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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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A SAMPLING OF REFERENCES

  1. Quality Director & Academician — Caroline Day MD, UCSD Family Medicine Director of Clinical Quality
  2. Law Judge — Ronald L. Diedrich, Director & Chief Administrative Law Judge, Office of Administrative Hearings, State of California
  3. Medical Director — J. Robert Gray MD, Medical Director, OMNI Medical Group
  4. Chief Quality Officer — W. David Holloway MD, Senior Vice President, Chief Quality Officer, Parkview Health System
  5. Medical Leader — Doug Dammrose, MD, Senior Vice President & Medical Director of Blue Cross of Idaho
  6. Renal Nutritionist & Clinical Guideline Project Team Member — Carrie Mukaida, MS, RD, CSR, KP Hawaii Nephrology Division
  7. Insurer & Utilization Management Leader — Medical Director, Utilization Management, Major Insurance Company
  8. Academician — Kirsten L. Searfus MD, Director, Predoctoral Program in Family Medicine, University of California, San Diego
  9. Pharmacy Leader — Helen Sherman RPh, PharmD, Senior Director - Chief Pharmacy Officer Pharmacy Services, The Regence Group
  10. Insurer & Medical Leader — Donald D. Storey MD, Aetna Senior Medical Director, Seattle WA
  11. Medical Leader — Timothy Young MD, President, OMNI Group, St. John's Health System
  12. Industry Manager — National Account Manager, Major Pharmaceutical Firm
  13. Industry Manager — Government Account Manager, Major Pharmaceutical Firm
  14. Self-funded Group Health Plan Purchaser — S. Paul Mackey, General Manager, Human Resources Administration, Alliance Coal, LLC

........

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Quality Director & Academician

Caroline Day, MD
Assistant Clinical Professor
Director of Clinical Quality
UCSD Division of Family Medicine, Lewis
San Diego CA

....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....

Law Judge

Ronald L. Diedrich
Director and Chief Administrative Law Judge
Office of Administrative Hearings
State of California
560 J Street STE 300
Sacramento CA 95814

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.

Medical Director

J. Robert Gray, MD
Medical Director
OMNI Medical Group
1802 East 19th Street
Suite 400
Tulsa, OK 74104

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!).

We do charge a fee for this course, but heavily subsidize it because we are absolutely convinced that medical decision making should be based on the best evidence, and that practitioners should be conversant with evaluating evidence.

We do not even try to show a formal ROI for this, but have the gestalt that as our providers go through the courses that we are building a cadre of trained, critical thinkers that deal more rationally with medical decisions than ever before. It's been exciting to see some of the "conversions" of doctors as they really start seeing a whole new way of thinking about evidence-based diagnosis and treatment. We are now getting to a point of critical mass in our organization of primary care providers, and the tipping point will probably occur in 2005. We are also slowly getting specialists to attend and that is creating noticeable change in certain boards and committees in our tertiary medical center.

Our introduction to Mike and Sheri occurred by attending courses held by their former employer, Group Health Cooperative of Puget Sound. I first attended a course, then the next year 4 other docs went, and the next year 16 went. After that, Mike and Sheri left Group Health to establish Delfini....

OMNI is pleased with our relationship with Delfini. We are pleased to be able to work them frequently in the years to come....

Chief Quality Officer

W. David Holloway, MD
Senior Vice President, Chief Quality Officer
Parkview Health System
Fort Wayne IN

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.

Now, as the Chief Quality Officer of a bigger organization, I have a chance to talk with healthcare improvement thought-leaders from around the country. I am even more convinced today that you can find no one better in the US to teach this complex material in a way that physicians and others will "get". By "get", I mean learn in a way that can be applied, and isn't that the objective?

Medical Leader

Doug Dammrose, MD
Senior Vice President & Medical Director of Blue Cross of Idaho

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:

  • They were extremely well-prepared and knowledgeable about applied EBM
    The lectures and exercises provided a comfortable, non-threatening environment and were well received by the spine surgeons.
  • They are enthusiastic presenters, knowledgeable, and clearly dedicated to improving clinical care through the appropriate use of science.
Renal Nutritionist & Clinical Guideline Project Team Member

Carrie Mukaida, MS, RD, CSR
Renal Nutritionist
KP Nephrology Division

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.)

Sincerely yours,

Carrie Mukaida, MS, RD, CSR
Renal Nutritionist
KP Nephrology Division

Insurer & Utilization Management Leader

Name & Company Name confidential
Medical Director, Utilization Management
Insurance Company

....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.

Academician

Kirsten L. Searfus, MD
Director, Predoctoral Program in Family Medicine
University of California, San Diego
9500 Gilman Drive, Mail Code 0696
La Jolla, CA 92093-0696

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

Helen Sherman, RPh, PharmD
Senior Director - Chief Pharmacy Officer
Pharmacy Services
The Regence Group
Portland OR

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:

  • They are truly trusted national experts on evidence-based medicine. They are known nationally for their excellence in evidence-based medicine.
  • They are very dedicated to delivering excellent, effective programs--customizing sessions to meet client-specific needs. (Our seminar was completely custom to what we requested).
  • Clearly, they are extremely passionate about making a positive difference in improving the quality of healthcare, as well as providing and excellent experience for their audience.
  • Their approach is very thought provoking.
  • Attendees leave their seminars with practical, real-world tools and experiences at hand.
  • They show enthusiasm, keep their sessions interactive by engaging the audience participation.
  • Our entire staff was very motivated to stretch further professionally as a result of our interactions with Ms. Strite and Dr. Stuart.

In summary, Ms. Strite and Dr. Stuart have world-class expertise and offerings in evidenced-based medicine....

Insurer & Medical Leader

Donald D. Storey, MD
Aetna Senior Medical Director
Seattle , Washington


...I have worked with Delfini and Sheri for approximately 6 months, exploring avenues in which Delfini can help my organization, both internally and externally, better understand and use Evidence Based Medicine (EBM).

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....

Medical Leader

Timothy Young, MD
President, OMNI Group
St. John's Health System
Tulsa OK

...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....

Industry Manager

Name & Company Name Confidential I
National Account Manager
Major Pharmaceutical Firm

...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.

I highly recommend Mike Stuart, MD, Sheri Strite, Delfini and the programs they develop and present!

Industry Manager
Name & 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

S. Paul Mackey
General Manager
Human Resources Administration
Alliance Coal, LLC

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.

Sincerely,
Paul Mackey

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