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Critical Appraisal Training Intensive: Spine Care

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Mission: Explore variation in spinal surgery in Idaho. According to the Dartmouth Atlas Project, spinal surgery is four times greater in Idaho than elsewhere in the country. Is this appropriate care? Or inappropriate variation? Use scientific evidence to help answer these questions.

Concept: Identify a clinical group working in spine care who is interested in exploring appropriate and inappropriate care using an evidence-based approach. Provide them with training and support with a goal of creating a successful evidence-based clinical improvement project should change be desirable. Learnings will be applicable to other projects, plus team members will be able to facilitate similar projects with other clinical groups within the care system.

Delfini Role: Provide training, facilitation and support to the team to conduct the project and to effect both clinical and evidence-based process change.

An article about the project was published in the Idaho Statesman, Thursday, July 20, 2006, by Dr. Doug Dammrose, Senior Vice President & Medical Director of Blue Cross of Idaho

Testimonial: 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.

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

At Spine Care Project

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Project Outline

Phase I: Provide Training in the Essentials of Evidence-based Medicine with a Focus on Critical Appraisal
"Helping Our Patients: An Evidence- and Value-based Initiative to Quality Spinal Care:" Essentials

June 23 & 24, 2006

The Blue Cross of Idaho Foundation for Health, in collaboration with the Idaho-based NeuroSciences Group, and with support through an educational grant from Medtronic, Inc., sponsored a two-day basic training course on Evidence-Based Medicine conducted by Delfini. Attendees were enthusiastic about the conference and their learnings. Key studies of interest in spine care were identified and critically appraised for validity and usefulness by the group.

Phase II: Provide Training in Advanced Evidence-based Medicine Topics & in the Essentials of Evidence- and Value-base Clinical Improvement
"Helping Our Patients: An Evidence- and Value-based Initiative to Quality Spinal Care:" Advanced Concepts

July 21 & 22, 2006

With continued collaboration with the Idaho-based NeuroSciences Group, and with support from Medtronic, Inc., the Blue Cross of Idaho Foundation for Health sponsored a second two-day intensive educational conference conducted by Delfini. More key studies were evaluated and the group discussed potential areas of interest for conducting a clinical improvement project.

Phase III: Explore Clinical Improvement Topics
The group agreed to reconvene to explore various projects which could improve care for patients using their new skills and tools. Communications with patients were reported to be more evidence-based.



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