Linking Hospital Managers to the Literature: An Evidence-based Approach

ROBIN FEATHERSTONE April 14, 2011

Your Information Seeking Behaviour

Origins of the Evidence-based Movement

1990s: David Sackett et al. from McMaster coined the term, Evidence-based Medicine (EBM)

Aimed to improve the quality of information used to make decisions Migrated to other sectors - dentistry, nursing, management, etc.

What is Evidence-based Health Services Management (EBHSM)?

Aids in the decision-making process Incorporates quality evidence from the literature Seeks to evaluate managerial strategies and improve the performance of health services organizations
(Kovner & Rundall, 2006)

Todays Objective
learn to search for the best quality information to practice evidence-based decision-making in hospital management

How Questions Influence Search Results

High = lots of articles

Broad Questions

Retrieval (# of search results)

Narrow Questions
Low = very few articles Low = mostly irrelevant articles

Relevancy

High = directly relevant articles

Guidelines for Formulating a Question

1- What management tool/technique are you thinking of using? 2- What process or outcome do you wish to achieve? 3- What is the setting?

(Kovner & Rundall, 2006)

From Thought to Question

How do interdisciplinary teams function?

What workplace conditions are necessary to support collaboration among members of interdisciplinary teams?

Exercise 5 minutes
In pairs, develop a narrow question based on the following topics: 1. Transforming Care at the Bedside 2.Patient flows

Levels of Evidence Pyramid

Level 1: Systematic Reviews of Randomized Controlled Trials FILTERED Level 2: Multicenter/Comparative studies Level 3: Single site studies Less Time Less Work Less Evidence

Level 4: Descriptive studies/Case Reports

Level 5. Expert Opinion

UNFILTERED
More Time More Work More Evidence

Cochrane Library - DEMO

Contents
Cochrane Reviews -Approx. 4000 full-text reviews -Therapy, prevention and diagnosis information

Other Reviews

-Approx. 16,000 abstracts -International coverage -Covers effects of clinical interventions

-Approx. 600,000 summaries of ongoing or completed clinical trials -International coverage -Summaries of reports of methods used in clinical trials

Clinical Trials

Methods Studies

Technology Assessments
Economic Evaluations

-Abstracts of studies assessing health care technologies

-Abstracts and brief records of studies looking at costs and effects of competing healthcare interventions

Exercise
Search the Cochrane Library to answer the question: What are effective methods for increasing patient participation in clinical decision making?

Medline via PubMed - DEMO

produced by the National Library of Medicine (U.S.) indexes 5,500+ journals in the health sciences provides references and abstracts to journal articles

FILTERED

UNFILTERED

Using Subject Headings

Search each concept in your question separately Mapping each of your concepts to a subject heading will find: the preferred search term in the database articles about your topic

Exercise

Find articles that discuss procedures for patient admissions from the ER

Tip: Break down the question into its separate concepts before searching.

What is the MeSH term for:

Patient admissions?
Emergency room? Procedures?

Subheadings
Use to investigate specific aspects of your topic Narrows your search e.g., Patient Admission = ~15,600 results Patient Admission/methods = ~8 results

Frequently used subheadings for management topics: /economics, /methods, /organization & administration, /statistics & numerical data

Combining search terms

OR related terms for an individual concept; increases your search results AND two/more concepts together to find relevant articles; decreases your search results

e.g., tertiary care hospitals OR university teaching hospitals

e.g., re-engineering of jobs AND health care services

PubMed DEMO: Find articles that discuss procedures for patient admissions from the ER

Applying limits
Language Year

Age group
Publication Type, etc.

Exercise

What are the costs involved to support teaching activities in a university teaching hospital?

15 minute break

Principles of Online Searching

1. Define your question.

2. Break down the question into its separate concepts.

3. Search each concept separately.

4. Combine search terms (AND/OR).

5. Apply limits. 6. Evaluate your results. 7. Modify your search strategy if necessary.

Exercise

Does organizational culture impact patient safety management?

About PubMed HSR Queries Filter

An automated method to filter your PubMed search Limits your results to studies about health care quality and costs - Appropriateness of care
- Process assessment - Outcome assessment - Costs - Economics - Qualitative research

FILTERED

UNFILTERED

Applying the HSR Queries Filter to your PubMed Search

Copy your PubMed search strategy. Go to PubMeds homepage. Click on the Topic-Specific Queries link. Click on the Health Services (HSR) Queries link. Paste your PubMed search strategy in the search box.

About ProQuest Databases

Contains:
Business references (ABI/INFORM, CBCA, Research Library) Company profiles (Hoover s) News sources (Canadian Newstand) Government and Industry Reports (Canadian Research Index)
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UNFILTERED

ProQuest Databases Demo

Exercise
Go to http://muhclibraries.mcgill.ca/ adminguide.php . In pairs, search ProQuest Databases to answer the questions:

1.Does the implementation of Transforming Care at the Bedside impact on job satisfaction? 2.Who are Sodexo, Inc.s main competitors?

Summary
What resources will help you to find: Systematic Reviews of RCTs? Process assessments? Company profiles? Newspaper articles?

Summary contd.
Where would you place the following resources on the pyramid? PubMed Cochrane Library ProQuest HSR Queries filter

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UNFILTERED

Useful References on EBHSM

1. Reay T, Berta W, Kohn MK. What's the evidence on evidence-based management? Academy of Management Perspectives. 2009;23(4):5-18. Rousseau DM, McCarthy S. Educating managers from an evidence-based perspective. Academy of Management Learning & Education. 2007;6(1):84-101.

2.

3.

Kovner AR, Rundall TG. Evidence-based management reconsidered. Frontiers of Health Services Management. 2006;22(3):3-22.
Chan KS, Morton SC, Shekelle PG. Systematic reviews for evidence-based management: how to find them and what to do with them. American Journal of Managed Care. 2004;10(11 Pt 1):806-12. Walshe K, Rundall TG. Evidence-based management: from theory to practice in health care. Milbank Quarterly. 2001;79(3):429-57.

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