Evidence- and Value-based Solutions for Health Care™
Clinical Improvement Consults, Content Development, Training & Seminars, Tools
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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 From Our History of Key Relationships, Projects & Noteworthy Items
Also see Sample Projects for details about selected projects.
The healthcare quality improvement examples below illustrate the diversity of Delfini’s offerings. The following are a sampling of collaborative healthcare quality improvement projects with other groups.
We have a track record of the highest quality continuing medical education most especially in evidence- and value-based healthcare improvement processes and critical appraisal of scientific research and its conversion into useful clinical information.
We have a strong reputation for quality work in evidence-based clinical guidelines development, evidence-based performance measurement training and performance measures development, health committee improvements such as Pharmacy and Therapeutics Committee work (P&T) including pharmacist education, formulary development and facilitating healthcare quality improvement projects.
We have developed high quality systematic reviews, evaluation of comparative effectiveness research (CER), drug monographs and other reviews.
Our goal is to provide others with the skills to accomplish evidence-based quality improvement activities and content. We excel at teaching critical appraisal skills, accomplishing clinical reviews and developing decision-support for various target groups. We are skilled at accomplishing much-needed health care quality improvement as illustrated below.
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Aetna, Virginia
Mason & Delfini
Delfini conducted a health care quality system assessment of VM
for Aetna. We were very impressed with the dedicated staff at
VM who we witnessed bringing evidence into daily practice. Mike
presented "Evidence-for Everybody" at a VM health care
conference that was broadly attended by a wide span of stakeholders.
Alliance
Coal Group Health Plan
Purchasers can make a difference in health care. We are pleased
to have helped Alliance Coal's benefits administrator explore
how evidence-based medicine could be incorporated into their health
care strategies. This group has created an impressive cardiovascular
risk reduction initiative to improve outcomes for all of Alliance
Coal's employees.
American
Academy of Family Physicians
From our American Academy of Performance Measures Program
— September 10-12, 2004
Performance Measures: A Practical Approach to Improving
the Quality of Clinical Care — Overall
Program Score 5.0 out of 5.0
AAFP hand-picked thirty-six physicians from the applicants to
receive training to represent the AAFP on national specialty boards
and consortiums charged with creating and evaluating performance
measures. We also gave them skills in doing quality improvements
in their own settings. The representative for the AMA Physicians
Consortium who was an observer at the meeting, stated it was an
outstanding program and incredibly well organized.
From the Director:
“I wanted to let you both know how much I appreciated your willingness to adapt the program to our specific needs. When you do something new, you always wonder how it will be received by the attendees. This program exceeded our high expectations! The family physicians who attended were interested and engaged throughout the two and one-half day program and I am sure the tools you shared will find good use in the near future for many of them. Thank you for devoting your energy and your professionalism to our project."Bruce Bagley, M.D.
Medical Director for Quality Improvement
American Academy of Family Physicians
American
Academy of Neurology
We provided AAN with resources to create web modules
to train residents and faculty.
Blue Cross
of Idaho
Idaho's variation in spinal care is significant. Delfini
has been working for several years with leadership at BC of Idaho
to explore how an evidence-based approach may improve care and
reduce this variation. An intensive four-day training program
took place in the summer of 2006 with resulting improvements.
Read more here.
Department
of Defense Pharmacoecononomic Center
Delfini has provided training on effective meetings and effective
meetings in health care, along with training in critical appraisal
and evidence-based Pharmacy & Therapeutics committee approaches.
DynaMed
Mike and Sheri are contributing editors for DynaMed which is a
medical information database with a large number of clinical topic
summaries designed for use at the point of care with a goal of
providing evidence summaries and regular updating. DynaMed was
developed by Brian Alper, MD, MSPH. You can read about DynaMed
at http://www.ebscohost.com/dynamed/
HealthWise
Delfini has provided training the HealthWise leadership and staff and has provided tips for producing evidence-based content.
Kaiser Permanente
Hawaii (KPHI)
Delfini has conducted a series of healthcare quality improvement
activities with KPHI over the years that have resulted in improved
patient-centered care, patient outcomes and even awards!
