Evidence Based Health Care Quality Help: Delfini Tools

Terms of Use In downloading or reviewing any of these tools or revewing any the information conveyed in this website which represents our original work, you implicitly agree that you have read our Notices and that you will not use these tools for any commercial purpose outside of delivering usual patient care such as would be provided by a health care system or individual clinician or by an EBM work group, without our permission, plus that you will seek our permission to create any derivative work or for any work utilizing any part of these tools in publication. You also agree that you will abide by the spirit of this intended agreement, and what it is attempting to effect, regardless of its specific wording. Lastly, you agree that you will convey these stipulations to any to whom you provide copies of our work.				Get Email Updates!
Because we are continually refining our tools, we recommend that you download tools just-in-time rather than storing them on your own computer to ensure you are getting our best version. Other Items of Interest Delfini Seminars 2011 Critical Appraisal Online Tutorial Delfini Flier
FAV Possibly Our Most Important Reading
Delfini Fact Sheet: Quality of Care, Quality of Science & Importance of Critical Appraisal Skills Why we are doing this work; why critical appraisal matters... Short version: Delfini Flier Overview: Framework for Evidence-based Critical Appraisal & Decision-making [PDF][WORD] New 08/02/2011 Overview: Framework for Evidence-based Critical Appraisal for Clinical Improvement Work [PDF][WORD] Version 10/31/2010 Critical Appraisal Online Tutorial: A brief (and hopefully fun) online tutorial on the basics of critical appraisal of therapeutic interventions. The emphasis is on evaluating efficacy claims of primary studies using superiority designs.
Utility Tools
EBM Glossary Online Searching the Medical Literature Tool [WORD] Version 10/13/2011 Delfini Favorite Sources [PDF] Version 10/13/2010 See also tools for Documentation Others available at Delfini Web Links
Critical Appraisal Tools Also see Critical Appraisal Online Tutorial: A brief (and hopefully fun) online tutorial on the basics of critical appraisal of therapeutic interventions. The emphasis is on evaluating efficacy claims of primary studies using superiority designs.
Topic	Code	Item	How We Use Them	Get
CRITICAL APPRAISAL Primary Studies : Short Tools Efficacy of therapies in superiority trials; some with notes and considerations for other circumstances	FAV	1-Pager Pearls: Basics of Evaluating Evidence in Superiority Trials for Therapies Aka The Short Essensials Teaching Tool for Superiority Trials for Therapies Version 06/08/2011	Novice/ Intermediate teaching tool, self-study guide, reminder tool	[WORD] [PDF]
	FAV	1-Pager Quick Checklist for Efficacy of Therapeutic Interventions (with supplemental questions for diagnostic testing and screening) Aka The "Short" Delfini Critical Appraisal Checklist Version 06/08/2011	All levels for reviewing with articles	[WORD] [PDF]
		1-Pager Pearls: Reminders for Validity Detectives for Critical Appraisal for Efficacy of Therapies Version 03/11/2011	Novice process key points	[WORD] [PDF]
CRITICAL APPRAISAL Primary Studies : Comprehensive Tool	FAV	~14 Pages Primary Studies: Long Tool Short EBM "Textbook" Version 10/11/2011	Explains concepts in the short tools and more; teaching tool, self-study guide	[WORD] [PDF]
: Diagnostic Testing	FAV	1-Pager Pearls: Diagnostic Testing Version 07/30/2010	Considerations	[WORD]
: Diagnostic Testing		Diagnostic Testing Calculator	For calculating measures of test function and getting results in natural English	[Excel]
: Screening		1-Pager Screening Version 07/30/2010	Considerations	[WORD]
: Oncology	FAV	1-Pager Chart of Oncology Outcomes Version 10/01/2010	Chart of various outcomes with issues discussion	[WORD] [PDF]
RESULTS ASSESSMENT	FAV	1-Pager Analyzing Results IMPORTANT: Includes information on assessing confidence intervals (also see Primers) Version 10/31/2011	Tips on assessing results and determining meaningful clinical benefit	[WORD] [PDF]
		1-Pager Composite Endpoints Version 08/31/2010	Considerations	[WORD] [PDF]
	FAV	1-Pager Intention-to-Treat (ITT) Analysis Version 10/25/2011	Considerations	[WORD] [PDF]
