Health Systems Eviden

Health Systems Eviden

E id t S t E

vidence 

to 

Suppor

t

Polic

y g makin

g and Mana

g 

emen

<< healthsystemsevidence.org >

Veterans Health Administration 

October 5th, 2010

Lori Greco MHSc, Knowledge Broker

Kaelan Moat, Doctoral Student
Agenda

 Overview of Health Systems Evidence

 Wh t it is What it is How is was created Why use it What is in it How to search it

 Tour of Health Systems Evidence Tour of Health Systems Evidence Demonstration searches
Hea t Syste s de ce a t 

lth Systems Evidence Part

3
Interactive Question 1 Interactive Question

1

 What is your role?

Cli i i Cli

n

i

c

ian

Researcher

Manager or AdministratorOther
Background

 John Lavis’ research program

 To promote the use of research evidenc

policymaking and management

 Michael Wilsons Michael Wilsons’ work to develop the da

work to develop the da
What is Health Systems Evidenc

What is Health Systems Evidenc

 Online repository Continuousl

y p u

pdated

 Easy to search
What is Health Systems Evidenc

What is Health Systems Evidenc

Contains polic

y-relevant synthesized resea

evidence about:

 governance, financial and delivery arrang

withi h lth t m ithin 

health sys

t

e

ms 

 implementation strategies that can suppo

implementation strategies that can suppo

change within health systems.
Interactive Question 2 Interactive Question

2

 Given what you know so far are you likely to use Given what you know so far, are you likely to use Health 

Health 

Evidence to find synthesized research evidence about gove

financial and delivery arrangements within health systems an

implementation strategies within health systems?

Yes

No 

Maybe 
Methods: How we build and maint

 On-going process of:

 Identifying and screening abstracts of systematic reviews

syntheses for inclusion; 

 Coding each included synthesis according to type and ho

health systems arrangements and implementation strateghealth systems arrangements and implementation strateg

 Searching for and linking to free online pdfs, full text file

summaries, ; abstracts;

 Applying a validated quality rating tool to produce a met

quality score for each synthesis and;

 Identifying countries in which the studies included in eac

conducted
How we build and maintain HS

 Identifying abstracts of research syntheses

 Centre for Reviews and Dissemination (UK) D

Centre for Reviews and Dissemination (UK) D

Abstracts of Reviews of Effects— “DARE” (wu

p ) dates

)

 Cochrane library of systematic reviews (monthl Cochrane Effective Practice and Organization o

Cochrane Effective Practice and Organization o

Group (EPOC)

 Other s

y y ntheses and sources of s

yntheses that a

identified (personal knowledge, forwards from list-servs, etc.)
How we build and maintain HS

 Screening abstracts of systematic reviews/other researc

for inclusion

 Reviews/overviews of reviews: at least two database

have been searched, explicit inclusion/exclusion cribe included be included

 Policy briefs: must address two or more of the polic

options for addressing the problem, and implementstrategies; and; they draw (at least in part) on systemreviews to describe what is known about two or moproblem options for addressing the problem and problem, options for addressing the problem, and

implementation strategies

 Performed inde

p yy endentl

y b

y at least two reviewers
How we build and maintain HS

 Coding each included synthesis according to type:

• Policy brief Policy brief• Overview of systematic review• Systematic review Systematic review• Systematic review (Cochrane)• Syste at c ev ew p otoco (o te Coc a e) mati

c review

p

rotocol (o

ften Cochr

a

ne)

 Coding each included synthesis according to type of qu

• Effectiveness

• Not effectiveness• Many 
How we build and maintain HS

 Coding based on which health system arrangement(s) an

im

p gy lementation strate

gies the

y address:

 Governance Arrangements (i.e. centralization/decen

of policy authority)

 Financial Arrangements (i.e. the use of fee for servic

form of remuneration)

 D li A t (i b tit ti f 

D

elivery 

Arrangemen

ts (i.e. su

b

stit

ution o

f nurse pra

for general physicians)

 Implementation strategies (i.e. providing consumers 

Implementation strategies (i.e. providing consumers 

information or education about a program)

 Independently coded by two reviewers
Health System Arrangements

Governance Arrangement 

(79)

Financial Arrangement 

(104)

De

Arrangem

• Policy Authority (14) Policy Authority (14)

• Financing (35)

• To whom care i

• Organizational authority 

(32)

Financing (35)

• Funding (21)

To whom care i

what efforts to r

( ) • B

y whom care i

• Professional authority (20)

• Remuneration (44)• Financial incentives for 

y 

• Where care is pr

• Commercial authority (11)• Consumer and stakeholder 

i l (23)

patients (27)

• Resource allocation (15)

•

With what infor

communication provided? (215)

involvement (23)

• With what level 

is care provided 
Implementation strategies

Consumer-targeted (135) Provider-targeted (181) 

• Information or education 

provision 

(104)

• Educational material (80)• Educational meeting (92) p ()

• Behaviour change support 

(64)

• Skill d t i

• Educational meeting (92)• Educational outreach visit (37)• Local opinion leader (7)

• Skills an

d compe

tencies 

development (32)

• (Personal) Support (32)

• Local consensus process (4)• Peer review (0)

A di d f db k (49) • Communication and 

decision-making facilitation (15)

•

A

udit an

d

feedbac

k (49)

• Reminders and prompt (0)• Tailored intervention 

(

2

)

• System participation (1)

( )

• Patient-mediated intervention (18)• Multi-faceted intervention (89)
How we build and maintain HS