Evidence-base Medicine Continuing Medical Education and Pharmacy Education Conference
In November 2006, Delfini partnered with KP Hawaii on a 4-day EBM Conference — "Talk Story, Talk Evidence ™" — that was highly well received. We provided training in a variety of evidence-based medicine topics. Featured were critical appraisal, guideline development and special workshops for EBM committees such as pharmacy and therapeutics committees (P & T committees) and medical technology assessment committees, plus training in performance measures and pay-for-performance. Delfini and KP Hawaii's collaborative work in Chronic Kidney Disease (CKD), including a clinical guideline, was featured.Evidence-based Medicine Chronic Kidney Disease (CKD) Management and Referral Clinical Practice Guideline & Healthcare Quality Improvement Project
Delfini was invited to help Kaiser Permanente Hawaii advance EBM within their organization. KP Hawaii has a strong committment to evidence- and value-based care —their leaders are committted and support EBM; they frequently have sponsored outstanding and well-attended EBM conferences and retreats; and, they have an impressive and active EBM working group.They were desirous of taking EBM to a new level and expanding and embedding evidence-based clinical improvement skills and techniques more solidly and more broadly into their culture. We came up with an idea for a working project that would provide just-in-time practical training, advance clinical care and help further "seed" cultural change. Thus, the award-winning KPHI Nephrology Chronic Kidney Disease management and referral project was conceived. A true success story with improved outcomes for patient-centered care as well as significantly advancing evidence-based practice within KPHI — many of the newly-trained participants enthusiastically embraced their new knowledge and skills and went on to participate in other evidence-based practice healthcare improvement initiatives and activities.
Evidence-based Medicine Hypertension Clinical Practice Guideline Project
Delfini facilitated just-in-time EBM training and clinical guidelines development work on Kaiser Permanente’s blood pressure management project which based on the Nephrology training and guideline development model.Evidence-based Medicine Venous Thromboembolism (VTE) Clinical Practice Guideline Project
Delfini was invited to again use the Delfini EBM training, clinical guidelines development model and healthcare quality improvement process techniques to develop KPHI's clinical guidelines dealing with the prevention of venous thromboembolism in total hip and total knee replacement surgery. This project was completed in early 2009 and approved by the their Quality Council. Read more about the evidence-based Venous Thromboembolism (VTE) Clinical Practice Guideline Project.
Lown Institute
04/16/2016: LOWN SUMMARY CONFERENCE CHICAGO
We were honored to participate in the Lown Institute's 4th Annual Conference in Chicago, April 16, 2016. John Ioannidis MD joined us to discuss "Medical Misinformation vs. Reliable and Clinically Useful Evidence for Truly Informed Consent and Improved Outcomes."
Workshop Summary: Knowing the reliability of medical evidence is required for making informed clinical decisions. There is a high likelihood of distorted study results when evidence is of low quality. However, most health care professionals are unaware that much medical science is not reliable or clinically useful. There currently exists a "medical misinformation mess"—a hidden and little known crisis affecting every patient. The basic skills for evaluating the quality of medical science are much easier to acquire and apply than most people think. Attendees learned to recognize the size and importance of this crisis through compelling cases, as well as to learned the basics about the common threats to validity in the medical literature.
Our take-home message to workshop attendees was simple:
1. If the evidence is of low quality the results are likely to be unreliable—therefore we must assess the validity of medical studies before seriously considering the results.
2. It is easy to learn how to assess medical evidence for reliability and clinical usefulness.
3. It is the responsibility of every healthcare professional to possess basic critical appraisal skills. We admire the Lown Institute for their efforts to inform others about the huge problems of bad science, overtreatment, under-treatment and the waste of valuable resources-- billions of wasted healthcare dollars each year.
McKesson
Collaboration
Delfini provided an EBM training intensive to McKesson
to help advance their application of evidence-based medicine in
their decision support work. McKesson embraced this training by
implementing an EBM initiative with a phased approach to incorporating
learnings into their products. Staff commented on how the training
positively enhanced their daily work immediately. A post-test
was administered following the training intensive, which resulted
in high scores of over 90 percent correct, reflecting good understanding
of basic EBM concepts such as bias, confounding and chance. Update:
Staff took a post-test about six months following the training,
and staff scores averaged an impressive 94.7 percent correct answers
on their test. They have continued to advance their evidence-based
practice knowledge through regular inhouse training sessions and
through an intensive EBM seminar we provided in May 2010.
MD Anderson,
University of Texas
For a number of years, Delfini worked as faculty for
MD Anderson's Clinical Safety & Effectiveness (CS&E) Training
Course based on Dr. Brent James' course for clinicians at Intermountain
Healthcare in Utah that offers skills to make improvements in
clinicians' care they deliver. MD Anderson states that, "The
CS&E Training Course will benefit MD Anderson for years to
come by developing a culture that embraces healthcare quality
improvements because the effort will be led by individuals who
have the most interest and knowledge of what needs to be improved
— the clinicians providing the care." We are pleased
to have spent considerable time with them to help advance their
skills in evidence-based practice.
