Evidence-informed Decision Making in the Era of COVID-19
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In partnership with the Community Health Nurses’ Initiatives Group (CHNIG), this webinar will provide an overview of Evidence-Informed Decision Making (EIDM) processes and apply those processes to the rapidly expanding COVID-19 literature. Learn how to think critically about headlines and find high-quality evidence you can trust.
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Evidence-informed Decision Making in the Era of COVID-19
- 1. November 25, 2020Emily Clark, MSc Emily Belita, RN, PhD Evidence-informed Decision Making in the Era of COVID-19
- 2. Presenter Emily Clark, MSc National Collaborating Centre for Methods and Tools
- 3. Housekeeping • We are testing a new webinar platform • Connection issues • We recommend using a wired Internet Connection • If you are experiencing technical issues please send a private message to admin • Use chat to post questions and/or comments throughout the webinar • Post your questions in the public chat box • Send questions about technical difficulties in a private chat to admin • Polling
- 4. After Today After the webinar, access the recording (in English) at www.youtube.com/nccmt and slides in English and French at www.slideshare.net/NCCMT/presentations.
- 5. Poll Question 1 How many people are watching today’s session with you? A) Just Me B) 2-3 C) 4-5 D) 6-10 E) >10
- 6. Poll Question 2 Have you visited the National Collaborating Centre for Methods and Tools’ website or used its resources before? A) Yes B) No
- 7. Poll Question 3 If you stated YES on the previous question, how many times have you used the NCCMT’s resources? A) Once B) 2-3 times C) 4-10 times D) 10+ times
- 8. Today’s Presentation Welcome, CHNIG members! • What are the NCCMT and the NCCPH? • What is evidence-informed public health (EIPH) • How has our approach to EIPH changed during the COVID-19 pandemic? • Overview of EIPH with COVID-19 lessons learned
- 10. National Collaborating Centre for Methods and Tools • Our vision: Stronger public health, driven by the best-available evidence, to improve the health and well-being of every person living in Canada. • We encourage and scale evidence-informed decision-making in health care organizations in Canada. We achieve this by providing high-quality resources, real-world training and practical mentorship that evolves with, and responds to, the ever-changing needs of public health.
- 11. What is Evidence-Informed Public Health? The process of distilling and disseminating the best available evidence from research, context and experience, and using that evidence to inform and improve public health practice, programs and policy. 11
- 12. What is Evidence-Informed Public Health? • The process of distilling and disseminating the best available evidence from research, context and experience • Using that evidence to inform and improve public health practice, programs and policy.
- 13. Decision making models 13 Opinion-based Ask question Make Decision Find Evidence Ask question Find Evidence Make Decision Evidence-based
- 14. Why Evidence-Informed Decision Making?
- 15. Why Evidence-Informed Decision Making? 15 • Reduce harms • Improve outcomes • Improve satisfaction • Maximize resources
- 17. 7-Steps of Evidence-informed Decision Making 17
- 18. Evidence during the COVID-19 pandemic • Explosion of research articles • New COVID-19-specific databases • Most up-to-date evidence often pre-print articles • How can you find and use evidence that you can trust?
- 19. NCCMT’s COVID-19 response • Pivoted from capacity building and training to evidence production • Urgent need for high-quality, synthesized evidence • Rapid Review Repository • Database of ongoing and completed rapid reviews from across Canada • Rapid Evidence Service • Rapid reviews completed by NCCMT • What have we learned about applying EIPH in a COVID-19 world?
