Evidence Based Health Care: Delfini Tool Library

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Delfini Co-founders: Michael E Stuart MD, President & Medical Director . Sheri Ann Strite, Managing Director & Principal

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Important Reading
Searching, Sources & Terms Uility Tools
Critical Appraisal Tools
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Tools & Educational Materials by Delfini

Basics For Evaluating Medical Research Studies:
A Simplified Approach
And Why Your Patients Need You To Know This

Delfini Group Evidence-based Practice Series
Short How-to Guide Book
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"Best help with evidence-based medicine available."
Marty Gabica, MD, Chief Medical Officer, Healthwise

This book is about how to evaluate the reliability and clinical usefulness of clinical trials. Written for physicians and other health care professionals, this book is written in easy-to-understand terms that even the layperson can understand and put to use. Now available for purchase.

Other tools and educational materials, created by Delfini, to help you perform a variety of tasks including critical appraisal of the medical literature and clinical quality improvements, are freely available below.

Our site makes available other resources as well from the work of others and other work we have done including clinical guidelines, systematic reviews, evidence-based commentaries, case studies and more. See Resources.

Marks our favorites.

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.
Because we are continually refining our tools, we recommend that you download tools just-in-time to ensure you are getting our most current version.
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 versions: Critical Appraisal Matters: Quick Facts 1-pager Version 08/16/2015 Overview: Framework for Evidence-based Critical Appraisal & Decision-making 1-pager: High-level outline of the "5 A"s framework for EBM and comprehensive considerations [PDF][WORD] Version 08/02/2011 Overview: Framework for Evidence-based Critical Appraisal for Clinical Improvement Work 1-pager: Outline of the hallmarks of EBM, the 10-phases of evidence-based clinical QI, "5 A"s of evidence-based practice, critical appraisal steps and key considerations [PDF][WORD] Version 08/14/2012 Critical Appraisal Online Tutorial A brief online tutorial on the basics of critical appraisal of therapeutic interventions. The emphasis is on evaluating efficacy claims of primary studies using superiority designs.
Searching, Sources & Terms Utility Tools
EBM Glossary Online Searching the Medical Literature Tool [WORD] [PDF] Version 05/23/2018 Delfini Favorite Sources [PDF] Version 08/31/2016 See also tools for Documentation Others available at Delfini Web Links
Critical Appraisal Tools Also see Critical Appraisal Online Tutorial: A brief 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	Item	User Info	Get
CRITICAL APPRAISAL Primary Studies : Short Tools Efficacy of therapies in superiority trials; some with notes and considerations for other circumstances	Orientation Version 05/16/2016	Beginner and up	[PDF] [WORD]
	1-Pager Pearls: Basics of Evaluating Evidence in Superiority Trials for Therapies Aka The Short Essensials Teaching Tool for Superiority Trials for Therapies Version 04/07/2017	Novice/ Intermediate teaching tool, self-study guide, reminder tool Quick appraisal process steps and is generally descriptive	[PDF] [WORD]
	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 06/28/2017	All levels for reviewing with articles Assumes user possesses core competencies in critical appraisal	[PDF] [WORD] Now available in template form as a worksheet for conductin and documenting appraisals: [WORD]
	1-Pager Pearls: Reminders for Validity Detectives for Critical Appraisal for Efficacy of Therapies Version 03/11/2011	Novice process key points Similar to above 2 tools, but very process oriented	[PDF] [WORD]
CRITICAL APPRAISAL Primary Studies : Comprehensive Tool	~11 Pages Primary Studies: Long Tool Short EBM "Textbook" Version 02/14/2013	Explains concepts in the short tools and more; teaching tool, self-study guide	[PDF] [WORD]
CRITICAL APPRAISAL: Comparative Designs	1-Pager Comparative Study Designs of Clinical Trials (Equivalence and Non-inferiority Trials) (see also Primers) Version 06/27/2017	Considerations for non-inferiority and equivalence trials	[PDF] [WORD]
CRITICAL APPRAISAL: Cross-over Designs	1-Pager Cross-over Designs Version 03/17/2014	Considerations	[PDF] [WORD]
: Diagnostic Testing	1-Pager Pearls: Diagnostic Testing Version 08/18/2015	Considerations	[PDF] [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	[PDF] [WORD]