Medtronic
Delfini participated with several EBM and medical technology assessment
leaders in the field to help launch an EBM initiative at Medtronic.
Our work with them included training in evidence-based medicine
and in economic analysis, plus how the two can be combined to
assess value.
Publications: selected (also see our Delfini Publications page)
Help for Medical Leaders & Organizations
Our three-part series on "The Evidence-based Organization," published in the American College of Physician Executive's, The Physician Executive, Journal of Medical Management is available on our website: Delfini American College of Physician Executives Publication PageEvidence-based Pharmacotherapy
Our evidence-based pharmacotherapy textbook chapter is freely available for download.Performance Measurement
Our commentary in Modern Health, along with other resources for creating, implementing and monitoring performance measures is available here.Delfini is mentioned in Shannon Brownlee's highly praised, Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, Bloomsbury USA; 1 edition (September 18, 2007), which was named the best economics book of 2007 by New York Times economics correspondent David Leonhardt, and in an article in the Washington Monthly adapted from the book. You can read the Washington Monthly article.
NBBJ
Although it may at first seem surprising to those of us in the
health professions, evidence-based medicine has inspired what
is referred to as "evidence-based design" (EvBD) in
the field of architecture. An evolving area, EvBD is in its infancy.
Medical architects, professors, marketers and others from Seattle-based
NBBJ, a leading architectural firm, were interested in learning
principles of evidence-based practice and engaged Delfini to provide
training and consultation to them. Of key interest was how EvBD
in a health care environment can create improvements in areas
such as health status outcomes, health care outcomes, patient
and provider satisfaction, efficiency and more.
Novartis
and Solara, a CommonHealth company
Delfini completed a significant update of the research on angiotensin
receptor blocker (ARBs) and ARB combinations to create a very
well received qualitative systematic review. Delfini also created
a successful training program to educate physicians which was
well received and which emphasized providing medical leaders and
clinicians with skills to make their own evaluations of the scientific
research.
Omni Medical
Group and St. John Medical Center
Since Delfini's inception, we go regularly to work with the Omni
Medical Group in Tulsa, Oklahoma, at St. John Medical Center.
The dedicated leadership of this group is intent upon training
all OMNI physicians to be evidence-based medicine practitioners.
The training programs are open to others well, and OMNI is active
in broadening EBM skills in the community including working to
provide this training to local residencies which now sponsor the
events.
Oregon
Health & Science University (OHSU)
Delfini
evaluated the safety, efficacy, and cost issues regarding arthroscopic
knee lavage and debridement versus medical management for osteoarthritis
and/or knee pain for the Washington State Health Authority in 2008. This qualitative systematic review was undertaken because
of significant concern over whether surgery is effective at improving
function or relieving pain and the rates of re-surgery and potential
complications. Briefly, the evidence showed that arthroscopic
lavage and debridement for osteoarthritis of the knee is not more
effective than sham surgery, and there are siginificant risks
such as venous thromboembolism, infection and bleeding. This review
was conducted by Delfini Group at the request of Oregon Health
and Sciences University Center for Evidence Based Policy. Here
is information about our qualitative systematic
review, the outcome for which is available online at http://www.hta.hca.wa.gov/knee.html.
Providence Health System Oregon
Delfini has had a long standing affiliation with Providence, providing
training and tools to Pharmacy & Therapeutics committee members and staffers. Providence leaders and staff of Pharmacy Servicces and P&T have a strong commitment to evidence-based medicine and understands the importance of critical appraisal to provide quality care for patients and value.
Qualis Health
Delfini participated with the American Medical Association to
assist Qualis Health in the review of existing performance measures
for the Center for Medicare and Medicaid Services (CMS) and to
identify candidates for new performance measures.
Rattan Juneja,
MBBS, MD, MRCP, Clarion Health, Indianapolis, Indiana
We have completed
a qualitative systematic review, through grant support from Clarion
Health, and have written a paper with another wonderful friend
and colleague, Rattan Juneja MD, on intensive insulin therapy
for hyperglycemic adults in the intensive care unit setting which
has been selected for Poster Presentation at the American Diabetes
Association's 70th Scientific Sessions, June 25-29, 2010, in Orlando,
FL. It will also be printed in the Scientific Sessions Abstract
Book, the June 2010 supplement to the journal Diabetes: Intensive
Insulin Therapy for The Treatment of Hyperglycemia in Critically
Ill Adults: A Qualitative Systematic Review and Critical Appraisal
of the Evidence.
Regence Blue
Cross/Blue Shield
Delfini has provided
training and tools, assisting with modifications to their monograph
process and templates, and Delfini has directly participated in
their work including evidence reviews for monographs.
