AAOS Bulletin - February, 2006

Workshop introduces evidence-based analysis

Participants learn concepts, gain insights for basing decisions on best available evidence

By Jill Elaine Hughes

Evidence-based analysis is one of the most important skills needed for the development of evidence-based practice guidelines and performance measures. With the current shift of both public and private payers to a “pay-for-performance” environment, orthopaedic surgeons must understand and participate in evidence-based analysis to ensure that the guidelines that are established accurately reflect the best available research evidence in orthopaedics.

To introduce members to the principles of evidence-based analysis, the AAOS Evidence-Based Practice Committee developed and hosted an Evidence-Based Analysis Workshop on Nov. 21, 2005. The free course was open to 50 AAOS fellows who agreed to assist the Academy in future evidence-based guideline projects. Participants represented a variety of orthopaedic subspecialty societies and more than 25 U.S. states and territories. Because the number of applicants exceeded the limited space, a second workshop is planned as part of the 2006 Annual Meeting, with priority given to those who were “wait-listed” for the first workshop.

Instruction and application

The full-day course provided both instruction in evidence-based analysis and the opportunity to immediately apply the information. The workshop was taught by Susan Levine, DVM, PhD, and Wendy L. Schneider, MSc, of Hayes, Inc., a private, for-profit health technology assessment company. The instructors are scientific researchers—well trained in epidemiology, scientific research study design and evidence-based medicine evaluation standards.

The morning session focused on the general principles of evidence analysis, using an overview/lecture format. In the afternoon, course attendees participated in a “hands-on” exercise that enabled them to apply the concepts to a systematic evaluation of the research/evidence quality of several articles from various orthopaedic journals.

Both the lectures and hands-on activity stressed the multiple “levels” of evidence quality; simply because an article appears in a respected journal does not necessarily mean the article’s research findings represent the best available evidence.

By the end of the day, attendees learned the basics of various methods and standards used for determining and ranking research evidence quality. Course attendees gained important insights into the fast-growing field of evidence-based practice, research study design and the rigorous standards used in evaluating and ranking scientific evidence. They also earned 6.75 CME credit hours.

Just the first step

The Evidence-Based Analysis Workshop is the first of many initiatives the Academy will implement over the next three to five years. By partnering in these efforts with the orthopaedic specialty society community—and the broader medical community in general—the AAOS hopes to develop comprehensive evidence-based orthopaedic practice guidelines and performance measures. The ultimate goal of these ongoing guidelines initiatives is to improve the quality of orthopaedic care.

While this course was an important first step in helping educate the AAOS fellowship about evidence-based analysis, it was only an introduction. Given the significant interest AAOS members continue to show in evidence-based practice, the Academy hopes to offer more in-depth courses on the topic in the future.

Jill Elaine Hughes is staff liaison to the Evidence-Based Practice Committee and the clinical quality improvement coordinator in the department of research and scientific affairs. She can be reached at hughes@aaos.org

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