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The Penn Medicine Center for Evidence-Based Practice: Supporting the Quality, Safety, and Value of Patient Care Through Evidence-Based Practice at the Systems Level (USA)

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Hospital-Based Health Technology Assessment

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Abstract

The University of Pennsylvania Health System Center for Evidence-based Practice (CEP) was established in 2006 by the Office of the Chief Medical Officer to support the quality, safety and value of patient care at Penn through evidence-based practice. To accomplish this mission, CEP performs rapid systematic reviews of the scientific literature to inform local practice and policy, translates evidence into practice through the use of computerized clinical decision support (CDS) interventions and clinical pathways, and offers education in evidence-based decision making to trainees, staff and faculty. The Center includes a physician director, three research analysts, six physician and nurse liaisons, a biostatistician, a health economist and an administrator, and collaborates closely with librarians and staff in informatics and quality improvement. To date, CEP has completed over 300 rapid reviews for clinical and administrative leaders on topics ranging from formulary management to device purchasing to development of best clinical practices. CEP has also created approximately 25 CDS tools to integrate evidence into practice, and is developing a pathways program to support standardization of care throughout our growing healthcare system. Lastly, CEP has enhanced the capacity for evidence-based decision making through a novel EBM curriculum for medical students, as well as courses and workshops for housestaff, fellows, faculty, advance practice providers and nurses. Our experience suggests hospital EPCs can efficiently synthesize and implement evidence addressing a range of clinical topics for diverse stakeholders, influence local decision making, and foster a culture of evidence-based practice, strengthening the quality, safety, and value of care provided.

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References

  1. Jayakumar KL, Lavenberg JA, Mitchell MD et al (2016) Evidence synthesis activities of a hospital evidence-based practice center and impact on hospital decision making. J Hosp Med 11(3):185–192

    Google Scholar 

  2. Umscheid CA, Brennan PJ (2015) Incentivizing “Structures” over “Outcomes” to bridge the knowing-doing gap. JAMA Intern Med 175(3):354–355

    Article  PubMed  Google Scholar 

  3. Olsen L, Aisner D, McGinnis JM (eds) (2007) Roundtable on evidence-based medicine. The learning healthcare system: workshop summary. National Academies Press, Washington, DC

    Google Scholar 

  4. Harrison MB, Legare F, Graham ID, Fervers B (2010) Adapting clinical practice guidelines to local context and assessing barriers to their use. Can Med Assoc J 182(2):E78–E84

    Article  Google Scholar 

  5. Mitchell MD, Williams K, Brennan PJ, Umscheid CA (2010) Integrating local data into hospital-based healthcare technology assessment: two case studies. Int J Technol Assess Health Care 26(3):294–300

    Article  PubMed  Google Scholar 

  6. Umscheid CA, Williams K, Brennan PJ (2010) Hospital-based comparative effectiveness centers: translating research into practice to improve the quality, safety and value of patient care. J Gen Intern Med 25(12):1352–1355

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gutowski C, Maa J, Hoo KS et al (2011) Health technology assessment at the University of California-San Francisco. J Healthc Manag Am Coll Healthc Exec 56(1):15–29; discussion 29–30

    Google Scholar 

  8. Schottinger J, Odell RM (2006) Kaiser permanente southern California regional technology management process: evidence-based medicine operationalized. Permanente J 10(1):38–41

    Google Scholar 

  9. Gagnon M-P (2014) Hospital-based health technology assessment: developments to date. Pharmacoeconomics. doi:10.1007/s40273-014-0185-3

    PubMed  Google Scholar 

  10. Cicchetti A, Marchetti M, Dibidino R, Corio M (2008) Hospital based health technology assessment world-wide survey. Health Technology Assessment International (HTAi), Hospital Based Health Technology Assessment Sub-interest Group

    Google Scholar 

  11. Stevens AJ, Longson C (2013) At the center of health care policy making: the use of health technology assessment at NICE. Med Decis Making 33(3):320–324