- 20. Defining a focused research question • Research questions should be: • Focused • Actionable 20
- 21. 21 Health Evidence™ Developing an Efficient Search Strategy Using PICO http://www.healthevidence.or g/practice-tools.aspx#PT2
- 22. Defining a focused research question • COVID-19 considerations • When? Early pandemic, 2nd wave • Where? Applicable to context 22
- 23. Efficient searching • Where should you start your search? • How can you optimize your search? 23
- 24. Systematic Reviews • High level of synthesized evidence on a given topic • Systematic, transparent methods • Meta-analysis: combines results of multiple studies 24 Study 1: 139 participants No effect Study 2: 389 participants No effect Study 3: 521 participants No effect Systematic review and meta- analysis: 1049 participants Effect + +
- 25. 25 Example: Search for “built environment” and “mental health” Summaries TRIP 3 Syntheses Health Evidence™ 34 Studies PubMed 194 Google Scholar 60 600 Google 4 330 000 (DiCenso et al., 2009; Haynes et al. 2005; Robeson et al., 2010) 6S Pyramid
- 26. Health Evidence™ Repository • Almost 6000 quality-rated systematic reviews evaluating the effectiveness of public health interventions 26
- 28. 28 • Sign up for free • Stay up-to- date with reviews relevant to topics you care about Health Evidence™ Evidence Service
- 29. COVID-19 Databases • Synthesized Evidence • LitCovid (Pubmed) • WHO* • L*OVE (Epistemonikos) • UNCOVER (Oxford)* • NCCMT* • McMaster Health Forum* • Single studies • LitCovid • WHO* • MMWR (CDC)* • MedRxiv pre-print server* Warning: Not all peer-reviewed
- 30. Can you be confident in the findings? Guidelines: AGREE II • http://www.agreetrust.org/resource-centre/agree-ii/ Systematic Reviews: Health Evidence™ Quality Appraisal Tool Critical Appraisal Skills Programme: Checklists • http://www.casp-uk.net/ • CASP offers free, downloadable checklists for: 30 • Randomised Controlled Trials • Systematic Reviews • Cohort Studies • Case-Control Studies • Qualitative Studies • Economic Evaluations • Diagnostic Studies • Clinical Prediction Rules Appraising for quality
- 31. Online Learning Modules • Interactive, problem-based • Free to access 31
- 32. Bringing it all together • Synthesis step critical for communicating evidence • Creating briefing notes to inform decision- makers Health Evidence™ Briefing Note: Decisions, Rationale Rationale and Key FindingsSummary http://www.healthevidence.org/practice- tools.aspx#PT6 • Rapid review guidebook: https://www.nccmt.ca/tools/rapid-review-guidebook
- 33. Understanding Research Evidence Video Series
- 34. Weighing findings by quality of evidence • Include quality in summary of findings • Present limitations of evidence and knowledge gaps • NCCMT uses Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate overall certainty of the findings • How likely are the findings to change with more evidence?
- 35. • Effective communication from public health leaders critical for COVID-19 response • How can we best communicate with public? 35 Rapid Review: Risk Communication
- 36. Key Points • Messaging should be clear, repeated, action-oriented and by a trusted leader. Certainty of evidence is moderate (GRADE). • Trust can be built by addressing uncertainty, acknowledging change and previous errors. Certain of evidence is low (GRADE) and may change as more data becomes available. • Communication should be tailored to audience in message and medium. Certainty of evidence is moderate (GRADE). • Positively framed messages emphasizing collective may be more effective. Certain of evidence is low (GRADE) and may change as more data becomes available. 36
- 37. Overview of Evidence • Majority of evidence from non-COVID-19 literature (e.g., previous epidemics, vaccinations, smoking), and may be less relevant in social media-driven world • Studies of COVID-19-specific messaging so far limited to analyzing spread of info via social media. • Characteristics of a trusted leader is not defined. 37
- 38. Registry of Methods and Tools • Searchable database of KT resources • Summaries and links 200+ resources • Categorized by: • Method/tool • KT and related activity • EIPH step 38
- 39. 39
- 40. Explore NCCMT’s Rapid Reviews • Check out nccmt.ca/covid-19/covid-19-rapid- evidence-service • 26 reviews and growing • Living review: Role of children in COVID-19 transmission • Sign up for email alerts for new or updated reviews 40
- 41. Getting Started: Assess your learning needs • SkillsAssessmentTool • 20 multiple choice questions • Personalized report
- 42. Getting Started • Connect via our newsletter, Twitter or Facebook • Check out a Rapid Review • Try the Skills Assessment • Try an Online Learning Module • Look up a relevant topic on Health Evidence™ 42
- 43. Questions?