How we build and maintain HS

 Searching for and linking to free online pdfs, full te

user friendly summaries, abstracts

 URLs for publicly available copies of included s

and user-friendly summaries of these syntheses identified and included in the database for each 

 i li k P bM d b i.e. li

n

ks to 

P

ubM

e

d a

bstracts, A li C h Austra

las

ian 

Coc

h

Centre Policy Liaison Initiative user-friendly sum

PDF files if the review is published in an open aPDF files if the review is published in an open a

journal
How we build and maintain HS

 Applying a validated quality rating tool to produce 

methodological quality score for each synthesis methodological quality score for each synthesis

 Two reviewers independently assess each system

review in the database using the AMSTAR qualreview in the database using the AMSTAR qual

tool



Reco c ed sco es a e epo ted w t eac ev ew n

ciled sco

res

a

r

e repo

rted

wi

th each review

 Country coding

 Two reviewers independently scan reviews to id

Two reviewers independently scan reviews to id

countries in which the studies included were co

 Reconciled codes appear in the database with e
Why use Health Systems Evide

Why use Health Systems Evide

 Saves time Saves time by helping to rapidly identify: by helping to rapidly identify:

 synthesis of the best available research evidence 

g p iven to

pic 

 prepared in a systematic and transparent way ho

wy w recentl

y the search for studies 

was conduc

 quality of the synthesis countries in which the studies included in the sy

countries in which the studies included in the sy

were conducted

 ke

yg y findin

gs from the s

ynthesis
What is in Health Systems Eviden

What is in Health Systems Eviden

 Details about Details about systematic reviews relevant 

systematic reviews relevant 

health systems

 policy briefs policy briefs overviews of systematic reviews syst ti i ematic reviews review protocols  li kn

ks to any user-f i dl i i ifi 

fr

iendly summar

ies, sc

ientific a

and full-text reports currently available
What is in Health Systems Evidenc

What is in Health Systems Eviden

 Over 1300 citations Over 1300 citations (at 2010 (at 2010

-

9

-24)

 17 policy briefs 15 overviews of systematic reviews 882 systematic reviews

• 299 Cochrane reviews

 154 protocols for Cochrane reviews 154 protocols for Cochrane reviews
Evidence Service Evidence Service

 General 

•

All new reviews (coming soon)

 Topic-specific services 

• Primary healthcare• Chronic disease management• Di b t t Di

a

b

e

tes managemen

t

• Chronic pain management• Rural healthcare strategy Rural healthcare strategy

 Subscribe at 

www.mcmasterhealthforum.org/healthsystemsevidence/evidence_s
Finding Research Evidence Finding Research Evidence

 Search by: 

 health system topic Canadian priority area (which may overlap with prio

in other jurisdictions) in other jurisdictions)

 type of synthesis type of research question type of research question author

o

pen search

 recent update any combination of these o

ptions
Finding Research Evidence 

Finding Research Evidence 

 Each search will yield a listing of syntheses 

 type of synthesis (e.g., policy brief) type of question (e.g., effectiveness) h lh ea

l

t

h system top

ic ( kill i (e.g., skill m

ix 

– rol i 

e expans

ion 

 title of the synthesis last year literature searched literature searched quality rating (using AMSTAR criteria) countries in which studies included in the synthesis 

in which studies included in the synthesis 

conducted

 links to any freely available user-friendly summaries

abstracts, and full-text reports.
A Searchable Question A Searchable Question

What do you want to find out? About the 

problem

 About options to address the problem Abo t option implementation consideration

Abo

u

t option implementation consideration
Interactive Question 3 Interactive Question

3

 What topic areas or practice/ research questions wo

use Health Systems Evidence to find researcabout?
Sample Search #1 Sample Search #1

Scenario:

 We want to provide a patient-centered medical 

model, e.g., more shared decision-making with and better coordination of care provided by speimprove outcomes for patients with chronic dis

healthsystemsevidence.org
Connect to HSE online Connect to HSE online
Sample Search #2

Scenario: We want to provide a patient-centered medical hom

model, g , p g (p y e.g., improving access (particularly with the of technology)
Sa p e Sea c #3 mple Search #3

S i cenar o: A local health authority seeks information about al

h lth r d li r m d l f r r r l mm iti healthcare delivery models for rural communities
Sample Search #4

Scenario: A research-funding agency needs to identify what’s 

known about implementation strategies to support 

national policy priorities national policy priorities
Sample Search #5 Sample Search #5

Scenario

 Discussions around the best ways improve the 

diabetes care have resulted in a suggestion to edproviders about best practices and unique strateensure eff i i l i f ffective 

imp

lementation o

f treatmen

t
Sample Search #6 Sample Search #6

Scenario

 One o

p g tion bein

g considered to reduce the cos

primary care service provision is to substitute nphysicians to deliver specific routine services
Next Steps for HSE Next Steps for HSE

 O i thl d t Ongo

ing monthly up

d

a

tes

 New topic-specific bulletins  General evidence service

Tutorials on content and use 

 Webinar series with the Canadian Cochrane  P d t f bi P

o

dcas

ts o

f webinars 
Interactive Question 4 Interactive Question

4

 G h k lkl Given what you now 

know, are you 

lik

e

ly to use H lhS ea

th

S

Evidence to find synthesized research evidence about gove

financial and delivery arrangements within health systems anfinancial and delivery arrangements within health systems an

implementation strategies within health systems ?

YesNo Maybe 
Questions?

Contacts: Lori Greco, Knowledge Broker

l@ t greco@mcmaster.ca

 Kaelan Moat, Doctoral Student

moatka@mcmaster.ca