Salem Hospital
Delfini has worked with Salem Hospital to help organize
and train their pharmacy & therapeutics committee members
and staff and train nurses and their medical librarian in evidence-based
medical technology assessment.
State of California
Administrative Law Judges — Office of Administrative Hearings for the State of California: December 2004
We conducted a program on Law and Medical Evidence for the Administrative Law Judges (ALJs) for the State of California. Many of the judges expressed that the information we presented will be useful in their work and even most of those, for whom this information is not directly related to their work, found the information to be very interesting. There was a strong sentiment that this kind of information is deeply needed by malpractice attorneys, medical boards and medical "experts."
State of Washington
Evidence Review work is described here.
Department of Social and Health Services (DSHS) chose Delfini to regularly train their staff and clinicians who conduct medical necessity and other reviews. Other state employees involved with improving Washington State’s plan for improving health care, such as from the Health Care Authority, are invited. Testimonial below:
Mike and Sheri, I just wanted to thank you once again for the great job you did today, teaching our staff EBM assessment for validity and usefulness. You were inspiring to our staff. I just loved to see how attentive they were and to hear the great questions that were asked. They were getting your messages! Fantastic.
People are raving about your training. I just heard how professional that it was, that HRSA and the other agencies were presented in style and the staff really appreciated that. I believe they recognized that we brought the very best to them, showing that we value EBM and their work in this area.
Again, thanks so much. It was such a pleasure to work with you to make this day so special for our staff.
SiriSiri Childs, Pharm D
Pharmacy Policy Office Chief
Department of Social & Health Services
Health & Recovery Services Administration
Division of Medical Benefits & Care Management
Medical Consulting & Pharmacy Policy Units
State of WashingtonKing County Healthcare Advisory Task Force: September 2004
Mike was invited to do a health care quality system assessment for the task force, reviewing Aetna. The review was structured, in part, on the Delfini Health Care Quality System Assessment Tool [PDF] and online tool [WORD Doc]. Caroline Whalen, Deputy County Administrative Officer, was reportedly very pleased with the quality of Mike's work.In the News June 15, 2004
The task force (and Mike) makes the news for completing their work. For those of you who have registered (free) with the Seattle Times, here's the link to the news story.Background
Mike served on a task force of some of the country's top experts in health care and cost management who are working on a plan to accomplish both goals for King County government in Washington State, in partnership with some of the area's biggest employers. Mike's expertise and knowledge was certainly felt. County Executive Rom Sims is quoted as saying, "The task force's work is stunning because they are raising issues with us that we never would have thought about. It's a breathtaking change. I don't think anyone thought you could get a higher quality of care and lower your costs." Mike, who served as the luminary for evidence-based medicine, was one of the panel members interviewed for the Seattle PI.Washington State Health Authority — see OHSU arthroscopic knee lavage and debridement versus medical management for osteoarthritis and/or knee pain
University
of California, San Diego School of Medicine
A federal grant supported Sheri's developing an educational
program for 4th year medical students on rotation in Family Medicine
at the University of California, San Diego, during her tenure
at UCSD as Associate Director, Program Development:
"Sheri, I very much appreciate...the incredible job you have done with the curriculum for 426....Your boundless enthusiasm for teaching and your passion for evidence-based approach to care is unparalleled and will certainly lead to continued success." Full reference letter here.
Kirsten Searfus, MD
Pre-doctorate Program Director
UCSD Family Medicine
San Diego CA
University of Texas (see MD Anderson above)
University
of Washington
Mike annually teaches the evidence-based medicine module in a
Medical Management course targeting midcareer medical leaders
who are seeking additional certification.
Mike has provided teaching to family medicine residents at Group Health Cooperative, a part of the University of Washington's family medicine residency network.
WellPoint
We have done considerable work to help make groups as
efficient and effective as possible in doing evidence- and value-based
formulary management work. We have also had the privilege of working
with some highly sophisticated groups to help them advance further
into greater practice of evidence- and value-based formulary
decision-making. The Wellpoint staff we have worked with are
among the best we have ever seen.
Webinar Example
No sooner did we get our first videocasting under our belt, but we got invited to do a "Webinar." Broadcast live from Sheri's Cajun Cottage in beautiful San Diego! It was like hosting a radio show! The audience loved it and felt they gained a lot. We've done more since with similarly happy results.Comments from participants: "Really enjoyed the training...What a great seminar!!!...Very worthwhile and learned a lot...Really enjoyed...Very informative...Wonderful...Excellent training program, most informative and enjoyable...Great presentation...LOVED IT!"
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