Evidence- and Value-based Solutions for Health Care™
Clinical Improvement Consults, Content Development, Training & Seminars, Tools
The EBM Information Quest: Is it true? Is it useful? Is it usable?™
Delfini Co-founders: Michael E Stuart MD, President & Medical Director . Sheri Ann Strite, Managing Director & Principal
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|Quality Director & Academician|
....I am a fellow (for more background you can read my bio on their web page) in the Department of Family Medicine at UCSD, having served as an assistant medical director for the previous three years while at UCSF in San Francisco. Thus I am versed the challenge of bringing docs together to design quality improvement efforts and the need to have this based in evidence driven approach.
I attended the AAFP Performance Measures conference back in October where Sheri and Mike put on a top-notch program for leaders across the country who desire to translate evidence-based medicine in organizational systems improvement. I had been a participant in the AAFP Fundamental of Management longitudinal course ... and many of the October's conference attendees were the faculty of that program.
Everyone at the conference found the structure and content exceeded their expectations and were very jazzed to think about bringing this back "home" for action. Whereas I cannot give testimony to the return on investment of a program of Mike and Sheri's since my institution doesn't directly invest in such needed and high quality program development (being the rather behind academic world when it comes to this quality improvement demand), I can say that the head of my department, Dr. Ted Ganiats, who works with performance measures and guidelines groups across the country and himself is recognized as a national leader in the area, notes that these two go above and beyond any group he has ever worked with (which is why he recruited Sheri to be part of UCSD, why he made a point of connecting me with them, and why he feels are department offerings for students/ residents/ faculty are exemplary evidence-based efforts for the whole UCSD campus).
Also, I can comment on the
clarity of their approach ... I am completing my MPH in health services
administration and thus have heard many presentations from "experts"
in organizational redesign, program development, and concepts of epidemiology/big
picture scientific critique — many concepts of my coursework were
reiterating in the most eloquent manner, logical, and thorough, but not
misleading, manner through the various programs that Mike and Sheri design....
Ronald L. Diedrich
Dear Dr. Stuart and Ms. Strite,
Thank you for the presentation you made on November 29, 2004 to the California Office of Administrative Hearings' administrative law judges on evidence-based medicine. It was very well received. The information was provided in a concise and readily understandable manner. The judges now have a new and valuable tool to assist them in appraising the medical evidence that is submitted in the hearings over which they preside.
I can highly recommend the instruction you make available through the Delfini Group. I believe that your presentation on evidence-based medicine would also be of great interest and use to other groups, such as state agencies that license health care professionals, both government and private attorneys who practice in the area of health care, and those individuals who testify as medical experts.
Robert Gray, MD
OMNI Medical Group engaged
Delfini first in 2001, with another organization in Tulsa serving as co-sponsor.
Since then, OMNI alone has sponsored courses every 6 months to train physicians,
mid-level providers, and other key management personnel in the concepts
of critical appraisal of medical literature. We usually have 20-40 people
attend, and one of the large local HMO's grants scholarships for some
attendees (that's how sold on Mike and Sheri THEY are!).
|Chief Quality Officer|
David Holloway, MD
My introduction to Mike and
Sheri was in 1996 or '97. At that time I was with an integrated system
in Tulsa, St. John Health System, and helping to introduce quality concepts
to the employed medical group of 80 physicians. We looked at [other groups
who] offered courses in these matters. We were especially interested in
evidence-based medicine for our leadership and frontline primary care
physicians. After creating a "wish list" of requirements, a
small group attended sessions from each candidate organization. The evaluation
process revealed that the course work offered by Mike and Sheri at the
Group Health Cooperative EBM Conference best met our requirements for
EBM training. Even after leaving GHC, Mike and Sheri continue to provide
EBM training for St. John every year.