: Oncology	1-Pager Chart of Oncology Outcomes Version 10/01/2010	Chart of various outcomes with issues discussion	[PDF] [WORD]
RESULTS ASSESSMENT	1-Pager Analyzing Results IMPORTANT: Includes information on assessing confidence intervals (also see Primers) Version 07/01/2015	Tips on assessing results and determining meaningful clinical benefit	[PDF] [WORD]
	Attrition Quick Test Calculator Version 08/03/2017	Even a small loss of patients may impact study results. This calculator helps you determine whether the impact may be great or small to decide if you need to do further analyses.	[XLS]
	1-Pager Composite Endpoints Version 07/15/2014	Considerations	[PDF] [WORD]
	1-Pager Intention-to-Treat (ITT) Analysis Version 11/02/2012	Considerations	[PDF] [WORD]
	ITT Recalcuation Spreadsheet Version 01/18/2015	Aids with assignng missing values and re-computing p-value	[Excel]
	1-Pager Time-to-Event-Analysis Version 10/22/2018	Considerations	[PDF] [WORD]
SAFETY	1-Pager Pearls: Safety Version 04/02/2019	Considerations	[PDF] [WORD]
SAFETY & REGISTRIES	1-Pager Registry Evaluation Checklist: Safety of Interventions Critical appraisal considerations for evaluating registries for use for safety assessments and safety studies. Version 11/23/2010	Considerations	[PDF] [WORD]
WITHIN-PATIENT DESIGN CONSIDERRATIONS	A list of considerations for within-patient designs in which a patient serves as his or her own control. Dermatology example. Version 08/28/2019	Considerations	[PDF] [WORD]
CRITICAL APPRAISAL Secondary Studies & Secondary Sources	1-Pager on Working with Secondary Resources Secondary studies & sources such as guidelines 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. Version 09/09/2018	Principal advice for working with secondary studies & sources including audit advice	[PDF] [WORD]
CRITICAL APPRAISAL Secondary Studies : Short Tool	1-Pager Pearls: Basics of Evaluating Secondary Studies (including meta-analyses) Version 08/28/2019	Novice/ Intermediate teaching tool, self-study guide, reminder tool	[PDF] [WORD]
CRITICAL APPRAISAL Secondary Studies : Comprehensive Tool	~10 Pager Systematic Review Tool Version 08/28/2019	Principal tool for appraising secondary studies; teaching tool, self-study guide	[PDF] [WORD]
CRITICAL APPRAISAL Secondary Sources : Short Tool	1-Pager Pearls: Basics of Evaluating Secondary Sources (eg, clinical guidelines, pathways, clinical recommendations, disease management protocols) Version 09/07/2010	Novice/ Intermediate teaching tool, self-study guide, reminder tool	[PDF] [WORD]
CRITICAL APPRAISAL Secondary Sources : Comprehensive Tool	~10 Pager QI Project Appraisal Tool Secondary Sources reference primary and secondary studies (e.g., clinical guidelines, disease management protocols, pathways, etc.) Version 04/11/2013	Principal tool for appraising secondary sources; teaching tool, self-study guide	[PDF] [WORD]
CRITICAL APPRAISAL Economic Studies : Comprehensive Tool	2-Pager Healthcare Economic Study Review Tool Version 01/29/2013	Principal tool for appraising any economic studies such as cost-effectiveness analyses and pharmacoeconomic studies; teaching tool, self-study guide	[PDF] [WORD]
CRITICAL APPRAISAL Economic Studies : Comprehensive Tool	1-Pager QALYs Version 10/30/2012	Key Points about QALYs	[PDF] [WORD]
CONCLUDING & SUMMARIZING	1-Pager Grading Version 07/01/2013	Short advice on evidence grading	[PDF] [WORD]
	Grading, Wording Conclusions and Results Table Tool Version 04/13/2015	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	[PDF] [WORD]
	PICPOT-SD Checklist Version 11/07/2016	Tool for framing questions, summarizing studies and more	[PDF] [WORD]
	Ideal Study Parameters Version 01/30/2013	Preparation for scientific review	[PDF] [WORD]
	1-Pager Evidence Synthesis Overview Version 08/21/2014	Short advice on creating an evidence summary	[PDF] [WORD]
	Evidence Synthesis Tool Version 01/30/2013	Tips for combining results from multiple studies	[PDF] [WORD]
	The Delfini Decision-support Semaphore Example: MRI for Women at High Risk of Breast Cancer Version 03/01/2011 Multiple examples	Example of a way to present highly complex evidence-based information and other considerations	[PDF] [WORD] for MRI only [PDF] [WORD] for sampler including MRI
	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 a short list of some of our favored sources! Version 01/30/2013	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 Version 01/30/2013	For online documentation for project work	[WORD] [PDF]
Critical Appraisal Primers & White Papers
Evidence Essentials—Critical Appraisal Online Tutorial: A brief 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	Item	User Info	Get
Study Design Issues	Case Series Version 01/31/2013	Problems with	[PDF]
	Observations for Interventions Version 01/31/2013	General weaknesses of observations	[PDF]
	Problems Narrative Reviews Version 01/31/2013	Problems with	[PDF]
