Problem Definition
Solution Generation
Impact evaluation
Resource Mobilisation
Impact Assesment
Implementation
Evaluation Benefit
Medication Delivery
Minimal Use
High Consumption
96% of heart attack victims were prescribed beta-blocker treatment in 2005, up from 62% in 1996* 77.7% of children enrolled in private health plans received all recommended immunizations, up 5% from 72.5% in 2004* Evidence-based guidelines from the American College of Cardiology and the American Heart Association have reduced mortality among patients who have had a heart attack
* National Committee for Quality Assurance in US
The integration of individual clinical expertise with the best available clinical evidence from systematic research.
David L Sackett, W Scott Richardson, William Rosenberg, R Brian Haynes Evidence Based Medicine--How to Practice and Teach EBM, 1996
Uses of EBM
Use of empirically-verified treatments in the care of patients Incorporation of research results into the process of care Ability to critically appraise research results
Levels of Evidences
(I-1) a well done systematic review of 2 or more RCTs (I-2) a RCT (II-1) a cohort study
(II-2) a case-control study (II-3) a dramatic uncontrolled experiment (III) respected authorities, expert committees, etc.. (IV) ...someone once told me....
Health Model
Determinants of Health
Environment Physical Social Human Biology Life Style/Behavior Risk Factors Health Care System
Health Status
Subjective Health Mortality Morbidity Injury MCH/Others
Consequences of Health
Quality of Life Health Service Utilization Use of Medication Others
Mortality-based measures Crude mortality Age-specific mortality Age adjusted mortality Leading causes of deaths Life expectancy Years of potential life lost (YPLL)
Source: Arah OA, et al. A conceptural framework for the OECD Health Care Quality Indicators Project. Int J Quality Health Care. 2006; Sep 18; Suppl.1:5-13.
Administrative Data
Demographics, Diagnosis, Treatment, Medication, Laboratory, Mortality/morbidity, etc
Data Warehouse
(Storing and Organize Data)
Data Analyses
Primary Data
Adverse outcomes, inpatient indicators, infection control, APACHE for ICU,
Medical records,etc
Health Determinants:
Age Sex Other risk factor
BPH-community
Health Status:
Morbidity: incidence or prevalence Disability
Health Determinants:
Age specific morbidity
Health Impact
Input:
Characteristic of patient Provider skill Standard of facility
Process:
Waiting time in outpatient service Operation waiting time Readmission to OT
Output:
Healing time
Impact:
Quality of life including sexual life
Opportunity Event
Quality Measure = Event / Oppurtunity = Numerator (N) / Denominator (D) N = Number of Sedated Patients who Fell D = Total Number of Patient Falls
Medicine used to be simple, ineffective and relatively safe. Now it is complex, effective and potentially dangerous.
Sir Cyril Chantler, former Dean Guys, King and St. Thomass Medical and Dental School, Lancet 1999