According to the Dartmouth Atlas Project, lumbar spine surgery is four times greater in Idaho than most areas of the country. Recently the Delfini Group conducted two evidence-based training sessions where Idaho spine surgeons actively participated in evaluating the evidence regarding surgery and other modalities for lumbar back pain and discussed ways to improve patient care in this area.
I believe the evidence-based approach used by Delfini is the right way to approach inappropriate variation in healthcare. I fully support Delfini’s step-wise approach to assessing medical technologies.
If we are to assure that our patients receive appropriate care, we as health care professionals must be able to search for and critically appraise the medical literature and commit to a statement about the quality of the evidence before making recommendations to others. Only then can we have informed discussions with our patients and colleagues about reasonable management strategies. One of the biggest problems in healthcare is that new diagnostic and therapeutic interventions are instituted without the support of good science.
I can highly recommend the Delfini faculty:
|Renal Nutritionist & Clinical Guideline Project Team Member|
Mukaida, MS, RD, CSR
This letter is to endorse the Educational Session Proposal, “Evaluating the Medical Literature for Validity and Usefulness,” by Michael Stuart, MD and Sheri Ann Strite, Delfini Group.
I have had the privilege and honor to be part of a group of physicians and pharmacists who are developing practice guidelines for the management of chronic kidney disease (CKD). KP Hawaii is committed to promoting and implementing evidence-based medical (EBM) practice and integrating this into our electronic medical records system. Our organization’s leadership arranged to have the Delfini Group serve as consultants to this team, based on their prior collaborative work and Delfini’s successful track records.
Although we have been working with Mike and Sheri only since April, our CKD group has been extremely impressed by their knowledge, organization and planful guidance. As a team, they are very skillful at facilitating teleconferences, with focused discussions and action-planning. On July 13, 2005, Mike and Sheri came to Honolulu to conduct a full-day training in critical appraisal of the medical literature, foundation skills for any EBM practice. They have developed a wealth of tools, including checklists, process-flow models, reading and writing tips and evidence grading tools, to help even a novice reviewer feel that he can unlock the “mysteries of medical mumbo-jumbo” to read between the lines and separate the wheat from the chaff. And there is a lot of chaff out there, with about 10,000 articles being published in the medical literature weekly.
Mike and Sheri are gifted facilitators and passionate educators. I have rarely encountered workshop presenters who are so well-prepared and well-versed in their subject matter. Both are engaging, up-beat, and empowering in their presentations. They are extremely generous with their knowledge and expertise: explore their website, delfini.org, to examine some of their tools, checklists, etc.
Registered Dietitians, in general, unfortunately, have not been well-educated in critical appraisal skills to evaluate medical literature. Although we are making excellent progress in developing practice guidelines, too many of us rely blindly on others to review the literature, and accept published data at face value. In fact, one of my young dietitian acquaintances recently commented to me, that she was developing evidence-based practice guidelines. When I asked her about her methodology, she replied that she was citing whatever was published to support her recommendations. She admitted that she thought that that was what EBM meant: to cite published data (whether or not it was critically reviewed). Many professionals, physicians included, assume that an article that makes it through the gauntlet of an editorial review board has met high standards of research.
Mike and Sheri have also developed a package of teachable skills for conducting meetings, teleconferences and minute-taking. These skills include how to develop agendas and templates for minutes, keep discussions focused, build consensus, and achieve clarity among participants. In fact, they were recently invited to do such a training for a large organization. Their client list and endorsements are impressive! (Again, reference their website.)
Carrie Mukaida, MS, RD, CSR
|Insurer & Utilization Management Leader|
& Company Name confidential
....I have known Michael Stuart and Sheri Strite for many years in their capacity at Delfini. When I first met them, I was a primary care physician, and I have continued to attend their sessions since moving....
Mike and Sheri demonstrate an excellent work ethic and are incredibly hard working. In the time I have known them, they continue to refine and customize the content and training experience they deliver to fully suit the needs of whomever they are training. They truly put their heart and soul into their work and are very committed to the training of the EBM (evidence-based medicine) paradigm, which is so lacking in America today. Although the concept is gaining some traction, it still seems pitifully lacking where the "rubber meets the road," viz. when the physician is doing his/her medical decision-making with the patient in their office.
