Becoming ADEPT 2 October 2003 Janette Boynton Senior Health Information Scientist

Content NHS Quality Improvement Scotland (NHS QIS) –Background –Purpose –Functions –Structure Information support for NHS QIS products

Background Established January 2003 –“…to achieve better integration and co-ordination of work on clinical effectiveness and quality improvement.” NHS QIS brings together –Clinical Resource and Audit Group (CRAG) –Clinical Standards Board for Scotland (CSBS) –Health Technology Board for Scotland (HTBS) –Nursing and Midwifery Practice Development Unit (NMPDU) –Scottish Health Advisory Service (SHAS)

Purpose “To improve the quality of healthcare in Scotland by setting standards and monitoring performance, and by providing advice, guidance and support to NHSScotland on effective clinical practice and service improvements.”

Functions To determine, share and promote consistent high quality care across Scotland –clinical audit, assessing clinical and cost effectiveness of health interventions, clinical guidelines, best practice statements, To set clinical and non-clinical standards To review and monitor performance through self- assessment and external peer review, and investigate serious service failures To support implementation of clinical governance

Structure Guidance and Standards Performance Assessment and Practice Development Planning and Resource Management Scottish Health Council/Patient and Public Involvement

Information, libraries and knowledge Based within the Planning and Resource Management Directorate within the Planning and Quality Management Unit Rationale –Contribute to the scoping and evidence based gathering processes, which are central to the work of the organisation –Ensure that information resources are selected organised and delivery in an appropriate and timely fashion

Products Health Technology Assessments (long) –clinical effectiveness, patient issues, organisational issues, economic evaluations Health Technology Assessments (short) –clinical & cost effectiveness Evidence Notes Best Practice Statements New Drugs Committee evaluations Project work (e.g. clinical outcome indicators)

Systematic literature searching Three stages –Topic proposal search –Scoping searches –Main literature search

Topic proposal search To avoid duplication of effort To assist the ‘evidence base evaluation’ part of the topic selection process Types of information –Secondary literature (e.g. HTAs, Cochrane Reviews) –Ongoing evidence-based research –Knowledge of the Scottish situation (e.g. SEHD publications) –Economic evaluations

Scoping searches To help define methodology –Indicate the volume and quality of the primary literature (no. of RCTs, no of ‘other’ study types) –Turn policy questions into HTA research questions To facilitate resource planning –Staff time, ILL budget, translation costs Types of information –Topic proposal search, quick searches of primary literature sources (MEDLINE, EMBASE etc.)

Main literature search Identifying primary studies –Formulate clear search questions –Recognise the ‘best’ evidence to answer a question –Identify the sources to search –Search information sources effectively Snowball, R. Health Information & Libraries Journal 2002;19(2):109-12

Formulating clear search questions Well-built questions –Patient or problem –Intervention or exposure –Comparison intervention –Outcome(s) of interest Oxman AD, Sackett DL, Guyatt GH. JAMA;270(17):

Recognising the ‘best’ evidence to answer each question T: In alcohol dependence, is acamprosate or naltrexone more effective for preventing relapse? D: What is the accuracy of screening for alcohol problems in primary care? A: What are the environmental risk factors associated with binge drinking in college students? P: What is the long-term prognosis of patients with alcoholic cardiomyopathy following total abstinence? CE: Are brief interventions cost-effective for problem drinkers? Q: What are adolescents' perceptions of parental alcoholism?

Identifying the sources to search Databases –MEDLINE, EMBASE, CINAHL, PsycINFO, NHS EED Searchable e-journal packages –Science Direct, Ingenta, Registers of Research –mRCT, National Research Register, cancer.gov Conference Proceedings –Index to Conference Proceedings, ISI Proceedings Dissertations – –Digital Dissertations, Index to Theses Hand-searching, interested parties, Internet ….

Searching sources effectively Translating the parts of the question into search terms Sensitivity versus precision Boolean logic Filters

Challenges Publication bias Time versus quality trade-off Nature of HTA, BPS etc. questions –Multiple questions –Variety of ‘best’ evidence