1. Providing evidence for healthcare decision Silvia Pregno Rome, October 15, 2012

2. Health professionals, patients, policymakers and the public all want to make healthcare decisions that are informed by the best available research evidence. Helping inform patients, clinicians and policymakers

3. This requires reliable summaries (systematic reviews) of the evidence of the advantages and disadvantages of our options. Helping inform patients, clinicians and policymakers This requires reliable summaries (systematic reviews) of the evidence of the advantages and disadvantage s of our options.

4. It also requires complex judgements. Helping inform patients, clinicians and policymakers

5. Systematic reviews of the effects of healthcare provide essential, but not sufficient information for making well informed decisions.

6. Helping inform patients, clinicians and policymakers Review authors and people who use reviews draw conclusions about the quality of the evidence (how confident we can be in the estimates of effects), either implicitly or explicitly. Such judgments guide subsequent decisions.

7. Helping inform patients, clinicians and policymakers For example, clinical actions are likely to differ depending on whether one concludes that the evidence that warfarin reduces the risk of stroke in patients with atrial fibrillation is convincing (high quality) or that it is unconvincing (low quality).

8. Helping inform patients, clinicians and policymakers Similarly, policy decisions are likely to differ depending on whether one concludes that the evidence that specialised stroke units reduce the risk of death and disability (compared with treating acute stroke patients in general medical wards) is convincing or not.

9. A generic knowledge translation framework across the research, policy, managerial, and societal domains. Bosch-Capblanch X, Lavis JN, Lewin S, Atun R, et al. (2012) Guidance for Evidence-Informed Policies about Health Systems: Rationale for and Challenges of Guidance Development. PLoS Med 9(3): e1001185. doi:10.1371/journal.pmed.1001185 http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001185

10. . Potential links between guidance and policy development at global and national levels. Lavis JN, Røttingen J-A, Bosch-Capblanch X, Atun R, et al. (2012) Guidance for Evidence-Informed Policies about Health Systems: Linking Guidance Development to Policy Development. PLoS Med 9(3): e1001186. doi:10.1371/journal.pmed.1001186 http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001186

11. Commonly used tools to assess systematic reviews and their findings and to assess clinical guidelines. Lewin S, Bosch-Capblanch X, Oliver S, Akl EA, et al. (2012) Guidance for Evidence-Informed Policies about Health Systems: Assessing How Much Confidence to Place in the Research Evidence. PLoS Med 9(3): e1001187. doi:10.1371/journal.pmed.1001187 http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001187

12. . Example of factors affecting decisions about strength of recommendations— Lay or community health workers to reduce childhood mortality. Lewin S, Bosch-Capblanch X, Oliver S, Akl EA, et al. (2012) Guidance for Evidence-Informed Policies about Health Systems: Assessing How Much Confidence to Place in the Research Evidence. PLoS Med 9(3): e1001187. doi:10.1371/journal.pmed.1001187 http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001187

13. Key features of a health system that can influence decision- making about how to address a health system problem. Lavis JN, Røttingen J-A, Bosch-Capblanch X, Atun R, et al. (2012) Guidance for Evidence-Informed Policies about Health Systems: Linking Guidance Development to Policy Development. PLoS Med 9(3): e1001186. doi:10.1371/journal.pmed.1001186 http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001186

14. The GRADE Working Group is a collaboration of over 60 organisations from around the world that has developed a systematic and transparent approach to making judgments about :GRADE the quality of evidence (how confident we are in estimates of effect) and the strength of recommendations (how confident we are that the desirable effects of adherence to a recommendation outweigh the undesirable effects). The GRADE Working Group

15. To benefit from this work, health care decision makers need to: have access to evidence-based clinical recommendations or briefs describing policy options, be able to understand that information and be enabled to make decisions that reflect their own values or the values of those affected. The GRADE Working Group and health care decision

16. Maximizing the Impact of Systematic Reviews in Health Care Decision Making: A Systematic Scoping Review of Knowledge-Translation Resources DUNCAN CHAMBERS, PAUL M. WILSON, CARL A. THOMPSON, ANDRIA HANBURY, KATHERINE FARLEY, and KATE LIGHT The Milbank Quarterly, Vol. 89, No. 1, 2011 (pp. 131–156)

17. Conclusions: Systematic review producers provide a variety of resources to help policymakers, of which focused summaries are the most common. More evaluations of these resources are required to ensure users’ needs are being met, to demonstrate their impact, and to justify their funding.

