1. Teaching Evidence Assimilation for Collaborative Health Care
Building Capacity for Scientifically Informed Healthcare
Peter Wyer MD
Co-Chair, Section on Evidence Based Health Care
New York Academy of Medicine
Department of Medicine, Columbia University Medical Center

2. ACKNOWLEDGEMENTS SEBHC TEACH Team Advisors NYAM Staff Arlene Smaldone
Peter Wyer
Co-Chairs
Barney Eskin
Secretary
Michael Cantor
Treasurer
Sharron Close
Dawn Dowding
Louise Falzon
Pat Gallagher
Jaime Gray
Judy Honig
TJ Jirasevijinda
Vepuka Kauari
Julia Lavenberg
Nikhil Mull
Allison Piazza
Patricia Quinlan
Karen Schoelles
Suzana Alves Silva
Alexandr Tichter
Jonathan Treadwell
Ian Graham
Eddy Lang
Sharon Straus
Henry Ting
Marita Titler
Craig Umscheid
Donna Fingerhut
Margarita Guevara
Reggie Richards-Peelle
Anthony Shih

3. DISCLOSURES No Faculty Disclosures Declared
TEACHING EVIDENCE ASSIMILATION FOR COLLABORATIVE HEALTHCARE
DISCLOSURES
No Faculty Disclosures Declared
Generous Donation of Electronic Resources:
Annals of Internal Medicine (ACP Journal Club)
BMJ Group (Clinical Evidence, Best Practice, EB Journals)
Wiley (Cochrane Library)
EBSCO (Dynamed, CINAHL)
McGraw-Hill-JAMA (JAMAEvidence)
Wolters-Kluwer (Joanna Briggs)
ACKNOWLEDGEMENT
ECRI Institute

4. TEACH
Evidence Assimilation
Collaborative Health Care

5. Defragmentation of EBCP
Knowledge translation/evidence-based practice
Development of clinical policies and guidelines
Foundations of evidence-based healthcare

6. Common Skills Across Dimensions
Problem delineation
Formulating information needs
Finding the most relevant evidence
Appraising evidence quality and importance
Integration with practice-based evidence
Assimilation of resulting knowledge into clinical and systems level actions

7. Level 1 Narrative, interpersonal and epidemiological skills
Constructed priorities and preferences
Road Map for evidence literacy
Defining information needs
Finding relevant and applicable research
Evaluating the quality of evidence
Reconsidering applicability to healthcare, policies and practice

8. Level 2 Practice based health technology assessment
Clinical policies and recommendations
Specific health care settings
Guideline appraisal and adaptation
The GRADE system

9. Level 3 Team based problem definition
Gathering ‘internal’ + ‘external’ evidence
Use of health services/implementation research
Analysis of barriers and facilitators
Educational interventions, decision support
Monitoring measurable and sustainable impact
Maintaining currency and sustainability

10. A Quality Improvement Orientation
Start with problem, not the evidence
Use practice based data
Integrate use of research with operations and work flow
Adhere to the focus on patient-important outcomes = the ‘central dogma’ of EBM

11. The Road Map Patient Centered Information Queries
“Given my personal characteristics, conditions and preferences, what should I expect will happen to me?”  (Frequency)
‘How confident should I be in the criteria you/we are using to answer the previous question?’  (Performance)
“What are my options and what are the potential benefits and harms of those options?”  (Utility)

12. The Road Map Hierarchy of Information

13. NOT: “Not EBM”
EBM no longer defined in the literature, hence cannot say “this is ‘not EBM’”!

14. Relationship Centered Care
: Pew Commission/Fetzer Inst
Tasked to integrate psychosocial and biomedical issues in health care
Proposed epistemologically defined construct
Polanyi: tacit dimension
Merleau-Ponty: predecessor of complexity theory
Explicitly identified tendencies
Schon: Reflective action
Engel: Biopsychosocial model
Subsequent developments-relationship to complexity theory, complex adaptive systems,
Wyer, Silva, Post ,Quinlan. J Eval Clin Pract 2014

15. The social processes of healthcare
Research literacy
Silva SA, Charon R, Wyer PC. JECP ;17:

16. Summary and Clarification
“EBP”≠ “EBM”
Emphasis on applicability and adaptation
Reject fixed hierarchy of research designs
RCT evidence relevant but may be indirect
A QI approach to “EBP”