Evidence Informed Best Practice

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Evidence Informed Best Practice

• Dr. Richard Volpe
• Professor and Projects Director
• Life Span Adaptation Projects
• University of Toronto
• 45 Walmer Road, Toronto, Ontario, Canada
• email richard.volpe_at_utoronto.ca
• April 24, 2007

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Evidence-Based Practice

• the conscientious, explicit and judicious use of
  current best evidence in making decisions about
  the care of individual patients requiring the
  integration of best research evidence with
  clinical expertise and patient values (Sackett,
  2000)

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Evidence-Based Decision Making(EBDM)

• The systematic application of the best available
  evidence to the evaluation of options and to
  decision-making in clinical, management and
  policy settings. (Prime Ministers National
  Forum on Health in 1997)

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The Challenge of Evidence-Based Practice to
Injury Prevention

• Nature of Evidence
• Shortage of Evidence

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ONF Strategic Funding Initiative

• Implement an evidence-based injury prevention
  practices in Ontario.
• Evaluate their effectiveness and potential in
  reducing the incidence of head and spinal cord
  injury.
• To assist communities and other interested
  stakeholders to go forward after the
  implementation evaluations and to secure
  long-term funding.
• Determine policy impact and implications of
  implementations.
• Inform and make recommendations to the provincial
  government and other stakeholders on the
  feasibility of this strategic initiative and any
  implications for future directions.

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Objectives of the ONF Best Practice Reviews

• Survey the range of neurotrauma prevention
  strategies and programs.
• Identify examples of effective, evidence-based
  practice.
• Describe, analyze and evaluate these in terms of
  their effectiveness for diverse age groups.
• Develop and strengthen networks by mobilizing
  public support and encouraging the participation
  of stakeholders.
• Provide a casebooks of exemplary, evidence based
  neurotrauma prevention efforts.
• Create a means of distributing the casebooks,
  resource documents and field contacts.

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Best Practice Nomination

• Theoretical relevance (capable of conceptual
  elaboration)
• Inclusion of at least three of the five Es
  (Education, Enactment, Engineering, Economics,
  Evaluation)
• Life span orientation
• Exhibition of innovative and effective strategies
• Employment of mixed research methods and
  perspectives (triangulation)
• Availability of sufficient documented evaluation
  research information
• Strong evidence for the reduction of incidence
• Replicability and adaptability
• Effort to address communication and dissemination
  issues

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Knowledge Transfer

• Systematic Reviews
• Compendium of Effective, Evidenced Based
  Practices In the Prevention of Neurotrauma
• Preventing Neurotrauma A Casebook of Evidenced
  Based Practices
• Road Safety Review
• Source book of Evidenced-Based Practices in the
  Prevention of Severe Injuries
• Science and Sustainability in Injury Prevention
• Preventing Severe Sports injuries

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New South Wales
Stay On Your Feet (SOYF) Senior Falls Prevention
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SOYF in Ontario

• Implement the SOYF Program in 3 trial communities
• Evaluate its effectiveness in reducing senior
  falls across the three communities
• Evaluate effectiveness of the program in the
  province
• Determine the feasibility of implementing the
  mutifaceted intervention within Ontario
• Determine policy impact and implications to
  seniors falls
• Inform and make recommendations to the provincial
  government and other stakeholders on feasibility

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Upstate New York
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ONF Shaken Baby Syndrome Prevention Program
Ontario Best Start Resource Centre
North Bay North Bay General Hospital North Bay
Public Health CCPIP Midwives of North Bay
Sudbury Sudbury General Hospital Sudbury Public
Health Midwives of Sudbury
Kingston Better Beginnings Public Health
Mississauga Credit Valley Hospital
Oshawa Lakeridge Health Centre
Hamilton McMaster University Public Health
Services Healthy Babies
Toronto University of Toronto Life Span
Adaptation Projects Institute of Child Study,
OISE/UT
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Safe Waitakere Community Injury Prevention
Project(WCIPP)AUCKLAND, NEW ZEALAND
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ONF Implementation of a Community-Systems
Approach to Injury Prevention- North Bay, Ontario

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SUSTAINABILITY SCALE
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The Challenge of Evidence-Based Practice to
Injury Prevention

• Nature of Evidence
• Shortage of Evidence

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• Evidence and ActionEvidence and Prevention

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Identified Knowledge DomainsofPublic Health

• General Public Health Epidemiology
  Biostatistics Vital Statistics Surveillance
  Environmental Health Occupational Health
  Health Services Administration Social
  Behavioral Sciences Health Promotion Education
  Community Health

Maternal Child Health Public Health Nursing
Disaster Control Emergency Services
Communicable Diseases HIV/AIDS Nutrition
Chronic Diseases Conditions Public Health
Laboratory Sciences Public Health Informatics
Global Health
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• The Life Space

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We Know Enough

• Injuries are not the result of accidental events
  but are predictable.
• Risk factors are identifiable and modifiable.
• Risk factors can substitute for understanding
  causes.
• Risk factors also point to protective factors.
• More than one risk factor usually needed to bring
  about an adverse outcome.
• More than one positive factor usually needed to
  produce a positive outcome.

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Injury Prevention as Change in Complex Systems

• Life span transformations in individuals and
  groups that emerge in the process of adaptation.

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Evidence Informed Practice
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Wisdom

• A wise person is one who uses his or her
  successful intelligence in order to seek a common
  good, by balancing intrapersonal, interpersonal,
  and extrapersonal interests over the short and
  long terms through the infusion of values in
  order to adapt to, shape, and select
  environments.
• (Sternberg, 1990)