Rakesh -

I am very interested in hearing more about the use of IT to better 
incorporate individual patient data with population data.
There have been some interesting articles in the BMJ (N.Black et al) on 
'High-qaulity clinical databases' that offer the opportunity (as I see 
it) to derive population level inferences from 'experientally' collected 
data, but my sense is this requires a fair level of IT/programming 
sophistication that is currently out of reach for the public mental 
health center that I work in.

Would be interested to hear especially if you have low cost/easily 
usable IT methods in use.

-Best,


Vinod H Srihari, MD
Assistant Professor
Department of Psychiatry
Yale University School of Medicine

Director, STEP Clinic
Specialized Treatment Early in Psychosis

Staff Psychiatrist
Connecticut Mental Health Center (CMHC)
34 Park Street
New Haven, CT 06519

Office  (203) 974-7816
Fax      (203) 974-7502



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Angela Melder wrote:
>
> Dimitri and rakesh
>
>  
>
> These texts may provide some helpful/interesting insights:
>
>    1. Quality improvement research : understanding the science of
>       change in healthcare / edited by Richard Grol, Richard Baker,
>       Fiona Moss. Publisher: London : BMJ, 2004.
>
>  
>
>    2. Improving Patient Care: The Implementation of Change in Clinical
>       Practice (Paperback) by Richard Grol (Author), Michel Wensing
>       (Author), Martin Eccles (Author
>
>  
>
> I have also had some experience of getting evidence into practice 
> using a Quality Improvement in Health Care Programme (in 3 Australian 
> Hospitals) and clinical governance policy. I am not sure if these 
> kinds of structures exist in the UK but the project I conducted was 
> successful at engaging hospital staff and working toward getting 
> evidence to influence and change practices that were affecting the 
> quality of care being delivered in specific hospital departments. If 
> you want any further details please let me know.
>
>  
>
> Regards
>
> Angela
>
>  
>
>  
>
> ------------------------------------------------------------------------
>
> *From:* Evidence based health (EBH) 
> [mailto:[log in to unmask]] *On Behalf Of *Rakesh Biswas
> *Sent:* 20 March 2008 12:11
> *To:* [log in to unmask]
> *Subject:* Re: Typology of evidence based practice
>
>  
>
> Thanks Dimitri,
>
>  
>
> I find your typology of evidence based practice very interesting as it 
> appears to have emerged out of clinical practice.
>
>  
>
> Unfortunately we are yet to achieve a collaboration of clinical 
> practitioners (who may not have time or interest to sit through the 
> analysis involved in systematic reviews) and ivory tower evidence 
> based practitioners ( who are more into synthesizing systematic 
> reviews etc but understandably may not have time for actual clinical 
> practice). 
>
>  
>
> The question is how do we bring about a collaborative network that can 
> accomodate these typologies? Like a self critical clinician regularly 
> opening up his/her experiential information for suggestions from 
> evidence based practitioners and even intelligent patients across the 
> world (without losing his or her patient's privacy) would not only 
> facilitate evidence based practice but also augment clinical learning 
> (as the day to day experiential information that a clinician gains is 
> otherwise lost to the world but could actually be incorporated in his 
> her clinical e-portfolio). This would document experiential data (that 
> is mostly otherwise lost regularly) which in turn could 
> be appropriately structured with current best evidence (this 
> is something like evidence based case reports but we need them in 
> larger quantities, ideally for each and every patient that we come 
> across and not just the 'interesting cases'). Also it may not be 
> restricted to clinicians as pathologists, pharmacologists, 
> microbiologists and all other paraclinical do get involved with 
> patients as individuals and may not just restrict themselves to larger 
> population based studies.
>
>  
>
> In the end I guess it boils down to the old debate of the differences 
> and challenges in caring for individuals vs populations but if we can 
> get out of that there is a way where we could achieve a collaborative 
> merger between caring for individuals and populations where we could 
> start recording  our day to day individual patient 
> clinical experiential/clinical problem solving data and mash them with 
> evidence based/population based data. IT has the power to do that, 
> this is not only record individual experiences but also structure them 
> with evidence based empirical data. We are involved in one such 
> project and would be glad to share details individually.
>
>  
>
> rakesh
>
>  
>
>
>
>  
>
> On 3/19/08, *Dimitri Spyridonidis* <[log in to unmask] 
> <mailto:[log in to unmask]>> wrote:
>
> dear all
>
> Apologies for cross posting
>
> I am trying to build up a model of how could evidence based 
> practice(EBP) be
> delivered and have identified these 5 different typologies
>
> 1) clinicians who are self critical on their practices and using regular
> audits of their practices
> 2)clinicians who are using their own personal experience and skills
> interrogating of published research using thehierarchy of evidence
> 3) Evidence is socially constructed -Professional consensus is 
> essential for
> the adoption of valid scientific evidence
> 4) use of national agreed guidelines
> 5) Problem Solving Model: The existence of a problem pulls knowledge into
> practice.The need to generate a solution or choose among alternatives 
> is the
> impetus to facilitate EBP
>
> I would welcome any comments on this model and would really appreciate if
> you do think there could be additional models to facilitate evidence based
> practice
>
>
>
>
>  
>