- 44. Share your story! • Are you using EIDM in your practice? We want to hear about it! • Email us: nccmt@mcmaster.ca • Need support for EIDM? Contact us for help! • Email us: nccmt@mcmaster.ca • We typically respond within 24 business hours 44
- 45. Webinar Feedback Your responses will be kept anonymous. Please indicate your level of agreement with the following 1. Participating in the webinar increased my knowledge and understanding of evidence-informed decision making. Strongly agree Agree Undecided Disagree Strongly Disagree
- 46. Webinar Feedback Your responses will be kept anonymous. Please indicate your level of agreement with the following: 2. I will use the information from today’s webinar in my own practice. Strongly agree Agree Undecided Disagree Strongly Disagree
- 47. Webinar Feedback Your responses will be kept anonymous. 3. Which of the following statements apply to your experience with the webinar today (check all that apply): □ The webinar was relevant to me and my public health practice □ The webinar was effectively facilitated □ The webinar had opportunities to participate □ The webinar was easy to follow along □ The webinar met my expectations
- 48. Webinar Feedback Your responses will be kept anonymous. 4. Can we contact you in the future to discuss how the NCCMT can improve its webinar series? □ Yes □ No
- 49. Webinars from the NCCMT Learn more about our webinars: http://www.nccmt.ca/capacity-development/webinars 49
- 50. For more information: NCCMT website: www.nccmt.ca Contact: nccmt@mcmaster.ca
Hinweis der Redaktion
- There are a few housekeeping items to cover before starting this webinar. We recommend using a wired internet connection for the webinar today. For best results, if possible, use the latest version of Google Chrome or Firefox Internet browsers. If you do have any technical difficulties, please send a private message to admin (NCCMT) and we will be able to respond to those request (as shown in image). If you have any questions for the presenters throughout the webinar, please send them to the public chat and we will make sure to get to those at the end of the webinar. There will be a few polling questions today in the webinar. When they are open they will pop-up over the slide. Please note- there might be a slight delay in the polling questions popping up. Once you enter your response, press submit. If you select do it later, it will go to your open queue and can be completed at any time during the webinar (as shown in the image).
- The slides and recording will be available after today’s webinar in about two weeks. The recording will be posted on our YouTube account and the slides will be posted on our SlideShare account. We will also send out tweets when they are posted – keep an eye out on our Twitter at @nccmt.
- The National Collaborating Centre for Methods and Tools is one of six National Collaborating Centres across Canada. We are hosted at McMaster University in Hamilton, Ontario, and our goal is to support public health professionals and organizations integrate evidence-informed decision making into our work. The National Collaborating Centres are funded by the Public Health Agency of Canada. We each focus on a different priority public health topic. From the West, there is the National Collaborating Centre for Indigenous Health in Prince George British Columbia, the National Collaborating Centre for Environmental Health in Vancouver, British Columbia, the National Collaborating Centre for Infectious Disease in Winnipeg, Manitoba, the National Collaborating Centre for Healthy Public Policy in Montreal, Quebec, and the National Collaborating Centre for Determinants of Health in Antigonish, Nova Scotia.
