Department of Veterans Affairs Health Services Research Development

Department of Veterans Affairs Health Services Research & Development Service Lynn Mc. Queen, Dr. PH, MS, RN Evidence-Based Practice: Policy Change June, 2002

Overview i. Policy and evidence-based practice i. Implications and context i. What are we doing? i. Similarities in cross-national approaches & methods i. Differences in cross-national approaches & methods i. Is it working? i. Overall gaps and shared priorities i. Towards an international agenda i. Action steps & Challenge for this meeting

Evidence-Base Practice Within A Policy Context i. The implications of using a policy perspective i. Historical influences i. Current trends i. Key definitions and concepts i. Policy implementation across systems i. Evaluation and impact measurement i. Feedback, use, evolution i. Shared priorities, goals, and resources

What are we doing? Is it working? How do we collectively learn from each other so that we can: i Advance individually? i Evolve the collective state of science? i Tackle the tough issues at increasingly complex levels? i Know if it’s working? i Build momentum?

Similarities • Goals • Local • National • International • Approaches, Methods, & Measures • Who is doing what? • How do we find out? • Where are the intersections? • How do we fill gaps together? • Roles • Mechanisms

Differences • Goals • Historical • Social & political • Economics • Professional • Overall incentives • Approaches, Methods, & Measures • Resources • Output • Use • Interpretation • Feedback • Overall incentives

A Powerful Intersection ! • Shared Challenges • Shared Priorities

Towards An International Agenda • Agreement on Basics • Action Steps • Dealing With Complexity & Differences • Starting Points Challenges For This Meeting

Agreeing On Basics? • Definitions • Concepts • Models • Approaches • Methods • Measures • Output • Feedback mechanisms • Communication

Agreeing On Goals? Adding To Translation Science · Findings of common interests · E. g. the effectiveness of reminders · Processes of common interest · E. g. reminder effectiveness is influenced by how many are implemented

Agreeing on ideas and concepts? “Evidence-Based Quality Improvement” (EBQI) is systematized so that. . . 8 Providing the right care at the right time to the right patient becomes routine

Agreeing on Output? What Type? What Format? · Diabetes: Efforts to increase provider awareness of diabetes treatment priorities were associated with changes in medical care that will substantially reduce both cardiovascular events and deaths. Over the next five years, this will result in about 4, 000 fewer heart attacks and strokes and will prevent about 3, 000 deaths.

Agreeing On Evolution Of Evidence-Based Tools? • Development, use, improvement of decision aids • Feed back to decisionmakers in useful formats, when needed • Use what we have now but pushing the boundaries • Ever-increasing interpretation and ability to deal with complexity & uncertainty

Agreeing On An International Model That Supports Integration Expand overall policy advancement through integration of the shared needs at the intersection of: • Evidence-based quality improvement (EBQI) • Research

International Policy Change Research Findings, Impact Clinical QI Feedback/ Improved Care Shared Goals, Resources, Output

Action Through Relationships & Communication Around An International Need Demonstrating What Is Possible Through… • Actively engaging key target audiences • Finding common incentives • Building formal & informal networks • Developing an international action plan

Summary: Policy Improvement In Evidence-Based Health i. Policy and evidence-based practice Within Context i. More similarities than differences i. Similarities in cross-national approaches & methods i. Differences in cross-national approaches & methods i. Much to learn from each other i. Overall gaps and shared priorities i. Agreement needed on key issues i. Develop a model and action plan together during this meeting