18. DECIDE is an international collaborative research project linked to the GRADE Working Group that will develop and evaluate strategies for communicating and disseminating evidence- based recommendations and policy briefs. The DECIDE

19. These strategies will be tailored to the information needs of patients, clinicians and policymakers. The DECIDE

20. They will include frameworks to help people to go from evidence to decisions, as well as strategies for communicating research findings The DECIDE

21. The DECIDE project started in January 2011 and will run for five years. It has received funding from the European Union 7 th Framework Programme (FP7/2007-2013) under grant agreement number 258583. More information about the project can be found on our web pages. The DECIDE

23. The DECIDE Project

24. Structure of the project Phase 1 – Strategy development and user testing Task 1: Brainstorming workshops Task 2: Stakeholder group feedbacks Task 3: Survey of policy makers and managers – their view on current dissemination strategies Task 4: User testing – how DECIDE’s dissemination strategies work with real users Phase 2 – Evaluating the strategies Phase 3 – Testing the strategies with real guidelines The DECIDE Project

25. Work Package 2 Policymaker and manager focussed strategies for communicating evidence-based recommendations The DECIDE-WP2

26. The WP2 has been leaded from the start by Alessandro Liberati at the Italian Cochrane Centre in Modena Starting from January 2012, it is leaded by Marina Davoli and now at the Department of Epidemilogy, Lazio Regional Health Service-Italy

27. Target audience Policy makers and managers and their support staff with responsibility for making coverage decisions. These coverage decisions can take place at national and/or regional level depending on the type of interventions. The DECIDE-WP2

28. Coverage decision: decisions by third party payers (public or private health insurers) about : whether and how much to pay for drugs, tests, devices or services and under what conditions. The DECIDE-WP2

29. Main objectives 1- To develop and test a “conceptual framework” that - in the context of the GRADE method – can assist policy makers and managers in going from the assessment of quality of evidence to decision(s) The DECIDE –WP2

30. Main objectives 2-To promote understanding of how evidence can be best communicated to policy makers and managers that have to make coverage decisions, and identify what information is relevant to them The DECIDE –WP2

31. Main objectives 3-To develop and evaluate tools and strategies for communicating evidence- based recommendations to policy makers and managers The DECIDE –WP2

32. Where are we ? Phase 1 – Strategy development and user testing We developed the first two tasks trough the comments and suggestions coming from an Italian Advisory Board and meetings in different settings, both in Italy and in other countries, with our stakeholders Task 1: Brainstorming workshops Task 2: Stakeholder group feedbacks The DECIDE –WP2

33. Where are we going? Phase 1 – Strategy development and user testing Task 3: Survey of policy makers and managers – their view on current dissemination strategies Task 4: User testing – how DECIDE’s dissemination strategies work with real users The DECIDE-WP2

34. Framework to go from evidence to decision It contains: different domains defined by different criteria criteria defined by question evidence judgments about the above mentioned criteria comments The DECIDE –WP2

35. A framework example

37. The DECIDE

41. The DECIDE-WP2

42. The Decide-WP2 Trough the comments and suggestions coming from the Italian Advisory Board ‘s brainstorming workshops and stakeholder group feedbacks, we obtained some first results reassumed in a poster presented at the Cochrane Colloquium in Auckland Those results are, at the same time, challenges

43. The DECIDE –WP2

44. The DECIDE-WP2 : What our stakeholders need Seriousness of the problem: More data about burden Benefits and Harms: Indirect comparison Definition of uncertainty of the effect Explanation about GRADE approach What is a desirable effect? Missing outcome Efficacy vs effectiveness

45. The DECIDE-WP2 : What our stakeholders need Equity: Better definition Efficacy and context conditioned Inappropriate use of resources substracted to other effective intervention Values: Consider both patientand caregiver values Costs: More information needed

46. Thank you Providing evidence for healthcare decision

47. The DECIDE –WP2

50. The DECIDE