Decision Support: More Than

Guidelines

presenter
location

Event (LS #1 or an introduction)

 Chronic Care Model

Community Health System

Resources and Policies Health Care Organization
Self-
Management Delivery Clinical
System Decision Information
Support Support
Design Systems

Informed, Prepared,
Productive
Activated Proactive
Patient Interactions
Practice Team

Functional and Clinical Outcomes

Decision Support Systems
• A process for incorporating guidelines,
education, expert advice and practice
aids into routine clinical practice
NCQA
 Decision Support
• Embed evidence-based guidelines which
describe stepped-care into daily clinical
practice.
• Integrate specialist expertise and primary
care.
• Use proven provider education methods.
• Share evidence-based guidelines and
information with patients to encourage their
participation.
What is evidence-based medicine?

Evidence-based medicine is the

conscientious, explicit and judicious use
of current best evidence in making
decisions about the care of individual
patients.
-David Sacket, BMJ 13 Jan 1996
What is evidence-based medicine?
• Evidence-based medicine is an approach to
health care that promotes the collection,
interpretation, and integration of valid, important
and applicable evidence.
• The best available evidence, moderated by
patient circumstances and preferences, is
applied to improve the quality of clinical
judgments.
McMaster University
What is evidence-based practice?

• Efforts made to base clinical & other healthcare

decisions on the best available evidence
• Evidence is critically appraised & synthesized
• The evidence synthesis is adapted to assist
providers & patients in making decisions about
specific clinical conditions.
Embed evidence-based
guidelines
into daily practice
Clinical Practice Guidelines
• Clinical guidelines are systematically
developed statements to assist
practitioners and patients in choosing
appropriate healthcare for specific
conditions.
-The Institute of Medicine
Clinical Practice Guidelines
Efforts to distill a large body of medical
knowledge into a convenient, readily
usable format.
- Eddy. The challenge. JAMA 1990;263:287-290
The purpose of clinical practice
guidelines

GAP
Current Optimal
Practice Health status
Practice
Satisfaction
Current Cost
Optimal
outcomes Utilization
Outcomes
Evidence-based Practice
• Begin with NIH Guidelines
– all team members should be familiar
• Identify thought/opinion leaders
– within your organization and outside
– systematic literature review
– organized learning within organization

Steve Simpson, MD Kansas University

Evidence-based practice, cont.
• Customize guidelines to your setting
• Embed in practice: able to influence real
time decision-making
Flow sheets with prompts
Decision rules in EMR
Share with patient
Reminders in registry
Standing orders
• Have data to monitor care
Attributes of Good Guidelines
• Clear definition of condition and population
• Exceptions are described
• Evidence summaries are available with links to
key articles
• Clinical actions for stepped-care are clearly
stated
• “Nice-to’s” that are not evidence-based are
omitted
• Regularly updated to incorporate new data
Stepped Care
• Often begins with lifestyle change or
adaptation (eliminate triggers, lose
weight, exercise more)
• First choice medication
• Either increase dose or add second
medication, and so on
• Includes referral guideline
Clinical Decision Maker
• Utilizes critical
thinking skills and
the nursing process

• Nursing Process:
Assessment,
Diagnosis, Planning,
Implementation,
Evaluation
Professional Accountability
• Responsibility that one assumes for their
practice
• Obligation to report or account for their
actions
– To the profession, public, and themselves
Accountability
• Begins with preconditions
– Ability
– Responsibility
– Authority
– Ends in accountability
• Alliance for Nursing Accreditation (ANA)
Client Advocate
• Nurse protects the clients human and
legal rights
• Providing information to assist in decision
making
• Patient Bill of Rights
 Comforter Role
• Caring for client as a
human being
• Role is traditional to
nursing
• Care is directed to
whole person, not
just a body part
• Demonstration of
care and concern
Communicator Role
• Role is central to all other roles
• Involves communication with client,
family, healthcare team members,
resource people, and the community
• Without clear, concise communication it
will be difficult to give effective care
Teacher/Educator Role
• Explains concepts and facts about health,
demonstrates procedures, reinforces
learning, determines understanding, and
evaluates progress of learning
• Unplanned or informal education
• Planned or formal education
KOMPONEN EBP
(Melnyk & Fineout-Overholt, 2011)

Bukti
Bukti
Internal
ekternal

Manfaat
dan
keinginan
pasien

Evidence Based Clinical Decision Making

KOMPONEN EBP
(Melnyk & Fineout-Overholt, 2011)

Hasil penelitian, teori-

BUKTI teori yang
Bukti lahir dari
EKTERN Internalpendapat
penelitian,
AL dari ahli, hasil dari
diskusi panel para ahli
Manfaat
dan
keinginan
pasien

Evidence Based Clinical Decision Making

KOMPONEN EBP
(Melnyk & Fineout-Overholt, 2011)

 Penilaian klinis
 Hasil dari proyek peningkatan
kualitas dalam rangka Bukti
meningkatkan kualitas Internal
Bukti
pelayanan klinik
ekternal
 Hasil dari pengkajian dan (Clinical
evaluasi pasien Expertise)
 Alasan klinis
 Evaluasi dan penggunaan Manfaat
sumber daya tenaga dan
kesehatan yang diperlukan keinginan
untuk melakukan treatment pasien
yang dipilih
 Mencapai hasil yang
diharapkan

Evidence Based Clinical Decision Making

KOMPONEN EBP
(Melnyk & Fineout-Overholt, 2011)

Memberikan manfaat terbaik untuk

kondisi pasien saat itu dan
meminimalkan pembiayaan
Bukti
Bukti
Internal
ekternal

Manfaat
dan
keinginan
pasien

Evidence Based Clinical Decision Making