Indirect Comparisons of Therapeutic Interventions	Problems With Indirect Comparisons & Advice Version 11/08/2018	Guidance on considerations for conducting or evaluating indirect comparisons of interventions, such as network analyses	[WORD] [PDF]
Various Topics	How to Read a Forest Plot Version 11/23/2013	Teaching aid, self-study guide	[PDF]
	Confidence Intervals & Their Use for Interpreting Significance of Results Version 11/23/2013	Teaching aid, self-study guide	[PDF of Slides]
	Correlation Analysis Version 06/13/2011	1-pager	[PDF] [WORD]
	"Real World" Data Version 12/09/2014	1-pager	[PDF]
Evidence-based Committee Help
Topic	Item	User Info	Get
General	EBM Committee Tips Tool Version 01/30/2013	General operational suggestions for leaders	[PDF] [WORD]
Committee Members	On Being An Effective Evidence-based Committee Member New 05/2013	Roles, responsibilities and ideals	[PDF] [WORD]
Formulary Management : Comprehensive	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	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
Topic	Item	User Info	Get
Evidence-based Clinical Quality Improvement (EBCQI) : Short Tool	2-Pager High level overview of evidence-based clinical quality improvement considerations	Key considerations for the Evidence‐ & Value‐based Organization and for Evidence‐ and Value‐based Clinical Quality Improvement efforts	[PDF]
: Comprehensive Tool	Suggestions for Evidence-based Quality Improvement Team Operations: Conducting Projects	Sequential steps and detailed tips for creating and managing EB-QI teams and projects	Available only through Delfini Programs
Project Development	Project Proposal Tool Version 01/30/2013	Considerations	[PDF] [WORD]
Impact Assessment	Project Change Assessment Tool Version 01/29/2013	Key considerations in addition to cost	[PDF] [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	Project Implementation Strategies and Tool Version 01/29/2013	Strategies for creating behavior change and implementing projects	[PDF] [WORD]
Measurement : Primer	2-Pager Quality Measurement Efforts Version 01/31/2013	Teaching aid, self-study guide	[PDF]
Performance Measurement : Comprehensive	Performance Measures (including selecting good projects) Version 01/29/2013 See also Delfini Publication Page: Performance Measurement	Sequential steps and detailed tips for development, implementation and reporting of performance measures, evaluating the validity and usefulness of measures, avoiding measurement pitfalls and more	[PDF] [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)
Topic	Item	User Info	Get
Information Development Help	Patient Information & Decision Aids Tool Version 05/29/2015	Considerations for patient communication tools	[PDF] [WORD]
Decision Support Help	Rx Messaging Scripts Template (Messaging script examples are available online.) Version 01/29/2013	Treatment messaging & decision support tools for specific clinical topics	[PDF] [WORD]
Engagement Help	GLIDE Patient Information & Engagement Encounter Map Greet Listen Inquire & Exchange Information Determine & Decide End Encounter Version 01/29/2013	Communication tool for physicians and others who directly engage with patients to provide information, decision and action-oriented information during clinical encounters	[PDF] [WORD]
Messaging Scripts	Explanation, template, samples	Messaging scripts are targeted treatment messaging & decision support tools for specific clinical topics. This tool, and accompanying template, can help you construct your own.	Web page
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
General Help for the Evidence-based Organization
Topic	Item	User Info	Get
The EBM Organization & Evidence-based Clinical Quality Improvement (EBCQI) : Short Tool	2-Pager Pearls: Outline of Key Considerations for the Evidence- & Value-based Organization and for Evidence- and Value-based Clinical Quality Improvement Efforts Version 05/04/2016	Tool for helping health systems organize for an evidence-based approach	[PDF] [WORD]
The EBM Organization	Health Care Quality System Assessment Tool Version 01/29/2013	Tool for assessing how prepared organizations are to apply an evidence-based quality approach; requirements	[PDF] [WORD]
EBM Organization Publications	American College of Physician Executives publication page: The EBM Organization 3-part series	General information	Online at links to the left
Miscellaneous Other Tools
*Delfini* Law & Medicine Tool Checklist for Evaluating the Evidence-based Medicine Approach of Medical “Experts” [PDF][WORD] Version 01/31/2013 *Delfini* Meeting & Office Management Tools (see above in various sections for EBM Committee tools) Effective & Efficient Meetings [PDF][WORD] Version 01/31/2013Webinar Tips [WORD] Version 01/30/2013 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