Translating Evidence into Practice Danny Liew Melbourne EpiCentre Medical Unit 1

Application of Evidence in Practice education and training access to, and interpretation of, evidence identifying and overcoming barriers culture change outcomes research: ‘practice-based evidence’

Overview (the problem with) evidence-based practice outcomes research –comparative effectiveness research –health technology assessment

Evidence-Based Practice

Efficacy vs Effectiveness efficacy: intervention ‘works’ in a research (clinical trial) setting effectiveness: intervention ‘works’ in the real-life setting often a large gap

circumscribed populations focus: benefit >> harm artificial environment short-term ?competing morbidity and mortality ?costs Clinical Trial vs Real-Life Settings

Can it work? (Efficacy) Does it work? (Effectiveness) Is it worth it? (Cost-Effectiveness) Evidence generation Evidence synthesis Decision- making Evidence-Based Practice Luce BR et al. Milbank Q. 2010;88:

Can it work? (Efficacy) Does it work? (Effectiveness) Is it worth it? (Cost-Effectiveness) Evidence generation Evidence synthesis Decision- making Clinical guidelines Clinical trials Clinical practice Health policy Regulatory approval Systematic reviews EBP - Current View Various methods Modified from: Luce BR et al. Milbank Q. 2010;88:

Can it work? (Efficacy) Does it work? (Effectiveness) Is it worth it? (Cost-Effectiveness) Evidence generation Evidence synthesis Decision- making Clinical guidelines Clinical trials Clinical practice Health policy Regulatory approval Systematic reviews Comparative effectiveness research Health technology assessment EBP - Ideal View Epidemiology, Registries Modified from: Luce BR et al. Milbank Q. 2010;88: Cost data

Comparative Effectiveness Research

Aspirin for Primary Prevention in the Elderly BMJ. doi: /bmj F (published 20 May 2005)

Aspirin for Primary Prevention in the Elderly BMJ. doi: /bmj F (published 20 May 2005)

Aspirin for Primary Prevention in the Elderly

Health Technology Assessment

dominated dominant net health gainnet health loss net positive costs net negative costs (cost saving) x incremental cost-effectiveness ratio = net cost/net health effect Cost-Effectiveness Plane

Aspirin in At-Risk Groups Cardiovasc Ther doi: /j x.

Summary beyond efficacy, EBP should encompass effectiveness and cost-effectiveness ‘practice-based evidence’: 2-way street between research and practice rich source of relevant data available in hospital settings

© Copyright The University of Melbourne 2008

Aspirin for Primary Prevention Ann Intern Med. 2002;136:

McKeon Review

total years lived quality-adjusted life years (QALYs) lived Summary Health Measures current best practice new intervention

Statins for Primary Prevention in Korea Clin Ther. 2009;31:

Heart Lung Circ. 2009;18:

Application of Evidence in Practice

Health Services Research

Health services evaluation* Can it work? (Efficacy) Does it work? (Effectiveness) Is it worth it? (Cost-Effectiveness) Evidence generation Evidence synthesis Decision- making Clinical guidelines Clinical trials Clinical practice Health policy Regulatory approval Systematic reviews Comparative effectiveness research Health technology assessment* EBP - Ideal View Epidemiology, Registries *Health services research = HTA + HSE + other Modified from: Luce BR et al. Milbank Q. 2010;88: Cost data