EBMpractice Net Belgium Stijn Van de Velde Robert
EBMpractice. Net - Belgium Stijn Van de Velde Robert Vander Stichele Siegfried Geens
EBMpractice. NET: a collaborative effort Non profit organisation � Open to Belgian organisations that produce EBM � � � Funding: – Reimbursement organisation (National Institute for Health and Disability Insurance, INAMI-RIZIV) – Started in 2011 4 Member groups: 2 – Government – Producers – Disseminators – Users � Founding members BCFI FARMAKA SSMG CEBAM FOD DG 1, 2 VIRTUAL LIBRARY DOMUS MEDICA KCE WVVK E-Health MINERVA WVVV EBMpractice. Net
AIM of the EBMpractice. Net � To optimise quality of care and efficiency by providing all Belgian healthcare professionals free access to: 1) An up to date database of selected Belgian and international guidelines (GL) 2) Belgian EBM information (other than GL) 3) An electronic clinical decision support system Primary focus: GP’s � Also muldisciplinary focus for allied health personnel and specialists � 3 EBMpractice. Net
Database of guidelines � Working principle: To be user-friendly the database should provide GL in 80 -90% of diagnosis – Number of Belgian GL too limited need for large amount of foreign GL need to be adapted searching for every missing topic the best foreign GL = not feasible Topics without Belgian GL: – purchase 1 foreign GL database (with intention to adapt) 4 EBMpractice. Net
Search for a comprehensive database of guidelines � Main candidates: CKS (UK) en EBM Guidelines (Finland Duodecim). – Study Italian Cochrane Centre: Banzi R, Liberati A, Moschetti I, Tagliabue L, Moja L. A review of online evidence-based practice point-of-care information summary providers. J – Internal evaluation: 1) EB methodology / Editorial quality 2) Coverage 3) Possibility to link with EPR 4) Adaptability 5) Cost Med Internet Res. 2010; 12(3): e 26. 5 EBM Guidelines (Finland Duodecim) EBMpractice. Net
Infostructure EBMpractice. Net Specific/general user query Computerised order with decision support system 6 User authorisation Access rights management Search engine (ICPC, ICD, Me. SH) User query analysis and routing Digital Library EBMpractice. Net Belgian GL summaries Belgian EBM information Finnish GL Summaries Finnish EBMScripts Externa l EBM website s
EBM-scripts r a p e u t i c s u g g e s t i o n s , Point of care 7 d i a g n o S t r u c t u r e d p a t i e n t EBMe. DS system d a t a f r EBMpractice. Net
EBM-scripts � Evaluation of sample of scripts (by Domus Medica, CAMG, UCL) – Key question: Can existing scripts be directly applied to Belgian setting? – Methods: 8 • Identification + analysis of scripts (www. ebmeds. org) for which GL Domus Medica was available • In depth analysis of sample of 10 scripts EBMpractice. Net
EBM-scripts � Results: Total nb of scripts n=187 Scripts without DM GL n=148 Scripts with DM GL n=39 -Agreement n=16 -Minor disagreement n=18 -Major disagreement n=5 9 EBMpractice. Net
EBM-scripts � In depth analysis of 10 scripts with disagreements – Same main references different recommendation because of contextual factors (eg. Obesity) – Same references different interpretation (eg. Hypertension, Diabetes type 2) – Different references because of lack in updating different recommendation (eg. Hypertension, Antibioticprophylaxis for bites, Obesity) 10 EBMpractice. Net
EBM Scripts - conclusions � Workflow required for evaluation/adaptation/validation of scripts ( and GL) – Substantial amount of work – Risk of alert fatigue More reminders Less attention � Careful selection of most important scripts 11 EBMpractice. Net
Organigram Functiona l analysts User query Project leader manager Search path designers Editor-in-Chief Technical staff Guideline abstracter s Programmers Secretariat Indexers 12 EBMpractice. Net Redaction
Next steps � Phase – – – Selection of priority topics Definition of work processes Restructuring Belgian GL to standard template Linking to Belgian EBM information Access to GL Duodecim with warning that information is not adapted Translation of GL Duodecim ( see presentation by technical partner IVS) � Phase – – 1: II: Adaption of priority GL for wich no Belgian GL are available Adaptation of selected EBM scripts � Continuous – Update of information 13 EBMpractice. Net
Impact evaluation � Collection of data and quality indicators by Ambulatory Care Health Information Lab – ACHIL � Development of research protocol to evaluate impact on the quality of care 14 EBMpractice. Net
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