The Joanna Briggs Institute Model for Evidence-based Healthcare


The Joanna Briggs Institute Model for Evidence-based Healthcare



you hi I'm Craig hi I'm Zack today we're going to be talking with you about the jointer briefs conceptual model for evidence-based health care getting the appropriate information into the hands of those who determine health policy and who deliver healthcare is fundamental to improvements in healthcare delivery and health outcomes the Institute's vision is to see a world in which the best available eminence is used to inform policy and practice to improve health and communities globally in order to see that vision become reality our mission is to facilitate the synthesis transfer and implementation of the best available evidence to ensure that feasibility appropriateness meaningfulness and effectiveness of health policy and health practice the best available evidence the context in which care is delivered the individual patient and the professional judgment and expertise of the health professional fully informed this process evidence-based healthcare does not eliminate the need for reasoning and reflection by a clinician on the contrary the clinician requires advanced clinical reasoning skills when deciding on what evidence and or what recommendations to follow for the individual patient they are treating when making clinical decisions health professionals are concerned with whether their approach is feasible appropriate meaningful and effective at JPI we refer to these four considerations of decision making as the fame scale feasibility is the extent to which an activity is practical and practicable clinical feasibility is about whether or not an activity or intervention is physically culturally or financially practical all it possible within a given context the I refers to appropriateness appropriateness is the extent to which an intervention or activity fits with or is apt in a situation clinical appropriateness is about how an activity or intervention relates to the context in which care is being given the M refers to meaningfulness meaningfulness refers to the meanings patients with an intervention or activity as a result of our experience of it meaningfulness relates to the personal experience opinions values thoughts beliefs and interpretations of patients or clients meaningfulness information may provide a clue as to remember patients are likely to positively or negatively experience health care practices and whether they will be accepted the e refers to effectiveness effectiveness is the extent to which an intervention when used appropriately achieves the intended effect clinical effectiveness is about the relationship between an intervention and clinical or health outcomes the jbi model of evidence-based health care was initially developed in 2005 but has been recently updated in 2016 the inner circle represents the pebble of knowledge while the inner wedges provide the Institute's conceptualization of the steps involved in the process of achieving an evidence-based approach to clinical decision making the outer wedges operationalize the component parts of the model and articulate how they might be actioned in a pragmatic way the arrows indicate that the flow can be bi-directional now let's go through the model piece-by-piece the inner circle represents evidence-based healthcare the JPI model conceptualizes evidence-based healthcare as that as decision-making that considers feasibility appropriateness meaningfulness and effectiveness of healthcare practices the best available evidence the context in which care is delivered the individual patient and the professional judgment and expertise of the health professional also inform this process evidence-based healthcare is at the center of everything we do here at JDI and at the center of our model the jbi believer evidence-based health care should be driven by the needs of global health the achievement of improved global health is seen as both a goal or endpoint and the driving force of evidence-based healthcare this may be action via sustainable impact often evidence implementation activities succeed in making a chain to healthcare practices unfortunately due to resourcing issues and the ever-changing nature of health services these changes may only be temporary to truly address and improve health care any improvements any positive improvements need to be lasting engagement and collaboration are all levels is imperative to successfully address the significant issues that we face in delivering evidence-based health care the knowledge we need includes gathering knowledge of what people need what resources are available and what limits constrain their choices this is vital to an evidence-based approach to the delivery of health care the evidence generation wedge of a model identifies discourse or narrative experience and research as legitimate means of knowledge generation it recognizes that the results of well-designed research studies grounded in any methodological position and it dates all personal opinion and expertise are all deemed valid methods of generating evidence to inform policy and practice research evidence mainly comes in a form of research both quantitative and qualitative that has been conducted to answer a question experience however evidence can also come in the form of experience including expertise and patient preferences or values discourse the discourse is a broad term incorporating various types of communication on debate including text and opinion regarding a subject evidence synthesis is the evaluation or analysis and collection of a research evidence and opinion on a specific topic to aid in decision-making in healthcare the three main components of this wedge are systematic reviews evidence summaries and guidelines systematic review the core evidence the core of evidence synthesis is the systematic review of literature on a particular condition intervention or issue the systematic review is essentially an analysis of all the available literature that is evidence and a judgment of the effectiveness or otherwise of a practice involving a series of comp steppes evidence summary a smaller scale evidence summary or rapid review has also emerged as a streamlined approach to synthesizing evidence in a timely manner clinical guidelines trustworthy clinical guidelines include the use of rigorous development methodology clear reporting of recommendations linked to the evidence include systematic reviews in their development and are conducted using transparent processes including extensive external peer review fundamental to the process of evidence-based decision making is the ability of those at a point of care to access synthesize research evidence evidence transfer is the co active participatory process to advance access to an uptake of evidence and local contexts it is a causal phenomenon consisting of factors that enable facilitate and support evidence implementation that is more than just a single interaction it incorporates active dissemination systems integration and education active dissemination active dissemination involves active methods to spread information such as email or social media formats to encourage motivation or uptake such as infographics decision aids or icon arrays and knowledge spreaders such as champions or fort leaders passive dissemination is of course still important systems integration the integration of evidence into systems is pivotal for evidence-based healthcare and this may relate to the inclusion of evidence in clinical decision support systems policies and processes education all forms of education such as CPD online face-to-face or an award level are a vital component of evidence transfer since the objective of evidence-based healthcare is optimal healthcare outcomes is seems self-evident that the implementation of best evidence in practice will be the key to its success evidence implementation is a purposeful in enabling set of activities designed to engage key stakeholders with research evidence to inform decision making and to generate sustained improvement in the quality of health care three components of evidence implementation include a context analysis the facilitation of practice change and evaluation of processes and outcomes context analysis any implementation strategy should carefully consider and analyze the context and setting for implementation including a consideration of how ready the organization is for change or implementation facilitation change or implementation projects require a facilitator or driver of change in an engaged process with all stakeholders evaluation to determine the impact of change in informed future activities data on processes and outcomes should be collected as part of any implementation project the overarching principles of this model are culture capacity communication and collaboration in this way issues relating to stakeholder engagement to localization of knowledge responsiveness to local knowledge requirements and sustainability are acknowledged in the process of evidence-based healthcare the complex and ever-changing healthcare environment means that there is no single linear approach that will work every time to move evidence into policy and practice however this model of evidence-based healthcare serves as a useful guide to inform academic and clinical organizations to practice evidence-based healthcare thank you for taking the time to listen to us today and for learning a little bit more about the journalist Institute's approach Devens based healthcare we hope you found it informative a little bit educational and hopefully very useful as you think about implementation into your area of clinical practice or policy if you have any questions for us please visit the jhana breeze Institute website at Joan of rigsy org you

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