- -At the NCCMT, our focus is on championing the use of evidence in public health decision making. -Through several strategies: -Curating the latest research and evidence on what works in public health -Sharing knowledge and developing skills for integrating evidence -Supporting public health to know that they can be confident in their decisions because they are informed by the best available evidence
- -I’ll talk a lot today about Evidence-informed public health. -What does that term mean to you? -Our definition is “the process of distilling and disseminating the best available evidence from research, context, and experience, and using that evidence to inform and improve public health policy and practice” -Provides a systematic approach to incorporating evidence in decisions -Simply, it means finding and using what works in public health -The terminology actually comes from David Sackett, who was a physician at McMaster, he pioneered Evidence-Based Medicine -Evidence-based practices have expanded to many other disciplines such as nursing, policy-making and public health. -Can anyone think about why we’re using the term Evidence-informed instead of Evidence-based? -There has been a backlash to EBM related to belief only acceptable evidence is from randomized controlled trials or meta-analyses. -We use the term evidence-informed to attempt to acknowledge that other types of evidence are important in making decisions
- -What does EIPH look like? -Part of my job is outreach, and I’ll often speak with someone in public health and ask how they’re using evidence to inform their work -Answer is often that they use evidence all the time -But when digging a little deeper, it usually goes like this. “We need to fix a problem. Let’s do Program X. Find me some evidence on Program X.” -You can Google and find evidence to support just about anything -We sometimes refer to that as opinion-based decision-making, or decision-based evidence-making -We’ll go how to do this in more detail, but the evidence-based model finds and considers all the evidence and brings it together to make a decision. -When we integrate the best available research evidence into the decision making process we are using an evidence-informed decision making process.
- -Why do you think Evidence-informed decision making is so important? -Some interventions that you expect to be beneficial may actually be causing inadvertent harm to individuals and communities. -Harm also comes in the form of wasting resources -When we use evidence, we can be confident in our decision to adopt the most effective practice -Communities expect that decisions are based on evidence
- -We emphasize that evidence is a broad definition -Research evidence – most relevant, high quality quantitative or qualitative evidence from a variety of disciplines and sectors relevant to PH -Community health issues/local context – surveillance data/community health status reports to determine magnitude of health issue in local setting + significant and importance of the issue in comparison to other community health concerns -Community/political preferences – needs and interests of community members, current political climate, current organizational/corporate climate -Public health resources – financial resources, human resources, materials (feasibility) -Important to note that this model is dynamic. For any given situation, any of the bubbles can exert more influence than the others.
- -The ‘how’ of EIDM -The steps in the wheel help guide you through the steps of evidence-informed practice -Outlines 7 steps to help address a particular issue by systematically incorporating evidence into the decision making process -Describe each step -Depending on the outcome, you may then re-enter the cycle again at define, it’s meant to be an ongoing process as needs change and knowledge changes -Majority of the rest of this presentation will focus on getting through these 7 steps, what’s involved and what tools exist to support you through the steps -Particular focus on what will be useful for a Knowledge Synthesis project, which I understand you’ll be doing next semester
- -Starting with Define -Does anyone know what PICO stands for? -What about PECO? When would you use PECO? -Systematic way of defining a problem or research question
- -Starting with Define -Does anyone know what PICO stands for? -What about PECO? When would you use PECO? -Systematic way of defining a problem or research question
- Searching is a step that can be very time consuming if you don’t have an efficient strategy In some provinces, public health organizations have full-time librarians on staff to help optimize searches If you start with a topic in Google, you’re going to get millions of hits, including: small studies, studies that weren’t done very well, opinion pieces, Gwyneth Paltrow’s website Google Scholar will limit you to academic journals, but still doesn’t filter by study type or size
- -Once you have found your evidence, you need to appraise it -Why? -People sometimes surprised that you need to appraise a systematic review. Isn’t it done systematically? Isn’t that the whole point? -Reality is that the systematic reviews and other literature vary widely in quality. Some you can have confidence in, others you may be less confident in using the results
- -If you’re not confident in communicating your research findings, you can take a look at our URE videos -These videos explain statistical concepts in easy to understand ways -They can help you communicate statistics in easy to understand ways -eg. If a smoking cessation program has an Odds Ratio of 2.13, what does that mean? You can report that it doubles the chances of quitting smoking. 11 videos: Relative Risk Number Needed to Treat Types of Reviews Odds Ratio Confidence Interval Forest Plots Clinical Significance Evidence-Informed Decision Making 6S Pyramid P value Standardized Mean Difference
- -I’ve shown a few of the recommended tools, but there are many, many more -Registry -Some are for the same steps, but with a different lens, e.g. equity -Some focus on other activities, like communication
- Launched oct 2017