		ITT Recalculation Spreadsheet	Aids with assignng missing values and re-computing p-value	[Excel]
	FAV	1-Pager Time-to-Event-Analysis Version 06/21/2011	Considerations	[WORD] [PDF]
		1-Pager Comparative Study Designs of Clinical Trials (Equivalence and Non-inferiority Trials) (see also Primers) Version 11/21/2010	Considerations for non-inferiority and equivalence trials	[WORD]
SAFETY		1-Pager Pearls: Safety Version 11/20/2010	Considerations	[WORD] [PDF]
SAFETY & REGISTRIES	NEW	1-Pager Registry Evaluation Checklist: Safety of Interventions Critical appraisal considerations for evaluating registries for use for safety assessments and safety studies. New 10/08/2010 Version 11/23/2010	Considerations	[WORD]
CRITICAL APPRAISAL Secondary Studies & Secondary Sources	NEW	1-Pager on Working with Secondary Resources Secondary studies & sources should be critically appraised. See tools below. Also the scientific content used in the source should be critical appraised or, at the very least audited: these are pearls for how to do that. New 09/08/2010	Principal advice for working with secondary studies & sources including audit advice	[WORD] [PDF]
CRITICAL APPRAISAL Secondary Studies : Short Tool		1-Pager Pearls: Basics of Evaluating Secondary Studies (including meta-analyses) New 08/21/2010	Novice/ Intermediate teaching tool, self-study guide, reminder tool	[WORD] [PDF]
CRITICAL APPRAISAL Secondary Studies : Comprehensive Tool	FAV	~10 Pager Systematic Review Tool	Principal tool for appraising secondary studies; teaching tool, self-study guide	[WORD] [PDF]
CRITICAL APPRAISAL Secondary Sources : Short Tool	NEW	1-Pager Pearls: Basics of Evaluating Secondary Sources (eg, clinical guidelines, pathways, clinical recommendations, disease management protocols) New 09/07/2010	Novice/ Intermediate teaching tool, self-study guide, reminder tool	[WORD] [PDF]
CRITICAL APPRAISAL Secondary Sources : Comprehensive Tool	FAV	~10 Pager QI Project Appraisal Tool Secondary Sources reference primary and secondary studies (e.g., clinical guidelines, disease management protocols, pathways, etc.)	Principal tool for appraising secondary sources; teaching tool, self-study guide	[WORD] [PDF]
CRITICAL APPRAISAL Economic Studies : Comprehensive Tool	FAV	2-Pager Healthcare Economic Study Review Tool Version 10/31/2011	Principal tool for appraising any economic studies such as cost-effectiveness analyses and pharmacoeconomic studies; teaching tool, self-study guide	[WORD]
CONCLUDING & SUMMARIZING	NEW	1-Pager Grading Version 06/08/2011	Short advice on evidence grading	[WORD] [PDF]
	FAV	Grading, Wording Conclusions and Results Table Tool Version 06/14/2011	Principal tool for advice on grading and wording; results table tool is a cut-and-paste utility Also information on systems GRADE and AHRQ-EHCP	[WORD] [PDF]
		Ideal Study Parameters Version 02/28/2011	Preparation for scientific review	[WORD]
	NEW	1-Pager Evidence Synthesis Overview Version 04/12/2011	Short advice on creating an evidence summary	[WORD]
		Evidence Synthesis Tool	Tips for combining results from multiple studies	[WORD]
	NEWFAV	The Delfini Decision-support Semaphore Example: MRI for Women at High Risk of Breast Cancer New 03/01/2011	Example of a way to present highly complex evidence-based information and other considerations	[WORD] [PDF]
		Qualitative Systematic Review Template	Master document for assembling a scientific review and report generation	Available only through Delfini Programs
DOCUMENTATION : Primary Studies		Study Summary & Critique	For online documentation for project work	[WORD]
		Mini-online application version	For online documentation for project work	[WORD]
		Quick Appraisal Topic Report Form Also contains our short list of our favored sources! New 02/14/2011	Another mini! It's good to have various formats to report evidence findings depending on needs. This one is a shorty for when your time is limited and you need to keep the report brief. Quick process steps included.	[WORD]
		Search Documentation	For online documentation for project work	[WORD]
Critical Appraisal Primers & White Papers
Evidence Essentials—Critical Appraisal Online Tutorial: A brief (and hopefully fun) online tutorial on the basics of critical appraisal of therapeutic interventions. The emphasis is on evaluating efficacy claims of primary studies using superiority designs.
