Hi Amit,

Thank you for starting this interesting and IMPORTANT discussion.

You (and everybody else) can find answers to your (and other important) 
questions in my paper “Evidence in Public Health and Health Impact 
Assessment”, available here http://icare.academia.edu/JordanPanayotov/Papers

I’d like to point out few things:

First, an important STARTING point which determines the role and use of 
Evidence is the distinction between implicit and explicit decision making. 
See Chapter “Implicit and Explicit Decision Making“ in the above mentioned 
paper.

For example, there is a short answer to your question 5. there:
Quote:
decision makers should always take into account preferences of tax payers, 
who finance health collectively, when making choices for publicly financed 
policies, programs, projects and interventions. In fact taking into account 
preferences of tax payers, who finance health collectively, is mandatory for 
getting right five of Donabedian’s “seven pillars of quality”
Unquote

Second, one should realize that in relation to Health there are DIFFERENT 
types of decisions depending on who is (mainly) concerned by the outcome and 
who is (mainly) financing the choice. See Chapter "Decision Making in 
Relation to Health" in avove mentioned paper, where I distinguish between:

I) Decisions of individuals for their personal choices, including decisions 
of parents for their children.

II) Decisions for personal services applied to individuals. These are 
related mainly in the provision of health care. (these can be funded in 
different combinations between the individual and the society, i.e. other 
individuals (insurers) and the tax-payers)

III) Decisions for complex interventions applied to whole populations. The 
outcome concerns populations and these are financed collectively, mainly by 
the taxpayers.
There are two subgroups, depending on the primary objective for those 
policies:
III.1) Interventions with primary objective improving health of whole 
populations.
III.2) Interventions in other spheres of the economy (energy, transport, 
education, etc.) with primary objective different than health, however with 
impact on health of populations.

Third, see sub-chapter "Evaluation of personal services applied to 
individuals" especially the part about Health Technology Assessment (HTA), 
where I conclude that: “the best intervention in one local context may well 
not be the best in different local context.”

Fourth, RE: your question "If one huge Cochrane Library is there, why the 
government need to spend on making a new EPC to provide evidence based 
summary"
Should you have comprehended the above, you’ll be able to understand that:

(i) Evidence in relation to Health is RELATIVE;
(ii) Cochrane Library, although registering observations in wide range of 
different local contexts, has many deficiencies in explaining WHY something 
did or did not work;  and therefore
(iii) Governments will need to spend on providing RELIABLE Evidence for 
decision-making.
(iv) Panayotov Matrix is USEFUL tool for providing reliable evidence in 
different local contexts.

Hope that this was useful for you and everybody else who is concerned with 
Evidence-Based Practice in relation to health.

All the best,

Jordan

P.S. When using the above mentioned paper I do expect anyone to adhere to 
the Guidelines on Ethical writing/editing/publishing (attached) by correctly 
acknowledging the source and giving credit to its originator.

*******
Jordan Panayotov, MEc, MPH (Health Economics)
Director
Independent Centre for Analysis & Research of Economies
Melbourne, Australia
www.icare.biz
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----- Original Message ----- 
From: "Amit" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, October 28, 2011 2:06 PM
Subject: Evidence Based Practice Centres and Impact on Health Care Quality


Dear All,

First of all, I thank the group for providing rich updates on various topics 
related to EBM.

I am a student and going to present a seminar as a classroom assignment on 
"evidence based practice centers (EPC)   and its impact on quality 
indicators" as described by Institute of Medicine (IOM). IOM gave six 
dimentions of quality as follows: safety, to avoid injury; effective, to 
provide effective  services; patient centered, to respect and resonse to 
patient preference; timely, to reduce waits; efficient, to avoid waste of 
equipments, supplies, ideas and energies; equitable, to provide care to all.

I searched a lot in literature but could not get exact articles realted to 
my question. It may be because they are too vague area.

EBP centres such CEBM, EPC under AHRQ etc. provides the evidence of highest 
level as systematic review or comparative effectiveness research and 
provides summary which hels decision making at bed side.

1. Are they going to be read and followed by the caregivers ? (Out-reach of 
EPC to the audience, caregivers and patients)
2. Do we always get a postive result following EPC recommendation?
3. Do EPCs create a hurdel in timelyness indicator of quality?
4. Do EPCs address only the indicators for effectiveness?
5. Do EPC ignore patient perspective? such as from available treatment 
options, patient may not favor the use drugs or procedure with best 
evidence.

I want to show how to make EPC in a health care systems to improve the 
quality. i.e. how many EPCs do we need for a particular region or hospital? 
but the big question is,  If one huge Cochrane Library is there, why the 
goverment need to spend on making a new EPC to provide evidence based 
summary.

I am sorry as I am not sure how to go from EBP to direct improvement in 
quality indicators. I would be thankful if anyone can provide a sources of 
literature regarding those area.

Thank you.

Amit
Graduate Student