    Google Scholar 

  12. Atkins D, Fink K, Slutsky J (2005) Better information for better health care: the evidence-based practice center program and the Agency for Healthcare Research and Quality. Ann Intern Med 142(12_Part_2):1035–1041

    Google Scholar 

  13. Slutsky JR, Clancy CM (2009) AHRQ’s effective health care program: why comparative effectiveness matters. Am J Med Qual 24(1):67–70

    Google Scholar 

  14. Grimshaw JM, Russell IT (1993) Effect of clinical guidelines on practice: a systematic review of rigorous evaluations. Lancet 342(8883):1317–1322

    Article  CAS  PubMed  Google Scholar 

  15. Mayes R (2007) The origins, development, and passage of Medicare’s revolutionary prospective payment system. J Hist Med Allied Sci 62(1):21–55

    Article  PubMed  Google Scholar 

  16. Burwell SM (2015) Setting value-based payment goals – HHS efforts to improve U.S. health care. N Engl J Med 372(10):897–899

    Article  CAS  PubMed  Google Scholar 

  17. Blumenthal D (2010) Launching HITECH. N Engl J Med 362(5):382–385

    Article  CAS  PubMed  Google Scholar 

  18. Kaiser Family Foundation (2010) Health reform. http://www.kff.org/health-reform/. Accessed 31 Aug 2015

  19. Luce BR, Brown RE (1995) The use of technology assessment by hospitals, health maintenance organizations, and third-party payers in the United States. Int J Technol Assess Health Care 11(1):79–92

    Article  CAS  PubMed  Google Scholar 

  20. Weingart SN, Weingart SN (1993) Acquiring advanced technology: decision-making strategies at twelve medical centers. Int J Technol Assess Health Care 9(4):530–538

    Article  CAS  PubMed  Google Scholar 

  21. Mitchell MD, Williams K, Kuntz G, Umscheid CA (2011) When the decision is what to decide: using evidence inventory reports to focus health technology assessments. Int J Technol Assess Health Care 27(2):127–132

    Article  PubMed  Google Scholar 

  22. Goodman C (2014) HTA 101. Introduction to health technology assessment. http://www.nlm.nih.gov/nichsr/hta101/ta10101.html. Accessed 31 Aug 2014

  23. Agarwal R, Brunelli SM, Williams K et al (2009) Gadolinium-based contrast agents and nephrogenic systemic fibrosis: a systematic review and meta-analysis. Nephrol Dial Transplant 24(3):856–863

    Article  CAS  PubMed  Google Scholar 

  24. Agarwal R, Williams K, Umscheid CA, Welch WC (2009) Osteoinductive bone graft substitutes for lumbar fusion: a systematic review. J Neurosurg Spine 11(6):729–740

    Article  PubMed  Google Scholar 

  25. Mitchell MD, Mikkelsen ME, Umscheid CA et al (2010) A systematic review to inform institutional decisions about the use of extracorporeal membrane oxygenation during the H1N1 influenza pandemic. Crit Care Med 38(6):1398–1404

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mitchell MD, Anderson BJ, Williams K, Umscheid CA (2009) Heparin flushing and other interventions to maintain patency of central venous catheters: a systematic review. J Adv Nurs 65(10):2007–2021

    Article  PubMed  Google Scholar 

  27. Mitchell MD, Lavenberg JG, Trotta RL, Umscheid CA (2014) Hourly rounding to improve nursing responsiveness: a systematic review. J Nurs Adm 44(9):462–472

    Article  PubMed  PubMed Central  Google Scholar 

  28. CRD Database (2015) NIHR Centre for Reviews and Dissemination, York, UK. http://www.crd.york.ac.uk/CRDWeb/. Accessed 31 Aug 2015

  29. Booth AM, Wright KE, Outhwaite H (2010) Centre for Reviews and Dissemination databases: value, content, and developments. Int J Technol Assess Health Care 26(4):470–472

    Google Scholar 

  30. Seem DL, Lee I, Umscheid CA, Kuehnert MJ (2013) Excerpt from PHS guideline for reducing HIV, HBV and HCV transmission through organ transplantation. Am J Transplant 13(8):1953–1962