Study Design Issues		Case Series	Problems with	[PDF]
	FAV	Observations for Interventions	General weaknesses of observations	[PDF]
		Problems with Narrative Reviews	Problems with	[PDF]
Various Topics		Comparative Directions (See also Critical Appraisal 1-Pager)	General issues and considerations	[PDF]
		Attrition Bias	Problems with	[PDF]
		Missingness Version 10/11/2011	White paper on issues	[PDF]
	FAV	How to Read a Forest Plot	Teaching aid, self-study guide	[PDF]
	FAV	Confidence Intervals & Their Use for Interpreting Significance of Results	Teaching aid, self-study guide	[PDF]
		Correlation Analysis New 06/13/2011	1-pager	[WORD]
	NEW	"Real World" Data New 10/31/2011	1-pager	[PDF]
Evidence-based Committee Help
General		EBM Committee Tips Tool	General operational suggestions	[WORD]
Formulary Management : Comprehensive	FAV	Committee Deliberations Tool & EBM Pharmacy & Therapeutics Committee Tips Tool	Sequential steps and detailed tips for effective committee functioning and decision-making	Available only through Delfini Programs
Formulary Management : Member Checklist		1-Pager Considerations list for committee members	Teaching aid, self-study guide, committee utility tool	Available only through Delfini Programs
Formulary Management Publications	FAV	Formulary Publication Page Evidence-based Pharmacotherapy Publication Page California Pharmacist Publication Page	Monograph and systematic review preparation help	Online at links to the left
Medical Technology Assessment : Comprehensive		EBM Medical Technology Assessment Committee Tips Tool	Sequential steps and detailed tips for effective committee functioning and decision-making	Available only through Delfini Programs
Quality Improvement Project Mangement Help
EB QI Model		Evidence-based Value Model for Clinical Quality Improvement	Beyond process improvement, a model for EBQI	Online mini version
The EB QI Team & the EB QI Project : Comprehensive	FAV	Suggestions for Evidence-based Quality Improvement Teams: Conducting Projects	Sequential steps and detailed tips for creating and managing EB-QI teams and projects	[WORD]
Project Development		Project Proposal Tool	Considerations	[WORD]
Impact Assessment		Project Change Assessment Tool	Key considerations in addition to cost	[WORD]
Impact Assessment Scenario		Flowing Evidence into Cost Analysis: Powerful Ways with NNT	A little illustration of some helpful ways to use NNT	Online
Implementation	FAV	Project Implementation Strategies and Tool	Strategies for creating behavior change and implementing projects	[WORD]
Measurement : Primer	FAV	2-Pager Quality Measurement Efforts	Teaching aid, self-study guide	[PDF]
Performance Measurement : Comprehensive		Performance Measures (including selecting good projects) See also Delfini Publication Page: Performance Measurement	Sequential steps and detailed tips for development, implementation, reporting and more	[WORD]
Cost Analysis Help		See Critical Appraisal Tools for "Healthcare Economic Study Review Tool"
Evidence Outcomes into Cost		NNT Comparison Calculator	A spreadsheet calculator to do NNT conversions for cost analysis	[Excel]
More Cost Analysis Tools & Ideas Electronic Spreadsheet Templates & Approaches (for ideas only!) Example for projecting impacts of change - Hypothetical Venous Ulcer Project [PDF] & [Excel] (There is no guarantee on the formulas, utility or anything else — you will need to examine closely and apply your own Excel skills and common sense to use!) & Approaches (example online at On The Same Page™ - *Flowing Evidence into Cost Analysis:* Powerful Ways with NNT) IBS Example — Impact Assessment Template & Sample: Spreadsheet template included as an optional, customizable aid designed to help health care organizations project potential changes which may result from successful guideline implementation. A completed tool is included as an example and was constructed using assumptions generated through meetings with national medical leaders. Overwrite these assumptions to reflect your own along with your local conditions. Use to perform sensitivity analyses. Useful, when modified, for other clinical improvement projects. Click here to download the sample tool — Impact Assessment Template [Excel]
Patient Tools for Healthcare Providers (& One for Patients)
Information Development Help		Patient Information & Decision Aids Tool	Considerations for patient communication tools	[WORD]
Decision Support Help	FAV	Rx Messaging Scripts Template (Messaging script examples are available online.)	Treatment messaging & decision support tools for specific clinical topics	[WORD]
Engagement Help	FAV	GLIDE Patient Information & Engagement Encounter Map Greet Listen Inquire & Exchange Information Determine & Decide End	Communication tool for physicians and others who directly engage with patients to provide information, decision and action-oriented information during clinical encounters	[PDF] & [WORD]
General Help		*On the Same* Page** ™ — for Practitioner/Patient Information & Decision Aids	A variety of patient-centered readings, examples and help	Online at links to the left
For Consumers		Consumer Tips To Aid in Evaluating Health Care Quality	For patients	[WORD]
General Help for the Evidence-based Organization
The EBM Organization	FAV	Health Care Quality System Assessment Tool	Tool for assessing how prepared organizations are to apply an evidence-based quality approach; requirements	[WORD]
The EBM Organization	FAV	Delfini Pearls: Key Considerations for the Evidence- & Value-based Organization and for Evidence- and Value-based Clinical Quality Improvement Efforts New 09/10/2010	Tool for helping health systems organize for an evidence-based approach	[WORD] [PDF]
EBM Organization Publications		American College of Physician Executives publication page: The EBM Organization 3-part series	General information	Online at links to the left
ROI		The Return-on-Investment for EBM	Case studies and stories	[online]
Miscellaneous Other Tools
*Delfini* Law & Medicine Tool Checklist for Evaluating the Evidence-based Medicine Approach of Medical “Experts” [WORD] *Delfini* Meeting & Office Management Tools (see above in various sections for EBM Committee tools) Effective & Efficient Meetings [WORD] Agenda Builder (no instructions provided and requires knowledge of Excel) [Excel] Webinar Tips [WORD] Research Searching Tips Caveats abound! A number of years ago, I was asked to lead a session on research searching at UCSD. I make no claims to the utility or completeness of this document — plus this was specifically geared to UCSD faculty, staff and students. But in case this is useful to someone else, here 'tis. [PDF] Sheri