives from each hospital, and patient advocates. The OCI-EBP uses GRADE methodology to appraise and summarize research evidence. Content expert teams use their clinical expertise to inform development of clinical questions, practice recommendations, and consensus statements. The OCI-EPB creates clinical decision support tools to support the guideline’s implementation. Multidisciplinary, clinical teams formally implement each guideline, design workflows that promote the delivery of consistent care, and use validated quality metrics to evaluate and apply continuous improvement efforts.
Results: To date, the OCI-EPB has engaged more than 150 learning health system members to develop nine clinical guidelines, including opioid prescribing, colorectal cancer screening, and others. Current guidelines under development include obesity management and pediatric pneumonia. Post-implementation data from the guidelines have shown reductions in length of stay, readmission rates, and opioid use.
Using our rapid review process and established partnerships, the OCI-EPB has contributed to Coronavirus care by conducting rapid reviews of emerging research to inform predictive modeling, development of triage risk assessment tools, and management of confirmed cases.
Conclusions: The OCI-EBP has been an innovative model for driving evidence-based change management and decision-making at OHSU. The team has worked closely with clinicians and health system members to critically analyze emerging evidence and rapidly build consensus; this framework and level of coordination is necessary for supporting meaningful integration of the best evidence available to improve patient care and quality.
Patient or healthcare consumer involvement: Patient advocates are included throughout process to provide their perspective during the appraisal and adaption of evidence into recommendations.
Objectives: The objectives of the OCI-EPB are to enable the learning health system to rapidly adapt as best evidence and health care delivery evolves, as well as relieve clinicians from time-consuming evidence review and summation, to improve the experience and outcomes for clinicians and patients.
Methods: Guideline topics are nominated by an oversight committee, and are developed in partnership with multidisciplinary content expert teams, engaging representatives from each hospital, and patient advocates. The OCI-EBP uses GRADE methodology to appraise and summarize research evidence. Content expert teams use their clinical expertise to inform development of clinical questions, practice recommendations, and consensus statements. The OCI-EPB creates clinical decision support tools to support the guideline’s implementation. Multidisciplinary, clinical teams formally implement each guideline, design workflows that promote the delivery of consistent care, and use validated quality metrics to evaluate and apply continuous improvement efforts.
Results: To date, the OCI-EPB has engaged more than 150 learning health system members to develop nine clinical guidelines, including opioid prescribing, colorectal cancer screening, and others. Current guidelines under development include obesity management and pediatric pneumonia. Post-implementation data from the guidelines have shown reductions in length of stay, readmission rates, and opioid use.
Using our rapid review process and established partnerships, the OCI-EPB has contributed to Coronavirus care by conducting rapid reviews of emerging research to inform predictive modeling, development of triage risk assessment tools, and management of confirmed cases.
Conclusions: The OCI-EBP has been an innovative model for driving evidence-based change management and decision-making at OHSU. The team has worked closely with clinicians and health system members to critically analyze emerging evidence and rapidly build consensus; this framework and level of coordination is necessary for supporting meaningful integration of the best evidence available to improve patient care and quality.
Patient or healthcare consumer involvement: Patient advocates are included throughout process to provide their perspective during the appraisal and adaption of evidence into recommendations.