All you have to do is read through the Delfini bios to realize what incredible experience Mike and Sheri have. They are highly effective trainers, not just in enabling people to do the work, but also in boosting their motivation, confidence and inspiration. Many of the doctors who were fundamentally EBM "ignorant" prior to a session with Michael and Sheri come away from that experience applying EBM principles in their daily practice and sharing what they have learned with their fellow practitioners. I am simply unaware of any other group, person, or persons who are offering the full range of services and expertise that Delfini can offer, particularly in such an effective, simplified and practical way. For all these reasons, I have been looking for ways to incorporate their services into my company and have continued to work with Sheri and Mike to come up with innovative ways to bring this message further down the line to inform patients and business group leaders to help impact the EBM equation. As you can see, I am very excited as to what Delfini has to offer. I fully believe these two have the potential to have a significant impact on the way we practice medicine today. Not because they are the only ones who are working to promote EBM, but because they are two of the very few voices in America who can present EBM in such a precise, functional package that doctors are able to walk away from the session and immediately apply the concepts learned.
L. Searfus, MD
I am writing in support of Sheri Strite and her ability to effectively provide EBM curriculum to a variety of audiences. I have participated in an EBM workshop she developed for our community family physician preceptors and was impressed by the clarity of the materials and their ease of use. The materials were extremely well received, particularly impressive in a group of practicing clinicians for whom reviewing the literature seems time consuming and arduous.
Based on this exposure, I asked Ms. Strite to develop an EBM curriculum for fourth year medical students in the context of their elective family medicine month. I obtained a small amount of grant funding to support her work and have been impressed by how enthusiastically she has approached this task. Over the last year and a half, she has moved from a lecture based to a web based curriculum to better engage the students.
This year, she has implemented an EBM project where the students independently analyze a paper by utilizing the standard set of questions used in the Delfini approach to assessing the literature.
She has consistently sought out and been incredibly responsive to feedback and has been willing to provide almost immediate adaptations when requested. She makes herself readily available to students and continually strives to provide the highest quality experience possible to them. Her enthusiasm for the subject is infectious and she is completely reliable.
In addition, Ms. Strite and Michael Stuart together helped develop test questions that we use on the final exam for the course.
Ms. Strite consistently seeks
to improve her curriculum and overall has been very well received by our
students. I enthusiastically support her application to your company to
provide EBM training and believe she would be successful in any venue.
Thank you for your consideration.
|Pharmacy Services Leader|
Sherman, RPh, PharmD
I am writing in reference to Sheri Strite and Dr. Michael Stuart of the Delfini Group, and their evidence-based medicine work. With great pleasure, I highly recommend the evidence-based work of Ms. Strite and Dr. Stuart. They are top quality, effective, and practical.
I've attended over six seminars taught by Ms. Strite and Dr. Stuart throughout my career. With each seminar, I've been stretched further and further in improving my evidence-based skills. Because of the extensive value I observed, Ms. Strite Sheri and Dr. Stuart provided an extensive seminar focused on the work our clinical pharmacy staff here at The Regence Group do in evaluating pharmaceuticals. Our company immediately recognized the great value and expertise that Ms. Strite and Dr. Stuart provide. Our goal is to continue to work with them regularly on an ongoing basis.
Some of my specific thoughts include:
In summary, Ms. Strite and Dr. Stuart have world-class expertise and offerings in evidenced-based medicine....
|Insurer & Medical Leader|
D. Storey, MD
I have been very impressed and pleased with the breadth and depth of the knowledge possessed by Sheri and Delfini, their extremely well developed sense of responsibility and initiative, and their high degree of collaboration with me and my organization. I am truly looking forward to a long term relationship with Sheri in the area of EBM, and would recommend Sheri and Delfini with the highest degree of enthusiasm to any organization that is wishing to expand and enhance their understanding and use of EBM....