    Article  CAS  PubMed  Google Scholar 

  31. Han JH, Sullivan N, Leas BF, Pegues DA, Kaczmarek JL, Umscheid CA (2015) Cleaning hospital room surfaces to prevent healthcare-associated infections: a systematic overview. Ann Intern Med 163(8):598–607

    Google Scholar 

  32. Umscheid CA, Agarwal RK, Brennan PJ, Healthcare Infection Control Practices Advisory Committee (2010) Updating the guideline development methodology of the Healthcare Infection Control Practices Advisory Committee (HICPAC). Am J Infect Control 38(4):264–273

    Article  PubMed  Google Scholar 

  33. Gould CV, Umscheid CA, Agarwal RK et al (2009) Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 31(4):319–326

    Article  Google Scholar 

  34. MacCannell T, Umscheid CA, Agarwal RK et al (2011) Guideline for the prevention and control of norovirus gastroenteritis outbreaks in healthcare settings. Infect Control Hosp Epidemiol 32(10):939–969

    Article  PubMed  Google Scholar 

  35. Hartling L, Guise J-M, Kato E et al (2015) A taxonomy of rapid reviews links report types and methods to specific decision-making contexts. J Clin Epidemiol 68(12):1451–1462

    Google Scholar 

  36. Featherstone RM, Dryden DM, Foisy M et al (2015) Advancing knowledge of rapid reviews: an analysis of results, conclusions and recommendations from published review articles examining rapid reviews. Syst Rev 4:50. doi:10.1186/s13643-015-0040-4

    Article  PubMed  PubMed Central  Google Scholar 

  37. Guise JM, Chang C, Viswanathan M et al (2014) Agency for Healthcare Research and Quality Evidence-Based Practice Center methods for systematically reviewing complex multicomponent health care interventions. J Clin Epidemiol 67(11):1181–1191

    Google Scholar 

  38. Umscheid CA, Hanish A, Chittams J et al (2012) Effectiveness of a novel and scalable clinical decision support intervention to improve venous thromboembolism prophylaxis: a quasi-experimental study. BMC Med Inform Decis Mak. doi:10.1186/1472-6947-12-92

    PubMed  PubMed Central  Google Scholar 

  39. Baillie CA, Epps M, Hanish A et al (2014) Usability and impact of a computerized clinical decision support intervention designed to reduce urinary catheter utilization and catheter-associated urinary tract infections. Infect Control Hosp Epidemiol 35(9):1147–1155

    Article  PubMed  PubMed Central  Google Scholar 

  40. McGreevey JD 3rd (2013) Order sets in electronic health records: principles of good practice. Chest 143(1):228–235

    Article  PubMed  Google Scholar 

  41. Baillie CA, VanZandbergen C, Tait G et al (2013) The readmission risk flag: using the electronic health record to automatically identify patients at risk for 30-day readmission. J Hosp Med 8(12):689–695

    Article  PubMed  PubMed Central  Google Scholar 

  42. Umscheid CA, Betesh J, VanZandbergen C et al (2015) Development, implementation, and impact of an automated early warning and response system for sepsis. J Hosp Med 10(1):26–31

    Article  PubMed  Google Scholar 

  43. Guidi JL, Clark K, Upton MT et al (2015) Clinician perception of the effectiveness of an Early Warning and Response System for sepsis in an academic medical center. Annals of the American Thoracic Society 12(10):1514–1519

    Google Scholar 

  44. Kinsman L, Rotter T, James E et al (2010) What is a clinical pathway? Development of a definition to inform the debate. BMC Med 8:31

    Article  PubMed  PubMed Central  Google Scholar 

  45. Rotter T, Kinsman L, James E, Machotta A, Gothe H, Willis J et al (2010) Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev 17:3

    Google Scholar 

  46. Barbieri JS, French B, Umscheid CA (2015) Uptake and impact of a clinical diagnostic decision support tool at an academic medical center. Diagnosis 2(2):123–127

