A.5 Evidence-informed practice

Question 1

What does the Fourth Australian Atlas of Healthcare Variation examine?

Answer 1

Variation in healthcare use according to where people live, how their care is funded, and their level of socioeconomic disadvantage.

Question 2

List the six clinical areas covered by the Fourth Australian Atlas of Healthcare Variation.

Answer 2

• Early planned births
• Chronic disease and infection
• Ear, nose and throat surgery in children and young people
• Lumbar spinal surgery
• Gastrointestinal investigations
• Medicines usage in older people

Question 3

What is considered desirable variation in healthcare?

Answer 3

Variation that reflects differences in people’s healthcare needs or informed choices about treatment options.

Question 4

What constitutes unwarranted variation in healthcare?

Answer 4

Variation due to patient care not supported by evidence, uncertainty about intervention’s place in therapy, or differences in access to and appropriateness of care.

Question 5

What do the Atlases suggest about Australian healthcare?

Answer 5

Australian healthcare is suboptimal, featuring high rates of harmful interventions, preventable admissions, low rates of appropriate care in high-burden groups, and unexplained higher rates of interventions.

Question 6

What percentage of heart failure patients received excellent care according to guidelines in a recent Australian study?

Answer 6

13%

Question 7

What is the definition of health informatics according to Georgiou?

Answer 7

Health informatics can be described as the very engine room driving evidence-based medicine.

Question 8

Define evidence-based practice.

Answer 8

Integrating the best available research evidence with clinical expertise and the patient’s unique values and circumstances.

Question 9

What is the first step in evidence-based clinical practice?

Answer 9

Frame the clinical question.

Question 10

What does the PICO framework stand for?

Answer 10

• Population
• Intervention
• Comparison
• Outcome

Question 11

What does the ‘Population’ component of PICO refer to?

Answer 11

The scope of the problem, addressing the condition of interest and characteristics of the sub-population.

Question 12

What does the ‘Intervention’ component of PICO describe?

Answer 12

What will be done differently with/for the patient or what is different about this patient.

Question 13

What does the ‘Comparison’ component of PICO involve?

Answer 13

The alternative or contrast to the intervention.

Question 14

What are the possible types of outcomes in the ‘Outcome’ component of PICO?

Answer 14

• Immediate
• Intermediate
• Longer term

Question 15

What additional consideration can be added to PICO to form PICOT?

Answer 15

‘T’ for time frame for research.

Question 16

What defines clinical practice guidelines?

Answer 16

Statements that include recommendations intended to optimize patient care, informed by a systematic review of evidence.

Question 17

What role do systematic reviews play in evidence-based clinical practice?

Answer 17

They provide formal assessments of the scientific evidence related to a clinical question.

Question 18

What is The Cochrane Collaboration known for?

Answer 18

Producing and disseminating systematic reviews of healthcare interventions.

Question 19

What is the NHMRC’s two-step approach to assessing evidence?

Answer 19

• Summarize primary studies and systematic reviews
• Summarize information about the strength of the evidence

Question 20

What are the three key questions to consider when reviewing evidence according to the NHMRC?

Answer 20

• Is there a real effect?
• Is the size of the effect clinically important?
• Is the evidence relevant to practice?

Question 21

What is the hierarchy of evidence levels according to the NHMRC?

Answer 21

• I: Systematic review of RCTs
• II: One properly designed RCT
• III-1: Pseudo-randomised controlled trials
• III-2: Comparative studies with concurrent controls
• III-3: Comparative studies with historical control
• IV: Case series

Question 22

What is the significance of clinical significance in relation to statistical significance?

Answer 22

Clinical significance refers to whether the difference between approaches is significant enough to warrant a change in practice.

Question 23

What are the two main outcomes of RCTs that are not double-blind with inadequate allocation concealment?

Answer 23

Larger estimates in favour of the new intervention and exaggeration of the estimated treatment effect.

Question 24

What is the primary aim of applying evidence in healthcare?

Answer 24

To identify individuals or groups for whom the proposed treatment is more likely to do good than harm.

Question 25

What are the five questions recommended by NHMRC to assess applicability of interventions?

Answer 25

* What are the beneficial and harmful effects of the intervention? * Are there variations in the relative treatment effect? * How does the treatment effect vary with baseline risk level? * What are the predicted absolute risk reductions for individuals? * Do the benefits outweigh the harms?

Question 26

What is the PDCA cycle used for in healthcare?

Answer 26

To introduce improvements in healthcare.

Question 27

What are the four phases of the Plan-Do-Check-Act cycle?

Answer 27

* Planning * Doing * Checking * Acting

Question 28

What does the planning phase of the PDCA cycle involve?

Answer 28

* Identifying and analysing the problem * Discussing scenarios * Identifying data to be collected * Clarifying roles and actions

Question 29

In the PDCA cycle, what is the purpose of the 'Doing' phase?

Answer 29

Testing a potential solution on a small scale.

Question 30

What is evaluated in the 'Checking' phase of the PDCA cycle?

Answer 30

How effective the test solution was and whether it could be improved.

Question 31

What does the 'Acting' phase of the PDCA cycle entail?

Answer 31

Implementing the improved solution fully.

Question 32

What is the difference between process evaluation and outcome evaluation?

Answer 32

Process evaluation monitors implementation, while outcome evaluation measures the realization of objectives.

Question 33

What are immediate outcomes in the context of healthcare evaluation?

Answer 33

First-order changes, including participant behaviors and observable practice results.

Question 34

What are the steps in the US CDC evaluation model?

Answer 34

* Engaging stakeholders * Describing the program * Focusing the evaluation design * Gathering credible evidence * Justifying conclusions * Ensuring use and sharing lessons learned

Question 35

What are the four groups of standards proposed by the CDC for evaluating quality?

Answer 35

* Utility standards * Feasibility standards * Propriety standards * Accuracy standards

Question 36

True or False: Evidence-based practice has no criticisms.

Answer 36

False

Question 37

What common criticisms are associated with evidence-based clinical practice?

Answer 37

* Potential conflict between sources of guidelines * Applicability of generalized evidence to specific cases * Expense of generating and maintaining evidence * Under-representation of negative results * Impingement on clinicians’ professional autonomy * Information overload

Question 38

What are barriers to the systematic implementation of evidence-based practice?

Answer 38

* Relevant information is difficult to access * Skill and resource deficiencies * Lack of appropriately skilled clinicians * Lack of systemic incentives * Lack of influential leadership * Long lead times in assimilating evidence * Relevant information is highly dispersed

Question 39

What opportunities does health informatics present to overcome barriers in evidence-based practice?

Answer 39

* Online knowledge management resources * Decision support systems * Remote care delivery * Closer alignment of clinical governance * ICT enabled leadership * Electronic health records * Data analytics * Aggregation and clinical portals