...I have know Mike and Sheri for many years, dating back to their days at Group Health....We're trying to change a culture here at our health system, and we are starting to see some significant changes. They are excellent teachers, and have a thorough understanding of their subject material. We get great evaluations every time they come. One of our local insurance companies scholarships up to 40 people for each course, because they are so impressed by the course.
We really didn't consider any others because we are unaware of anyone who does a comparable job. Plus, they're just plain fun to work with....
& Company Name Confidential I
...I’d like to offer an unequivocal endorsement of the nature and value of the training and programs Delfini produces and delivers. I have known Mike and Sheri for over three years. They have completed six programs directly for customers of mine. These training sessions have contained components of evidence-based medicine, critical assessment of medical literature and communications with providers. The comments from my customers (Clinical PharmD’s, and MD’s) have been consistently excellent.
In my experience, it has been a pleasure working with Mike and Sheri on both a professional and personal level. They both work extremely hard and have excellent experience and a high level of expertise. They are highly effective trainers and enable people not to just improve their clinical skills, but also to help them feel motivated, confident and inspired.
The training materials that Mike Stuart and Sheri Strite produce are incredibly practical and useful. They have taken time to tailor programs specifically to the requests of my accounts clinical/business needs.
They have gone above and beyond to meet my company's and particularly my clients' expectations. In several cases this has occurred without additional funding for customization, but solely because Mike and Sheri truly believe in their mission of improving the quality of health care. It is clear that they spend many hours updating and refining their materials and presentations.
Mike and Sheri have proven
to be a trusted, reliable resource for my company and for my customers.
They follow up on requests in a timely manner. Most importantly, they
deliver results, as measured by improved clinical performance on the part
of my clients and an enhanced reputation for my company for delivering
such high level programs.
& Company Name Confidential II
Government Account Manager
Major Pharmaceutical Firm
Sheri Strite and Dr. Mike Stuart have conducted numerous programs for this organization and our strategic customers over the past several years throughout the various segments of our business, and without exception, they have been extremely well received and have consistently garnered the highest praise possible in post program evaluations.
We have had nothing but complete satisfaction with the value they have brought to our organization. They are highly effective trainers not just in enabling people to do the work of critical review of literature and practice and implement evidenced based medicine, but also to feel motivated, confident and inspired.
The materials that Sheri and Mike produce are practical and useful as is the wealth of information on their website which is accessible to participants in the programs.
They have always been willing to customize their work to meet the individual needs of attendees even if that is a deviation from the original concept we jointly established. From my personal attendance at several of the programs, their cutting edge experience and expertise is continually evident, and I would recommend them to your organization.
|Self-funded Group Health Plan Purchaser|
Dear Ms. Strite and Dr. Stuart:
Thank you very much for including me in the OMNI-sponsored Evidence Based Medicine (EBM) workshop conducted in Tulsa, OK. Your training was one of the finest and most intense learning experiences with which I have been involved for quite some time. I appreciate your creative styles, ability to communicate intense and complex information and your compassion and commitment to the subject matter.
As a health care purchaser, many of the new things that I learned from your training were vital to beginning to understand the “value” equation in today’s health care delivery system. In addition I found the implication of your training sad, startling and very concerning.
As the officer responsible for developing and executing Alliance Coal Group Health Plans Strategy for improving the Health of Alliance Plan Participants and reducing unnecessary costs, integrating Evidence Based Medicine (EBM) principles into the strategy is one of the most important yet difficult tasks. I appreciate your offer to assist me in this endeavor.
Central to applying EBM concepts
is a common understanding. I believe we must begin by developing a common
understanding of EBM principles and their potential application among
Alliance’s Health Care Strategy Partners, HR Professionals, and
Sr. Management....Thank you again.