    Article  Google Scholar 

  47. Umscheid CA, Maenner MJ, Mull N et al (2016) Using educational prescriptions to teach medical students evidence-based medicine. Med Teach 13:1–6

    Google Scholar 

  48. Patel N, Brennan PJ, Metlay J et al (2015) Building the pipeline: the creation of a residency training pathway for future physician leaders in health care quality. Acad Med 90(2):185–190

    Article  PubMed  Google Scholar 

  49. Wyer PC, Umscheid CA, Wright S et al (2015) Teaching evidence assimilation for collaborative health care (TEACH) 2009–2014: building evidence-based capacity within health care provider organizations. EGEMS (Washington, DC) 3(2):1165

    Google Scholar 

  50. Brown M, Hurwitz J, Brixner D, Malone DC (2013) Health care decision makers’ use of comparative effectiveness research: report from a series of focus groups. J Manag Care Pharm 19(9):745–754

    PubMed  Google Scholar 

  51. Khangura S, Konnyu K, Cushman R et al (2012) Evidence summaries: the evolution of a rapid review approach. Syst Rev 1(1):10

    Article  PubMed  PubMed Central  Google Scholar 

  52. Watt A, Cameron A, Sturm L et al (2008) Rapid reviews versus full systematic reviews: an inventory of current methods and practice in health technology assessment. Int J Technol Assess Health Care 24(2):133–139

    Article  PubMed  Google Scholar 

  53. Clancy CM, Cronin K (2005) Evidence-based decision making: global evidence, local decisions. Health Aff 24(1):151–162

    Article  Google Scholar 

  54. Abstrackr (2015) Center for Evidence Based Medicine http://tuftscaes.org/citation_screening. Accessed 31 Aug 2015

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Acknowledgments

We thank our colleagues at the University of Pennsylvania for their many important contributions to the center over the years, including Joel Betesh MD, Jalpa A. Doshi PhD, Stephanie Dunbar, David Goldmann MD, Neil O. Fishman MD, Benjamin C. French PhD, Kishore L. Jayakumar BS, Sherry Morgan PhD, MLS, RN, Nikhil Mull MD, and Maylene Qiu MA.

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Authors and Affiliations

  1. Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Craig A. Umscheid MD, MSCE, Kendal Williams MD, MPH & Patrick J. Brennan MD

  2. Center for Evidence-based Practice, University of Pennsylvania Health System, 3535 Market Street Mezzanine, Suite 50, Philadelphia, PA, 19104, USA

    Craig A. Umscheid MD, MSCE, Matthew D. Mitchell PhD, Brian F. Leas MA, MS, Julia G. Lavenberg PhD, Kendal Williams MD, MPH & Patrick J. Brennan MD

Authors
  1. Craig A. Umscheid MD, MSCE
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  2. Matthew D. Mitchell PhD
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  3. Brian F. Leas MA, MS
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  4. Julia G. Lavenberg PhD
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  5. Kendal Williams MD, MPH
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  6. Patrick J. Brennan MD
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Corresponding author

Correspondence to Craig A. Umscheid MD, MSCE .

Editor information

Editors and Affiliations

  1. Assessment of Innovations and New Technologies, Hospital Clinic Barcelona, Barcelona, Catalonia, Spain

    Laura Sampietro-Colom

  2. Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada

    Janet Martin

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Umscheid, C.A., Mitchell, M.D., Leas, B.F., Lavenberg, J.G., Williams, K., Brennan, P.J. (2016). The Penn Medicine Center for Evidence-Based Practice: Supporting the Quality, Safety, and Value of Patient Care Through Evidence-Based Practice at the Systems Level (USA). In: Sampietro-Colom, L., Martin, J. (eds) Hospital-Based Health Technology Assessment. Adis, Cham. https://doi.org/10.1007/978-3-319-39205-9_18

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  • DOI: https://doi.org/10.1007/978-3-319-39205-9_18

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  • Publisher Name: Adis, Cham

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